Phase Equilibria and Transport Properties in the Systems AgNO3/RCN/H2O. R = CH3, C2H5, C3H7, C4H,, C6H5, and C6H5CH2

NASA Astrophysics Data System (ADS)

Das, Surjya P.; Wittekopf, Burghard; Weil, Konrad G.

1988-11-01

Silver nitrate can form homogeneous liquid phases with some organic nitriles and water, even when there is no miscibility between the pure liquid components. We determined the shapes of the single phase regions in the ternary phase diagram for the following systems: silver nitrate /RCN /H2O with R =CH3, C3H7, C6H5, and C6H5CH2 at room temperature and for R =C6H5 also at 60 °C and O °C. Furthermore we studied kinematic viscosities, electrical conductivities, and densities of mixtures containing silver nitrate, RCN, and water with the mole ratios X /4 /1 (0.2≦ X ≦S 3.4). In these cases also R = C2H5 and C4H9 were studied. The organic nitriles show different dependences of viscosity and conductivity on the silver nitrate content from the aliphatic ones.

RCN adds crosses in remembrance.

PubMed

2014-11-18

Outgoing RCN president Andrea Spyropoulos (left) and RCN student council member Claire Jeeves planted crosses at the Field of Remembrance at Westminster last week to honour all nurses who have died in times of conflict.

History of the Rare Cancer Network and Past Research

PubMed Central

Mirimanoff, René-Olivier; Ozsahin, Mahmut; Thariat, Juliette; Ozyar, Enis; Schick, Ulrike; Pehlivan, Berrin; Krengli, Marco; Pellanda, Alessandra Franzetti; Vees, Hansjörg; Cai, Ling; Scandolaro, Luciano; Belkacemi, Yazid; Villà, Salvador; Igdem, Sefik; Lutsyk, Myroslav; Miller, Robert C.

2014-01-01

Approximately, twenty years ago, the Rare Cancer Network (RCN) was formed in Lausanne, Switzerland, to support the study of rare malignancies. The RCN has grown over the years and now includes 130 investigators from twenty-four nations on six continents. The network held its first international symposium in Nice, France, on March 21-22, 2014. The proceedings of that meeting are presented in two companion papers. This manuscript reviews the history of the growth of the RCN and contains the abstracts of fourteen oral presentations made at the meeting of prior RCN studies. From 1993 to 2014, 74 RCN studies have been initiated, of which 54 were completed, 10 are in progress or under analysis, and 9 were stopped due to poor accrual. Forty-four peer reviewed publications have been written on behalf of the RCN. PMID:25276325

Using the knowledge and skills of retired RCN representatives.

PubMed

Janes, Jenny

2014-11-04

I read with interest the article by Zeba Arif (Reflections October 8) and the letter from June Clark (October 15) about retired RCN activists. I have repeatedly raised this issue within the RCN, to little effect.

Naval Ship Database: Database Design, Implementation, and Schema

DTIC Science & Technology

2013-09-01

incoming data. The solution allows database users to store and analyze data collected by navy ships in the Royal Canadian Navy ( RCN ). The data...understanding RCN jargon and common practices on a typical RCN vessel. This experience led to the development of several error detection methods to...data to be stored in the database. Mr. Massel has also collected data pertaining to day to day activities on RCN vessels that has been imported into

Methods for Identifying Part Quality Issues and Estimating Their Cost with an Application Using the UH-60

DTIC Science & Technology

2014-01-01

WPU report. TOP 5 Items with PQDRs by Value ($M) RCN # (*Oldest PQDR) Nomenclature I/E SOS NIIN CAT Qty Def Unit Cost Total # PQDR s End Item Value...401667 4 AH-64D 1.581 145 TOP 5 PQDRs by Age (Days) RCN # Nomenclature I/E SOS NIIN CAT Qty Def Unit Cost End Item Value ($M) Age (Days) W45N7V-09-0274

The Effects of Select Histidine to Cysteine Mutations on Transcriptional Regulation by E. coli RcnR‡

PubMed Central

Higgins, Khadine A.; Hu, Heidi Q.; Chivers, Peter T.; Maroney, Michael J.

2013-01-01

The RcnR metalloregulator represses the transcription of the Co(II) and Ni(II) exporter, RcnAB. Previous studies have shown that Co(II) and Ni(II) bind to RcnR in six-coordinate sites, resulting in de-repression. Here, the roles of His60, His64, and His67 in specific metal recognition are examined. His60 and His64 correspond to ligands that are important for Cu(I) binding in the homologous Cu(I)-responsive metalloregulator, CsoR. These residues are known to be functionally important in RcnR transcriptional regulation. XAS was used to examine the structure of bound cognate and non-cognate metal ions, and lacZ reporter assays were used to assess the transcription of rcnA in response to metal binding in the three His → Cys mutations, H60C, H64C and H67C. These studies confirm that both Ni(II) and Co(II) use His64 as a ligand. H64C-RcnR is also the only known mutation that retains a Co(II) response while eliminating the response to Ni(II) binding. XAS data indicate that His60 and His67 are potential Co(II) ligands. The effects of the mutations of His60, His64, and His67 residues on the structures of the non-cognate metal ions (Zn(II) and Cu(I)) reveals that these residues have distinctive roles in binding non-cognate metals. None of the His → Cys mutants in RcnR confer any response to Cu(I) binding, including H64C-RcnR, where the ligands involved in Cu(I) binding in CsoR are present. These data indicate that while the secondary, tertiary and quaternary structures of CsoR and RcnR are quite similar, small changes in primary sequence reveal that the specific mechanisms involved in metal recognition are quite different. PMID:23215580

DOE Office of Scientific and Technical Information (OSTI.GOV)

Westbrook, JW; Walker, AR; Neves, LG

Genetically improving constitutive resin canal development in Pinus stems may enhance the capacity to synthesize terpenes for bark beetle resistance, chemical feedstocks, and biofuels. To discover genes that potentially regulate axial resin canal number (RCN), single nucleotide polymorphisms (SNPs) in 4027 genes were tested for association with RCN in two growth rings and three environments in a complex pedigree of 520 Pinus taeda individuals (CCLONES). The map locations of associated genes were compared with RCN quantitative trait loci (QTLs) in a (P.taedaxPinuselliottii)xP.elliottii pseudo-backcross of 345 full-sibs (BC1). Resin canal number was heritable (h(2)0.12-0.21) and positively genetically correlated with xylem growthmore » (r(g)0.32-0.72) and oleoresin flow (r(g)0.15-0.51). Sixteen well-supported candidate regulators of RCN were discovered in CCLONES, including genes associated across sites and ages, unidirectionally associated with oleoresin flow and xylem growth, and mapped to RCN QTLs in BC1. Breeding is predicted to increase RCN 11% in one generation and could be accelerated with genomic selection at accuracies of 0.45-0.52 across environments. There is significant genetic variation for RCN in loblolly pine, which can be exploited in breeding for elevated terpene content.« less

Why do Reservoir Computing Networks Predict Chaotic Systems so Well?

NASA Astrophysics Data System (ADS)

Lu, Zhixin; Pathak, Jaideep; Girvan, Michelle; Hunt, Brian; Ott, Edward

Recently a new type of artificial neural network, which is called a reservoir computing network (RCN), has been employed to predict the evolution of chaotic dynamical systems from measured data and without a priori knowledge of the governing equations of the system. The quality of these predictions has been found to be spectacularly good. Here, we present a dynamical-system-based theory for how RCN works. Basically a RCN is thought of as consisting of three parts, a randomly chosen input layer, a randomly chosen recurrent network (the reservoir), and an output layer. The advantage of the RCN framework is that training is done only on the linear output layer, making it computationally feasible for the reservoir dimensionality to be large. In this presentation, we address the underlying dynamical mechanisms of RCN function by employing the concepts of generalized synchronization and conditional Lyapunov exponents. Using this framework, we propose conditions on reservoir dynamics necessary for good prediction performance. By looking at the RCN from this dynamical systems point of view, we gain a deeper understanding of its surprising computational power, as well as insights on how to design a RCN. Supported by Army Research Office Grant Number W911NF1210101.

RCN1/OsABCG5, an ATP-binding cassette (ABC) transporter, is required for hypodermal suberization of roots in rice (Oryza sativa).

PubMed

Shiono, Katsuhiro; Ando, Miho; Nishiuchi, Shunsaku; Takahashi, Hirokazu; Watanabe, Kohtaro; Nakamura, Motoaki; Matsuo, Yuichi; Yasuno, Naoko; Yamanouchi, Utako; Fujimoto, Masaru; Takanashi, Hideki; Ranathunge, Kosala; Franke, Rochus B; Shitan, Nobukazu; Nishizawa, Naoko K; Takamure, Itsuro; Yano, Masahiro; Tsutsumi, Nobuhiro; Schreiber, Lukas; Yazaki, Kazufumi; Nakazono, Mikio; Kato, Kiyoaki

2014-10-01

Suberin is a complex polymer composed of aliphatic and phenolic compounds. It is a constituent of apoplastic plant interfaces. In many plant species, including rice (Oryza sativa), the hypodermis in the outer part of roots forms a suberized cell wall (the Casparian strip and/or suberin lamellae), which inhibits the flow of water and ions and protects against pathogens. To date, there is no genetic evidence that suberin forms an apoplastic transport barrier in the hypodermis. We discovered that a rice reduced culm number1 (rcn1) mutant could not develop roots longer than 100 mm in waterlogged soil. The mutated gene encoded an ATP-binding cassette (ABC) transporter named RCN1/OsABCG5. RCN1/OsABCG5 gene expression in the wild type was increased in most hypodermal and some endodermal roots cells under stagnant deoxygenated conditions. A GFP-RCN1/OsABCG5 fusion protein localized at the plasma membrane of the wild type. Under stagnant deoxygenated conditions, well suberized hypodermis developed in wild types but not in rcn1 mutants. Under stagnant deoxygenated conditions, apoplastic tracers (periodic acid and berberine) were blocked at the hypodermis in the wild type but not in rcn1, indicating that the apoplastic barrier in the mutant was impaired. The amount of the major aliphatic suberin monomers originating from C(28) and C(30) fatty acids or ω-OH fatty acids was much lower in rcn1 than in the wild type. These findings suggest that RCN1/OsABCG5 has a role in the suberization of the hypodermis of rice roots, which contributes to formation of the apoplastic barrier. © 2014 The Authors The Plant Journal © 2014 John Wiley & Sons Ltd.

The Ca2+/Calcineurin-Dependent Signaling Pathway in the Gray Mold Botrytis cinerea: The Role of Calcipressin in Modulating Calcineurin Activity

PubMed Central

Harren, Karin; Schumacher, Julia; Tudzynski, Bettina

2012-01-01

In the gray mold fungus Botrytis cinerea the Gα subunit Bcg1 of a heterotrimeric G protein is an upstream activator of the Ca2+/calmodulin-dependent phosphatase calcineurin. In this study we focused on the functional characterization of the catalytic subunit of calcineurin (BcCnA) and its putative regulator calcipressin (BcRcn1). We deleted the genes encoding both proteins to examine their role concerning growth, differentiation and virulence. The ΔbccnA mutant shows a severe growth defect, does not produce conidia and is avirulent, while the loss of BcRcn1 caused retardation of hyphal growth and delayed infection of host plants, but had no impact on conidiation and sclerotia formation. Expression of several calcineurin-dependent genes and bccnA itself is positively affected by BcRcn1. Complementation of the Δbcrcn1 mutant with a GFP-BcRcn1 fusion construct revealed that BcRcn1 is localized in the cytoplasm and accumulates around the nuclei. Furthermore, we showed that BcCnA physically interacts with BcRcn1 and the regulatory subunit of calcineurin, BcCnB. We investigated the impact of several protein domains characteristic for modulation and activation of BcCnA via BcRcn1, such as the phosphorylation sites and the calcineurin-docking site, by physical interaction studies between BcCnA and wild-type and mutated copies of BcRcn1. Based on the observed phenotypes we conclude that BcRcn1 acts as a positive modulator of BcCnA and the Ca2+/calcineurin-mediated signal transduction in B. cinerea, and that both proteins regulate fungal development and virulence. PMID:22844520

RCN members throw away chance to have their say on pensions.

PubMed

Karim, Kelvin

2012-03-07

I have just seen the result of the RCN ballot of members on the government's pensions offer. The vote closed on February 27 and 65,759 votes were cast, a turnout of 16 per cent of the RCN members eligible to vote.

RCN faces challenges over rising inequalities within profession.

PubMed

Owen, Michael

2014-08-19

It is difficult to understand why the RCN will not join colleagues in the Royal College of Midwives and other health unions in balloting members on industrial action (Editorial and News July 30). Is the RCN fearful of the outcome should the response be a yes?

RCN asks: are you prepared to strike for better pay?

PubMed

Mckew, Matthew

2017-04-19

The RCN has opened an online poll on whether members would strike over pay. Some 270,000 RCN members are being asked for their views on NHS pay, two weeks after governments in England, Scotland and Wales announced the latest below-inflation pay increases.

Representativeness of four precipitation observational networks of China

NASA Astrophysics Data System (ADS)

Ren, Yuyu; Ren, Guoyu

2012-08-01

Four precipitation observational networks with varied station densities are maintained in China. They are: the Global Climate Observation System (GCOS) Surface Network (GSN), the national Reference Climate Network (RCN), the national Basic Meteorological Network (BMN), and the national Ordinary Meteorological Network (OMN). The GSN, RCN, BMN, and the merged network of RCN and BMN (R&B) have been widely used in climatology and climate change studies. In this paper, the impact of the usage of different networks on the precipitation climatology of China is evaluated by using the merged dataset of All Station Network (ASN) as a benchmark. The results show that all networks can capture the main features of the country average precipitation and its changing trends. The differences of average annual precipitation of the various networks from that of the ASN are less than 50 mm (⩽ 10%). All networks can successfully detect the rising trend of the average annual precipitation during 1961-2009, with the R&B exhibiting the best representativeness (only 2.90% relative difference) and the GSN the poorest (39.77%). As to the change trends of country average monthly precipitation, the networks can be ranked in descending order as R&B (1.27%), RCN (2.35%), BMN (4.17%), and GSN (7.46%), and larger relative differences appear from August to November. The networks produce quite consistent spatial patterns of annual precipitation change trends, and all show an increasing trend of precipitation in Northwest and Southeast China, and a decreasing trend in North China, Northeast China, and parts of central China. However, the representativeness of the BMN and R&B are better in annual and seasonal precipitation trends, in spite of the fact that they are still far from satisfactory. The relative differences of trends in some months and regions even reach more than 50%. The results also show that the representativeness of the RCN for country average precipitation is higher than that of the BMN because the RCN has a more homogeneous distribution of stations.

Former director of RCN Wales Liz Hewett began at Ty Maeth in 1998.

PubMed

Lenzy, Tracy

2016-06-01

Great story in Nursing Standard about the book Nursing Matters, which delves into the 50th anniversary of the RCN headquarters in Wales, Ty Maeth (features, May 18). However, Liz Hewett began working at the RCN in Wales in 1998 - not in 1988 as stated in the article.

Further development of raccoon poxvirus-vectored vaccines against plague (Yersinia pestis)

USGS Publications Warehouse

Rocke, Tonie E.; Iams, Keith P.; Dawe, S.; Smith, Susan; Williamson, Judy L.; Heisey, Dennis M.; Osorio, Jorge E.

2009-01-01

In previous studies, we demonstrated protection against plague in mice and prairie dogs using a raccoon pox (RCN) virus-vectored vaccine that expressed the F1 capsular antigen of Yersinia pestis. In order to improve vaccine efficacy, we have now constructed additional RCN-plague vaccines containing two different forms of the lcrV (V) gene, including full-length (Vfull) and a truncated form (V307). Mouse challenge studies with Y. pestis strain CO92 showed that vaccination with a combination of RCN-F1 and the truncated V construct (RCN-V307) provided the greatest improvement (P = 0.01) in protection against plague over vaccination with RCN-F1 alone. This effect was mediated primarily by anti-F1 and anti-V antibodies and both contributed independently to increased survival of vaccinated mice.

Characterization of recombinant Raccoonpox Vaccine Vectors in Chickens

USGS Publications Warehouse

Hwa, S.-H.; Iams, Keith P.; Hall, Jeffrey S.; Kingstad, B.A.; Osorio, Jorge E.

2010-01-01

Raccoonpox virus (RCN) has been used as a recombinant vector against several mammalian pathogens but has not been tested in birds. The replication of RCN in chick embryo fibroblasts (CEFs) and chickens was studied with the use of highly pathogenic avian influenza virus H5N1 hemagglutinin (HA) as a model antigen and luciferase (luc) as a reporter gene. Although RCN replicated to low levels in CEFs, it efficiently expressed recombinant proteins and, in vivo, elicited anti-HA immunoglobulin yolk (IgY) antibody responses comparable to inactivated influenza virus. Biophotonic in vivo imaging of 1-wk-old chicks with RCN-luc showed strong expression of the luc reporter gene lasting up to 3 days postinfection. These studies demonstrate the potential of RCN as a vaccine vector for avian influenza and other poultry pathogens. ?? American Association of Avian Pathologists 2010.

Further development of raccoon poxvirus-vectored vaccines against plague (Yersinia pestis).

PubMed

Rocke, Tonie E; Iams, Keith P; Dawe, Sandra; Smith, Susan R; Williamson, Judy L; Heisey, Dennis M; Osorio, Jorge E

2009-12-11

In previous studies, we demonstrated protection against plague in mice and prairie dogs using a raccoon pox (RCN) virus-vectored vaccine that expressed the F1 capsular antigen of Yersinia pestis. In order to improve vaccine efficacy, we have now constructed additional RCN-plague vaccines containing two different forms of the lcrV (V) gene, including full-length (Vfull) and a truncated form (V307). Mouse challenge studies with Y. pestis strain CO92 showed that vaccination with a combination of RCN-F1 and the truncated V construct (RCN-V307) provided the greatest improvement (P=0.01) in protection against plague over vaccination with RCN-F1 alone. This effect was mediated primarily by anti-F1 and anti-V antibodies and both contributed independently to increased survival of vaccinated mice.

Convergent Evolution of Calcineurin Pathway Roles in Thermotolerance and Virulence in Candida glabrata

PubMed Central

Chen, Ying-Lien; Konieczka, Jay H.; Springer, Deborah J.; Bowen, Samantha E.; Zhang, Jing; Silao, Fitz Gerald S.; Bungay, Alice Alma C.; Bigol, Ursela G.; Nicolas, Marilou G.; Abraham, Soman N.; Thompson, Dawn A.; Regev, Aviv; Heitman, Joseph

2012-01-01

Candida glabrata is an emerging human fungal pathogen that is frequently drug tolerant, resulting in difficulties in treatment and a higher mortality in immunocompromised patients. The calcium-activated protein phosphatase calcineurin plays critical roles in controlling drug tolerance, hyphal growth, and virulence in diverse fungal pathogens via distinct mechanisms involving survival in serum or growth at host temperature (37° and higher). Here, we comprehensively studied the calcineurin signaling cascade in C. glabrata and found novel and uncharacterized functions of calcineurin and its downstream target Crz1 in governing thermotolerance, intracellular architecture, and pathogenesis in murine ocular, urinary tract, and systemic infections. This represents a second independent origin of a role for calcineurin in thermotolerant growth of a major human fungal pathogen, distinct from that which arose independently in Cryptococcus neoformans. Calcineurin also promotes survival of C. glabrata in serum via mechanisms distinct from C. albicans and thereby enables establishment of tissue colonization in a murine systemic infection model. To understand calcineurin signaling in detail, we performed global transcript profiling analysis and identified calcineurin- and Crz1-dependent genes in C. glabrata involved in cell wall biosynthesis, heat shock responses, and calcineurin function. Regulators of calcineurin (RCN) are a novel family of calcineurin modifiers, and two members of this family were identified in C. glabrata: Rcn1 and Rcn2. Our studies demonstrate that Rcn2 expression is controlled by calcineurin and Crz1 to function as a feedback inhibitor of calcineurin in a circuit required for calcium tolerance in C. glabrata. In contrast, the calcineurin regulator Rcn1 activates calcineurin signaling. Interestingly, neither Rcn1 nor Rcn2 is required for virulence in a murine systemic infection model. Taken together, our findings show that calcineurin signaling plays critical roles in thermotolerance and virulence, and that Rcn1 and Rcn2 have opposing functions in controlling calcineurin signaling in C. glabrata. PMID:22690377

RCN should resist temptation to quit international nursing body.

PubMed

Buchanan, Maura; Hancock, Christine; Hughes, Pat; Keighley, Tom; Murphy, Shelagh; Rafferty, Anne Marie; Robinson, Jane; Salvage, Jane

2013-05-08

The RCN is on the cusp of a decision that could have profound effects on nursing worldwide. RCN council faces a momentous choice about whether and when to exercise its new power to withdraw the college from membership of the International Council of Nurses (ICN) (letters April 10, analysis and letters April 17, news and letters May 1).

The RCN1-encoded A subunit of protein phosphatase 2A increases phosphatase activity in vivo

NASA Technical Reports Server (NTRS)

Deruere, J.; Jackson, K.; Garbers, C.; Soll, D.; Delong, A.; Evans, M. L. (Principal Investigator)

1999-01-01

Protein phosphatase 2A (PP2A), a heterotrimeric serine/threonine-specific protein phosphatase, comprises a catalytic C subunit and two distinct regulatory subunits, A and B. The RCN1 gene encodes one of three A regulatory subunits in Arabidopsis thaliana. A T-DNA insertion mutation at this locus impairs root curling, seedling organ elongation and apical hypocotyl hook formation. We have used in vivo and in vitro assays to gauge the impact of the rcn1 mutation on PP2A activity in seedlings. PP2A activity is decreased in extracts from rcn1 mutant seedlings, and this decrease is not due to a reduction in catalytic subunit expression. Roots of mutant seedlings exhibit increased sensitivity to the phosphatase inhibitors okadaic acid and cantharidin in organ elongation assays. Shoots of dark-grown, but not light-grown seedlings also show increased inhibitor sensitivity. Furthermore, cantharidin treatment of wild-type seedlings mimics the rcn1 defect in root curling, root waving and hypocotyl hook formation assays. In roots of wild-type seedlings, RCN1 mRNA is expressed at high levels in root tips, and accumulates to lower levels in the pericycle and lateral root primordia. In shoots, RCN1 is expressed in the apical hook and the basal, rapidly elongating cells in etiolated hypocotyls, and in the shoot meristem and leaf primordia of light-grown seedlings. Our results show that the wild-type RCN1-encoded A subunit functions as a positive regulator of the PP2A holoenzyme, increasing activity towards substrates involved in organ elongation and differential cell elongation responses such as root curling.

HCA Voices Make Council Debut.

PubMed

Cardwell, David

2012-11-28

I have been an RCN member since 2002 when healthcare assistants (HCAs) had to have an NVQ level 3 to join - so I got one. Soon after, with encouragement from the general secretary and chair of congress, I was the first HCA to vote and speak at RCN congress - in a speech in favour of nursery nurses joining the RCN with an NVQ level 2 qualification.

A Model for Forecasting Enlisted Student IA Billet Requirements

DTIC Science & Technology

2016-03-01

Professional Apprentice Career Track PCS Permanent Change of Station PG Paygrade PFY Previous Fiscal Year POM Program Objectives Memorandum RCN Rating...paygrade levels contribute to fleet manning issues. Rating Control Number ( RCN ) Fit measures fleet manning levels for each community. Excess manning in one...lower RCN Fit levels. Second, authorized billets in TFMMS serve as the primary input for generating Enlisted Programmed Authorizations (EPA

Two new polytypes of 2,4,6-tri­bromo­benzo­nitrile

PubMed Central

Britton, Doyle; Noland, Wayland E.; Tritch, Kenneth J.

2016-01-01

Three polymorphs of 2,4,6-tri­bromo­benzo­nitrile (RCN), C7H2Br3N, two of which are novel and one of which is a redetermination of the original structure first determined by Carter & Britton [(1972). Acta Cryst. B28, 945–950] are found to be polytypic. Each has a layer structure which differs only in the stacking of the layers. Each layer is composed of mol­ecules associated through C≡N⋯Br contacts which form R 2 2(10) rings. Two such rings are associated with each N atom; one with each ortho-Br atom. No new polytypes of 1,3,5-tri­bromo-2-iso­cyano­benzene (RNC) were found but a re-determination of the original structure by Carter et al. [(1977). Cryst. Struct. Commun. 6, 543–548] is presented. RNC was found to be isostructural with one of the novel polytypes of RCN. Unit cells were determined for 23 RCN samples and 11 RNC samples. Polytypes could not be distinguished based on crystal habits. In all four structures, each mol­ecule of the asymmetric unit lies across a mirror plane. PMID:26958382

Assessing Sonar Performance in Realistic Environments

DTIC Science & Technology

2012-10-01

ASPIRE project, a number of shortcomings were identified in conjunction with RCN partners in the 1C (Underwater Warfare) Thrust. These were: • There is...and the algorithms and models integrated into it to be tested on non-research platforms such as RCN ships. Much of the work undertaken in WBE 2...Sensitivity and Transmission Estimation Tool R & D Research and Development RCN Royal Canadian Navy REA Rapid Environmental Assessment REP Recognized

Infectivity of attenuated poxvirus vaccine vectors and immunogenicity of a raccoonpox vectored rabies vaccine in the Brazilian Free-tailed bat (Tadarida brasiliensis)

USGS Publications Warehouse

Stading, Benjamin; Osorio, Jorge E.; Velasco-Villa, Andres; Smotherman, Michael; Kingstad-Bakke, Brock; Rocke, Tonie E.

2016-01-01

Bats (Order Chiroptera) are an abundant group of mammals with tremendous ecological value as insectivores and plant dispersers, but their role as reservoirs of zoonotic diseases has received more attention in the last decade. With the goal of managing disease in free-ranging bats, we tested modified vaccinia Ankara (MVA) and raccoon poxvirus (RCN) as potential vaccine vectors in the Brazilian Free-tailed bat (Tadarida brasiliensis), using biophotonic in vivo imaging and immunogenicity studies. Animals were administered recombinant poxviral vectors expressing the luciferase gene (MVA-luc, RCN-luc) through oronasal (ON) or intramuscular (IM) routes and subsequently monitored for bioluminescent signal indicative of viral infection. No clinical illness was noted after exposure to any of the vectors, and limited luciferase expression was observed. Higher and longer levels of expression were observed with the RCN-luc construct. When given IM, luciferase expression was limited to the site of injection, while ON exposure led to initial expression in the oral cavity, often followed by secondary replication at another location, likely the gastric mucosa or gastric associated lymphatic tissue. Viral DNA was detected in oral swabs up to 7 and 9 days post infection (dpi) for MVA and RCN, respectively. While no live virus was detected in oral swabs from MVA-infected bats, titers up to 3.88 x 104 PFU/ml were recovered from oral swabs of RCN-infected bats. Viral DNA was also detected in fecal samples from two bats inoculated IM with RCN, but no live virus was recovered. Finally, we examined the immunogenicity of a RCN based rabies vaccine (RCN-G) following ON administration. Significant rabies neutralizing antibody titers were detected in the serum of immunized bats using the rapid fluorescence focus inhibition test (RFFIT). These studies highlight the safety and immunogenicity of attenuated poxviruses and their potential use as vaccine vectors in bats.

Infectivity of attenuated poxvirus vaccine vectors and immunogenicity of a raccoonpox vectored rabies vaccine in the Brazilian Free-tailed bat (Tadarida brasiliensis)

PubMed Central

Stading, Ben R.; Osorio, Jorge E.; Velasco-Villa, Andres; Smotherman, Michael; Kingstad-Bakke, Brock

2017-01-01

Bats (Order Chiroptera) are an abundant group of mammals with tremendous ecological value as insectivores and plant dispersers, but their role as reservoirs of zoonotic diseases has received more attention in the last decade. With the goal of managing disease in free-ranging bats, we tested modified vaccinia Ankara (MVA) and raccoon poxvirus (RCN) as potential vaccine vectors in the Brazilian Free-tailed bat (Tadarida brasiliensis), using biophotonic in vivo imaging and immunogenicity studies. Animals were administered recombinant poxviral vectors expressing the luciferase gene (MVA-luc, RCN-luc) through oronasal (ON) or intramuscular (IM) routes and subsequently monitored for bioluminescent signal indicative of viral infection. No clinical illness was noted after exposure to any of the vectors, and limited luciferase expression was observed. Higher and longer levels of expression were observed with the RCN-luc construct. When given IM, luciferase expression was limited to the site of injection, while ON exposure led to initial expression in the oral cavity, often followed by secondary replication at another location, likely the gastric mucosa or gastric associated lymphatic tissue. Viral DNA was detected in oral swabs up to 7 and 9 days post infection (dpi) for MVA and RCN, respectively. While no live virus was detected in oral swabs from MVA-infected bats, titers up to 3.88 × 104 PFU/ml were recovered from oral swabs of RCN-infected bats. Viral DNA was also detected in fecal samples from two bats inoculated IM with RCN, but no live virus was recovered. Finally, we examined the immunogenicity of a RCN based rabies vaccine (RCN-G) following ON administration. Significant rabies neutralizing antibody titers were detected in the serum of immunized bats using the rapid fluorescence focus inhibition test (RFFIT). These studies highlight the safety and immunogenicity of attenuated poxviruses and their potential use as vaccine vectors in bats. PMID:27650872

Glutamate Ligation in the Ni(II)- and Co(II)-Responsive Escherichia coli Transcriptional Regulator, RcnR

DOE Office of Scientific and Technical Information (OSTI.GOV)

Carr, Carolyn E.; Musiani, Francesco; Huang, Hsin-Ting

Escherichia coli RcnR (resistance to cobalt and nickel regulator, EcRcnR) is a metal-responsive repressor of the genes encoding the Ni(II) and Co(II) exporter proteins RcnAB by binding to PRcnAB. The DNA binding affinity is weakened when the cognate ions Ni(II) and Co(II) bind to EcRcnR in a six-coordinate site that features a (N/O)5S ligand donor-atom set in distinct sites: while both metal ions are bound by the N terminus, Cys35, and His64, Co(II) is additionally bound by His3. On the other hand, the noncognate Zn(II) and Cu(I) ions feature a lower coordination number, have a solvent-accessible binding site, and coordinatemore » protein ligands that do not include the N-terminal amine. A molecular model of apo-EcRcnR suggested potential roles for Glu34 and Glu63 in binding Ni(II) and Co(II) to EcRcnR. The roles of Glu34 and Glu63 in metal binding, metal selectivity, and function were therefore investigated using a structure/function approach. X-ray absorption spectroscopy was used to assess the structural changes in the Ni(II), Co(II), and Zn(II) binding sites of Glu → Ala and Glu → Cys variants at both positions. The effect of these structural alterations on the regulation of PrcnA by EcRcnR in response to metal binding was explored using LacZ reporter assays. These combined studies indicate that while Glu63 is a ligand for both metal ions, Glu34 is a ligand for Co(II) but possibly not for Ni(II). The Glu34 variants affect the structure of the cognate metal sites, but they have no effect on the transcriptional response. In contrast, the Glu63 variants affect both the structure and transcriptional response, although they do not completely abolish the function of EcRcnR. The structure of the Zn(II) site is not significantly perturbed by any of the glutamic acid variations. The spectroscopic and functional data obtained on the mutants were used to calculate models of the metal-site structures of EcRcnR bound to Ni(II), Co(II), and Zn(II). The results are interpreted in terms of a switch mechanism, in which a subset of the metal-binding ligands is responsible for the allosteric response required for DNA release.« less

Improving NEC Fit

DTIC Science & Technology

2015-09-01

issues The Navy primarily uses Rating Control Number ( RCN ) Fit and NEC Fit to measure and assess enlisted fleet manning levels.1 In general, Fit...measures the quantity and quality of the crew relative to the unit’s authorized requirements. RCN Fit measures how well units are manned at the rating...below RCN Fit, and levels for non-critical NECs have been even lower. The levels in September 2014 indicate that a quarter of the critical NEC

A Trend Analysis of Sea Day Measures

DTIC Science & Technology

2014-04-30

Royal Canadian Navy ( RCN ) uses the number of days at sea as the common metric to help quantify a ship’s progression towards a particular level of...there is an interest in validating whether the fleet is still doing the same level of “core RCN ” activities at sea as it has in the past. Due to the...proxy for the whole RCN fleet) was placed into one of nine exercise categories: 1 A

Joint conference.

PubMed

1999-10-01

The Irish Emergency Nurses Association and RCN A&E Nursing Association are holding a conference in Newry, Co Down on November 25. Topics include an update on the Faculty of Emergency Nursing, the management of chest trauma, obstetric emergencies, management of pre-tibial lacerations, and what's hip on the drug scene. Cost: £50 RCN members; £70 for nonmembers (includes dinner and disco). Conference only £35. Contact, Claire Morrissy, RCN, 17 Windsor Avenue, Belfast. Tel 01232-668236.

A Communications-based Mission Planning Tool Concept for Low-cost Tactical UXV Operations

DTIC Science & Technology

2014-04-01

communication with its base station. Significance to defence and security The Royal Canadian Navy ( RCN ) makes extensive use of unmanned aerial...further concepts for their use in RCN operations, such as off-board jamming. Communication with UAVs or USVs (UXVs) will be lost if the UXV travels too...conditions that allow communications to be extended to areas beyond the expected operating range of the UXV. This should benefit RCN operations and would

Strategic Joint Staff Force Posture and Readiness Process Analysis

DTIC Science & Technology

2014-03-31

Identifiers that reflect Limitations and/or Restraints. Below is a screenshot of the View 3 worksheet for the RCN : Strategic Joint Staff Force...Commanders’ Notes M Manual N = RCN , L = CA, A = RCAF, etc. same as with current FP&R. L1 Commanders Note Commanders’ Note that describes a...Commanders’ Notes O Manual N = RCN , L = CA, A = RCAF, etc. same as with current FP&R. Mandatory if there is a Limitation and/or Restraint. Endurance

Human Factors Analysis and Layout Guideline Development for the Canadian Surface Combatant (CSC) Project

DTIC Science & Technology

2013-04-01

project was to provide the Royal Canadian Navy ( RCN ) with a set of guidelines on analysis, design, and verification processes for effective room...design, and verification processes that should be used in the development of effective room layouts for Royal Canadian Navy ( RCN ) ships. The primary...designed CSC; however, the guidelines could be applied to the design of any multiple-operator space in any RCN vessel. Results: The development of

Paediatric conference.

PubMed

1999-04-01

The venue for the postponed RCN Children in A&E (Within the RCN A&E Nursing Association) Annual Conference, Saturday, April 24 1999 will be The Education Centre, Birmingham Children's Hospital, Steelhouse Lane, Birmingham.

Reaction kinetics of O( 3P) with acrylonitrile and crotononitrile

NASA Astrophysics Data System (ADS)

Upadhyaya, Hari P.; Naik, Prakash D.; Pavanaja, Ubaradka B.; Kumar, Awadhesh; Vatsa, Rajesh K.; Sapre, Avinash V.; Mittal, Jai P.

1997-08-01

The reaction of oxygen atoms O( 3P) with unsaturated nitriles (RCN), viz. acrylonitrile (CH 2=CHCN), and crotononitrile (CH 3CH=CHCN), was studied in a flow discharge tube in the pressure range 1.2-1.7 Torr using the O( 3P) chemiluminescence titration method. The rate constants for the reaction O( 3P) + RCN → products was determined at room temperature to be (4.9 ± 1.0) × 10 -13 and (5.4 ± 0.8) × 10 -13 cm 3 molecule -1 s -1 for acrylonitrile and crotononitrile respectively. The activation energies for the above reactions were estimated using the MNDO method. The formation of a biradical involving the addition of an oxygen atom to the double bond is proposed as the major channel for the reaction.

Developing the RCN Executive Nurse Network.

PubMed

Chapman, Naomi

2012-06-01

The Royal College of Nursing (RCN) has been reviewing how it engages with senior nurses across the UK. As part of a new approach to engagement, it was decided to establish a UK-wide network for nurses at executive level across all sectors of care provision. In this article, the author, who was appointed RCN Executive Nurse Network manager in November 2011, explains who the network is for, what it offers, how it will work and how it will be developed over the coming year.

Royal honour.

PubMed

2001-03-07

RCN adviser in nursing practice Susan Scott visited Buckingham Palace last week to receive her MBE from the Queen. Ms Scott, who received the honour for services to nursing and the RCN, is pictured with her granddaughter Mollie.

District nursing is vital.

PubMed

Bliss, Julie

2016-08-03

Queen's Nursing Institute chief executive Crystal Oldman has welcomed the RCN congress resolution urging RCN council to lobby for all district nurses to have a specialist practice qualification. This provides the ideal route for future talent and must be supported.

RCN Nurse of the Year 2016: 'Award win will open doors'.

PubMed

Cole, Elaine

2017-01-04

'The Nurse Awards have opened doors,' says Venetia Wynter-Blyth, RCN Nurse of the Year 2016. 'I cannot emphasise enough how many opportunities have been presented to us as a result of winning this award.'

Nurses in Northern Ireland feel blamed for A&E problems, says RCN.

PubMed

2014-08-05

Emergency nurses in Northern Ireland believe they are being scapegoated for delays in A&E departments when these are the result of broader failings in the health and social care system, the RCN has warned.

Leading lights.

PubMed

2001-06-01

Christine Hancock led a delegation of nurses to Surrey Ambulance Service NHS Trust last month as one of her last engagements as RCN general secretary. Leading nurses from across the south east visited the trust, which has established a traffic light system so that A&E nurses divert ambulance crews from busy units. Trust managers also hope to cut referrals to A&E by 40 per cent by using a 'whole-system' approach to treating patients. (Left to right) RCN council member for Oxford region Debbie Pearman, senior call co-ordinator Linda Tee, Miss Hancock and RCN A&E Nursing Association chair Lynda Holt.

Diamond, aromatic, aliphatic components of interstellar dust grains: Random covalent networks in carbonaceous grains

NASA Astrophysics Data System (ADS)

Duley, W. W.

1995-05-01

A formalism based on the theory of random covalent networks (RCNs) in amorphous solids is developed for carbonaceous dust grains. RCN solutions provide optimized structures and relative compositions for amorphous materials. By inclusion of aliphatic, aromatic, and diamond clusters, solutions specific to interstellar materials can be obtained and compared with infrared spectral data. It is found that distinct RCN solutions corresponding to diffuse cloud and molecular cloud materials are possible. Specific solutions are derived for three representative objects: VI Cyg No. 12, NGC 7538 (IRS 9), and GC IRS 7. While diffuse cloud conditions with a preponderance of sp2 and sp3 bonded aliphatic CH species can be reproduced under a variety of RCN conditions, the presence of an abundant tertiary CH or diamond component is highly constrained. These solutions are related quantitatively to carbon depletions and can be used to provide a quantitative estimate of carbon in these various dust components. Despite the abundance of C6 aromatic rings in many RCN solutions, the infrared absorption due to the aromatic stretch at approximately 3.3 micrometers is weak under all conditions. The RCN formalism is shown to provide a useful method for tracing the evolutionary properties of interstellar carbonaceous grains.

A mutation in protein phosphatase 2A regulatory subunit A affects auxin transport in Arabidopsis

NASA Technical Reports Server (NTRS)

Garbers, C.; DeLong, A.; Deruere, J.; Bernasconi, P.; Soll, D.; Evans, M. L. (Principal Investigator)

1996-01-01

The phytohormone auxin controls processes such as cell elongation, root hair development and root branching. Tropisms, growth curvatures triggered by gravity, light and touch, are also auxin-mediated responses. Auxin is synthesized in the shoot apex and transported through the stem, but the molecular mechanism of auxin transport is not well understood. Naphthylphthalamic acid (NPA) and other inhibitors of auxin transport block tropic curvature responses and inhibit root and shoot elongation. We have isolated a novel Arabidopsis thaliana mutant designated roots curl in NPA (rcn1). Mutant seedlings exhibit altered responses to NPA in root curling and hypocotyl elongation. Auxin efflux in mutant seedlings displays increased sensitivity to NPA. The rcn1 mutation was transferred-DNA (T-DNA) tagged and sequences flanking the T-DNA insert were cloned. Analysis of the RCN1 cDNA reveals that the T-DNA insertion disrupts a gene for the regulatory A subunit of protein phosphatase 2A (PP2A-A). The RCN1 gene rescues the rcn1 mutant phenotype and also complements the temperature-sensitive phenotype of the Saccharomyces cerevisiae PP2A-A mutation, tpd3-1. These data implicate protein phosphatase 2A in the regulation of auxin transport in Arabidopsis.

Effect of storage temperatures and humidity on proximate composition, peroxide value and iodine value of raw cashew nuts.

PubMed

Ajith, Sabna; Pramod, S; Prabha Kumari, C; Potty, V P

2015-07-01

The equilibrium moisture content (EMC) of raw cashew nuts (RCN) were determined using the standard static gravimetric method at 30 °C, 40 °C and 50 °C for relative humidity (RH) ranging from 43 to 90 %. The proximate composition analysis, peroxide value and iodine value of RCN were assessed at this equilibrium stage. The RCN kept under the humidity of 86 and 90 percentage at all studied temperatures developed mold growth within 24-48 h of time. The better storage condition assessed for raw cashew nut is 67 % of RH at 30 °C and the values obtained for EMC, proximate composition analysis, peroxide value and iodine value are within the same range as observed with harvested RCN. Highlights • Raw cashew nut storage condition identified • It was analysed with different temperature (30 (°)C, 40 (°)C and 50 (°)C) and relative humidity (43 %-90 %) • Better storage condition for raw cashew nut is in 67 % of RH at 30 (°)C • In this condition the EMC was 8.11 % as within the range of moisture in harvested RCN.

Association appoints new RCN A&E Chair.

PubMed

1999-09-01

Lynda Holt, A&E Clinical Manager at Warwick Hospital has become Chair of the RCN A&E Nursing Association following the resignation of Karen Castille who has been seconded to the Department of Health (England) to work on the A&E modernisation programme.

"A New Arm of the GSC: the RCN4GSC" and "Curation of MIGS-compliant Data" (GSC 8 Meeting)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Field, Dawn; Sterk, Peter

2009-09-09

The Genomic Standards Consortium was formed in September 2005. It is an international, open-membership working body which promotes standardization in the description of genomes and the exchange and integration of genomic data. The 2009 meeting was an activity of a five-year funding "Research Coordination Network" from the National Science Foundation and was organized held at the DOE Joint Genome Institute with organizational support provided by the JGI and by the University of California - San Diego. Dawn Field of the NERC Centre for Ecology & Hydrology briefly describes RCN4GSC and Peter Sterk of the NERC Centre for Ecology & Hydrologymore » follows with a talk on curation of MIGS-compliant data at the Genomic Standards Consortium's 8th meeting at the DOE JGI in Walnut Creek, Calif. on Sept. 9, 2009.« less

A New Arm of the GSC: The RCN4GSC and Curation of MIGS-compliant Data (GSC8 Meeting)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Field, Dawn; Sterk, Peter

2009-09-09

The Genomic Standards Consortium was formed in September 2005. It is an international, open-membership working body which promotes standardization in the description of genomes and the exchange and integration of genomic data. The 2009 meeting was an activity of a five-year funding Research Coordination Network from the National Science Foundation and was organized held at the DOE Joint Genome Institute with organizational support provided by the JGI and by the University of California - San Diego. Dawn Field of the NERC Centre for Ecology and Hydrology briefly describes RCN4GSC and Peter Sterk of the NERC Centre for Ecology and Hydrologymore » follows with a talk on curation of MIGS-compliant data at the Genomic Standards Consortium 8th meeting at the DOE JGI in Walnut Creek, Calif. on Sept. 9, 2009.« less

A New Arm of the GSC: The RCN4GSC and Curation of MIGS-compliant Data (GSC8 Meeting)

ScienceCinema

Field, Dawn; Sterk, Peter

2018-01-09

The Genomic Standards Consortium was formed in September 2005. It is an international, open-membership working body which promotes standardization in the description of genomes and the exchange and integration of genomic data. The 2009 meeting was an activity of a five-year funding Research Coordination Network from the National Science Foundation and was organized held at the DOE Joint Genome Institute with organizational support provided by the JGI and by the University of California - San Diego. Dawn Field of the NERC Centre for Ecology and Hydrology briefly describes RCN4GSC and Peter Sterk of the NERC Centre for Ecology and Hydrology follows with a talk on curation of MIGS-compliant data at the Genomic Standards Consortium 8th meeting at the DOE JGI in Walnut Creek, Calif. on Sept. 9, 2009.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cowan, R. D.; Rajnak, K.; Renard, P.

This is a set of three Fortran IV programs, RCN29, HFMOD7, and RCN229, based on the Herman--Skillman and Charlotte Froese Fischer programs, with extensive modifications and additions. The programs compute self-consistent-field radial wave functions and the various radial integrals involved in the computation of atomic energy levels and spectra.

Requirements for VICTORIA Class Fire Control System: Contact Management Function

DTIC Science & Technology

2014-07-01

Canadian Navy ( RCN ) is currently upgrading the fire control system, which will include moving the software to new modular consoles which have screens...Development RCN Royal Canadian Navy SAC Sensor Analysis Coordinator; also called Command Display Console (CDC) operator SAR Search and Rescue SME

Send politicians a message at RCN congress.

PubMed

2017-05-09

With RCN congress being held this month and a general election soon after there may never be a better time for the college and other unions to lobby for what matters most to nurses, and for what opinion polls tell us the public want: good quality services.

U.S. EPA, Pesticide Product Label, SODIUM HYPOCHLORITE SOLUTION, 10/26/1990

EPA Pesticide Factsheets

2011-04-21

... JUL!\\t!<:. ~ can(~ lO':'C~ ~ rf1~onl; ~~~1~~ ~~ : t~v!rcn.entil ~r~:!tt~~~ ~;e,(!. ... Jt;l~. ~er ;~~can(~ (o.:.c~ !be rp;:OOii ~!~!( of :~ t~y!rcn''"t~l ...

The Present and Future Opportunities of the Rare Cancer Network: An International Consortium for Advancement of Oncologic Care

PubMed Central

2015-01-01

To date, the Rare Cancer Network (RCN) has initiated more than 90 studies and 54 peer-reviewed publications were produced as a result. The Second International Symposium of the Rare Cancer Network recently took place in Istanbul, Turkey on April 17-18, 2015, and update was given on multiple currently ongoing projects, while also giving room for new proposals which will shape the direction of future studies for the group. This companion issue of the RCN Proceedings summarized the findings of this meeting, while also serving as a call for fresh projects and papers which will continue to energize the group and advance the oncologic science. A brief introduction to the principles, history, and vision of the RCN was also included. To review, the academic year of 2014-15 marked an enormous success for the international members of the RCN, with the generation of 8 fully published papers and more than 12 newly proposed topics. By the collective efforts of all RCN members, in the future, we look forward to the upcoming opportunities in continuing to advance the standard of chemo- and radiotherapeutic oncologic care for selected rare tumor topics. The studies of these rare cancers often do not allow the design and execution of prospectively enrolled trials; however, these uncommon malignancies do impact the humankind and add to its suffering globally in significant ways. PMID:26500735

RCN sets the bar high for advanced nursing status.

PubMed

2017-02-08

Details of how senior, specialist nurses will be able to accredit themselves as advanced practitioners are starting to emerge from the RCN. It is immediately apparent that qualifying for this status is going to be far from easy, given the significant expectations that are likely to be set.

Children with autism need better hospital care, says RCN.

PubMed

Keogh, Kat

2017-06-12

Nurses have called for improvements to the care of children with autism in hospitals and the community. About 1% of children in the UK have autism spectrum disorder (ASD), which affects social interaction, behaviour and communication. However, as healthcare services are pushed to breaking point, support for such children is dwindling, the RCN warns.

RCN congress offers nurses the chance to tell it how it is.

PubMed

Davies, Janet

2016-06-22

Almost a year into my role as RCN chief executive and general secretary, one of the things I have enjoyed most is the opportunity to speak out on behalf of nurses. Wherever you work, as a registrant or healthcare assistant, yours are the voices that need to be heard.

Why RCN Nurse of the Year is such an inspiring winner.

PubMed

2017-05-10

Remember the name: Melanie Davies, RCN Nurse of the Year 2017 and a truly extraordinary woman. She has transformed care for people with learning disabilities on her ward, driven through changes across her hospital and health board in south Wales, and inspired others to follow suit across the country.

A Community-Building Framework for Collaborative Research Coordination across the Education and Biology Research Disciplines

ERIC Educational Resources Information Center

Pelaez, Nancy; Anderson, Trevor R.; Gardner, Stephanie M.; Yin, Yue; Abraham, Joel K.; Barlett, Edward L.; Gormally, Cara; Hurney, Carol A.; Long, Tammy M.; Newman, Dina L.; Sirum, Karen; Stevens, Michael T.

2018-01-01

Since 2009, the U.S. National Science Foundation Directorate for Biological Sciences has funded Research Coordination Networks (RCN) aimed at collaborative efforts to improve participation, learning, and assessment in undergraduate biology education (UBE). RCN-UBE projects focus on coordination and communication among scientists and educators who…

Your chance to shape the future of the RCN and the profession.

PubMed

2017-07-19

Offering you the chance to join a committee is unlikely to set your pulse racing, so let's put it another way: would you like to join a group of dynamic nurses who will help shape the future of the RCN and the wider nursing profession? If the answer is yes, then read on.

Summit of the Research Coordination Networks for Undergraduate Biology Education

ERIC Educational Resources Information Center

Eaton, Carrie Diaz; Allen, Deborah; Anderson, Laurel J.; Bowser, Gillian; Pauley, Mark A.; Williams, Kathy S.; Uno, Gordon E.

2016-01-01

The first summit of projects funded by the National Science Foundation's Research Coordination Networks for Undergraduate Biology Education (RCN-UBE) program was held January 14-16, 2016, in Washington, DC. Sixty-five scientists and science educators from 38 of the 41 Incubator and Full RCN-UBE awards discussed the value and contributions of RCNs…

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schoendorff, George E.; De Jong, Wibe A.; Gordon, Mark S.

The formation of uranyl dicationic complexes containing water and nitrile (acetonitrile, propionitrile, and benzonitrile) ligands, [UO2(H2O)n(RCN)m]2+, has been studied using density functional theory (DFT) with a relativistic effective core potential (RECP) to account for scalar relativistic effects on uranium. It is shown that nitrile addition is favored over the addition of water ligands. Decomposition of these complexes to [UO2OH(H2O)n(RCN)m]+ by the loss of either H3O+ or (RCN+H)+ is also examined. It is found that this reaction occurs when the coordination sphere of uranyl is unsaturated. Additionally, this reaction is influenced by the size of the nitrile ligand with reactions involvingmore » acetonitrile being the most prevalent.« less

Genetic and chemical reductions in protein phosphatase activity alter auxin transport, gravity response, and lateral root growth

NASA Technical Reports Server (NTRS)

Rashotte, A. M.; DeLong, A.; Muday, G. K.; Brown, C. S. (Principal Investigator)

2001-01-01

Auxin transport is required for important growth and developmental processes in plants, including gravity response and lateral root growth. Several lines of evidence suggest that reversible protein phosphorylation regulates auxin transport. Arabidopsis rcn1 mutant seedlings exhibit reduced protein phosphatase 2A activity and defects in differential cell elongation. Here we report that reduced phosphatase activity alters auxin transport and dependent physiological processes in the seedling root. Root basipetal transport was increased in rcn1 or phosphatase inhibitor-treated seedlings but showed normal sensitivity to the auxin transport inhibitor naphthylphthalamic acid (NPA). Phosphatase inhibition reduced root gravity response and delayed the establishment of differential auxin-induced gene expression across a gravity-stimulated root tip. An NPA treatment that reduced basipetal transport in rcn1 and cantharidin-treated wild-type plants also restored a normal gravity response and asymmetric auxin-induced gene expression, indicating that increased basipetal auxin transport impedes gravitropism. Increased auxin transport in rcn1 or phosphatase inhibitor-treated seedlings did not require the AGR1/EIR1/PIN2/WAV6 or AUX1 gene products. In contrast to basipetal transport, root acropetal transport was normal in phosphatase-inhibited seedlings in the absence of NPA, although it showed reduced NPA sensitivity. Lateral root growth also exhibited reduced NPA sensitivity in rcn1 seedlings, consistent with acropetal transport controlling lateral root growth. These results support the role of protein phosphorylation in regulating auxin transport and suggest that the acropetal and basipetal auxin transport streams are differentially regulated.

Meet the RCN Nurse of the Year 2017.

PubMed

Cole, Elaine

2017-05-10

'Never again on my ward, in my hospital, on my health board; that's what I resolved and I felt it in my heart,' says RCN Nurse of the Year 2017 Melanie Davies. 'I have driven it and made it real. I made a promise to Paul's family that no other patient or family would experience the care that he sadly received.'

RCN Nurse of the Year pioneers cancer 'prehab'.

PubMed

2016-05-11

Being diagnosed with cancer is traumatic enough, but being told you will need major surgery as part of your treatment only serves to increase the sense of foreboding and trepidation. Venetia Wynter-Blyth responded by developing a programme that has proved so successful that her patients' experience of care has been transformed, and last week she was named RCN Nurse of the Year.

Conference call.

PubMed

2002-03-01

The RCN A&E Nursing Association, Black Country A&E professional development group and University of Wolverhampton school of health are holding the Emergency Nursing Research 2002 conference on March 6 in Wolverhampton. For more information, contact Alastair Gray by phone on 01902 307999 ext 2055 or by email at a.d.gray@wlv.ac.uk. Details available at www.man.ac.uk/rcn/conference/enrc2002.doc.

PPP1R12A Copy Number Is Associated with Clinical Outcomes of Stage III CRC Receiving Oxaliplatin-Based Chemotherapy

PubMed Central

Zhang, Chenbo; Li, Ajian; Li, Huaguang; Peng, Kangsheng; Wei, Qing; Lin, Moubin; Liu, Zhanju; Yin, Lu; Li, Jianwen

2015-01-01

Aim. To investigate the correlation between PPP1R12A gene copy number and clinical outcomes of oxaliplatin-based regimen in stage III colorectal cancer (CRC). Methods. A total of 139 paraffin-embedded tissue samples of stage III CRC patients who received oxaliplatin-based treatment after radical surgery were recruited. Genomic DNA was extracted and purified from paraffin-embedded sections. Quantitative PCR methods were used to detect the relative copy number (RCN) of PPP1R12A. Results. Statistical analysis demonstrated that low PPP1R12A RCN was associated with poor RFS (HR = 2.186, 95% CI: 1.293–3.696; P = 0.003) and OS (HR = 2.782, 95% CI: 1.531–5.052; P < 0.001). Additionally, when patients were stratified according to subgroups of stage III and tumor location, poor RFS and OS were also observed in the low PPP1R12A RCN group with significance (RFS: IIIB HR = 2.870, P < 0.001; colon HR = 1.910, P = 0.037; OS: IIIB HR = 3.527, P < 0.001; IIIC HR = 2.662, P = 0.049; rectum HR = 4.229, P = 0.002). Conclusion. Our findings suggest the copy number of PPP1R12A can independently predict recurrence and overall survival of stage III colorectal cancer patients receiving oxaliplatin-based chemotherapy. PMID:26113782

RCN4GSC workshop report: managing data at the interface of biodiversity and (meta)genomics, March 2011

USDA-ARS?s Scientific Manuscript database

The Genomic Standards Consortium (GSC) is an international working body with the mission of working towards richer descriptions of genomic and metagenomic data through the development of standards and tools for supporting the consistent documentation of contextual information about sequences. Becaus...

12 CFR 350.4 - Contents of annual disclosure statement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... for each such year. The annual disclosure statement may, at the option of bank management, consist of... Reserve System: (i) Schedule RC (Balance Sheet); (ii) Schedule RC-N (Past Due and Nonaccrual, Loans... option, provide additional information that bank management considers important to an evaluation of the...

12 CFR 18.4 - Contents of annual disclosure statement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the preceding year. The annual disclosure statement may, at the option of bank management, consist of... schedules. (1) For national banks: (i) Schedule RC (Balance Sheet); (ii) Schedule RC-N (Past Due and... narrative. Bank management may, at its option, provide a narrative discussion to supplement the annual...

Enhanced ethylene responsiveness in the Arabidopsis eer1 mutant results from a loss-of-function mutation in the protein phosphatase 2A A regulatory subunit, RCN1.

PubMed

Larsen, Paul Brian; Cancel, Jesse Daniel

2003-06-01

Ethylene signaling in Arabidopsis begins with a family of five ethylene receptors that regulate the activity of the Raf-like kinase, CTR1. Recent work to identify novel factors required for modulating ethylene signaling resulted in the isolation of enhanced ethylene response 1 (eer1), a mutant that displays both increased sensitivity and increased amplitude of response to ethylene. Molecular cloning of eer1 reveals that its mutant phenotype results from a loss-of-function mutation in the previously characterized RCN1, one of three PP2A A regulatory subunits in Arabidopsis. Our analysis shows that neither RCN1 expression nor PP2A activity is regulated by ethylene. Instead, we found that Arabidopsis PP2A-1C, a PP2A catalytic subunit previously characterized as interacting with RCN1, associates strongly with the kinase domain of CTR1 in vitro. This likely represents a role for PP2A in modulation of CTR1 activity because an in vitro kinase assay did not reveal phosphorylation of either RCN1 or PP2A-1C by CTR1, indicating that neither of them is a substrate for CTR1. PP2A activity is required for Ras-dependent activation of mammalian Raf, with reductions in PP2A activity significantly compromising the effectiveness of this mechanism. Our genetic and biochemical results suggest that a similar requirement for PP2A activity exists for ethylene signaling, with loss-of-function mutations affecting PP2A activity possibly reducing the effectiveness of CTR1 activation, thus lowering the threshold required for manifestation of ethylene response.

Recombinant raccoon pox vaccine protects mice against lethal plague

USGS Publications Warehouse

Osorio, J.E.; Powell, T.D.; Frank, R.S.; Moss, K.; Haanes, E.J.; Smith, S.R.; Rocke, T.E.; Stinchcomb, D.T.

2003-01-01

Using a raccoon poxvirus (RCN) expression system, we have developed new recombinant vaccines that can protect mice against lethal plague infection. We tested the effects of a translation enhancer (EMCV-IRES) in combination with a secretory (tPA) signal or secretory (tPA) and membrane anchoring (CHV-gG) signals on in vitro antigen expression of F1 antigen in tissue culture and the induction of antibody responses and protection against Yersinia pestis challenge in mice. The RCN vector successfully expressed the F1 protein of Y. pestis in vitro. In addition, the level of expression was increased by the insertion of the EMCV-IRES and combinations of this and the secretory signal or secretory and anchoring signals. These recombinant viruses generated protective immune responses that resulted in survival of 80% of vaccinated mice upon challenge with Y. pestis. Of the RCN-based vaccines we tested, the RCN-IRES-tPA-YpF1 recombinant construct was the most efficacious. Mice vaccinated with this construct withstood challenge with as many as 1.5 million colony forming units of Y. pestis (7.7×104 LD50). Interestingly, vaccination with F1 fused to the anchoring signal (RCN-IRES-tPA-YpF1-gG) elicited significant anti-F1 antibody titers, but failed to protect mice from plague challenge. Our studies demonstrate, in vitro and in vivo, the potential importance of the EMCV-IRES and secretory signals in vaccine design. These molecular tools provide a new approach for improving the efficacy of vaccines. In addition, these novel recombinant vaccines could have human, veterinary, and wildlife applications in the prevention of plague.

Come on RCN - What's your position on the EU referendum?

PubMed

Travis, Mike

2016-05-04

The Royal College of Midwives is ahead of other health unions on the great EU debate, issuing a clear statement of where they stand that will help members think about how they vote on June 23. The European question is complex and the media will not focus on economic and worker welfare. Where is the RCN in all this? It says it has a 'neutral' stance!

MI group launch.

PubMed

2002-10-01

The RCN minor injuries group was due to be launched last month as Emergency Nurse went to press. The sub-group of the RCN A&E Nursing Association is to be chaired by Mark Preston, senior nurse and modern matron at Alfred Bean Hospital, East Yorkshire. A&E sister at the Royal Preston Hospital Sarifa Kabir is to be secretary, with clinical nurse manager at Heatherwood Hospital, Berkshire, Gail King as vice chair.

The discovery of [Ni(NHC)RCN]2 species and their role as cycloaddition catalysts for the formation of pyridines.

PubMed

Stolley, Ryan M; Duong, Hung A; Thomas, David R; Louie, Janis

2012-09-12

The reaction of Ni(COD)(2), IPr, and nitrile affords dimeric [Ni(IPr)RCN](2) in high yields. X-ray analysis revealed these species display simultaneous η(1)- and η(2)-nitrile binding modes. These dimers are catalytically competent in the formation of pyridines from the cycloaddition of diynes and nitriles. Kinetic analysis showed the reaction to be first order in [Ni(IPr)RCN](2), zeroth order in added IPr, zeroth order in nitrile, and zeroth order in diyne. Extensive stoichiometric competition studies were performed, and selective incorporation of the exogenous, not dimer bound, nitrile was observed. Post cycloaddition, the dimeric state was found to be largely preserved. Nitrile and ligand exchange experiments were performed and found to be inoperative in the catalytic cycle. These observations suggest a mechanism whereby the catalyst is activated by partial dimer-opening followed by binding of exogenous nitrile and subsequent oxidative heterocoupling.

Is there a stable B2Π state for the CNO molecule?

NASA Astrophysics Data System (ADS)

Marian, Christel; Hess, Bernd A.; Schöttke, Sigrid; Buenker, Robert J.

1987-07-01

We report MRD-CI calculations on the ground state X2Π and the excited states A2Σ + and B2Π of the CNO molecule in linear geometry. The surfaces for oxygen and carbon extraction are calculated using a limited CI expansion of 47 configuration state functions; in the vicinity of the minima obtained with this procedure large-scale CI calculations are carried out including deter-mination of the spin-orbit splitting of the 2Π states of the minima. We find that the B2Π state will be difficult to detect spectroscopically due to an avoided crossing just at the equilibrium geometry of the ground state at RCN = 2.25 a.u., RNO = 2.30 a.u. Accordingly we find two shallow minima for B2Π at RCN = 2.33 a.u., RNO = 2.91 a.u. and RCN = 2.78 a.u., RNO = 2.28 a.u., respectively.

Getting eHealth into basic nursing education: report of the RCN information in nursing project.

PubMed

Clark, June; Baker, Bernice; Baker, David

2009-01-01

This paper reports the results of a project undertaken in 2008 by the Royal College of Nursing's Information in Nursing Forum. The project, undertaken by the RCN IN Forum in association with the RCN Education Forum and the RCN Association of Nursing Students, was in two parts. The first part consisted of an on-line survey of nursing students to discover their "readiness" for working in an electronic environment. The second part consisted of a workshop for invited stakeholders - organisations responsible for commissioning and providing basic nursing education, regulators, nurse teachers, and nursing students themselves - the objective of which was to consider the results of the survey and other information, in order to develop a consensus on how best to incorporate eHealth issues into basic nursing education. The survey was undertaken during April 2008 via the RCN website. Students were asked how well they felt their nursing education had prepared them for competencies set out in a previously published model curriculum. 1,120 students responded. 565 students who had used electronic patient records during their most recent clinical placement were asked about their experience. Students rated their basic computer skills much higher than their understanding of eHealth. While they felt competent to document assessments and care plans using paper records, few felt competent to do so using electronic records. Few know anything about telehealth (remote diagnosis and delivery of healthcare) or telecare (assistive technology in people's homes). Among those who had used computers in their most recent clinical placement there were clear breaches of the protocols designed to ensure security and confidentiality. Twenty seven invited participants attended the workshop held in October 2008, plus 12 members of the participating Forums and relevant RCN staff. Following presentation and discussion of the findings of the survey, participants worked in three groups to identify and discuss issues arising from the survey, and to identify barriers using a Force Field Analysis. All participants agreed eHealth should be an integral part of nursing education and not an "add-on", and that the responsibility for "Getting eHealth into basic nursing education" had to be shared by university based educators, placement supervisors, and regulators.

Pinoid kinase regulates root gravitropism through modulation of PIN2-dependent basipetal auxin transport in Arabidopsis thaliana

NASA Astrophysics Data System (ADS)

Muday, Gloria; Sukumar, Poornima; Edwards, Karin; Delong, Alison; Rahman, Abidur

Reversible protein phosphorylation is a key regulatory mechanism governing polar auxin transport. We tested the hypothesis that PINOID (PID)-mediated phosphorylation and RCN1- regulated dephosphorylation might antagonistically regulate auxin transport and gravity response in seedling roots. Here we show that basipetal IAA transport and gravitropism are reduced in pid mutant seedlings, while acropetal transport and lateral root development are unchanged. Treatment of wild-type seedlings with the protein kinase inhibitor, staurosporine, phenocopied the reduced auxin transport and gravity response of pid-9 and reduced formation of asymmetric DR5-revGFP expression at the root tip after reorientation relative to gravity. Gravitropism and auxin transport in pid are resistant to further inhibition by staurosporine. Gravity response defects of rcn1 and pid-9 are partially rescued by treatment with staurosporine or the phosphatase inhibitor, cantharidin, respectively, and in the pid-9 rcn1 double mutant. Furthermore, the effect of staurosporine is lost in pin2, and a PIN2::GFP fusion protein accumulates in endomembrane compartments after staurosporine treatment. In the pid-9 mutant, immunological techniques find a similar PIN2 localization. These data suggest that staurosporine inhibits gravitropism and basipetal IAA transport by blocking PID action and altering PIN2 localization and support the model that PID and RCN1 reciprocally regulate root gravitropic curvature.

Royal College of Nursing (Rcn) code of professional conduct: a discussion document.

PubMed Central

Dawson, J D; Altschul, A T; Sampson, C; Smith, A M

1977-01-01

We are printing in its entirety the discussion document which sets out a code of professional conduct for nurses published by the Royal College of Nursing in November 1976 together with commentaries by the Assistant Secretary of the British Medical Association, a professor of nursing studies, student nurses and a lawyer. The image of the nurse is still that of one of Florence Nightingale's young ladies or of a member of a religious order who is wholly dedicated to caring for the sick. Today, as this document and the comments upon it show, 'dedication' is still part of the motive which leads a man or woman to become a nurse but in addition, and this is where the public may be ignorant or choose to be ignorant, nursing offers a career where intellectual achievement and the satisfaction of a demanding job bring their proper financial reward and place in the professional community. We are grateful to the Royal College of Nursing for permission to publish this document. PMID:926130

PINOID kinase regulates root gravitropism through modulation of PIN2-dependent basipetal auxin transport in Arabidopsis.

PubMed

Sukumar, Poornima; Edwards, Karin S; Rahman, Abidur; Delong, Alison; Muday, Gloria K

2009-06-01

Reversible protein phosphorylation is a key regulatory mechanism governing polar auxin transport. We characterized the auxin transport and gravitropic phenotypes of the pinoid-9 (pid-9) mutant of Arabidopsis (Arabidopsis thaliana) and tested the hypothesis that phosphorylation mediated by PID kinase and dephosphorylation regulated by the ROOTS CURL IN NAPHTHYLPHTHALAMIC ACID1 (RCN1) protein might antagonistically regulate root auxin transport and gravity response. Basipetal indole-3-acetic acid transport and gravitropism are reduced in pid-9 seedlings, while acropetal transport and lateral root development are unchanged. Treatment of wild-type seedlings with the protein kinase inhibitor staurosporine phenocopies the reduced auxin transport and gravity response of pid-9, while pid-9 is resistant to inhibition by staurosporine. Staurosporine and the phosphatase inhibitor, cantharidin, delay the asymmetric expression of DR5revGFP (green fluorescent protein) at the root tip after gravistimulation. Gravity response defects of rcn1 and pid-9 are partially rescued by treatment with staurosporine and cantharidin, respectively. The pid-9 rcn1 double mutant has a more rapid gravitropic response than rcn1. These data are consistent with a reciprocal regulation of gravitropism by RCN1 and PID. Furthermore, the effect of staurosporine is lost in pinformed2 (pin2). Our data suggest that reduced PID kinase function inhibits gravitropism and basipetal indole-3-acetic acid transport. However, in contrast to PID overexpression studies, we observed wild-type asymmetric membrane distribution of the PIN2 protein in both pid-9 and wild-type root tips, although PIN2 accumulates in endomembrane structures in pid-9 roots. Similarly, staurosporine-treated plants expressing a PIN2GFP fusion exhibit endomembrane accumulation of PIN2GFP, but no changes in membrane asymmetries were detected. Our data suggest that PID plays a limited role in root development; loss of PID activity alters auxin transport and gravitropism without causing an obvious change in cellular polarity.

Mechanisms of nickel toxicity in microorganisms

PubMed Central

Macomber, Lee

2014-01-01

Summary Nickel has long been known to be an important human toxicant, including having the ability to form carcinomas, but until recently nickel was believed to be an issue only to microorganisms living in nickel-rich serpentine soils or areas contaminated by industrial pollution. This assumption was overturned by the discovery of a nickel defense system (RcnR/RcnA) found in microorganisms that live in a wide range of environmental niches, suggesting that nickel homeostasis is a general biological concern. To date, the mechanisms of nickel toxicity in microorganisms and higher eukaryotes are poorly understood. In this review, we summarize nickel homeostasis processes used by microorganisms and highlight in vivo and in vitro effects of exposure to elevated concentrations of nickel. On the basis of this evidence we propose four mechanisms of nickel toxicity: 1) nickel replaces the essential metal of metalloproteins, 2) nickel binds to catalytic residues of non-metalloenzymes; 3) nickel binds outside the catalytic site of an enzyme to inhibit allosterically, and 4) nickel indirectly causes oxidative stress. PMID:21799955

High Rates of Psychiatric Comorbidity in Narcolepsy: Findings From the Burden of Narcolepsy Disease (BOND) Study of 9,312 Patients in the United States.

PubMed

Ruoff, Chad M; Reaven, Nancy L; Funk, Susan E; McGaughey, Karen J; Ohayon, Maurice M; Guilleminault, Christian; Black, Jed

2017-02-01

To evaluate psychiatric comorbidity patterns in patients with a narcolepsy diagnosis in the United States. Truven Health Analytics MarketScan Research Databases were accessed to identify individuals ≥ 18 years of age with ≥ 1 ICD-9 diagnosis code(s) for narcolepsy continuously insured between 2006 and 2010 and non-narcolepsy controls matched 5:1 (age, gender, region, payer). Extensive subanalyses were conducted to confirm the validity of narcolepsy definitions. Narcolepsy subjects and controls were compared for frequency of psychiatric comorbid conditions (based on ICD-9 codes/Clinical Classification Software [CCS] level 2 categories) and psychiatric medication use. The final population included 9,312 narcolepsy subjects and 46,559 controls (each group, mean age = 46.1 years; 59% female). All categories of mental illness were significantly more prevalent in patients with narcolepsy versus controls, with the highest excess prevalence noted for CCS 5.8 Mood disorders (37.9% vs 13.8%; odds ratio [OR] = 4.0; 95% CI, 3.8-4.2), CCS 5.8.2 Depressive disorders (35.8% vs 13.0%; OR = 3.9; 95% CI, 3.7-4.1), and CCS 5.2 Anxiety disorders (25.1% vs 11.9%; OR = 2.5; 95% CI, 2.4-2.7). Excess prevalence of anxiety and mood disorders (narcolepsy vs controls) was higher in younger age groups versus older age groups. Psychiatric medication usage was higher in the narcolepsy group versus controls in the following categories: selective serotonin reuptake inhibitors (36% vs 17%), anxiolytic benzodiazepines (34% vs 19%), hypnotics (29% vs 13%), serotonin-norepinephrine reuptake inhibitors (21% vs 6%), and tricyclic antidepressants (13% vs 4%) (all P values < .0001). Narcolepsy is associated with significant comorbid psychiatric illness burden and higher psychiatric medication usage compared with the non-narcolepsy population. © Copyright 2016 Physicians Postgraduate Press, Inc.

A multidisciplinary approach to vascular surgery procedure coding improves coding accuracy, work relative value unit assignment, and reimbursement.

PubMed

Aiello, Francesco A; Judelson, Dejah R; Messina, Louis M; Indes, Jeffrey; FitzGerald, Gordon; Doucet, Danielle R; Simons, Jessica P; Schanzer, Andres

2016-08-01

Vascular surgery procedural reimbursement depends on accurate procedural coding and documentation. Despite the critical importance of correct coding, there has been a paucity of research focused on the effect of direct physician involvement. We hypothesize that direct physician involvement in procedural coding will lead to improved coding accuracy, increased work relative value unit (wRVU) assignment, and increased physician reimbursement. This prospective observational cohort study evaluated procedural coding accuracy of fistulograms at an academic medical institution (January-June 2014). All fistulograms were coded by institutional coders (traditional coding) and by a single vascular surgeon whose codes were verified by two institution coders (multidisciplinary coding). The coding methods were compared, and differences were translated into revenue and wRVUs using the Medicare Physician Fee Schedule. Comparison between traditional and multidisciplinary coding was performed for three discrete study periods: baseline (period 1), after a coding education session for physicians and coders (period 2), and after a coding education session with implementation of an operative dictation template (period 3). The accuracy of surgeon operative dictations during each study period was also assessed. An external validation at a second academic institution was performed during period 1 to assess and compare coding accuracy. During period 1, traditional coding resulted in a 4.4% (P = .004) loss in reimbursement and a 5.4% (P = .01) loss in wRVUs compared with multidisciplinary coding. During period 2, no significant difference was found between traditional and multidisciplinary coding in reimbursement (1.3% loss; P = .24) or wRVUs (1.8% loss; P = .20). During period 3, traditional coding yielded a higher overall reimbursement (1.3% gain; P = .26) than multidisciplinary coding. This increase, however, was due to errors by institution coders, with six inappropriately used codes resulting in a higher overall reimbursement that was subsequently corrected. Assessment of physician documentation showed improvement, with decreased documentation errors at each period (11% vs 3.1% vs 0.6%; P = .02). Overall, between period 1 and period 3, multidisciplinary coding resulted in a significant increase in additional reimbursement ($17.63 per procedure; P = .004) and wRVUs (0.50 per procedure; P = .01). External validation at a second academic institution was performed to assess coding accuracy during period 1. Similar to institution 1, traditional coding revealed an 11% loss in reimbursement ($13,178 vs $14,630; P = .007) and a 12% loss in wRVU (293 vs 329; P = .01) compared with multidisciplinary coding. Physician involvement in the coding of endovascular procedures leads to improved procedural coding accuracy, increased wRVU assignments, and increased physician reimbursement. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

The Discovery of [Ni(NHC)RCN]2 Species and their Role as Cycloaddition Catalysts for the Formation of Pyridines

PubMed Central

Stolley, Ryan M.; Duong, Hung A.; Thomas, David R.; Louie, Janis

2012-01-01

The reaction of Ni(COD)2, IPr, and nitrile affords dimeric [Ni(IPr)RCN]2 in high yields. X-ray analysis revealed these species display simultaneous η1- and η2-nitrile binding modes. These dimers are catalytically competent in the formation of pyridines from the cycloaddition of diynes and nitriles. Kinetic analysis showed the reaction to be first order in [Ni(IPr)RCN]2, zeroth order in added IPr, zeroth order in nitrile, and zeroth order in diyne. Extensive stoichiometric competition studies were performed, and selective incorporation of the exogenous, not dimer bound, nitrile was observed. Post cycloaddition, the dimeric state was found to be largely preserved. Nitrile and ligand exchange experiments were performed and found to be inoperative in the catalytic cycle. These observations suggest a mechanism whereby the catalyst is activated by partial dimer-opening followed by binding of exogenous nitrile and subsequent oxidative heterocoupling. PMID:22917161

Variations on a theme - the evolution of hydrocarbon solids. I. Compositional and spectral modelling - the eRCN and DG models

NASA Astrophysics Data System (ADS)

Jones, A. P.

2012-04-01

Context. The compositional properties of hydrogenated amorphous carbons are known to evolve in response to the local conditions. Aims: We present a model for low-temperature, amorphous hydrocarbon solids, based on the microphysical properties of random and defected networks of carbon and hydrogen atoms, that can be used to study and predict the evolution of their properties in the interstellar medium. Methods: We adopt an adaptable and prescriptive approach to model these materials, which is based on a random covalent network (RCN) model, extended here to a full compositional derivation (the eRCN model), and a defective graphite (DG) model for the hydrogen poorer materials where the eRCN model is no longer valid. Results: We provide simple expressions that enable the determination of the structural, infrared and spectral properties of amorphous hydrocarbon grains as a function of the hydrogen atomic fraction, XH. Structural annealing, resulting from hydrogen atom loss, results in a transition from H-rich, aliphatic-rich to H-poor, aromatic-rich materials. Conclusions: The model predicts changes in the optical properties of hydrogenated amorphous carbon dust in response to the likely UV photon-driven and/or thermal annealing processes resulting, principally, from the radiation field in the environment. We show how this dust component will evolve, compositionally and structurally in the interstellar medium in response to the local conditions. Appendices A and B are available in electronic form at http://www.aanda.org

Research Coordination Network: Geothermal Biology and Geochemistry in Yellowstone National Park

NASA Astrophysics Data System (ADS)

Inskeep, W. P.; Young, M. J.; Jay, Z.

2006-12-01

The number and diversity of geothermal features in Yellowstone National Park (YNP) represent a fascinating array of high temperature geochemical environments that host a corresponding number of unique and potentially novel organisms in all of the three recognized domains of life: Bacteria, Archaea and Eukarya. The geothermal features of YNP have long been the subject of scientific inquiry, especially in the fields of microbiology, geochemistry, geothermal hydrology, microbial ecology, and population biology. However, there are no organized forums for scientists working in YNP geothermal areas to present research results, exchange ideas, discuss research priorities, and enhance synergism among research groups. The primary goal of the YNP Research Coordination Network (GEOTHERM) is to develop a more unified effort among scientists and resource agencies to characterize, describe, understand and inventory the diverse biota associated with geothermal habitats in YNP. The YNP RCN commenced in January 2005 as a collaborative effort among numerous university scientists, governmental agencies and private industry. The YNP RCN hosted a workshop in February 2006 to discuss research results and to form three working groups focused on (i) web-site and digital library content, (ii) metagenomics of thermophilic microbial communities and (iii) development of geochemical methods appropriate for geomicrobiological studies. The working groups represent one strategy for enhancing communication, collaboration and most importantly, productivity among the RCN participants. If you have an interest in the geomicrobiology of geothermal systems, please feel welcome to join and or participate in the YNP RCN.

Time trend of injection drug errors before and after implementation of bar-code verification system.

PubMed

Sakushima, Ken; Umeki, Reona; Endoh, Akira; Ito, Yoichi M; Nasuhara, Yasuyuki

2015-01-01

Bar-code technology, used for verification of patients and their medication, could prevent medication errors in clinical practice. Retrospective analysis of electronically stored medical error reports was conducted in a university hospital. The number of reported medication errors of injected drugs, including wrong drug administration and administration to the wrong patient, was compared before and after implementation of the bar-code verification system for inpatient care. A total of 2867 error reports associated with injection drugs were extracted. Wrong patient errors decreased significantly after implementation of the bar-code verification system (17.4/year vs. 4.5/year, p< 0.05), although wrong drug errors did not decrease sufficiently (24.2/year vs. 20.3/year). The source of medication errors due to wrong drugs was drug preparation in hospital wards. Bar-code medication administration is effective for prevention of wrong patient errors. However, ordinary bar-code verification systems are limited in their ability to prevent incorrect drug preparation in hospital wards.

Computational Confirmation of the Carrier for the "XCN" Interstellar Ice Bank: OCN(-) Charge Transfer Complexes

NASA Technical Reports Server (NTRS)

Park, J.-Y.; Woon, D. E.

2004-01-01

Recent experimental studies provide evidence that carrier for the so-called XCN feature at 2165 cm(exp -1) (4.62 micron) in young stellar objects is an OCN(-)/NH4(+) charge transfer (CT) complex that forms in energetically processed interstellar icy grain mantles. Although other RCN nitriles and RCN iosonitriles have been considered, Greenberg's conjecture that OCN(-) is associated with the XCN feature has persisted for over 15 years. In this work we report a computational investigation that thoroughly confirms the hypothesis that the XCN feature observed in laboratory studies can result from OCN(-)/NH4(+) CT complexes arising from HNCO and NH3, in a water ice environment. Density functional theory calculations with theory calculations with HNCO, NH3, and up to 12 waters reproduce seven spectroscopic measurements associated with XCN: the band origin of the asymmetric stretching mode of OCN(-), shifts due to isotopic substitutions of C, N, O, and H, and two weak features. However, very similar values are also found for the OCN(-)/NH4(+) CT complex arising from HOCN and NH3. In both cases, the complex forms by barrierless proton transfer from HNCO or HOCN to NH3 during the optimization of the solvated system. Scaled B3LYP/6-31+G** harmonic frequencies for HNCO and HOCN cases are 2181 and 2202 cm(exp -1), respectively.

Chemiluminescent reaction of oxygen atoms with some nitrile compounds

NASA Astrophysics Data System (ADS)

Upadhyaya, Hari P.; Pavanaja, Ubaradka B.; Sapre, Avinash V.; Rama Rao, Kuchimanchi V. S.; Mittal, Jai P.

1994-09-01

In a discharge-flow experiment, chemiluminescent reactions of oxygen atoms (O( 3P)) with organic nitriles (RCN) are studied. For unsaturated nitriles RCN (R: CH 2=CH; CH 2=C(CH 3); CH 2=CH(CH 2)) the observed emission is attributed to CN * (B→X) and NO * (γ:A→X and β: B→X, bands). For saturated and phenyl nitriles (R: CH 3; C 2H 5; C 6H 5) emission is only observed from CN * (B 2Σ +). A suitable reaction mechanism for the observed emission is proposed.

Reflections on preparing a poster for an RCN conference.

PubMed

Hand, Helen

2010-01-01

The acceptance letter for the RCN Annual International Nursing Research Conference signalled the start of my doctoral research dissemination process and my first attempt at presenting a poster. The poster is potentially an excellent springboard for discussion, since information provided on the poster will, by necessity, be superficial, leaving the interested reader to access the detail from the person most passionate, insightful, enthusiastic and knowledgeable about the research--the presenter. This paper describes the planning, preparation and presentation of the poster followed by a critical reflection on the process in the light of literature.

Appropriate glove use in dermatitis prevention.

PubMed

Gallagher, Rose; Sunley, Kim

Work-related skin problems in nursing staff have risen in recent years, and inspections by the Health and Safety Executive in 2011 found a number of NHS trusts failing in their duties to prevent and manage the risks of work-related dermatitis. In response, the Royal College of Nursing issued guidelines on glove use and the prevention of contact dermatitis in nursing (RCN, 2012). These involved close collaboration between the professional and trade union parts of the RCN because failure to prevent and manage skin problems affects the safety of both staff and patients.

Comparison of electrocardiographic findings and associated risk factors between Taiwan Chinese and US White adults.

PubMed

Wu, Chih-Cheng; Yeh, Wen-Ting; Crow, Richard S; Bai, Chyi-Huey; Pan, Wen-Harn

2008-08-18

Electrocardiographic (ECG) findings are known to differ by race, however, systematic comparisons of findings between eastern and western countries are rare. To compare the ECG findings and associated coronary heart disease (CHD) risk factors between Taiwan Chinese and US White adults aged >or=40 years. We compared the prevalence rate of Minnesota Code criteria based ECG findings and associated CHD risk factors by using data from the third National Health and Nutrition Examination Survey (NHANES III) and the Nutrition and Health Survey in Taiwan (NAHSIT, 1993-1996). Examining all the ECG findings collectively, we observed a higher prevalence of major Minnesota Code findings in Taiwan Chinese women than in US White women (15.0% vs. 10.5%), particularly ST segment depression (5.4% vs. 2.4%) and T wave abnormalities (10.8% vs. 4.8%). The prevalence of major Minnesota Code findings was similar in both Taiwan Chinese and US White men (22.7% vs. 19.6%). Taiwan Chinese men had a higher prevalence of ST segment elevation (13.7% vs. 0.9%). Taiwan Chinese also had a higher prevalence of left ventricular hypertrophy with repolarization change than US Whites in both sexes (2.7% vs. 1.4% for men, 4.3% vs. 1.3% for women). Taiwan Chinese had more favorable CHD risk factor profiles than US Whites, including lipid profile, obesity, central obesity, and smoking status. The prevalence of hypertension was similar between the two groups, however, a lower percentage of Taiwan Chinese received treatment. Taiwan Chinese men had a lower prevalence of diabetes mellitus than US White men, whereas Taiwan Chinese women had a higher prevalence than US White women. These results suggest that substantial differences in ECG findings exist between Taiwan Chinese and US Whites which cannot be entirely explained by CHD risk factors alone.

Consumption of baits containing raccoon pox-based plague vaccines protects black-tailed prairie dogs (Cynomys ludovicianus).

PubMed

Rocke, Tonie E; Pussini, Nicola; Smith, Susan R; Williamson, Judy; Powell, Bradford; Osorio, Jorge E

2010-01-01

Baits containing recombinant raccoon poxvirus (RCN) expressing plague antigens (fraction 1 [F1] and a truncated form of the V protein-V307) were offered for voluntary consumption several times over the course of several months to a group of 16 black-tailed prairie dogs (Cynomys ludovicianus). For comparison, another group of prairie dogs (n = 12) was injected subcutaneously (SC) (prime and boost) with 40 microg of F1-V fusion protein absorbed to alum, a vaccine-adjuvant combination demonstrated to elicit immunity to plague in mice and other mammals. Control animals received baits containing RCN without the inserted antigen (n = 8) or injected diluent (n = 7), and as there was no difference in their survival rates by Kaplan-Meier analysis, all of them were combined into one group in the final analysis. Mean antibody titers to Yersinia pestis F1 and V antigen increased (p < 0.05) in the vaccinated groups compared to controls, but titers were significantly higher (p < 0.0001) in those receiving injections of F1-V fusion protein than in those orally vaccinated with RCN-based vaccine. Interestingly, upon challenge with approximately 70,000 cfu of virulent Y. pestis, oral vaccination resulted in survival rates that were significantly higher (p = 0.025) than the group vaccinated by injection with F1-V fusion protein and substantially higher (p < 0.0001) than the control group. These results demonstrate that oral vaccination of prairie dogs using RCN-based plague vaccines provides significant protection against challenge at dosages that simulate simultaneous delivery of the plague bacterium by numerous flea bites.

A Recombinant Raccoon Poxvirus Vaccine Expressing both Yersinia pestis F1 and Truncated V Antigens Protects Animals against Lethal Plague

PubMed Central

Rocke, Tonie E.; Kingstad-Bakke, Brock; Berlier, Willy; Osorio, Jorge E.

2014-01-01

In previous studies, we demonstrated in mice and prairie dogs that simultaneous administration of two recombinant raccoon poxviruses (rRCN) expressing Yersinia pestis antigens (F1 and V307—a truncated version of the V protein) provided superior protection against plague challenge compared to individual single antigen constructs. To reduce costs of vaccine production and facilitate implementation of a sylvatic plague vaccine (SPV) control program for prairie dogs, a dual antigen construct is more desirable. Here we report the construction and characterization of a novel RCN-vectored vaccine that simultaneously expresses both F1 and V307 antigens. This dual antigen vaccine provided similar levels of protection against plague in both mice and prairie dogs as compared to simultaneous administration of the two single antigen constructs and was also shown to protect mice against an F1 negative strain of Y. pestis. The equivalent safety, immunogenicity and efficacy profile of the dual RCN-F1/V307 construct warrants further evaluation in field efficacy studies in sylvatic plague endemic areas. PMID:26344891

A recombinant raccoon poxvirus vaccine expressing both Yersinia pestis F1 and truncated V antigens protects animals against lethal plague.

USGS Publications Warehouse

Rocke, Tonie E.; Kingstad-Bakke, B; Berlier, W; Osorio, J.E.

2014-01-01

In previous studies, we demonstrated in mice and prairie dogs that simultaneous administration of two recombinant raccoon poxviruses (rRCN) expressing Yersinia pestis antigens (F1 and V307-a truncated version of the V protein) provided superior protection against plague challenge compared to individual single antigen constructs. To reduce costs of vaccine production and facilitate implementation of a sylvatic plague vaccine (SPV) control program for prairie dogs, a dual antigen construct is more desirable. Here we report the construction and characterization of a novel RCN-vectored vaccine that simultaneously expresses both F1 and V307 antigens. This dual antigen vaccine provided similar levels of protection against plague in both mice and prairie dogs as compared to simultaneous administration of the two single antigen constructs and was also shown to protect mice against an F1 negative strain of Y. pestis.. The equivalent safety, immunogenicity and efficacy profile of the dual RCN-F1/V307 construct warrants further evaluation in field efficacy studies in sylvatic plague endemic areas.

Multi-Centre Clinical Evaluation of Photothermal Radiometry and Luminescence Correlated with International Benchmarks for Caries Detection

PubMed Central

Silvertown, Josh D.; Abrams, Stephen H.; Sivagurunathan, Koneswaran S.; Kennedy, Julia; Jeon, Jinseok; Mandelis, Andreas; Hellen, Adam; Hellen, Warren; Elman, Gary; Ehrlich, Richard; Chouljian, Raffy; Finer, Yoav; Amaechi, Bennett T.

2017-01-01

Introduction: A clinical study was initiated to investigate a caries detection device (The Canary System (CS)), based on photothermal radiometry and modulated luminescence (PTR-LUM). The primary objective of this study was to determine if PTR-LUM values (in the form of Canary Numbers; CN) correlate with International Caries Diagnostic and Assessment System (ICDAS II) scores and clinical situations. The secondary objectives of this study were to monitor the safety of PTR-LUM, and collect data to determine how CN values could be used to differentiate healthy from decayed tooth surfaces on a normalized scale. Methods: The trial was a four site, non-blinded study. Data was collected from 92 patients, resulting in 842 scanned tooth surfaces over multiple appointments. Surfaces were assessed according to ICDAS II, and further stratified into five clinical situation categories: 1) healthy surface, 2) non-cavitated white and/or brown spots; 3) caries lesions; 4) cavitation and 5) teeth undergoing remineralization therapy. CN data was analyzed separately for smooth and occlusal surfaces. Using a semi-logarithmic graph to plot raw CN (rCN) and normalized (CN) values, rCN data was normalized into a scale of 0-100. Results: Linear correlations (R2) between CN and ICDAS II groupings for smooth and occlusal surfaces were calculated as 0.9759 and 0.9267, respectively. The mean CN values derived from smooth (20.2±0.6) and occlusal (19±1.0) surfaces identified as healthy had significantly lower CN values (P<0.05) compared with the values from the other clinical situation categories. No adverse events were reported. Conclusion: The present study demonstrated the safety of PTR-LUM for clinical application and its ability to distinguish sound from carious tooth surfaces. A clear shift from the baseline in both PTR and LUM in carious enamel was observed depending on the type and nature of the lesion, and correlated to ICDAS II classification codes, which enabled the preliminary development of a Canary Scale. PMID:29290842

A novel compensation method for the anode gain non-uniformity of multi-anode photomultiplier tubes

NASA Astrophysics Data System (ADS)

Lee, Chan Mi; Kwon, Sun Il; Ko, Guen Bae; Ito, Mikiko; Yoon, Hyun Suk; Lee, Dong Soo; Jong Hong, Seong; Lee, Jae Sung

2012-01-01

The position-sensitive multi-anode photomultiplier tube (MA-PMT) is widely used in high-resolution scintillation detectors. However, the anode gain non-uniformity of this device is a limiting factor that degrades the intrinsic performance of the detector module. The aim of this work was to develop a gain compensation method for the MA-PMT and evaluate the resulting enhancement in the performance of the detector. The method employs a circuit that is composed only of resistors and is placed between the MA-PMT and a resistive charge division network (RCN) used for position encoding. The goal of the circuit is to divide the output current from each anode, so the same current flows into the RCN regardless of the anode gain. The current division is controlled by the combination of a fixed-value series resistor with an output impedance that is much larger than the input impedance of the RCN, and a parallel resistor, which detours part of the current to ground. PSpice simulations of the compensation circuit and the RCN were performed to determine optimal values for the compensation resistors when used with Hamamatsu H8500 MA-PMTs. The intrinsic characteristics of a detector module consisting of this MA-PMT and a lutetium-gadolinium-oxyorthosilicate (LGSO) crystal array were tested with and without the gain compensation method. In simulation, the average coefficient of variation and max/min ratio decreased from 15.7% to 2.7% and 2.0 to 1.2, respectively. In the flood map of the LGSO-H8500 detector, the uniformity of the photopeak position for individual crystals and the energy resolution were much improved. The feasibility of the method was shown by applying it to an octagonal prototype positron emission tomography scanner.

News update.

PubMed

2012-11-28

The RCN has raised concerns that many healthcare assistants are paid less than the ethical minimum. While the current UK-wide minimum wage is £6.19 per hour, the Living Wage Foundation - which campaigns for minimum wages that refl ect the cost of living - claims the minimum wage should be £8.30 per hour in London and £7.20 per hour in other parts of UK. Commenting during the recent Living Wage Week, RCN general secretary Peter Carter said: 'This affects college members, particularly healthcare assistants in the private sector, who are often paid less than the living wage. Some struggle to make ends meet, forcing them to claim benefi ts.'

A Community-Building Framework for Collaborative Research Coordination across the Education and Biology Research Disciplines.

PubMed

Pelaez, Nancy; Anderson, Trevor R; Gardner, Stephanie M; Yin, Yue; Abraham, Joel K; Bartlett, Edward L; Gormally, Cara; Hurney, Carol A; Long, Tammy M; Newman, Dina L; Sirum, Karen; Stevens, Michael T

2018-06-01

Since 2009, the U.S. National Science Foundation Directorate for Biological Sciences has funded Research Coordination Networks (RCN) aimed at collaborative efforts to improve participation, learning, and assessment in undergraduate biology education (UBE). RCN-UBE projects focus on coordination and communication among scientists and educators who are fostering improved and innovative approaches to biology education. When faculty members collaborate with the overarching goal of advancing undergraduate biology education, there is a need to optimize collaboration between participants in order to deeply integrate the knowledge across disciplinary boundaries. In this essay we propose a novel guiding framework for bringing colleagues together to advance knowledge and its integration across disciplines, the "Five 'C's' of Collaboration: Commitment, Collegiality, Communication, Consensus, and Continuity." This guiding framework for professional network practice is informed by both relevant literature and empirical evidence from community-building experience within the RCN-UBE Advancing Competencies in Experimentation-Biology (ACE-Bio) Network. The framework is presented with practical examples to illustrate how it might be used to enhance collaboration between new and existing participants in the ACE-Bio Network as well as within other interdisciplinary networks.

Detecting chronic kidney disease in population-based administrative databases using an algorithm of hospital encounter and physician claim codes.

PubMed

Fleet, Jamie L; Dixon, Stephanie N; Shariff, Salimah Z; Quinn, Robert R; Nash, Danielle M; Harel, Ziv; Garg, Amit X

2013-04-05

Large, population-based administrative healthcare databases can be used to identify patients with chronic kidney disease (CKD) when serum creatinine laboratory results are unavailable. We examined the validity of algorithms that used combined hospital encounter and physician claims database codes for the detection of CKD in Ontario, Canada. We accrued 123,499 patients over the age of 65 from 2007 to 2010. All patients had a baseline serum creatinine value to estimate glomerular filtration rate (eGFR). We developed an algorithm of physician claims and hospital encounter codes to search administrative databases for the presence of CKD. We determined the sensitivity, specificity, positive and negative predictive values of this algorithm to detect our primary threshold of CKD, an eGFR <45 mL/min per 1.73 m² (15.4% of patients). We also assessed serum creatinine and eGFR values in patients with and without CKD codes (algorithm positive and negative, respectively). Our algorithm required evidence of at least one of eleven CKD codes and 7.7% of patients were algorithm positive. The sensitivity was 32.7% [95% confidence interval: (95% CI): 32.0 to 33.3%]. Sensitivity was lower in women compared to men (25.7 vs. 43.7%; p <0.001) and in the oldest age category (over 80 vs. 66 to 80; 28.4 vs. 37.6 %; p < 0.001). All specificities were over 94%. The positive and negative predictive values were 65.4% (95% CI: 64.4 to 66.3%) and 88.8% (95% CI: 88.6 to 89.0%), respectively. In algorithm positive patients, the median [interquartile range (IQR)] baseline serum creatinine value was 135 μmol/L (106 to 179 μmol/L) compared to 82 μmol/L (69 to 98 μmol/L) for algorithm negative patients. Corresponding eGFR values were 38 mL/min per 1.73 m² (26 to 51 mL/min per 1.73 m²) vs. 69 mL/min per 1.73 m² (56 to 82 mL/min per 1.73 m²), respectively. Patients with CKD as identified by our database algorithm had distinctly higher baseline serum creatinine values and lower eGFR values than those without such codes. However, because of limited sensitivity, the prevalence of CKD was underestimated.

Detecting chronic kidney disease in population-based administrative databases using an algorithm of hospital encounter and physician claim codes

PubMed Central

2013-01-01

Background Large, population-based administrative healthcare databases can be used to identify patients with chronic kidney disease (CKD) when serum creatinine laboratory results are unavailable. We examined the validity of algorithms that used combined hospital encounter and physician claims database codes for the detection of CKD in Ontario, Canada. Methods We accrued 123,499 patients over the age of 65 from 2007 to 2010. All patients had a baseline serum creatinine value to estimate glomerular filtration rate (eGFR). We developed an algorithm of physician claims and hospital encounter codes to search administrative databases for the presence of CKD. We determined the sensitivity, specificity, positive and negative predictive values of this algorithm to detect our primary threshold of CKD, an eGFR <45 mL/min per 1.73 m2 (15.4% of patients). We also assessed serum creatinine and eGFR values in patients with and without CKD codes (algorithm positive and negative, respectively). Results Our algorithm required evidence of at least one of eleven CKD codes and 7.7% of patients were algorithm positive. The sensitivity was 32.7% [95% confidence interval: (95% CI): 32.0 to 33.3%]. Sensitivity was lower in women compared to men (25.7 vs. 43.7%; p <0.001) and in the oldest age category (over 80 vs. 66 to 80; 28.4 vs. 37.6 %; p < 0.001). All specificities were over 94%. The positive and negative predictive values were 65.4% (95% CI: 64.4 to 66.3%) and 88.8% (95% CI: 88.6 to 89.0%), respectively. In algorithm positive patients, the median [interquartile range (IQR)] baseline serum creatinine value was 135 μmol/L (106 to 179 μmol/L) compared to 82 μmol/L (69 to 98 μmol/L) for algorithm negative patients. Corresponding eGFR values were 38 mL/min per 1.73 m2 (26 to 51 mL/min per 1.73 m2) vs. 69 mL/min per 1.73 m2 (56 to 82 mL/min per 1.73 m2), respectively. Conclusions Patients with CKD as identified by our database algorithm had distinctly higher baseline serum creatinine values and lower eGFR values than those without such codes. However, because of limited sensitivity, the prevalence of CKD was underestimated. PMID:23560464

Synthesis of reduced carbon nitride at the reduction by hydroquinone of water-soluble carbon nitride oxide (g-C{sub 3}N{sub 4})O

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kharlamov, Alexey; Bondarenko, Marina, E-mail: mebondarenko@ukr.net; Kharlamova, Ganna

For the first time at the reduction by hydroquinone of water-soluble carbon nitride oxide (g-C{sub 3}N{sub 4})O reduced carbon nitride (or reduced multi-layer azagraphene) is obtained. It is differed from usually synthesized carbon nitride by a significantly large (on 0.09 nm) interplanar distance is. At the same time, the chemical bonds between atoms in a heteroatomic plane of reduced carbon nitride correspond to the bonds in a synthesized g-C{sub 3}N{sub 4}. The samples of water-soluble carbon nitride oxide were synthesized under the special reactionary conditions of a pyrolysis of melamine and urea. We believe that reduced carbon nitride consists ofmore » weakly connected carbon-nitrogen monosheets (azagraphene sheets) as well as reduced (from graphene oxide) graphene contains weakly connected graphene sheets. - Graphical abstract: XRD pattern and schematic atomic model of one layer of reduced carbon nitride, carbon nitride oxide and synthesized carbon nitride. For the first time at the reduction by hydroquinone of the water-soluble carbon nitride oxide (g-C{sub 3}N{sub 4})O is obtained the reduced carbon nitride (or reduced multi-layer azagraphene). Display Omitted - Highlights: • First the reduced carbon nitride (RCN) at the reduction of the carbon nitride oxide was obtained. • Water-soluble carbon nitride oxide was reduced by hydroquinone. • The chemical bonds in a heteroatomic plane of RCN correspond to the bonds in a synthesized g-C{sub 3}N{sub 4}. • Reduced carbon nitride consists of poorly connected heteroatomic azagraphene layers.« less

VS30, site amplifications and some comparisons: The Adapazari (Turkey) case

NASA Astrophysics Data System (ADS)

Ozcep, Tazegul; Ozcep, Ferhat; Ozel, Oguz

The aim of this study was to investigate the role of VS30 in site amplifications in the Adapazari region, Turkey. To fulfil this aim, amplifications from VS30 measurements were compared with earthquake data for different soil types in the seismic design codes. The Adapazari area was selected as the study area, and shear-wave velocity distribution was obtained by the multichannel analysis of surface waves (MASWs) method at 100 sites for the top 50 m of soil. Aftershock data following the Mw 7.4 Izmit earthquake of 17 August 1999 gave magnitudes between 4.0 and 5.6 at six stations installed in and around the Adapazari Basin, at Babalı, Şeker, Genç, Hastane, Toyota and Imar. This data was used to estimate site amplifications by the reference-station method. In addition, the fundamental periods of the station sites were estimated by the single station method. Site classifications based on VS30 in the seismic design codes were compared with the fundamental periods and amplification values. It was found that site amplifications (from earthquake data) and relevant spectra (from VS30) are not in good agreement for soils in Adapazari (Turkey).

Summit of the Research Coordination Networks for Undergraduate Biology Education

PubMed Central

Eaton, Carrie Diaz; Allen, Deborah; Anderson, Laurel J.; Bowser, Gillian; Pauley, Mark A.; Williams, Kathy S.; Uno, Gordon E.

2016-01-01

The first summit of projects funded by the National Science Foundation’s Research Coordination Networks for Undergraduate Biology Education (RCN-UBE) program was held January 14–16, 2016, in Washington, DC. Sixty-five scientists and science educators from 38 of the 41 Incubator and Full RCN-UBE awards discussed the value and contributions of RCNs to the national biology education reform effort. The summit illustrated the progress of this innovative UBE track, first awarded in 2009. Participants shared experiences regarding network development and growth, identified best practices and challenges faced in network management, and discussed work accomplished. We report here on key aspects of network evaluation, characteristics of successful networks, and how to sustain and broaden participation in networks. Evidence from successful networks indicates that 5 years (the length of a Full RCN-UBE) may be insufficient time to produce a cohesive and effective network. While online communication promotes the activities of a network and disseminates effective practices, face-to-face meetings are critical for establishing ties between network participants. Creation of these National Science Foundation–funded networks may be particularly useful for consortia of faculty working to address problems or exchange novel solutions discovered while introducing active-learning methods and/or course-based research into their curricula.

Ab initio SCF calculations on the potential energy surface of potassium cyanide (KCN)

NASA Astrophysics Data System (ADS)

Wormer, Paul E. S.; Tennyson, Jonathan

1981-08-01

The potential energy surface of KCN has been generated by ab initio SCF calculations in the region of equilibrium bond distances. An analytic representation of the surface is presented. The calculations show that the bonding between K and CN is ionic, and that the structure of KCN is triangular, which confirms recent experimental findings. The computed geometry is &KCN = 62.4°, rCK = 5.492a0, and rCN = 2.186a0.

The Effectors and Sensory Sites of Formaldehyde-responsive Regulator FrmR and Metal-sensing Variant *

PubMed Central

Osman, Deenah; Piergentili, Cecilia; Chen, Junjun; Sayer, Lucy N.; Usón, Isabel; Huggins, Thomas G.; Robinson, Nigel J.; Pohl, Ehmke

2016-01-01

The DUF156 family of DNA-binding transcriptional regulators includes metal sensors that respond to cobalt and/or nickel (RcnR, InrS) or copper (CsoR) plus CstR, which responds to persulfide, and formaldehyde-responsive FrmR. Unexpectedly, the allosteric mechanism of FrmR from Salmonella enterica serovar Typhimurium is triggered by metals in vitro, and variant FrmRE64H gains responsiveness to Zn(II) and cobalt in vivo. Here we establish that the allosteric mechanism of FrmR is triggered directly by formaldehyde in vitro. Sensitivity to formaldehyde requires a cysteine (Cys35 in FrmR) conserved in all DUF156 proteins. A crystal structure of metal- and formaldehyde-sensing FrmRE64H reveals that an FrmR-specific amino-terminal Pro2 is proximal to Cys35, and these residues form the deduced formaldehyde-sensing site. Evidence is presented that implies that residues spatially close to the conserved cysteine tune the sensitivities of DUF156 proteins above or below critical thresholds for different effectors, generating the semblance of specificity within cells. Relative to FrmR, RcnR is less responsive to formaldehyde in vitro, and RcnR does not sense formaldehyde in vivo, but reciprocal mutations FrmRP2S and RcnRS2P, respectively, impair and enhance formaldehyde reactivity in vitro. Formaldehyde detoxification by FrmA requires S-(hydroxymethyl)glutathione, yet glutathione inhibits formaldehyde detection by FrmR in vivo and in vitro. Quantifying the number of FrmR molecules per cell and modeling formaldehyde modification as a function of [formaldehyde] demonstrates that FrmR reactivity is optimized such that FrmR is modified and frmRA is derepressed at lower [formaldehyde] than required to generate S-(hydroxymethyl)glutathione. Expression of FrmA is thereby coordinated with the accumulation of its substrate. PMID:27474740

The IS-GEO RCN: Fostering Collaborations for Intelligent Systems Research to Support Geosciences

NASA Astrophysics Data System (ADS)

Gil, Y.; Pierce, S. A.

2016-12-01

Geoscience problems are complex and often involve data that changes across space and time. Frequently geoscience knowledge and understanding provides valuable information and insight for problems related to energy, water, climate, mineral resources, and our understanding of how the Earth evolves through time. Simultaneously, many grand challenges in the geosciences cannot be addressed without the aid of computational support and innovations. Intelligent and Information Systems (IS) research includes a broad range of computational methods and topics such as knowledge representation, information integration, machine learning, robotics, adaptive sensors, and intelligent interfaces. IS research has a very important role to play in accelerating the speed of scientific discovery in geosciences and thus in solving challenges in geosciences. Many aspects of geosciences (GEO) research pose novel open problems for intelligent systems researchers. To develop intelligent systems with sound knowledge of theory and practice, it is important that GEO and IS experts collaborate. The EarthCube Research Coordination Network for Intelligent Systems for Geosciences (IS-GEO RCN) represents an emerging community of interdisciplinary researchers producing fundamental new capabilities for understanding Earth systems. Furthermore, the educational component aims to identify new approaches to teaching students in this new interdisciplinary area, seeking to raise a new generation of scientists that are better able to apply IS methods and tools to geoscience challenges of the future. By providing avenues for IS and GEO researchers to work together, the IS-GEO RCN will serve as both a point of contact, as well as an avenue for educational outreach across the disciplines for the nascent community of research and practice. The initial efforts are focused on connecting the communities in ways that help researchers understand opportunities and challenges that can benefit from IS-GEO collaborations. The IS-GEO RCN will jumpstart interdisciplinary research collaborations in this emerging new area so that progress across both disciplines can be accelerated.

Drugs and falls in community-dwelling older people: a national veterans study.

PubMed

French, Dustin D; Campbell, Robert; Spehar, Andrea; Cunningham, Francesca; Bulat, Tatjana; Luther, Stephen L

2006-04-01

The aim of this study was to identify which specific medications within recognized major problematic drug categories that increase risk of falling were prescribed to veterans before their out-patient treatment for a fall. This was a retrospective, cross-sectional national secondary outpatient data analysis with an age- and sex-matched comparison group. The setting was the national Veterans Health Administration (VHA) ambulatory health care system in fiscal year (FY) 2004. The study population was VHA patients aged>or=65 years who had fall-related outpatient clinical health care encounters in FY 2004 (as indicated by diagnostic codes) and who received >or=1 outpatient medication during the study period. The age- and sex-matched comparison group consisted of an equal number of patients with nonspecific chest pain. The percentage of patients in each group receiving medications (at the time of the outpatient encounter) that affect the cardiovascular system (CVS), central nervous system (CNS), or musculoskeletal system (MSS) was compared with Bonferrom-adjusted P values. The study sample consisted of 20,551 patients; the comparison group included the same number of patients. More patients with fall-coded encounters used CNS drugs than those with nonspecific chest pain (42.05% vs 29.29%). Also, within the CNS category, more patients with fall-coded encounters used antiparkinsonian medications (3.67% vs 1.32%), Alzheimer's disease medications (ie, cholinesterase inhibitors [5.40% vs 2.35%]), anticonvulsants/barbiturates (8.95% vs 5.18%), antidepressants (22.50% vs 14.16%), antipsychotics (4.68% vs 2.01%), opioid analgesics and narcotics (11.21% vs 9.09%), and benzodiazepines (7.60% vs 5.96%) (all, P<0.002). More patients with nonspecific chest pain received CVS drugs compared with the fall-coded group (69.13% vs 63.07%; P<0.002). Within the CVS category, more patients in the nonspecific chest pain group received angiotensin-II receptor antagonists, angiotensin-converting enzyme inhibitors, beta-blockers, calcium channel blockers, vasodilators, diuretics, and antiarrhythmics (all, P<0.002). No differences were noted between groups in the MSS category, except for NSAIDs, which more patients in the nonspecific chest pain group used than in the fall-coded group (6.44% vs 5.63%; P<0.002). In this study, subjects with a health care encounter for a fall (as indicated by diagnostic code) were prescribed significantly more CNS-category medications than subjects in the age- and sex-matched comparison group.

Responses of the terrestrial carbon cycle to drought: modeling sensitivities of the interactive nitrogen and dynamic vegetation

NASA Astrophysics Data System (ADS)

Jia, B.; Wang, Y.; Xie, Z.

2016-12-01

Drought can trigger both immediate and time-lagged responses of terrestrial ecosystems and even cause sizeable positive feedbacks to climate warming. In this study, the influences of interactive nitrogen (N) and dynamic vegetation (DV) on the response of the carbon cycle in terrestrial ecosystems of China to drought were investigated using the Community Land Model version 4.5 (CLM4.5). Model simulations from three configurations of CLM4.5 (C, carbon cycle only; CN, dynamic carbon and nitrogen cycle; CNDV, dynamic carbon and nitrogen cycle as well as dynamic vegetation) between 1961 and 2010 showed that the incorporation of a prognostic N cycle and DV into CLM4.5 reduce the predicted annual means and inter-annual variability of predicted gross primary production (GPP) and net ecosystem production (NEP), except for a slight increase in NEP for CNDV compared to CN. These model improvements resulted in better agreement with observations (7.0 PgC yr-1) of annual GPP over the terrestrial ecosystems in China for CLM45-CN (7.5 PgC yr-1) and CLM45-CNDV (7.3 PgC yr-1) than for CLM45-C (10.9 PgC yr-1). Compared to the CLM45-C, the carbon-nitrogen coupling strengthened the predicted response of GPP to drought, resulting in a higher correlation with the standardized precipitation index (SPI; rC = 0.62, rCN = 0.67), but led to a weaker sensitivity of NEP to SPI (rC = 0.51, rCN = 0.45). The CLM45-CNDV had the longest lagged responses of GPP to drought among the three configurations. These results enhance our understanding of the response of the terrestrial carbon cycle to drought.

Vulnerability of Permafrost Carbon Research Coordination Network

NASA Astrophysics Data System (ADS)

Schuur, E. A.; McGuire, A. D.; Canadell, J.; Harden, J. W.; Kuhry, P.; Romanovsky, V. E.; Turetsky, M. R.; Schädel, C.

2011-12-01

Approximately 1700 Pg (billion tons) of soil carbon are stored in the northern circumpolar permafrost zone, more than twice as much carbon than currently contained in the atmosphere. Permafrost thaw, and the microbial decomposition of previously frozen organic carbon, is considered one of the most likely positive feedbacks from terrestrial ecosystems to the atmosphere in a warmer world. Yet, the rate and form of release is highly uncertain but crucial for predicting the strength and timing of this carbon cycle feedback this century and beyond. Here we report on the formation of a new research coordination network (RCN) whose objective is to link biological C cycle research with well-developed networks in the physical sciences focused on the thermal state of permafrost. We found that published literature in the Science Citation Index identified with the search terms 'permafrost' and 'carbon' have increased dramatically in the last decade. Of total publications including those keywords, 86% were published since 2000, 65% since 2005, and 36% since 2008. Interconnection through this RCN is designed to produce new knowledge through research synthesis that can be used to quantify the role of permafrost carbon in driving climate change in the 21st century and beyond. An expert elicitation conducted as part of the RCN activities revealed that the total effect of carbon release from permafrost zone soils on climate is expected to be up to 30-46 Pg C over the next three decades, reaching 242-324 Pg C by 2100 and potentially up to 551-710 Pg C over the next several centuries under the strongest warming scenario presented to the group. These values, expressed in billions of tons of C in CO2 equivalents, combine the effect of C released both as CO2 and as CH4 by accounting for the greater heat-trapping capacity of CH4. Much of the actual C release by weight is expected to be in the form of CO2, with only about 3.5% of that in the form of CH4. However, the higher global warming potential of CH4 means that almost half of the effect of future permafrost zone carbon emissions on climate forcing was expected by this group to be a result of CH4 emissions from wetlands, lakes, and other oxygen-limited environments where organic matter will be decomposing. These results demonstrate the vulnerability of organic C stored in near surface permafrost to increasing temperatures. Future activities of this network include synthesizing information in formats that can be assimilated by biospheric and climate models, and that will contribute to future assessments of the IPCC.

Performance of MIMO-OFDM using convolution codes with QAM modulation

NASA Astrophysics Data System (ADS)

Astawa, I. Gede Puja; Moegiharto, Yoedy; Zainudin, Ahmad; Salim, Imam Dui Agus; Anggraeni, Nur Annisa

2014-04-01

Performance of Orthogonal Frequency Division Multiplexing (OFDM) system can be improved by adding channel coding (error correction code) to detect and correct errors that occur during data transmission. One can use the convolution code. This paper present performance of OFDM using Space Time Block Codes (STBC) diversity technique use QAM modulation with code rate ½. The evaluation is done by analyzing the value of Bit Error Rate (BER) vs Energy per Bit to Noise Power Spectral Density Ratio (Eb/No). This scheme is conducted 256 subcarrier which transmits Rayleigh multipath fading channel in OFDM system. To achieve a BER of 10-3 is required 10dB SNR in SISO-OFDM scheme. For 2×2 MIMO-OFDM scheme requires 10 dB to achieve a BER of 10-3. For 4×4 MIMO-OFDM scheme requires 5 dB while adding convolution in a 4x4 MIMO-OFDM can improve performance up to 0 dB to achieve the same BER. This proves the existence of saving power by 3 dB of 4×4 MIMO-OFDM system without coding, power saving 7 dB of 2×2 MIMO-OFDM and significant power savings from SISO-OFDM system.

Apparent field safety of a raccoon poxvirus-vectored plague vaccine in free-ranging prairie dogs (Cynomys spp.), Colorado, USA.

PubMed

Tripp, Daniel W; Rocke, Tonie E; Streich, Sean P; Abbott, Rachel C; Osorio, Jorge E; Miller, Michael W

2015-04-01

Prairie dogs (Cynomys spp.) suffer high rates of mortality from plague. An oral sylvatic plague vaccine using the raccoon poxvirus vector (designated RCN-F1/V307) has been developed for prairie dogs. This vaccine is incorporated into palatable bait along with rhodamine B as a biomarker. We conducted trials in August and September 2012 to demonstrate uptake and apparent safety of the RCN-F1/V307 vaccine in two prairie dog species under field conditions. Free-ranging prairie dogs and other associated small rodents readily consumed vaccine-laden baits during field trials with no apparent adverse effects; most sampled prairie dogs (90%) and associated small rodents (78%) had consumed baits. Visual counts of prairie dogs and their burrows revealed no evidence of prairie dog decline after vaccine exposure. No vaccine-related morbidity, mortality, or gross or microscopic lesions were observed. Poxviruses were not isolated from any animal sampled prior to bait distribution or on sites that received placebo baits. We isolated RCN-F1/V307 from 17 prairie dogs and two deer mice (Peromyscus maniculatus) captured on sites where vaccine-laden baits were distributed. Based on these findings, studies examining the utility and effectiveness of oral vaccination to prevent plague-induced mortality in prairie dogs and associated species are underway.

Apparent field safety of a raccoon poxvirus-vectored plague vaccine in free-ranging prairie dogs (Cynomys spp.), Colorado, USA

USGS Publications Warehouse

Tripp, Daniel W.; Rocke, Tonie E.; Streich, Sean P.; Abbott, Rachel C.; Osorio, Jorge E.; Miller, Michael W.

2015-01-01

Prairie dogs (Cynomys spp.) suffer high rates of mortality from plague. An oral sylvatic plague vaccine using the raccoon poxvirus vector (designated RCN-F1/V307) has been developed for prairie dogs. This vaccine is incorporated into palatable bait along with rhodamine B as a biomarker. We conducted trials in August and September 2012 to demonstrate uptake and apparent safety of the RCN-F1/V307 vaccine in two prairie dog species under field conditions. Free-ranging prairie dogs and other associated small rodents readily consumed vaccine-laden baits during field trials with no apparent adverse effects; most sampled prairie dogs (90%) and associated small rodents (78%) had consumed baits. Visual counts of prairie dogs and their burrows revealed no evidence of prairie dog decline after vaccine exposure. No vaccine-related morbidity, mortality, or gross or microscopic lesions were observed. Poxviruses were not isolated from any animal sampled prior to bait distribution or on sites that received placebo baits. We isolated RCN-F1/V307 from 17 prairie dogs and two deer mice (Peromyscus maniculatus) captured on sites where vaccine-laden baits were distributed. Based on these findings, studies examining the utility and effectiveness of oral vaccination to prevent plague-induced mortality in prairie dogs and associated species are underway.

Promoting excellence in care.

PubMed

2004-07-01

Welcome to Nurse Researcher. This year's annual RCN International Nursing Research Conference was held recently in Cambridge, UK. The event, which attracted over 500 delegates from a range of diverse and academic settings across the world, brought together nurses and other healthcare professionals to promote and develop nursing knowledge. Over 200 papers and poster presentations covered a wide range of topics in nursing and healthcare research, including: issues in research methodology; education; theoretical perspectives; transcultural nursing; evidence-based practice; employment issues; and research governance. In addition to concurrent sessions and posters, many symposia, workshops and other fringe and networking events offered opportunities for sharing good practice and research collaboration. Next year's conference will be held in Belfast, Northern Ireland, UK from Tuesday 8 to Friday 11 March 2005. For more information visit: www.man.ac.uk/rcn/research2005.

Community violence and pregnancy health behaviors and outcomes.

PubMed

Okah, Felix A; Oshodi, Adebayo; Liu, Yifei; Cai, Jinwen

2014-08-01

Community violence is associated with health-compromising behaviors (HCBs) and adverse general health and pregnancy outcomes. It is unknown whether these effects persist after adjusting for health behaviors. Retrospective cohort study of 36,637 pregnancies, 2005-2009, using birth certificate/hospital discharge databases. Community violence rate = (nonaccidental injuries/total injuries) × 100%. ZIP codes were categorized into levels (CVL) by quartiles (lowest, 1, to highest, 4). Outcomes included HCBs (tobacco, alcohol, or drugs), fetal death, preterm birth, and infant small-for-gestational-age (SGA). Covariates included HCBs and maternal characteristics. The CVL median (interquartile range) was 5.5% (3.8%-8.8%). As CVL increased, rates of HCBs (8% vs 13% vs 14% vs 16%), fetal death (4 vs 5 vs 6 vs 8/1000 pregnancies), preterm birth (8% vs 9% vs 11% vs 13%), and infant SGA (8% vs 10% vs 13% vs 16%) increased. The odds of preterm birth (CVL1 = 1.00 [reference] vs CVL2 = 1.00 [0.88-1.14] vs CVL3 = 1.10 [0.96-1.26] vs CVL4 = 1.25 [1.09-1.42]) and infant SGA (CVL2 = 1.03 [0.93-1.17] vs CVL3 = 1.15 [1.01-1.30] vs CVL4 = 1.21 [1.07-1.38]) increased, after controlling for HCB. CVL is associated with fetal death, preterm birth, and infant SGA, independent of HCB. These findings may support the role of violence-reduction programs in improving pregnancy health behaviors and outcomes.

Dietary Intakes of Elite 14- to 19-Year-Old English Academy Rugby Players During a Pre-Season Training Period.

PubMed

Smith, Deborah R; Jones, Ben; Sutton, Louise; King, Roderick F G J; Duckworth, Lauren C

2016-12-01

Good nutrition is essential for the physical development of adolescent athletes, however data on dietary intakes of adolescent rugby players are lacking. This study quantified and evaluated dietary intake in 87 elite male English academy rugby league (RL) and rugby union (RU) players by age (under 16 (U16) and under 19 (U19) years old) and code (RL and RU). Relationships of intakes with body mass and composition (sum of 8 skinfolds) were also investigated. Using 4-day diet and physical activity diaries, dietary intake was compared with adolescent sports nutrition recommendations and the UK national food guide. Dietary intake did not differ by code, whereas U19s consumed greater energy (3366 ± 658 vs. 2995 ± 774 kcal·day -1 ), protein (207 ± 49 vs. 150 ± 53 g·day -1 ) and fluid (4221 ± 1323 vs. 3137 ± 1015 ml·day -1 ) than U16s. U19s consumed a better quality diet than U16s (greater intakes of fruit and vegetables; 4.4 ± 1.9 vs. 2.8 ± 1.5 servings·day -1 ; nondairy proteins; 3.9 ± 1.1 vs. 2.9 ± 1.1 servings·day -1 ) and less fats and sugars (2.0 ± 1. vs. 3.6 ± 2.1 servings·day -1 ). Protein intake vs. body mass was moderate (r = .46, p < .001), and other relationships were weak. The findings of this study suggest adolescent rugby players consume adequate dietary intakes in relation to current guidelines for energy, macronutrient and fluid intake. Players should improve the quality of their diet by replacing intakes from the fats and sugars food group with healthier choices, while maintaining current energy, and macronutrient intakes.

Recursive Algorithms for Real-Time Digital CR-RCn Pulse Shaping

NASA Astrophysics Data System (ADS)

Nakhostin, M.

2011-10-01

This paper reports on recursive algorithms for real-time implementation of CR-(RC)n filters in digital nuclear spectroscopy systems. The algorithms are derived by calculating the Z-transfer function of the filters for filter orders up to n=4 . The performances of the filters are compared with the performance of the conventional digital trapezoidal filter using a noise generator which separately generates pure series, 1/f and parallel noise. The results of our study enable one to select the optimum digital filter for different noise and rate conditions.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lebrilla, C.B.; Schulze, C.; Schwarz, H.

The gas-phase reaction of bare Fe/sup +/ atoms with linear alkyl nitriles generates end-on complexes which, depending on geometrical constraints, specifically interact with remote C-H bonds. Based on chain length effect studies and the investigation of labeled precursors, a mechanism is suggested which accounts for the chemospecificity observed for the loss of H/sub 2/ and C/sub 2/H/sub 4/ from RCN/Fe/sup +/ complexes. This mechanism does not follow the analogous reaction of Fe/sup +/ with alkenes and alkynes but involves an initial C-H insertion of the remote CH bonds followed by a C-C insertion.

Formally specifying the logic of an automatic guidance controller

NASA Technical Reports Server (NTRS)

Guaspari, David

1990-01-01

The following topics are covered in viewgraph form: (1) the Penelope Project; (2) the logic of an experimental automatic guidance control system for a 737; (3) Larch/Ada specification; (4) some failures of informal description; (5) description of mode changes caused by switches; (6) intuitive description of window status (chosen vs. current); (7) design of the code; (8) and specifying the code.

Chance of a lifetime.

PubMed

Luck, Ann

2003-10-01

When Sarah Needham (pictured above) was given the opportunity to attend the RCN A&E Nursing Association's annual conference in Edinburgh three years ago, she had no idea that it would change her life.

Leadership and management influences on personal and professional development and group dynamics: a student's experience.

PubMed

Ahmed, Fathima

2018-03-07

The ever-evolving nature of nursing requires professionals to keep their knowledge up to date and uphold the Nursing and Midwifery Council (NMC) Code by engaging themselves in ongoing personal and professional development (PPD). This article aims to highlight the importance of good leadership and management in healthcare and to explore the literature surrounding leadership and management, such as the current NHS healthcare leadership model ( NHS Leadership Academy 2013 ), the Leading Change, Adding Value Framework underpinned by the 10 commitments and 6Cs ( NHS England 2016 ) and the NMC Code ( NMC 2015a ) in relation to PPD. It examines how nurses can be supported in their PPD by their team leader and or managers using examples experienced in a clinical setting while caring for children and young people (CYP). Furthermore, the importance of team working and group processes in the context of leadership will be deliberated, using examples of formative group work to illustrate principles described in the literature. Finally, reflections will be discussed on how learning from this experience can influence future practice when caring for CYP. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Trauma with Injury Severity Score of 75: Are These Unsurvivable Injuries?

PubMed Central

Peng, Jin; Wheeler, Krista; Shi, Junxin; Groner, Jonathan Ira; Haley, Kathryn Jo; Xiang, Huiyun

2015-01-01

Trauma patients with an ISS=75 have been deliberately excluded from some trauma studies because they were assumed to have "unsurvivable injuries." This study aimed to assess the true mortality among patients with an ISS=75, and to examine the characteristics and primary diagnoses of these patients. Retrospective review of the 2006-2010 U.S. Nationwide Emergency Department Sample (NEDS) generated 2,815 patients with an ISS=75 for analysis, representing an estimated 13,569 patients in the country. Dispositions from the emergency department and hospital for these patients were tabulated by trauma center level. Survivors and non-survivors were compared using Pearson's chi-square test. Primary diagnosis codes of these patients were tabulated by mortality status. Overall, about 48.6% of patients with an ISS=75 were discharged alive, 25.8% died and 25.6% had unknown mortality status. The mortality risks of these patients did not vary significantly across different levels of trauma centers (15.6% vs. 13.0%, P = 0.16). Non-survivors were more likely than survivors to: be male (81.2% vs. 74.4%, P < 0.0001), be over 65 years (20.3% vs. 10.2%, P < 0.0001), be uninsured (33.8% vs. 19.1%), have at least one chronic condition (58.0% vs. 43.7%, P <0.0001), sustain life-threatening injuries (79.2% vs. 49.4%, P<0.0001), sustain penetrating injuries (42.0% vs. 25.9%, P<0.0001), and have injuries caused by motor vehicle crashes (32.9% vs. 21.1%, P<0.0001) or firearms (21.9% vs. 4.4%, P<0.0001). The most frequent diagnosis code was 862.8 (injury to multiple and unspecified intrathoracic organs, without mention of open wound into cavity). Our results revealed that at least half of patients with an ISS=75 survived, demonstrating that the rationale for excluding patients with an ISS=75 from analysis is not always justified. To avoid bias and inaccurate results, trauma researchers should examine the mortality status of patients with an ISS=75 before exclusion, and explicitly describe their method of generating ISS scores. PMID:26230931

High rate of hypoglycemia in 6770 type 2 diabetes patients with comorbid dementia: A multicenter cohort study on 215,932 patients from the German/Austrian diabetes registry.

PubMed

Prinz, Nicole; Stingl, Julia; Dapp, Albrecht; Denkinger, Michael D; Fasching, Peter; Jehle, Peter M; Merger, Sigrun; Mühldorfer, Steffen; Pieper, Urte; Schuler, Andreas; Zeyfang, Andrej; Holl, Reinhard W

2016-02-01

Dementia and type 2 diabetes (T2D) are two major phenomena in older people. To compare anti-hyperglycemic therapy and diabetes-related comorbidities between elderly T2D patients with or without comorbid dementia. 215,932 type 2 diabetes patients aged ≥ 40 years (median [Q1;Q3]: 70.4 [61.2;77.7] years) from the standardized, multicenter German/Austrian diabetes patient registry, DPV, were studied. To identify patients with comorbid dementia, the registry was searched by ICD-10 codes, DSM-IV/-5 codes, respective search terms and/or disease-specific medication. For group comparisons, multiple hierarchic regression modeling with adjustments for age, sex, and duration of diabetes was applied. 3.1% (n=6770; 57% females) of the eligible T2D patients had clinically recognized comorbid dementia. After adjustment for demographics, severe hypoglycemia (insulin group: 14.8 ± 0.6 vs. 10.4 ± 0.2 events per 100 patient-years, p<0.001), hypoglycemia with coma (insulin group: 7.6 ± 0.4 vs. 3.9 ± 0.1 events per 100 patient-years, p<0.001), depression (9.9 vs. 4.7%, p<0.001), hypertension (74.7 vs. 72.2%, p<0.001), stroke (25.3 vs. 6.5%, p<0.001), diabetic foot syndrome (6.0 vs. 5.2%, p=0.004), and microalbuminuria (34.7 vs. 32.2%, p<0.001) were more common in dementia patients compared to T2D without dementia. Moreover, patients with dementia received insulin therapy more frequently (59.3 vs. 54.7%, p<0.001), but metabolic control (7.7 ± 0.1 vs. 7.7 ± 0.1%) was comparable to T2D without dementia. In T2D with dementia, higher rates of hypoglycemia and other diabetes-related comorbidities were observed. Hence, the risks of a glucocentric and intense diabetes management with insulin and a focus on tight glycemic control without considering other factors may outweigh the benefits in elderly T2D patients with comorbid dementia. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Police accident report forms: safety device coding and enacted laws.

PubMed

Brock, K; Lapidus, G

2008-12-01

Safety device coding on state police accident report (PAR) forms was compared with provisions in state traffic safety laws. PAR forms were obtained from all 50 states and the District of Columbia (states/DC). For seat belts, 22 states/DC had a primary seat belt enforcement law vs 50 with a PAR code. For car seats, all 51 states/DC had a law and a PAR code. For booster seats, 39 states/DC had a law vs nine with a PAR code. For motorcycle helmets, 21 states/DC had an all-age rider helmet law and another 26 a partial-age law vs 50 with a PAR code. For bicycle helmets, 21 states/DC had a partial-age rider helmet law vs 48 with a PAR code. Therefore gaps in the ability of states to fully record accident data reflective of existing state traffic safety laws are revealed. Revising the PAR forms in all states to include complete variables for safety devices should be an important priority, independent of the laws.

Developing and maintaining compassionate care in nursing.

PubMed

Henderson, Amanda; Jones, Jenny

2017-09-20

Compassionate care is a fundamental aspect of nursing, and is an important value that is embedded in nurses' professional standards and codes of practice. However, nurses may experience several challenges in their practice that can impede their ability to provide compassionate care. This article aims to support and guide nurses in developing their capacity to be compassionate. It explores concepts related to compassion, including compassion satisfaction, fatigue, literacy and self-compassion, and outlines strategies that nurses can implement to promote compassionate care. This article encourages nurses to identify their personal and professional values, to understand how these can influence their attitudes and behaviours. By raising awareness of these concepts, as well as the challenges and changing nature of compassion, it is hoped that nurses' capacity to provide compassionate care will be enhanced. ©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Understanding and meeting your legal responsibilities as a nurse.

PubMed

Terry, Louise; Carr, Graham; Halpin, Yvonne

2017-11-15

Nurses, midwives and nursing students are legally responsible for their actions. This article discusses the legal standard of care required in relation to nursing and midwifery practice and nurses' professional standards and code of conduct. It examines how courts in the UK determine if nurses have met their duty of care and how nurses must ensure they maintain competence to provide safe care. It examines why organisational knowing - understanding the organisation in which one is employed; its people, values and how it works - is important for all nurses, regardless of their level in the organisation. It also discusses workplace incivility and its adverse effects on nurses, patient care and healthcare organisations. The article explains that if nurses are uncertain why they are doing something, they should investigate this further, because the law expects nurses to be able to justify their actions, or failure to act. ©2017 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Territorial shifts in clinical practice.

PubMed

1998-01-01

Junior doctors are frightened about the erosion of their role and the change of the power relationship between themselves and nurses, the 26th RCN A&E Nursing Association Annual Conference in Daresbury has been told.

Carbon atom clusters in random covalent networks: PAHs as an integral component of interstellar HAC

NASA Astrophysics Data System (ADS)

Jones, A. P.

1990-11-01

Using a random covalent network (RCN) model for the structure of hydrogenated amorphorous carbon (HAC) and the available laboratory data, it is shown that aromatic species are a natural consequence of the structure of amorphous carbons formed in the laboratory. Amorphous carbons in the interstellar medium are therefore likely to contain a significant fraction of Polycyclic aromatic hydrocarbons (PAH) species within the 'amorphous' matrix making up these materials. This aromatic component can be produced in situ during the accretion of gas phase carbon species on to grains in the interstellar medium under hydrogen-poor conditions, or subsequent to deposition as a result of photolysis (photodarkening). The fraction of interstellar carbon present in HAC in the form of PAHs, based upon a RCN model, is consistent with the observed Unidentified infrared (UIR) emission features.

[Study on nutrient and salinity in soil covered with different vegetations in Shuangtaizi estuarine wetlands].

PubMed

Song, Xiao-Lin; Lü, Xian-Guo; Zhang, Zhong-Sheng; Chen, Zhi-Ke; Liu, Zheng-Mao

2011-09-01

Nutrient elements and salinity in soil covered by different vegetations including Phragmites australis (Clay.) Trin., Typha orientalis Presl., Puccinellia distans Parl, and Suaeda salsa in Shuangtaizi estuarine wetlands were investigated to study their distribution characteristics and to reveal the nutrient element variation during the vegetation succession processes. Results indicated that total potassium, total phosphorus and salinity were different significantly in soil between different plant communities while available phosphorus, total nitrogen, available nitrogen, available potassium, total sulfur, iron and soil organic carbon were different insignificantly. Correlation analysis suggested that soil organic carbon were related significantly to total nitrogen, available phosphorus, available potassium, which implied that decomposition of plant litter might be the mail source of soil nitrogen and available nutrient. Salinity was significantly related to total phosphorus and iron in soil. In Shuangtaizi estuarine wetland soil, ratios of carbon to nitrogen (R(C/N)) was in the range of 12.21-26.33 and the average value was 18.21, which was higher than 12.0. It indicated that soil organic carbon in Shuangtaizi estuarine mainly came from land but not ocean and plants contributed the most of soil organic matters. There was no significant difference in R(C/N) between soil from the four plant communities (F = 1.890, p = 0.151). R(C/N) was related significantly to sol salinity (r = 0.346 3, p = 0.035 8) and was increasing with soil salinity.

Analysis of Pax6 contiguous gene deletions in the mouse, Mus musculus, identifies regions distinct from Pax6 responsible for extreme small-eye and belly-spotting phenotypes.

PubMed

Favor, Jack; Bradley, Alan; Conte, Nathalie; Janik, Dirk; Pretsch, Walter; Reitmeir, Peter; Rosemann, Michael; Schmahl, Wolfgang; Wienberg, Johannes; Zaus, Irmgard

2009-08-01

In the mouse Pax6 function is critical in a dose-dependent manner for proper eye development. Pax6 contiguous gene deletions were shown to be homozygous lethal at an early embryonic stage. Heterozygotes express belly spotting and extreme microphthalmia. The eye phenotype is more severe than in heterozygous Pax6 intragenic null mutants, raising the possibility that deletions are functionally different from intragenic null mutations or that a region distinct from Pax6 included in the deletions affects eye phenotype. We recovered and identified the exact regions deleted in three new Pax6 deletions. All are homozygous lethal at an early embryonic stage. None express belly spotting. One expresses extreme microphthalmia and two express the milder eye phenotype similar to Pax6 intragenic null mutants. Analysis of Pax6 expression levels and the major isoforms excluded the hypothesis that the deletions expressing extreme microphthalmia are directly due to the action of Pax6 and functionally different from intragenic null mutations. A region distinct from Pax6 containing eight genes was identified for belly spotting. A second region containing one gene (Rcn1) was identified for the extreme microphthalmia phenotype. Rcn1 is a Ca(+2)-binding protein, resident in the endoplasmic reticulum, participates in the secretory pathway and expressed in the eye. Our results suggest that deletion of Rcn1 directly or indirectly contributes to the eye phenotype in Pax6 contiguous gene deletions.

Prevalence and Risk Factors for Early Seizure in Patients with Traumatic Brain Injury: Analysis from National Trauma Data Bank.

PubMed

Majidi, Shahram; Makke, Yamane; Ewida, Amr; Sianati, Bahareh; Qureshi, Adnan I; Koubeissi, Mohamad Z

2017-08-01

Traumatic brain injury (TBI) is a well-known risk factor for seizures. We aimed to identify the frequency and risk factors for seizure occurrence during hospitalization for TBI. We used ICD-9-CM codes to identify patients 18 years of age or older from the National Trauma Data Bank who were admitted with TBI. We also used ICD-9-CM codes to identify the subset who had seizures during hospitalization. Patient demographics, comorbidities, Glasgow Coma Scale (GCS) score, Injury Severity Score Abbreviated Injury Scale (ISSAIS), in-hospital complications, and discharge disposition were compared in the seizure group (SG) and no-seizure group (NSG). A total of 1559 patients had in-hospital seizures, comprising 0.4% of all patients admitted with TBI. The mean age of SG was 3 years older than NSG [51 vs. 48; p < 0.0001]. African-American ethnicity (20 vs. 12%, p < 0.0001) and moderate TBI (8 vs. 4%, p < 0.0001) were more common in SG. History of alcohol dependence was more common in the SG (25 vs. 11%, p < 0.0001). Fall was the most common mechanism of injury in SG (56 vs. 36% in NSG; p < 0.0001). Subdural hematoma was more common in SG (31 vs. 21%, p < 0.0001). SG had higher rates of pneumonia, ARDS, acute kidney injury, and increased ICP. The average length of hospital stay was significantly higher in SG (10 vs. 6 days, p < 0.0001), and these patients had higher rate of discharge to nursing facility (32 vs. 25%, p < 0.0001). In-hospital seizures occur in 0.4% of all TBI patients. Although infrequent, seizure occurrence is associated with higher rates of hospital complications such as pneumonia and ARDS and is an independent predictor of longer hospital stay and worse hospital outcome.

Advances and Directions for the Intelligent Systems for Geosciences Research Community: Updates and Opportunities from the NSF EarthCube IS-GEO RCN

NASA Astrophysics Data System (ADS)

Pierce, S. A.

2017-12-01

The Earthcube Intelligent Systems for Geosciences Research Collaboration Network (IS-GEO RCN) represents an emerging community of interdisciplinary researchers aiming to create fundamental new capabilities for understanding Earth systems. Collaborative efforts across IS-GEO fields of study offer opportunities to accelerate scientific discovery and understanding. The IS-GEO community has an active membership of approximately 65 researchers and includes researchers from across the US, international members, and an early career committee. Current working groups are open to new participants and are focused on four thematic areas with regular coordination meetings and upcoming sessions at professional conferences. (1) The Sensor-based data Collection and Integration Working group looks at techniques for analyzing and integrating of information from heterogeneous sources, with a possible application for early warning systems. (2) The Geoscience Case Studies Working group is creating benchmark data sets to enable new collaborations between geoscientists and data scientists. (3) The Geo-Simulations Working group is evaluating the state of the art in practices for parametrizations, scales, and model integration. (4) The Education Working group is gathering, organizing and collecting all the materials from the different IS-GEO courses. Innovative IS-GEO applications will help researchers overcome common challenges while will redefining the frontiers of discovery across fields and disciplines. (Visit IS-GEO.org for more information or to sign up for any of the working groups.)

Hostile reception greets Bottomley Congress speech.

PubMed

1990-04-04

Health Minister Virginia Bottomley's attempts to persuade delegates that there are 'exciting' opportunities for nurses in the Government's plans for the health service failed, as she faced growing hostility from the audience at RCN Congress last week.

Be confident in a digital world.

PubMed

Wright, Richard

As the government announces a £100 million nursing technology fund for NHS trusts to support staff in improving patient care, the findings of an RCN survey of IT nurse training investment make for interesting reading.

Evaluation of compliance with the Spanish Code of self-regulation of food and drinks advertising directed at children under the age of 12 years in Spain, 2012.

PubMed

León-Flández, K; Rico-Gómez, A; Moya-Geromin, M Á; Romero-Fernández, M; Bosqued-Estefania, M J; Damián, J; López-Jurado, L; Royo-Bordonada, M Á

2017-09-01

To evaluate compliance levels with the Spanish Code of self-regulation of food and drinks advertising directed at children under the age of 12 years (Publicidad, Actividad, Obesidad, Salud [PAOS] Code) in 2012; and compare these against the figures for 2008. Cross-sectional study. Television advertisements of food and drinks (AFD) were recorded over 7 days in 2012 (8am-midnight) of five Spanish channels popular to children. AFD were classified as core (nutrient-rich/low-calorie products), non-core (nutrient-poor/rich-calorie products) or miscellaneous. Compliance with each standard of the PAOS Code was evaluated. AFD were deemed to be fully compliant when it met all the standards. Two thousand five hundred and eighty-two AFDs came within the purview of the PAOS Code. Some of the standards that registered the highest levels of non-compliance were those regulating the suitability of the information presented (79.4%) and those prohibiting the use of characters popular with children (25%). Overall non-compliance with the Code was greater in 2012 than in 2008 (88.3% vs 49.3%). Non-compliance was highest for advertisements screened on children's/youth channels (92.3% vs. 81.5%; P < 0.001) and for those aired outside the enhanced protection time slot (89.3% vs. 86%; P = 0.015). Non-compliance with the PAOS Code is higher than for 2008. Given the lack of effectiveness of self-regulation, a statutory system should be adopted to ban AFD directed at minors, or at least restrict it to healthy products. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Validation and Intercomparison Studies Within GODAE

DTIC Science & Technology

2009-09-01

unlimited. 13. SUPPLEMENTARY NOTES 20091228154 14. ABSTRACT During the Global Ocean Data Assimilation Experiment (GODAE), seven international... global -ocean and basin-scale forecasting systems of different countries in routine interaction and continuous operation, (2) to assess the quality and... Franchi , 7000 Public Affairs (Unclassified/ Unlimited Only), Code 7o30 4 Division, Code ^VtcV Vs-Jc \\ -Vi<-’/c ••>’ 3^v’.-:5, w. 3Uo|eri 1

U.S. Army Air Forces in World War II. Combat Chronology 1941-1945

DTIC Science & Technology

1991-01-01

B-17’s and B-24’s bomb M/Ys at Troyes , Reims, Sarreguemines, Metz, Liege, and Brussels. 5/1/44 Ninth AF The last of the 11 bomb gps (8 medium and 3...weather and photo rcn over Shimushu and bomb Matsuwa area. 5/25/44 Eighth AF 859 B-17’s and B-24’s operating in 4 forces bomb M/Ys at Mulhouse, Troyes ...Dessau, Oschersleben, Halberstadt, Rotenburg, Zwischenahn, Oldenburg, Diepholz, and Handorf; M/Ys at Brussels, Troyes , and Reims; V-weapon sites at Watten

DOE Office of Scientific and Technical Information (OSTI.GOV)

Funke, L.A.; Espenson, J.H.

Reactions of chromium(II) perchlorate with acidified solutions of hydrogen peroxide in water containing modest concentrations of an organic nitrile (RCN) give rise to the cationic organochromium complexes CrCH/sub 2/CN/sup 2 +/ (RCN = acetonitrile), CrCH/sub 2/CH/sub 2/CN/sup 2 +/ (propionitrile), and CrCH/sub 2/CH(CH/sub 3/)CN/sup 2 +/ (isobutyronitrile). These cyanoalkyl complexes are quite resistant to decomposition in aqueous perchloric acid and can be separated by ion-exchange chromatography. Their composition was established by identification of the organic bromide formed by reaction with aqueous bromine. The complexes react with Hg/sup 2 +/ first to form the corresponding HgR/sup +/ and then (if excessmore » organochromium is present) HgR/sub 2/. Kinetic studies for the first stage of this reaction were carried out. The data are consistent with a bimolecular electrophilic substitution process (S/sub E/2 mechanism).« less

Exposure to benzo[a]pyrene of Hepatic Cytochrome P450 Reductase Null (HRN) and P450 Reductase Conditional Null (RCN) mice: Detection of benzo[a]pyrene diol epoxide-DNA adducts by immunohistochemistry and 32P-postlabelling.

PubMed

Arlt, Volker M; Poirier, Miriam C; Sykes, Sarah E; John, Kaarthik; Moserova, Michaela; Stiborova, Marie; Wolf, C Roland; Henderson, Colin J; Phillips, David H

2012-09-03

Benzo[a]pyrene (BaP) is a widespread environmental carcinogen activated by cytochrome P450 (P450) enzymes. In Hepatic P450 Reductase Null (HRN) and Reductase Conditional Null (RCN) mice, P450 oxidoreductase (Por) is deleted specifically in hepatocytes, resulting in the loss of essentially all hepatic P450 function. Treatment of HRN mice with a single i.p. or oral dose of BaP (12.5 or 125mg/kg body weight) resulted in higher DNA adduct levels in liver (up to 10-fold) than in wild-type (WT) mice, indicating that hepatic P450s appear to be more important for BaP detoxification in vivo. Similar results were obtained in RCN mice. We tested whether differences between hepatocytes and non-hepatocytes in P450 activity may underlie the increased liver BaP-DNA binding in HRN mice. Cellular localisation by immunohistochemistry of BaP-DNA adducts showed that HRN mice have ample capacity for formation of BaP-DNA adducts in liver, indicating that the metabolic process does not result in the generation of a reactive species different from that formed in WT mice. However, increased protein expression of cytochrome b(5) in hepatic microsomes of HRN relative to WT mice suggests that cytochrome b(5) may modulate the P450-mediated bioactivation of BaP in HRN mice, partially substituting the function of Por. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Buying into a greater product procurement role for nurses.

PubMed

Blakemore, Sophie

2015-12-01

AT THE chief nursing officer (CNO) for England's summit this month, the RCN will publicise its campaign encouraging nurses to have more say in the choice of products, supplies and medicines they use on a daily basis.

Everyone is working together to ease the pressures in A&E.

PubMed

Kimber, Mark

2015-01-27

Nurse consultant Janet Youd, chair of the RCN Emergency Care Association, says nurses struggling to cope with unprecedented pressures in A&E departments should be awarded an extra half day's annual leave (Online News January 8).

The Royal College of Nursing: a century of dedication to nurses and patients.

PubMed

Davies, Janet

Janet Davies, Chief Executive of the Royal College of Nursing, reflects on the RCN's achievements since its foundation in 1916, and looks ahead to the challenges the nursing profession faces in 2016 and beyond.

Identification of the same polyomavirus species in different African horseshoe bat species is indicative of short-range host-switching events.

PubMed

Carr, Michael; Gonzalez, Gabriel; Sasaki, Michihito; Dool, Serena E; Ito, Kimihito; Ishii, Akihiro; Hang'ombe, Bernard M; Mweene, Aaron S; Teeling, Emma C; Hall, William W; Orba, Yasuko; Sawa, Hirofumi

2017-10-06

Polyomaviruses (PyVs) are considered to be highly host-specific in different mammalian species, with no well-supported evidence for host-switching events. We examined the species diversity and host specificity of PyVs in horseshoe bats (Rhinolophus spp.), a broadly distributed and highly speciose mammalian genus. We annotated six PyV genomes, comprising four new PyV species, based on pairwise identity within the large T antigen (LTAg) coding region. Phylogenetic comparisons revealed two instances of highly related PyV species, one in each of the Alphapolyomavirus and Betapolyomavirus genera, present in different horseshoe bat host species (Rhinolophus blasii and R. simulator), suggestive of short-range host-switching events. The two pairs of Rhinolophus PyVs in different horseshoe bat host species were 99.9 and 88.8 % identical with each other over their respective LTAg coding sequences and thus constitute the same virus species. To corroborate the species identification of the bat hosts, we analysed mitochondrial cytb and a large nuclear intron dataset derived from six independent and neutrally evolving loci for bat taxa of interest. Bayesian estimates of the ages of the most recent common ancestors suggested that the near-identical and more distantly related PyV species diverged approximately 9.1E4 (5E3-2.8E5) and 9.9E6 (4E6-18E6) years before the present, respectively, in contrast to the divergence times of the bat host species: 12.4E6 (10.4E6-15.4E6). Our findings provide evidence that short-range host-switching of PyVs is possible in horseshoe bats, suggesting that PyV transmission between closely related mammalian species can occur.

What provides a better value for your time? The use of relative value units to compare posterior segmental instrumentation of vertebral segments.

PubMed

Orr, R Douglas; Sodhi, Nipun; Dalton, Sarah E; Khlopas, Anton; Sultan, Assem A; Chughtai, Morad; Newman, Jared M; Savage, Jason; Mroz, Thomas E; Mont, Michael A

2018-02-02

Relative value units (RVUs) are a compensation model based on the effort required to provide a procedure or service to a patient. Thus, procedures that are more complex and require greater technical skill and aftercare, such as multilevel spine surgery, should provide greater physician compensation. However, there are limited data comparing RVUs with operative time. Therefore, this study aims to compare mean (1) operative times; (2) RVUs; and (3) RVU/min between posterior segmental instrumentation of 3-6, 7-12, and ≥13 vertebral segments, and to perform annual cost difference analysis. A total of 437 patients who underwent instrumentation of 3-6 segments (Cohort 1, current procedural terminology [CPT] code: 22842), 67 patients who had instrumentation of 7-12 segments (Cohort 2, CPT code: 22843), and 16 patients who had instrumentation of ≥13 segments (Cohort 3, CPT code: 22844) were identified from the National Surgical Quality Improvement Program (NSQIP) database. Mean operative times, RVUs, and RVU/min, as well as an annualized cost difference analysis, were calculated and compared using Student t test. This study received no funding from any party or entity. Cohort 1 had shorter mean operative times than Cohorts 2 and 3 (217 minutes vs. 325 minutes vs. 426 minutes, p<.05). Cohort 1 had a lower mean RVU than Cohorts 2 and 3 (12.6 vs. 13.4 vs. 16.4). Cohort 1 had a greater RVU/min than Cohorts 2 and 3 (0.08 vs. 0.05, p<.05; vs. 0.08 vs. 0.05, p>.05). A $112,432.12 annualized cost difference between Cohorts 1 and 2, a $176,744.76 difference between Cohorts 1 and 3, and a $64,312.55 difference between Cohorts 2 and 3 were calculated. The RVU/min takes into account not just the value provided but also the operative times required for highly complex cases. The RVU/min for fewer vertebral level instrumentation being greater (0.08 vs. 0.05), as well as the $177,000 annualized cost difference, indicates that compensation is not proportional to the added time, effort, and skill for more complex cases. Copyright © 2018 Elsevier Inc. All rights reserved.

Estimating Ten-Year Trends in Septic Shock Incidence and Mortality in United States Academic Medical Centers Using Clinical Data.

PubMed

Kadri, Sameer S; Rhee, Chanu; Strich, Jeffrey R; Morales, Megan K; Hohmann, Samuel; Menchaca, Jonathan; Suffredini, Anthony F; Danner, Robert L; Klompas, Michael

2017-02-01

Reports that septic shock incidence is rising and mortality rates declining may be confounded by improving recognition of sepsis and changing coding practices. We compared trends in septic shock incidence and mortality in academic hospitals using clinical vs claims data. We identified all patients with concurrent blood cultures, antibiotics, and vasopressors for ≥ two consecutive days, and all patients with International Classification of Diseases, 9th edition (ICD-9) codes for septic shock, at 27 academic hospitals from 2005 to 2014. We compared annual incidence and mortality trends. We reviewed 967 records from three hospitals to estimate the accuracy of each method. Of 6.5 million adult hospitalizations, 99,312 (1.5%) were flagged by clinical criteria, 82,350 (1.3%) by ICD-9 codes, and 44,651 (0.7%) by both. Sensitivity for clinical criteria was higher than claims (74.8% vs 48.3%; P < .01), whereas positive predictive value was comparable (83% vs 89%; P = .23). Septic shock incidence, based on clinical criteria, rose from 12.8 to 18.6 cases per 1,000 hospitalizations (average, 4.9% increase/y; 95% CI, 4.0%-5.9%), while mortality declined from 54.9% to 50.7% (average, 0.6% decline/y; 95% CI, 0.4%-0.8%). In contrast, septic shock incidence, based on ICD-9 codes, increased from 6.7 to 19.3 per 1,000 hospitalizations (19.8% increase/y; 95% CI, 16.6%-20.9%), while mortality decreased from 48.3% to 39.3% (1.2% decline/y; 95% CI, 0.9%-1.6%). A clinical surveillance definition based on concurrent vasopressors, blood cultures, and antibiotics accurately identifies septic shock hospitalizations and suggests that the incidence of patients receiving treatment for septic shock has risen and mortality rates have fallen, but less dramatically than estimated on the basis of ICD-9 codes. Copyright © 2016 American College of Chest Physicians. All rights reserved.

CTCF-Mediated and Pax6-Associated Gene Expression in Corneal Epithelial Cell-Specific Differentiation

PubMed Central

Tsui, Shanli; Wang, Jie; Wang, Ling; Dai, Wei; Lu, Luo

2016-01-01

Background The purpose of the study is to elicit the epigenetic mechanism involving CCCTC binding factor (CTCF)-mediated chromatin remodeling that regulates PAX6 gene interaction with differentiation-associated genes to control corneal epithelial differentiation. Methods Cell cycle progression and specific keratin expressions were measured to monitor changes of differentiation-induced primary human limbal stem/progenitor (HLS/P), human corneal epithelial (HCE) and human telomerase-immortalized corneal epithelial (HTCE) cells. PAX6-interactive and differentiation-associated genes in chromatin remodeling mediated by the epigenetic factor CTCF were detected by circular chromosome conformation capture (4C) and ChIP (Chromatin immunoprecipitation)-on-chip approaches, and verified by FISH (Fluorescent in situ hybridization). Furthermore, CTCF activities were altered by CTCF-shRNA to study the effect of CTCF on mediating interaction of Pax6 and differentiation-associated genes in corneal epithelial cell fate. Results Our results demonstrated that differentiation-induced human corneal epithelial cells expressed typical corneal epithelial characteristics including morphological changes, increased keratin12 expression and G0/G1 accumulations. Expressions of CTCF and PAX6 were suppressed and elevated following the process of differentiation, respectively. During corneal epithelial cell differentiation, differentiation-induced RCN1 and ADAM17 were found interacting with PAX6 in the process of CTCF-mediated chromatin remodeling detected by 4C and verified by ChIP-on-chip and FISH. Diminished CTCF mRNA with CTCF-shRNA in HTCE cells weakened the interaction of PAX6 gene in controlling RCN1/ADAM17 and enhanced early onset of the genes in cell differentiation. Conclusion Our results explain how epigenetic factor CTCF-mediated chromatin remodeling regulates interactions between eye-specific PAX6 and those genes that are induced/associated with cell differentiation to modulate corneal epithelial cell-specific differentiation. PMID:27583466

TRIAD II: do living wills have an impact on pre-hospital lifesaving care?

PubMed

Mirarchi, Ferdinando L; Kalantzis, Stella; Hunter, Daniel; McCracken, Emily; Kisiel, Theresa

2009-02-01

Living wills accompany patients who present for emergent care. To the best of our knowledge, no studies assess pre-hospital provider interpretations of these instructions. Determine how a living will is interpreted and assess how interpretation impacts lifesaving care. Three-part survey administered at a regional emergency medical system educational symposium to 150 emergency medical technicians (EMTs) and paramedics. Part I assessed understanding of the living will and do-not-resuscitate (DNR) orders. Part II assessed the living will's impact in clinical situations of patients requiring lifesaving interventions. Part III was similar to part II except a code status designation (full code) was incorporated into the living will. There were 127 surveys completed, yielding an 87% response rate. The majority were male (55%) and EMTs (74%). The average age was 44 years and the average duration of employment was 15 years. Ninety percent (95% confidence interval [CI] 84.6-95.4%) of respondents determined that, after review of the living will, the patient's code status was DNR, and 92% (95% CI 86.5-96.6%) defined their understanding of DNR as comfort care/end-of-life care. When the living will was applied to clinical situations, it resulted in a higher proportion of patients being classified as DNR as opposed to full code (Case A 78% [95% CI 71.2-85.6%] vs. 22% [95% CI 14.4-28.8%], respectively; Case B 67% [95% CI 58.4-74.9%] vs. 33% [95% CI 25.1-1.6%], respectively; Case C 63% [95% CI 55.1-71.9%] vs. 37% [95% CI 28.1-44.9%]), respectively. With the scenarios presented, this DNR classification resulted in a lack of or a delay in lifesaving interventions. Incorporating a code status into the living will produced statistically significant increases in the provision of lifesaving care. In Case A, intubation increased from 15% to 56% (p < 0.0001); Case B, defibrillation increased from 40% to 59% (p < 0.0001); and Case C, defibrillation increased from 36% to 65% (p < 0.0001). Significant confusion and concern for patient safety exists in the pre-hospital setting due to the understanding and implementation of living wills and DNR orders. This confusion can be corrected by implementing clearly defined code status into the living will.

Support sought for petition on safer staffing levels in Wales.

PubMed

2014-11-01

RCN WALES is urging the public to sign an e-petition supporting draft legislation on safe staffing. The petition calls for support for the Safe Nursing Staffing Levels (Wales) Bill, drawn up by Welsh Liberal Democrat leader Kirsty Williams.

Rescheduling the special interest group.

PubMed

Peace, Helen

1993-06-09

The committee members of the RCN Social Interest Group for Nurses Working Within Day Hospitals/Day Care for Older People would like to apologise to the large number of people who were interested in attending our conference, which unfortunately had to be postponed.

'Don't wait, look for opportunities'.

PubMed

2016-08-10

Steve Jamieson qualified as a nurse in 1986, and worked for the RCN for 17 years. He was deputy director of nursing, managing a team of professional leads across all areas of nursing, then chief executive of The Hospice of St Francis Berkhamsted.

Give UK nursing bigger global voice by rejoining ICN, college is urged.

PubMed

Longhurst, Chris

2015-08-26

The next chief executive of the International Council of Nurses should encourage the RCN to rejoin the organisation and ensure the UK has a greater say on nursing at a global level, a former college president believes.

Wide-Field CCD Photometry around Nine Open Clusters

NASA Astrophysics Data System (ADS)

Sharma, Saurabh; Pandey, A. K.; Ogura, K.; Mito, H.; Tarusawa, K.; Sagar, R.

2006-10-01

In this paper we study the evolution of the core and corona of nine open clusters using the projected radial density profiles derived from homogeneous CCD photometric data obtained with the 105 cm Kiso Schmidt telescope. The age and galactocentric distance of the target clusters vary from 16 to 2000 Myr and 9 to 10.8 kpc, respectively. Barring Be 62, which is a young open cluster, other clusters show a uniform reddening across the cluster region. The reddening in Be 62 varies from E(B-V)min=0.70 mag to E(B-V)max=1.00 mag. The coronae of six of the clusters in the present sample are found to be elongated; however, on the basis of the present sample it is not possible to establish any correlation between the age and shape of the core. The elongated core in the case of the young cluster Be 62 may reflect the initial conditions in the parental molecular cloud. The other results of the present study are as follows: (1) Core radius rc and corona size rcn/cluster radius rcl are linearly correlated. (2) The rc, rcn, and rcl are linearly correlated with the number of stars in that region. (3) In the age range 10-1000 Myr, the core and corona shrink with age. (4) We find that in the galactocentric distance range 9-10 kpc, the core and corona/cluster extent of the clusters increase with the galactocentric distance.

Florence Nightingale would have taken on the political fight, and so should we.

PubMed

Owen, Michael

2016-05-11

I agree with Mike Travis' comments (letters April 20) about the role and responsibilities of the trade union movement, and those of the RCN in caring for and fighting politically on behalf of nurses at all levels.

Burden of vaccine-preventable disease in adult Medicaid and commercially insured populations: analysis of claims-based databases, 2006–2010.

PubMed

Krishnarajah, Girishanthy; Carroll, Charlotte; Priest, Julie; Arondekar, Bhakti; Burstin, Stuart; Levin, Myron

2014-01-01

Vaccination rates among United States (US) adults are suboptimal, resulting in morbidity, mortality, and financial burden attributable to potentially vaccine-preventable diseases (VPDs). Unadjusted annual incidence proportions of VPDs were estimated for Medicaid and commercially insured adults aged 19-64 years using 2006-2010 claims, along with age/gender-adjusted incidence proportions for 2010. In 2010, 1.6 million Medicaid adults (mean age 34 ± 12 years; 73.4% female) and 33 million commercially insured (mean age 42 ± 13 years; 52.2% female) were included. Age/gender-adjusted incidence proportions (per 100 000) in 2010 among Medicaid vs commercially insured adults for meningococcal disease were 26.2 (95% CI 22.9-29.8) vs 2.0 (1.9-2.2) (P < 0.001); hepatitis B 88.9 (82.6-95.6) vs 17.5 (17.0-17.9) (P < 0.001); pneumococcal disease 98.2 (91.7-105.1) vs 21.1 (20.7-21.6) (P < 0.001); hepatitis A 19.8 (16.9-23.1) vs 4.5 (4.3-4.7) (P < 0.001); mumps 2.1 (1.3-3.3) vs 1.4 (1.3-1.6) (P = 0.14); measles 0.3 (0.1-1.0) vs 0.3 (0.2-0.3) (P = 0.38); herpes zoster (60- to 64-year-olds only) 459 (408-515) vs 473 (466-481) (P = 0.35); varicella (19- to 39-year-olds only) 6.5 (4.8-8.5) vs 8.0 (7.5-8.5) (P = 0.12); influenza 586 (573-598) vs 633 (631-636) (P < 0.001); and pertussis 1.8 (1.1-2.8) vs 3.2 (3.0-3.4) (P < 0.001). Research is needed to fully understand the causes of the disparity of the coded incidence of some VPDs in adult Medicaid population than commercially insured adults in the US.

Evaluating the Real-time and Offline Performance of the Virtual Seismologist Earthquake Early Warning Algorithm

NASA Astrophysics Data System (ADS)

Cua, G.; Fischer, M.; Heaton, T.; Wiemer, S.

2009-04-01

The Virtual Seismologist (VS) algorithm is a Bayesian approach to regional, network-based earthquake early warning (EEW). Bayes' theorem as applied in the VS algorithm states that the most probable source estimates at any given time is a combination of contributions from relatively static prior information that does not change over the timescale of earthquake rupture and a likelihood function that evolves with time to take into account incoming pick and amplitude observations from the on-going earthquake. Potentially useful types of prior information include network topology or station health status, regional hazard maps, earthquake forecasts, and the Gutenberg-Richter magnitude-frequency relationship. The VS codes provide magnitude and location estimates once picks are available at 4 stations; these source estimates are subsequently updated each second. The algorithm predicts the geographical distribution of peak ground acceleration and velocity using the estimated magnitude and location and appropriate ground motion prediction equations; the peak ground motion estimates are also updated each second. Implementation of the VS algorithm in California and Switzerland is funded by the Seismic Early Warning for Europe (SAFER) project. The VS method is one of three EEW algorithms whose real-time performance is being evaluated and tested by the California Integrated Seismic Network (CISN) EEW project. A crucial component of operational EEW algorithms is the ability to distinguish between noise and earthquake-related signals in real-time. We discuss various empirical approaches that allow the VS algorithm to operate in the presence of noise. Real-time operation of the VS codes at the Southern California Seismic Network (SCSN) began in July 2008. On average, the VS algorithm provides initial magnitude, location, origin time, and ground motion distribution estimates within 17 seconds of the earthquake origin time. These initial estimate times are dominated by the time for 4 acceptable picks to be available, and thus are heavily influenced by the station density in a given region; these initial estimate times also include the effects of telemetry delay, which ranges between 6 and 15 seconds at the SCSN, and processing time (~1 second). Other relevant performance statistics include: 95% of initial real-time location estimates are within 20 km of the actual epicenter, 97% of initial real-time magnitude estimates are within one magnitude unit of the network magnitude. Extension of real-time VS operations to networks in Northern California is an on-going effort. In Switzerland, the VS codes have been run on offline waveform data from over 125 earthquakes recorded by the Swiss Digital Seismic Network (SDSN) and the Swiss Strong Motion Network (SSMS). We discuss the performance of the VS algorithm on these datasets in terms of magnitude, location, and ground motion estimation.

The use of lectins as markers for differentiated secretory cells in planarians.

PubMed

Zayas, Ricardo M; Cebrià, Francesc; Guo, Tingxia; Feng, Junjie; Newmark, Phillip A

2010-11-01

Freshwater planarians have reemerged as excellent models to investigate mechanisms underlying regeneration. The introduction of molecular tools has facilitated the study of planarians, but cell- and tissue-specific markers are still needed to examine differentiation of most cell types. Here we report the utility of fluorescent lectin-conjugates to label tissues in the planarian Schmidtea mediterranea. We show that 16 lectin-conjugates stain planarian cells or tissues; 13 primarily label the secretory cells, their cytoplasmic projections, and terminal pores. Thus, we examined regeneration of the secretory system using lectin markers and functionally characterized two genes expressed in the secretory cells: marginal adhesive gland-1 (mag-1) and Smed-reticulocalbin1 (Smed-rcn1). RNAi knockdown of these genes caused a dramatic reduction of secretory cell lectin staining, suggesting a role for mag-1 and Smed-rcn1 in secretory cell differentiation. Our results provide new insights into planarian secretory system regeneration and add new markers for labeling several planarian tissues. © 2010 Wiley-Liss, Inc.

Utilizing Microelectromechanical Systems (MEMS) Micro-Shutter Designs for Adaptive Coded Aperture Imaging (ACAI) Technologies

DTIC Science & Technology

2009-03-01

52 Figure 4-1: Applied voltage versus deflection curve for Poly1/Poly2 stacked 300-μm single hot-arm actuator (shown on right...58 Figure 4-2: Applied voltage versus deflection curve for Poly1/Poly2 stacked 300-μm double hot-arm actuator (shown on...61 Figure 4-5: Deflection vs. power curves for an individual wedge from

VS30 – A site-characterization parameter for use in building Codes, simplified earthquake resistant design, GMPEs, and ShakeMaps

USGS Publications Warehouse

Borcherdt, Roger D.

2012-01-01

VS30, defined as the average seismic shear-wave velocity from the surface to a depth of 30 meters, has found wide-spread use as a parameter to characterize site response for simplified earthquake resistant design as implemented in building codes worldwide. VS30 , as initially introduced by the author for the US 1994 NEHRP Building Code, provides unambiguous definitions of site classes and site coefficients for site-dependent response spectra based on correlations derived from extensive borehole logging and comparative ground-motion measurement programs in California. Subsequent use of VS30 for development of strong ground motion prediction equations (GMPEs) and measurement of extensive sets of VS borehole data have confirmed the previous empirical correlations and established correlations of SVS30 with VSZ at other depths. These correlations provide closed form expressions to predict S30 V at a large number of additional sites and further justify S30 V as a parameter to characterize site response for simplified building codes, GMPEs, ShakeMap, and seismic hazard mapping.

Atomic Processes for XUV Lasers: Alkali Atoms and Ions

NASA Astrophysics Data System (ADS)

Dimiduk, David Paul

The development of extreme ultraviolet (XUV) lasers is dependent upon knowledge of processes in highly excited atoms. Described here are spectroscopy experiments which have identified and characterized certain autoionizing energy levels in core-excited alkali atoms and ions. Such levels, termed quasi-metastable, have desirable characteristics as upper levels for efficient, powerful XUV lasers. Quasi -metastable levels are among the most intense emission lines in the XUV spectra of core-excited alkalis. Laser experiments utilizing these levels have proved to be useful in characterizing other core-excited levels. Three experiments to study quasi-metastable levels are reported. The first experiment is vacuum ultraviolet (VUV) absorption spectroscopy on the Cs 109 nm transitions using high-resolution laser techniques. This experiment confirms the identification of transitions to a quasi-metastable level, estimates transition oscillator strengths, and estimates the hyperfine splitting of the quasi-metastable level. The second experiment, XUV emission spectroscopy of Ca II and Sr II in a microwave-heated plasma, identifies transitions from quasi-metastable levels in these ions, and provides confirming evidence of their radiative, rather than autoionizing, character. In the third experiment, core-excited Ca II ions are produced by inner-shell photoionization of Ca with soft x-rays from a laser-produced plasma. This preliminary experiment demonstrated a method of creating large numbers of these highly-excited ions for future spectroscopic experiments. Experimental and theoretical evidence suggests the CA II 3{ rm p}^5 3d4s ^4 {rm F}^circ_{3/2 } quasi-metastable level may be directly pumped via a dipole ionization process from the Ca I ground state. The direct process is permitted by J conservation, and occurs due to configuration mixing in the final state and possibly the initial state as well. The experiments identifying and characterizing quasi-metastable levels are compared to calculations using the Hartree-Fock code RCN/RCG. Calculated parameters include energy levels, wavefunctions, and transition rates. Based on an extension of this code, earlier unexplained experiments showing strong two-electron radiative transitions from quasi-metastable levels are now understood.

The potential of multi-slice computed tomography based volumetry for demonstrating reverse remodeling induced by cardiac resynchronization therapy.

PubMed

Langer, Christoph; Schroeder, Janina; Peterschroeder, Andreas; Vaske, Bernhard; Faber, Lothar; Welge, Dirk; Niethammer, Matthias; Lamp, Barbara; Butz, Thomas; Bitter, Thomas; Oldenburg, Olaf; Horstkotte, Dieter

2010-07-01

Multi-slice computed tomography (MSCT) was proved to provide precise cardiac volumetric assessment. Cardiac resynchronization therapy (CRT) is an effective treatment for selected patients with heart failure and reduced ejection fraction (HFREF). In HFREF patients we investigated the potential of MSCT based wall motion analysis in order to demonstrate CRT-induced reversed remodeling. Besides six patients with normal cardiac pump function serving as control group seven HFREF patients underwent contrast enhanced MSCT before and after CRT. Short cardiac axis views of the left ventricle (LV) in end-diastole (ED) and end-systole (ES) served for planimetry. Pre- and post-CRT MSCT based volumetry was compared with 2D echo. To demonstrate CRT-induced reverse remodeling, MSCT based multi-segment color-coded polar maps were introduced. With regard to the HFREF patients pre-CRT MSCT based volumetry correlated with 2D echo data for LV-EDV (MSCT 278.3+/-75.0mL vs. echo 274.4+/-85.6mL) r=0.380, p=0.401, LV-ESV (MSCT 226.7+/-75.4mL vs. echo 220.1+/-74.0mL) r=0.323, p=0.479 and LV-EF (MSCT 20.2+/-8.8% vs. echo 20.0+/-11.9%) r=0.617, p=0.143. Post-CRT MSCT correlated well with 2D echo: LV-EDV (MSCT 218.9+/-106.4mL vs. echo 188.7+/-93.1mL) r=0.87, p=0.011, LV-ESV (MSCT 145+/-71.5mL vs. echo 125.6+/-78mL) r=0.84, p=0.018 and LV-EF (MSCT 29.6+/-11.3mL vs. echo 38.6+/-14.6mL) r=0.89, p=0.007. There was a significant increase of the mid-ventricular septum in terms of absolute LV wall thickening of the responders (pre 0.9+/-2.1mm vs. post 3.3+/-2.2mm; p<0.0005). MSCT based volumetry involving multi-segment color-coded polar maps offers wall motion analysis to demonstrate CRT-induced reverse remodeling which needs to be further validated. 2010 Elsevier Ltd. All rights reserved.

Joint inversion for Vp, Vs, and Vp/Vs at SAFOD, Parkfield, California

USGS Publications Warehouse

Zhang, H.; Thurber, C.; Bedrosian, P.

2009-01-01

We refined the three-dimensional (3-D) Vp, Vs and Vp/Vs models around the San Andreas Fault Observatory at Depth (SAFOD) site using a new double-difference (DD) seismic tomography code (tomoDDPS) that simultaneously solves for earthquake locations and all three velocity models using both absolute and differential P, S, and S-P times. This new method is able to provide a more robust Vp/Vs model than that from the original DD tomography code (tomoDD), obtained simply by dividing Vp by Vs. For the new inversion, waveform cross-correlation times for earthquakes from 2001 to 2002 were also used, in addition to arrival times from earthquakes and explosions in the region. The Vp values extracted from the model along the SAFOD trajectory match well with the borehole log data, providing in situ confirmation of our results. Similar to previous tomographic studies, the 3-D structure around Parkfield is dominated by the velocity contrast across the San Andreas Fault (SAF). In both the Vp and Vs models, there is a clear low-velocity zone as deep as 7 km along the SAF trace, compatible with the findings from fault zone guided waves. There is a high Vp/Vs anomaly zone on the southwest side of the SAF trace that is about 1-2 km wide and extends as deep as 4 km, which is interpreted to be due to fluids and fractures in the package of sedimentary rocks abutting the Salinian basement rock to the southwest. The relocated earthquakes align beneath the northeast edge of this high Vp/Vs zone. We carried out a 2-D correlation analysis for an existing resistivity model and the corresponding profiles through our model, yielding a classification that distinguishes several major lithologies. ?? 2009 by the American Geophysical Union.

Conference calls.

PubMed

2002-07-01

Last minute places were still available as Emergency Nurse went to press at an RCN A&E Nursing Association symposium on July 2 to examine the impact of the Department of Health's Reforming Emergency Care strategy. For details of the event, to be held at Cheadle, Cheshire, call Grant Williams on 07771 740243.

INDOS: conversational computer codes to implement ICRP-10-10A models for estimation of internal radiation dose to man

DOE Office of Scientific and Technical Information (OSTI.GOV)

Killough, G.G.; Rohwer, P.S.

1974-03-01

INDOS1, INDOS2, and INDOS3 (the INDOS codes) are conversational FORTRAN IV programs, implemented for use in time-sharing mode on the ORNL PDP-10 System. These codes use ICRP10-10A models to estimate the radiation dose to an organ of the body of Reference Man resulting from the ingestion or inhalation of any one of various radionuclides. Two patterns of intake are simulated: intakes at discrete times and continuous intake at a constant rate. The IND0S codes provide tabular output of dose rate and dose vs time, graphical output of dose vs time, and punched-card output of organ burden and dose vs time.more » The models of internal dose calculation are discussed and instructions for the use of the INDOS codes are provided. The INDOS codes are available from the Radiation Shielding Information Center, Oak Ridge National Laboratory, P. O. Box X, Oak Ridge, Tennessee 37830. (auth)« less

Computer Power: Part 1: Distribution of Power (and Communications).

ERIC Educational Resources Information Center

Price, Bennett J.

1988-01-01

Discussion of the distribution of power to personal computers and computer terminals addresses options such as extension cords, perimeter raceways, and interior raceways. Sidebars explain: (1) the National Electrical Code; (2) volts, amps, and watts; (3) transformers, circuit breakers, and circuits; and (4) power vs. data wiring. (MES)

Angels or demons?

PubMed

2008-06-01

A fringe meeting at this year's RCN congress, 'Angels and demons… dignity at the heart of nursing', debated the issue of the media portrayal of nurses. Nurses are often depicted at polarised ends of the continuum and the event generated ideas and discussion about how nurses can influence the media portrayal of the profession.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Andrews, M.A.; Cheng, C.W.; Kelley, K.P.

Process for converting alkenes to form epoxides utilizes transition metal nitro complexes of the formula: M(RCN)/sub 2/XNO/sub 2/ wherein M is palladium or platinum, R is an alkyl or aryl group containing up to 12 carbon atoms, and X is a monoanionic, monodentate ligand such as chlorine, optionally in the presence of molecular oxygen.

Flexible model of work-based learning boosts development.

PubMed

Clark, Elisabeth

2011-01-19

I was interested to read your news story, 'Nurses miss out on essential training due to staff shortages' (January 5). As director of the Open University-RCN strategic alliance I would emphasise the importance of investing in continuing professional development (CPD), particularly in times of change and service redesign.

PubMed

Pritchard, Emma

2001-05-01

The Royal College of Nursing Gerontological Nursing Programme is compiling a database of nurses in the United Kingdom and Eire who are using the RCN Assessment Tool for older people. This database could be used for nurses using the tool to network with each other, share issues and keep nurses in touch with any developments regarding the tool.

HCA award winner's passion and enthusiasm shine through.

PubMed

Cole, Elaine

2017-05-24

A healthcare assistant who significantly improved care for people with learning disabilities through an individualised, gentler approach to taking blood has been recognised with a prestigious RCNi Nurse Award. Cemlyn Roberts, who works for Betsi Cadwaladr University Health Board in Wales, won the RCN Healthcare Assistant award category.

Tradeoffs of Using Administrative Claims and Medical Records to Identify the Use of Personalized Medicine for Patients with Breast Cancer

PubMed Central

Liang, Su-Ying; Phillips, Kathryn A.; Wang, Grace; Keohane, Carol; Armstrong, Joanne; Morris, William M.; Haas, Jennifer S.

2012-01-01

Background Administrative claims and medical records are important data sources to examine healthcare utilization and outcomes. Little is known about identifying personalized medicine technologies in these sources. Objectives To describe agreement, sensitivity, and specificity of administrative claims compared to medical records for two pairs of targeted tests and treatments for breast cancer. Research Design Retrospective analysis of medical records linked to administrative claims from a large health plan. We examined whether agreement varied by factors that facilitate tracking in claims (coding and cost) and that enhance medical record completeness (records from multiple providers). Subjects Women (35 – 65 years) with incident breast cancer diagnosed in 2006–2007 (n=775). Measures Use of human epidermal growth factor receptor 2 (HER2) and gene expression profiling (GEP) testing, trastuzumab and adjuvant chemotherapy in claims and medical records. Results Agreement between claims and records was substantial for GEP, trastuzumab, and chemotherapy, and lowest for HER2 tests. GEP, an expensive test with unique billing codes, had higher agreement (91.6% vs. 75.2%), sensitivity (94.9% vs. 76.7%), and specificity (90.1% vs. 29.2%) than HER2, a test without unique billing codes. Trastuzumab, a treatment with unique billing codes, had slightly higher agreement (95.1% vs. 90%) and sensitivity (98.1% vs. 87.9%) than adjuvant chemotherapy. Conclusions Higher agreement and specificity were associated with services that had unique billing codes and high cost. Administrative claims may be sufficient for examining services with unique billing codes. Medical records provide better data for identifying tests lacking specific codes and for research requiring detailed clinical information. PMID:21422962

Vulnerability of permafrost carbon research coordination network

NASA Astrophysics Data System (ADS)

Schädel, C.; Schuur, E. A. G.; McGuire, A. D.; Canadell, J. G.; Harden, J.; Kuhry, P.; Romanovsky, V. E.; Turetsky, M. R.

2012-04-01

Approximately 1700 Pg of soil carbon are stored in the northern circumpolar permafrost zone, more than twice as much carbon than currently contained in the atmosphere. Permafrost thaw, and the microbial decomposition of previously frozen organic carbon, is considered one of the most likely positive feedbacks from terrestrial ecosystems to the atmosphere in a warmer world. Yet, the rate and form of release is highly uncertain but crucial for predicting the strength and timing of this carbon cycle feedback this century and beyond. Here we report on the first products of a new research coordination network (RCN) whose objective is to link biological C cycle research with well-developed networks in the physical sciences focused on the thermal state of permafrost. We found that published literature in the Science Citation Index identified with the search terms 'permafrost' and 'carbon' have increased dramatically in the last decade. Of total publications including those keywords, 86% were published since 2000, 65% since 2005, and 36% since 2008. The first RCN activity consisted of an expert elicitation that revealed the total effect of carbon release from permafrost zone soils in climate is expected to be up to 30-46 Pg C over the next three decades, reaching 242-324 Pg C by 2100 and potentially up to 551-710 Pg C over the next several centuries under the strongest warming scenario presented to the group. These values, expressed in billions of tons of C in CO2 equivalents, combine the effect of C released both as CO2 and as CH4 by accounting for the greater heat-trapping capacity of CH4. However, the higher global warming potential of CH4 means that almost half of the effect of future permafrost zone carbon emissions on climate forcing was expected by this group to be a result of CH4 emissions from wetlands, lakes, and other oxygen-limited environments where organic matter will be decomposing. These results demonstrate the vulnerability of organic C stored in near surface permafrost to increasing temperatures. Future activities of this network include synthesizing information in formats that can be assimilated by biospheric and climate models, and that will contribute to future assessments of the IPCC.

Tibia shaft fractures: costly burden of nonunions.

PubMed

Antonova, Evgeniya; Le, T Kim; Burge, Russel; Mershon, John

2013-01-26

Tibia shaft fractures (TSF) are common for men and women and cause substantial morbidity, healthcare use, and costs. The impact of nonunions on healthcare use and costs is poorly described. Our goal was to investigate patient characteristics and healthcare use and costs associated with TSF in patients with and without nonunion. We retrospectively analyzed medical claims in large U.S. managed care claims databases (Thomson Reuters MarketScan®, 16 million lives). We studied patients ≥ 18 years old with a TSF diagnosis (ICD-9 codes: 823.20, 823.22, 823.30, 823.32) in 2006 with continuous pharmaceutical and medical benefit enrollment 1 year prior and 2 years post-fracture. Nonunion was defined by ICD-9 code 733.82 (after the TSF date). Among the 853 patients with TSF, 99 (12%) had nonunion. Patients with nonunion had more comorbidities (30 vs. 21, pre-fracture) and were more likely to have their TSF open (87% vs. 70%) than those without nonunion. Patients with nonunion were more likely to have additional fractures during the 2-year follow-up (of lower limb [88.9% vs. 69.5%, P < 0.001], spine or trunk [16.2% vs. 7.2%, P = 0.002], and skull [5.1% vs. 1.3%, P = 0.008]) than those without nonunion. Nonunion patients were more likely to use various types of surgical care, inpatient care (tibia and non-tibia related: 65% vs. 40%, P < 0.001) and outpatient physical therapy (tibia-related: 60% vs. 42%, P < 0.001) than those without nonunion. All categories of care (except emergency room costs) were more expensive in nonunion patients than in those without nonunion: median total care cost $25,556 vs. $11,686, P < 0.001. Nonunion patients were much more likely to be prescribed pain medications (99% vs. 92%, P = 0.009), especially strong opioids (90% vs. 76.4%, P = 0.002) and had longer length of opioid therapy (5.4 months vs. 2.8 months, P < 0.001) than patients without nonunion. Tibia fracture patterns in men differed from those in women. Nonunions in TSF's are associated with substantial healthcare resource use, common use of strong opioids, and high per-patient costs. Open fractures are associated with higher likelihood of nonunion than closed ones. Effective screening of nonunion risk may decrease this morbidity and subsequent healthcare resource use and costs.

Implementation and impact of a consensus diagnostic and management algorithm for complicated pneumonia in children.

PubMed

Pillai, Dinesh; Song, Xiaoyan; Pastor, William; Ottolini, Mary; Powell, David; Wiedermann, Bernhard L; DeBiasi, Roberta L

2011-12-01

Variable treatment exists for children with bacterial pneumonia complications such as pleural effusion and empyema. Subspecialists at an urban academic tertiary children's hospital created a literature-based diagnosis and management algorithm for complicated pneumonia in children. We proposed that algorithm implementation would reduce use of computed tomography (CT) for diagnosis of pleural infection, thereby decreasing radiation exposure, without increased adverse outcomes. A cross-sectional study was undertaken in children (3 months to 20 years old) with principal or secondary diagnosis codes for empyema and/or pleural effusion in conjunction with bacterial pneumonia. Study cohorts consisted of subjects admitted 15 months before (cohort 1, n = 83) and after (cohort 2, n = 87) algorithm implementation. Data were collected using clinical and financial data systems. Imaging studies and procedures were identified using Current Procedural Terminology codes. Statistical analysis included χ test, linear and ordinal regression, and analysis of variance. Age (P = 0.56), sex (P = 0.30), diagnoses (P = 0.12), and severity level (P = 0.84) were similar between cohorts. There was a significant decrease in CT use in cohort 2 (cohort 1, 60% vs cohort 2, 17.2%; P = 0.001) and reduction in readmission rate (7.7% vs 0%; P = 0.01) and video-assisted thoracoscopic surgery procedures (44.6% vs 28.7; P = 0.03), without concomitant increases in vancomycin use (34.9% vs 34.5%; P = 0.95) or hospital length of stay (6.4 vs 7.6 days; P = 0.4). Among patients who received video-assisted thoracoscopic surgery drainage (n = 57), there were no significant differences between cohorts in median time from admission to video-assisted thoracoscopic surgery (2 days; P = 0.29) or median duration of chest tube drainage (3 vs 4 days; P = 0.10). There was a statistically nonsignificant trend for higher rate of pathogen identification in cohort 2 (cohort 1, 33% vs cohort 2, 54.1%; P = 0.12); Streptococcus pneumonia was the most commonly identified pathogen in both cohorts (37.5% vs 27%; P = 0.23). Implementation of an institutional complicated pneumonia management algorithm reduced CT scan use/radiation exposure, VATS procedures, and readmission rate in children with a diagnosis of pleural infection, without associated increases in length of stay or vancomycin use. This algorithm provides the framework for future prospective quality improvement studies in pediatric patients with complicated pneumonia.

Multiple-Threshold Event Detection and Other Enhancements to the Virtual Seismologist (VS) Earthquake Early Warning Algorithm

NASA Astrophysics Data System (ADS)

Fischer, M.; Caprio, M.; Cua, G. B.; Heaton, T. H.; Clinton, J. F.; Wiemer, S.

2009-12-01

The Virtual Seismologist (VS) algorithm is a Bayesian approach to earthquake early warning (EEW) being implemented by the Swiss Seismological Service at ETH Zurich. The application of Bayes’ theorem in earthquake early warning states that the most probable source estimate at any given time is a combination of contributions from a likelihood function that evolves in response to incoming data from the on-going earthquake, and selected prior information, which can include factors such as network topology, the Gutenberg-Richter relationship or previously observed seismicity. The VS algorithm was one of three EEW algorithms involved in the California Integrated Seismic Network (CISN) real-time EEW testing and performance evaluation effort. Its compelling real-time performance in California over the last three years has led to its inclusion in the new USGS-funded effort to develop key components of CISN ShakeAlert, a prototype EEW system that could potentially be implemented in California. A significant portion of VS code development was supported by the SAFER EEW project in Europe. We discuss recent enhancements to the VS EEW algorithm. We developed and continue to test a multiple-threshold event detection scheme, which uses different association / location approaches depending on the peak amplitudes associated with an incoming P pick. With this scheme, an event with sufficiently high initial amplitudes can be declared on the basis of a single station, maximizing warning times for damaging events for which EEW is most relevant. Smaller, non-damaging events, which will have lower initial amplitudes, will require more picks to be declared an event to reduce false alarms. This transforms the VS codes from a regional EEW approach reliant on traditional location estimation (and it requirement of at least 4 picks as implemented by the Binder Earthworm phase associator) to a hybrid on-site/regional approach capable of providing a continuously evolving stream of EEW information starting from the first P-detection. Offline analysis on Swiss and California waveform datasets indicate that the multiple-threshold approach is faster and more reliable for larger events than the earlier version of the VS codes. This multiple-threshold approach is well-suited for implementation on a wide range of devices, from embedded processor systems installed at a seismic stations, to small autonomous networks for local warnings, to large-scale regional networks such as the CISN. In addition, we quantify the influence of systematic use of prior information and Vs30-based corrections for site amplification on VS magnitude estimation performance, and describe how components of the VS algorithm will be integrated into non-EEW standard network processing procedures at CHNet, the national broadband / strong motion network in Switzerland. These enhancements to the VS codes will be transitioned from off-line to real-time testing at CHNet in Europe in the coming months, and will be incorporated into the development of key components of CISN ShakeAlert prototype system in California.

Reconceptualizing Children's Suggestibility: Bidirectional and Temporal Properties

ERIC Educational Resources Information Center

Gilstrap, Livia L.; Ceci, Stephen J.

2005-01-01

Forty-one children (3 to 7 years) were exposed to a staged event and later interviewed by 1 of 41 professional interviewers. All interviews were coded with a detailed, mutually exclusive, and exhaustive coding scheme capturing adult behaviors (leading questions vs. neutral) and child behaviors (acquiescence vs. denial) in a temporally organized…

Evaluation of hospital complications and costs associated with using ultrasound guidance during abdominal paracentesis procedures.

PubMed

Patel, Pankaj A; Ernst, Frank R; Gunnarsson, Candace L

2012-01-01

Abdominal paracentesis is commonly performed for diagnostic, therapeutic, and palliative indications, but the use of ultrasound guidance for these procedures is relatively recent, variable, and not well documented. A retrospective database analysis of abdominal paracentesis procedures was performed to determine whether ultrasound guidance was associated with differences in adverse events (AEs) or hospital costs, compared to procedures without ultrasound guidance. The hospital database maintained by Premier was used to identify patients with abdominal paracentesis International Classification of Diseases - 9th Revision - Clinical Modification (ICD-9 code 54.9, Common Procedural Terminology CPT-4 codes 49080, 49081) in 2008. Use of ultrasound guidance was determined via patient billing data. The incidence of selected AEs and patients' hospitalization costs were calculated for two groups: procedures with ultrasound guidance and those without. Univariate and multivariable analyses were performed to evaluate differences between groups. This study identified 1297 abdominal paracentesis procedures, 723 (56%) with ultrasound and 574 (44%) without. The indications for paracentesis were similar between the two groups. The incidence of AEs was lower in ultrasound-guided procedures: all AEs (1.4% vs 4.7%, p = 0.01), post-paracentesis infection (0.41% vs 2.44%, p = 0.01), hematoma (0.0% vs 0.87%, p = 0.01), and seroma (0.14% vs 1.05%, p = 0.03). Analyses adjusted for patient and hospital covariates revealed significant reductions in AEs (OR = 0.349, 95% CI = 0.165, 0.739, p = 0.0059) and hospitalization costs ($8761 ± $5956 vs $9848 ± $6581, p < 0.001) for procedures with ultrasound guidance vs those without. There are several limitations to using claims data for clinical analyses; causality cannot be determined, the possibility of miscoded or missing data, and the inability to control for elements not captured in claims data that may influence clinical outcomes. The use of ultrasound guidance in abdominal paracentesis procedures is associated with fewer AEs and lower hospitalization costs than procedures where ultrasound is not used.

Identifying Pediatric Severe Sepsis and Septic Shock: Accuracy of Diagnosis Codes.

PubMed

Balamuth, Fran; Weiss, Scott L; Hall, Matt; Neuman, Mark I; Scott, Halden; Brady, Patrick W; Paul, Raina; Farris, Reid W D; McClead, Richard; Centkowski, Sierra; Baumer-Mouradian, Shannon; Weiser, Jason; Hayes, Katie; Shah, Samir S; Alpern, Elizabeth R

2015-12-01

To evaluate accuracy of 2 established administrative methods of identifying children with sepsis using a medical record review reference standard. Multicenter retrospective study at 6 US children's hospitals. Subjects were children >60 days to <19 years of age and identified in 4 groups based on International Classification of Diseases, Ninth Revision, Clinical Modification codes: (1) severe sepsis/septic shock (sepsis codes); (2) infection plus organ dysfunction (combination codes); (3) subjects without codes for infection, organ dysfunction, or severe sepsis; and (4) infection but not severe sepsis or organ dysfunction. Combination codes were allowed, but not required within the sepsis codes group. We determined the presence of reference standard severe sepsis according to consensus criteria. Logistic regression was performed to determine whether addition of codes for sepsis therapies improved case identification. A total of 130 out of 432 subjects met reference SD of severe sepsis. Sepsis codes had sensitivity 73% (95% CI 70-86), specificity 92% (95% CI 87-95), and positive predictive value 79% (95% CI 70-86). Combination codes had sensitivity 15% (95% CI 9-22), specificity 71% (95% CI 65-76), and positive predictive value 18% (95% CI 11-27). Slight improvements in model characteristics were observed when codes for vasoactive medications and endotracheal intubation were added to sepsis codes (c-statistic 0.83 vs 0.87, P = .008). Sepsis specific International Classification of Diseases, Ninth Revision, Clinical Modification codes identify pediatric patients with severe sepsis in administrative data more accurately than a combination of codes for infection plus organ dysfunction. Copyright © 2015 Elsevier Inc. All rights reserved.

Joint Services Electronics Program

DTIC Science & Technology

1990-07-31

Raghunath , Mandayam M.S. 88 Raman, Shankar M.S. 88 Scheckler, Ed M.S. 88 Song. Joon Ph. D. 88 Tsay, Jcnngang M.S. 89 Tsay, Rcn-Song Ph.D. 89 Vakhshoori...from Planar Resonators," submitted for publication to IEEE Trans. on Microwave Theory and Techniques, on April 17, 1990. Ranade M.T. Raghunath and A.G

Influence of conformational changes on spin crossover properties and superstructure formation in 2D coordination polymers [Fe(hbtz)2(RCN)2](ClO4)2.

PubMed

Książek, Maria; Kusz, Joachim; Białońska, Agata; Bronisz, Robert; Weselski, Marek

2015-11-14

2D structurally related iron(ii) coordination networks {[Fe(hbtz)2(RCN)2](ClO4)2}∞ featuring, besides tetrazol-2-yl rings in the first coordination sphere, also axially coordinated propionitrile or allyl cyanide molecules (R = C3H5-, 1; R = C2H5-, 2) were synthesized. Thermally induced spin crossover (SCO) in 1 takes place in two poorly resolved stages (T(1)1/2(↓) = T(1)1/2(↑) = 198 K, T(2)1/2(↓) = 170 K, T(2)1/2(↑) = 171 K) whereas in 2 complete and relatively gradual one step SCO (T1/2(↓) = T1/2(↑) = 160 K) occurs. Diversification of the SCO properties of the complexes originates from the ability of coordinated allyl cyanide in 1 to undergo conformational alterations, which is not observed for propionitrile molecules in 2. SCO in 1 is accompanied by a non-monotonic change of the contribution of allyl cyanide conformers which is related to reconstruction of the network of intermolecular contacts established between polymeric layers. The coordination network 1 exhibits extraordinary elasticity and in the second stage SCO, accompanied by conformational changes of allyl cyanide, triggers a crystallographic phase transition which leads to the formation of a superstructure. What is important, the formation of the superstructure is not caused by long range ordering of HS and LS iron(ii) ions. The structural alteration is associated with corrugation of the polymeric skeleton and disappearance of nitrile disorder. Irradiation of a single crystal of 1 at 15 K with laser light (520 nm) allowed producing a novel low temperature HS phase of 1 in which, contrary to the high temperature HS phase, disordering of anion and allyl cyanide molecules is not observed and the corrugated nature of the polymeric layer, characteristic of the LS phase, is preserved.

The Impact of Vision in Spatial Coding

ERIC Educational Resources Information Center

Papadopoulos, Konstantinos; Koustriava, Eleni

2011-01-01

The aim of this study is to examine the performance in coding and representing of near-space in relation to vision status (blindness vs. normal vision) and sensory modality (touch vs. vision). Forty-eight children and teenagers participated. Sixteen of the participants were totally blind or had only light perception, 16 were blindfolded sighted…

A Research Coordination Network for Ecological Applications of Terrestrial Laser Scanning

NASA Astrophysics Data System (ADS)

Condon, T. D.; Strahler, A. H.

2016-12-01

Enhancing the development of terrestrial laser scanning for ecological applications is the objective of a Research Coordination Network (RCN) now funded by the US National Science Foundation. The activity has two primary goals: (1) development of a low-cost lidar scanner that will provide accurate estimates of above-ground forest biomass for carbon modeling and monitoring procedures; and (2) development of a range of new ecological applications for TLS, based on rapid forest structure measurements and 3-D reconstructions of forest plots and stands. The network, first constituted in 2015, presently includes 69 participants, including researchers, professors, postdocs, and students at 32 institutions from Australia, Belgium, Canada, China, Finland, Netherlands, Switzerland, United Kingdom, and the United States. It is led by a Steering Committee of 15 researchers from 12 of these institutions. A primary activity of the TLSRCN is to facilitate communication of TLS developments and applications both within the group and to the broader scientific community at meetings and workshops. In 2015, RCN participants presented 27 papers and posters at international meetings and forums, including the Annual Conference of the Remote Sensing and Photogrammetry Society of the UK, SilviLaser 2015, and the Fall Meeting of the AGU. Within the group, bimonthly telecons allow the exchange of recent research developments and planning for group meetings and international conference presentations. Encouraging collaborative publications is also a focus of the RCN; 9 of 11 journal papers published in 2015 that reported TLS research by participants also combined authors from more than one research group participating in the network. The TLSRCN is supported by NSF Grant DBI-1455636 to Boston University, Alan Strahler Principal Investigator. Information for researchers interested in joining the network is available on the TLSRCN web site, tlsrcn.bu.edu. The image below shows a stand of Himalayan cedars at the Australian National Arboretum in Canberra. Acquired by the experimental Dual Wavelength Echidna Lidar, it is produced from the intensity information recorded from the 1556 nm laser (courtesy Michael Schaefer, CSIRO).

Generating a Metal-responsive Transcriptional Regulator to Test What Confers Metal Sensing in Cells*

PubMed Central

Osman, Deenah; Piergentili, Cecilia; Chen, Junjun; Chakrabarti, Buddhapriya; Foster, Andrew W.; Lurie-Luke, Elena; Huggins, Thomas G.; Robinson, Nigel J.

2015-01-01

FrmR from Salmonella enterica serovar typhimurium (a CsoR/RcnR-like transcriptional de-repressor) is shown to repress the frmRA operator-promoter, and repression is alleviated by formaldehyde but not manganese, iron, cobalt, nickel, copper, or Zn(II) within cells. In contrast, repression by a mutant FrmRE64H (which gains an RcnR metal ligand) is alleviated by cobalt and Zn(II). Unexpectedly, FrmR was found to already bind Co(II), Zn(II), and Cu(I), and moreover metals, as well as formaldehyde, trigger an allosteric response that weakens DNA affinity. However, the sensory metal sites of the cells' endogenous metal sensors (RcnR, ZntR, Zur, and CueR) are all tighter than FrmR for their cognate metals. Furthermore, the endogenous metal sensors are shown to out-compete FrmR. The metal-sensing FrmRE64H mutant has tighter metal affinities than FrmR by approximately 1 order of magnitude. Gain of cobalt sensing by FrmRE64H remains enigmatic because the cobalt affinity of FrmRE64H is substantially weaker than that of the endogenous cobalt sensor. Cobalt sensing requires glutathione, which may assist cobalt access, conferring a kinetic advantage. For Zn(II), the metal affinity of FrmRE64H approaches the metal affinities of cognate Zn(II) sensors. Counter-intuitively, the allosteric coupling free energy for Zn(II) is smaller in metal-sensing FrmRE64H compared with nonsensing FrmR. By determining the copies of FrmR and FrmRE64H tetramers per cell, then estimating promoter occupancy as a function of intracellular Zn(II) concentration, we show how a modest tightening of Zn(II) affinity, plus weakened DNA affinity of the apoprotein, conspires to make the relative properties of FrmRE64H (compared with ZntR and Zur) sufficient to sense Zn(II) inside cells. PMID:26109070

Stable Isotope Metabolic Labeling-based Quantitative Phosphoproteomic Analysis of Arabidopsis Mutants Reveals Ethylene-regulated Time-dependent Phosphoproteins and Putative Substrates of Constitutive Triple Response 1 Kinase*

PubMed Central

Yang, Zhu; Guo, Guangyu; Zhang, Manyu; Liu, Claire Y.; Hu, Qin; Lam, Henry; Cheng, Han; Xue, Yu; Li, Jiayang; Li, Ning

2013-01-01

Ethylene is an important plant hormone that regulates numerous cellular processes and stress responses. The mode of action of ethylene is both dose- and time-dependent. Protein phosphorylation plays a key role in ethylene signaling, which is mediated by the activities of ethylene receptors, constitutive triple response 1 (CTR1) kinase, and phosphatase. To address how ethylene alters the cellular protein phosphorylation profile in a time-dependent manner, differential and quantitative phosphoproteomics based on 15N stable isotope labeling in Arabidopsis was performed on both one-minute ethylene-treated Arabidopsis ethylene-overly-sensitive loss-of-function mutant rcn1-1, deficient in PP2A phosphatase activity, and a pair of long-term ethylene-treated wild-type and loss-of-function ethylene signaling ctr1-1 mutants, deficient in mitogen-activated kinase kinase kinase activity. In total, 1079 phosphopeptides were identified, among which 44 were novel. Several one-minute ethylene-regulated phosphoproteins were found from the rcn1-1. Bioinformatic analysis of the rcn1-1 phosphoproteome predicted nine phosphoproteins as the putative substrates for PP2A phosphatase. In addition, from CTR1 kinase-enhanced phosphosites, we also found putative CTR1 kinase substrates including plastid transcriptionally active protein and calcium-sensing receptor. These regulatory proteins are phosphorylated in the presence of ethylene. Analysis of ethylene-regulated phosphosites using the group-based prediction system with a protein–protein interaction filter revealed a total of 14 kinase–substrate relationships that may function in both CTR1 kinase- and PP2A phosphatase-mediated phosphor-relay pathways. Finally, several ethylene-regulated post-translational modification network models have been built using molecular systems biology tools. It is proposed that ethylene regulates the phosphorylation of arginine/serine-rich splicing factor 41, plasma membrane intrinsic protein 2A, light harvesting chlorophyll A/B binding protein 1.1, and flowering bHLH 3 proteins in a dual-and-opposing fashion. PMID:24043427

Gene-Silencing-Induced Changes in Carbohydrate Conformation in Relation to Bioenergy Value and Carbohydrate Subfractions in Modeled Plant (Medicago sativa) with Down-Regulation of HB12 and TT8 Transcription Factors

PubMed Central

Li, Xinxin; Hannoufa, Abdelali; Zhang, Yonggen; Yu, Peiqiang

2016-01-01

Gene silencing with RNA interference (RNAi) technology may be capable of modifying internal structure at a molecular level. This structural modification could affect biofunctions in terms of biodegradation, biochemical metabolism, and bioactive compound availability. The objectives of this study were to (1) Detect gene silencing-induced changes in carbohydrate molecular structure in an alfalfa forage (Medicago sativa spp. sativa: alfalfa) with down-regulation of genes that encode transcription factors TT8 and HB12; (2) Determine gene silencing-induced changes in nutrient bioutilization and bioavailability in the alfalfa forage (Medicago sativa); and (3) Quantify the correlation between gene silencing-induced molecular structure changes and the nutrient bioutilization and bioavailability in animals of ruminants. The experimental treatments included: T1 = Non-transgenic and no-gene silenced alfalfa forage (code “NT”); T2 = HB12-RNAi forage with HB12 gene down regulation (code “HB12”); T3 = TT8-RNAi forage with TT8 gene down regulation (code “TT8”). The HB12 and TT8 gene silencing-induced molecular structure changes were determined by non-invasive and non-destructive advanced molecular spectroscopy in a middle infrared radiation region that focused on structural, non-structural and total carbohydrate compounds. The nutrient bioutilization and bioavailability of the modified forage were determined using NRC-2001 system in terms of total digestive nutrient (TDN), truly digestible fiber (tdNDF), non-fiber carbohydrate (tdNDF), fatty acid (tdFA), crude protein (tdCP) and bioenergy profiles (digestible energy, metabolizable energy, net energy) for ruminants. The carbohydrate subfractions were evaluated using the updated CNCPS 6.0 system. The results showed that gene silencing significantly affected tdNFC (42.3 (NT) vs. 38.7 (HB12) vs. 37.4% Dry Matter (TT8); p = 0.016) and tdCP (20.8 (NT) vs. 19.4 (HB12) vs. 22.3% DM (TT8); p = 0.009). The gene-silencing also affected carbohydrate CA4 (7.4 (NT) vs. 4.2 (HB12) and 4.4% carbohydrate (CHO) (TT8), p = 0.063) and CB1 fractions (5.3 (NT) vs. 2.0 (HB12) and 2.6% CHO (TT8), p = 0.006). The correlation study showed that the structural CHO functional group peak area intensity at ca. 1315 cm−1 was significantly correlated to the TDN1x (r = −0.83, p = 0.042) and the tdNFC (r = −0.83, p = 0.042), the structural CHO functional group height intensity at ca. 1370 cm−1 was significantly correlated to the tdNDF (r = −0.87, p = 0.025). The A_Non-stCHO to A_StCHO ratio and A_Non-stCHO to A_CHO ratio were significantly correlated to the tdFA (r = 0.83–0.91, p < 0.05). As to carbohydrate fractions, both CA4 and CB1 correlated with carbohydrate spectral intensity of the H_1415 and the H_1315 (p = 0.039; p = 0.059, respectively), CB3 tended to correlate with the H_1150, H_1100 and H_1025 (p < 0.10). In conclusion, RNAi-mediated silencing of HB12 and TT8 modified not only inherent CHO molecular structure but also the biofunctions. The CHO molecular structure changes induced by RNAi gene silencing were associated with biofunctions in terms of the carbohydrate subfractions and nutrient digestion. PMID:27187372

Gene-Silencing-Induced Changes in Carbohydrate Conformation in Relation to Bioenergy Value and Carbohydrate Subfractions in Modeled Plant (Medicago sativa) with Down-Regulation of HB12 and TT8 Transcription Factors.

PubMed

Li, Xinxin; Hannoufa, Abdelali; Zhang, Yonggen; Yu, Peiqiang

2016-05-13

Gene silencing with RNA interference (RNAi) technology may be capable of modifying internal structure at a molecular level. This structural modification could affect biofunctions in terms of biodegradation, biochemical metabolism, and bioactive compound availability. The objectives of this study were to (1) Detect gene silencing-induced changes in carbohydrate molecular structure in an alfalfa forage (Medicago sativa spp. sativa: alfalfa) with down-regulation of genes that encode transcription factors TT8 and HB12; (2) Determine gene silencing-induced changes in nutrient bioutilization and bioavailability in the alfalfa forage (Medicago sativa); and (3) Quantify the correlation between gene silencing-induced molecular structure changes and the nutrient bioutilization and bioavailability in animals of ruminants. The experimental treatments included: T1 = Non-transgenic and no-gene silenced alfalfa forage (code "NT"); T2 = HB12-RNAi forage with HB12 gene down regulation (code "HB12"); T3 = TT8-RNAi forage with TT8 gene down regulation (code "TT8"). The HB12 and TT8 gene silencing-induced molecular structure changes were determined by non-invasive and non-destructive advanced molecular spectroscopy in a middle infrared radiation region that focused on structural, non-structural and total carbohydrate compounds. The nutrient bioutilization and bioavailability of the modified forage were determined using NRC-2001 system in terms of total digestive nutrient (TDN), truly digestible fiber (tdNDF), non-fiber carbohydrate (tdNDF), fatty acid (tdFA), crude protein (tdCP) and bioenergy profiles (digestible energy, metabolizable energy, net energy) for ruminants. The carbohydrate subfractions were evaluated using the updated CNCPS 6.0 system. The results showed that gene silencing significantly affected tdNFC (42.3 (NT) vs. 38.7 (HB12) vs. 37.4% Dry Matter (TT8); p = 0.016) and tdCP (20.8 (NT) vs. 19.4 (HB12) vs. 22.3% DM (TT8); p = 0.009). The gene-silencing also affected carbohydrate CA4 (7.4 (NT) vs. 4.2 (HB12) and 4.4% carbohydrate (CHO) (TT8), p = 0.063) and CB1 fractions (5.3 (NT) vs. 2.0 (HB12) and 2.6% CHO (TT8), p = 0.006). The correlation study showed that the structural CHO functional group peak area intensity at ca. 1315 cm(-1) was significantly correlated to the TDN1x (r = -0.83, p = 0.042) and the tdNFC (r = -0.83, p = 0.042), the structural CHO functional group height intensity at ca. 1370 cm(-1) was significantly correlated to the tdNDF (r = -0.87, p = 0.025). The A_Non-stCHO to A_StCHO ratio and A_Non-stCHO to A_CHO ratio were significantly correlated to the tdFA (r = 0.83-0.91, p < 0.05). As to carbohydrate fractions, both CA4 and CB1 correlated with carbohydrate spectral intensity of the H_1415 and the H_1315 (p = 0.039; p = 0.059, respectively), CB3 tended to correlate with the H_1150, H_1100 and H_1025 (p < 0.10). In conclusion, RNAi-mediated silencing of HB12 and TT8 modified not only inherent CHO molecular structure but also the biofunctions. The CHO molecular structure changes induced by RNAi gene silencing were associated with biofunctions in terms of the carbohydrate subfractions and nutrient digestion.

Development and Validity of the Rating Scales of Academic Skills for Reading Comprehension

ERIC Educational Resources Information Center

Shapiro, Edward S.; Gebhardt, Sarah; Flatley, Katie; Guard, Kirra B.; Fu, Qiong; Leichman, Erin S.; Calhoon, Mary Beth; Hojnoski, Robin

2017-01-01

The development and psychometric qualities of a measure using teacher judgment to rate performance in reading comprehension for narrative text is described--the Rating Scales for Academic Skills-Reading Comprehension Narrative (RSAS-RCN). Sixty-five teachers from the third, fourth, and fifth grades of 8 elementary schools completed the measure on…

Foundational Concepts and Underlying Theories for Majors in "Biochemistry and Molecular Biology"

ERIC Educational Resources Information Center

Tansey, John T.; Baird, Teaster, Jr.; Cox, Michael M.; Fox, Kristin M.; Knight, Jennifer; Sears, Duane; Bell, Ellis

2013-01-01

Over the past two years, through an NSF RCN UBE grant, the ASBMB has held regional workshops for faculty members and science educators from around the country that focused on identifying: 1) core principles of biochemistry and molecular biology, 2) essential concepts and underlying theories from physics, chemistry, and mathematics, and 3)…

Alkene epoxidation employing metal nitro complexes

DOEpatents

Andrews, M.A.; Cheng, C.W.; Kelley, K.P.

1982-07-15

Process for converting alkenes to form epoxides utilizes transition metal nitro complexes of the formula: M(RCN)/sub 2/XNO/sub 2/ wherein M is palladium or platinum, R is an alkyl or aryl group containing up to 12 carbon atoms, and X is a monoanionic, monodentate ligand such as chlorine, optionally in the presence of molecular oxygen.

Drosophila muller f elements maintain a distinct set of genomic properties over 40 million years of evolution.

PubMed

Leung, Wilson; Shaffer, Christopher D; Reed, Laura K; Smith, Sheryl T; Barshop, William; Dirkes, William; Dothager, Matthew; Lee, Paul; Wong, Jeannette; Xiong, David; Yuan, Han; Bedard, James E J; Machone, Joshua F; Patterson, Seantay D; Price, Amber L; Turner, Bryce A; Robic, Srebrenka; Luippold, Erin K; McCartha, Shannon R; Walji, Tezin A; Walker, Chelsea A; Saville, Kenneth; Abrams, Marita K; Armstrong, Andrew R; Armstrong, William; Bailey, Robert J; Barberi, Chelsea R; Beck, Lauren R; Blaker, Amanda L; Blunden, Christopher E; Brand, Jordan P; Brock, Ethan J; Brooks, Dana W; Brown, Marie; Butzler, Sarah C; Clark, Eric M; Clark, Nicole B; Collins, Ashley A; Cotteleer, Rebecca J; Cullimore, Peterson R; Dawson, Seth G; Docking, Carter T; Dorsett, Sasha L; Dougherty, Grace A; Downey, Kaitlyn A; Drake, Andrew P; Earl, Erica K; Floyd, Trevor G; Forsyth, Joshua D; Foust, Jonathan D; Franchi, Spencer L; Geary, James F; Hanson, Cynthia K; Harding, Taylor S; Harris, Cameron B; Heckman, Jonathan M; Holderness, Heather L; Howey, Nicole A; Jacobs, Dontae A; Jewell, Elizabeth S; Kaisler, Maria; Karaska, Elizabeth A; Kehoe, James L; Koaches, Hannah C; Koehler, Jessica; Koenig, Dana; Kujawski, Alexander J; Kus, Jordan E; Lammers, Jennifer A; Leads, Rachel R; Leatherman, Emily C; Lippert, Rachel N; Messenger, Gregory S; Morrow, Adam T; Newcomb, Victoria; Plasman, Haley J; Potocny, Stephanie J; Powers, Michelle K; Reem, Rachel M; Rennhack, Jonathan P; Reynolds, Katherine R; Reynolds, Lyndsey A; Rhee, Dong K; Rivard, Allyson B; Ronk, Adam J; Rooney, Meghan B; Rubin, Lainey S; Salbert, Luke R; Saluja, Rasleen K; Schauder, Taylor; Schneiter, Allison R; Schulz, Robert W; Smith, Karl E; Spencer, Sarah; Swanson, Bryant R; Tache, Melissa A; Tewilliager, Ashley A; Tilot, Amanda K; VanEck, Eve; Villerot, Matthew M; Vylonis, Megan B; Watson, David T; Wurzler, Juliana A; Wysocki, Lauren M; Yalamanchili, Monica; Zaborowicz, Matthew A; Emerson, Julia A; Ortiz, Carlos; Deuschle, Frederic J; DiLorenzo, Lauren A; Goeller, Katie L; Macchi, Christopher R; Muller, Sarah E; Pasierb, Brittany D; Sable, Joseph E; Tucci, Jessica M; Tynon, Marykathryn; Dunbar, David A; Beken, Levent H; Conturso, Alaina C; Danner, Benjamin L; DeMichele, Gabriella A; Gonzales, Justin A; Hammond, Maureen S; Kelley, Colleen V; Kelly, Elisabeth A; Kulich, Danielle; Mageeney, Catherine M; McCabe, Nikie L; Newman, Alyssa M; Spaeder, Lindsay A; Tumminello, Richard A; Revie, Dennis; Benson, Jonathon M; Cristostomo, Michael C; DaSilva, Paolo A; Harker, Katherine S; Jarrell, Jenifer N; Jimenez, Luis A; Katz, Brandon M; Kennedy, William R; Kolibas, Kimberly S; LeBlanc, Mark T; Nguyen, Trung T; Nicolas, Daniel S; Patao, Melissa D; Patao, Shane M; Rupley, Bryan J; Sessions, Bridget J; Weaver, Jennifer A; Goodman, Anya L; Alvendia, Erica L; Baldassari, Shana M; Brown, Ashley S; Chase, Ian O; Chen, Maida; Chiang, Scott; Cromwell, Avery B; Custer, Ashley F; DiTommaso, Tia M; El-Adaimi, Jad; Goscinski, Nora C; Grove, Ryan A; Gutierrez, Nestor; Harnoto, Raechel S; Hedeen, Heather; Hong, Emily L; Hopkins, Barbara L; Huerta, Vilma F; Khoshabian, Colin; LaForge, Kristin M; Lee, Cassidy T; Lewis, Benjamin M; Lydon, Anniken M; Maniaci, Brian J; Mitchell, Ryan D; Morlock, Elaine V; Morris, William M; Naik, Priyanka; Olson, Nicole C; Osterloh, Jeannette M; Perez, Marcos A; Presley, Jonathan D; Randazzo, Matt J; Regan, Melanie K; Rossi, Franca G; Smith, Melanie A; Soliterman, Eugenia A; Sparks, Ciani J; Tran, Danny L; Wan, Tiffany; Welker, Anne A; Wong, Jeremy N; Sreenivasan, Aparna; Youngblom, Jim; Adams, Andrew; Alldredge, Justin; Bryant, Ashley; Carranza, David; Cifelli, Alyssa; Coulson, Kevin; Debow, Calise; Delacruz, Noelle; Emerson, Charlene; Farrar, Cassandra; Foret, Don; Garibay, Edgar; Gooch, John; Heslop, Michelle; Kaur, Sukhjit; Khan, Ambreen; Kim, Van; Lamb, Travis; Lindbeck, Peter; Lucas, Gabi; Macias, Elizabeth; Martiniuc, Daniela; Mayorga, Lissett; Medina, Joseph; Membreno, Nelson; Messiah, Shady; Neufeld, Lacey; Nguyen, San Francisco; Nichols, Zachary; Odisho, George; Peterson, Daymon; Rodela, Laura; Rodriguez, Priscilla; Rodriguez, Vanessa; Ruiz, Jorge; Sherrill, Will; Silva, Valeria; Sparks, Jeri; Statton, Geeta; Townsend, Ashley; Valdez, Isabel; Waters, Mary; Westphal, Kyle; Winkler, Stacey; Zumkehr, Joannee; DeJong, Randall J; Hoogewerf, Arlene J; Ackerman, Cheri M; Armistead, Isaac O; Baatenburg, Lara; Borr, Matthew J; Brouwer, Lindsay K; Burkhart, Brandon J; Bushhouse, Kelsey T; Cesko, Lejla; Choi, Tiffany Y Y; Cohen, Heather; Damsteegt, Amanda M; Darusz, Jess M; Dauphin, Cory M; Davis, Yelena P; Diekema, Emily J; Drewry, Melissa; Eisen, Michelle E M; Faber, Hayley M; Faber, Katherine J; Feenstra, Elizabeth; Felzer-Kim, Isabella T; Hammond, Brandy L; Hendriksma, Jesse; Herrold, Milton R; Hilbrands, Julia A; Howell, Emily J; Jelgerhuis, Sarah A; Jelsema, Timothy R; Johnson, Benjamin K; Jones, Kelly K; Kim, Anna; Kooienga, Ross D; Menyes, Erika E; Nollet, Eric A; Plescher, Brittany E; Rios, Lindsay; Rose, Jenny L; Schepers, Allison J; Scott, Geoff; Smith, Joshua R; Sterling, Allison M; Tenney, Jenna C; Uitvlugt, Chris; VanDyken, Rachel E; VanderVennen, Marielle; Vue, Samantha; Kokan, Nighat P; Agbley, Kwabea; Boham, Sampson K; Broomfield, Daniel; Chapman, Kayla; Dobbe, Ali; Dobbe, Ian; Harrington, William; Ibrahem, Marwan; Kennedy, Andre; Koplinsky, Chad A; Kubricky, Cassandra; Ladzekpo, Danielle; Pattison, Claire; Ramirez, Roman E; Wande, Lucia; Woehlke, Sarah; Wawersik, Matthew; Kiernan, Elizabeth; Thompson, Jeffrey S; Banker, Roxanne; Bartling, Justina R; Bhatiya, Chinmoy I; Boudoures, Anna L; Christiansen, Lena; Fosselman, Daniel S; French, Kristin M; Gill, Ishwar S; Havill, Jessen T; Johnson, Jaelyn L; Keny, Lauren J; Kerber, John M; Klett, Bethany M; Kufel, Christina N; May, Francis J; Mecoli, Jonathan P; Merry, Callie R; Meyer, Lauren R; Miller, Emily G; Mullen, Gregory J; Palozola, Katherine C; Pfeil, Jacob J; Thomas, Jessica G; Verbofsky, Evan M; Spana, Eric P; Agarwalla, Anant; Chapman, Julia; Chlebina, Ben; Chong, Insun; Falk, I N; Fitzgibbons, John D; Friedman, Harrison; Ighile, Osagie; Kim, Andrew J; Knouse, Kristin A; Kung, Faith; Mammo, Danny; Ng, Chun Leung; Nikam, Vinayak S; Norton, Diana; Pham, Philip; Polk, Jessica W; Prasad, Shreya; Rankin, Helen; Ratliff, Camille D; Scala, Victoria; Schwartz, Nicholas U; Shuen, Jessica A; Xu, Amy; Xu, Thomas Q; Zhang, Yi; Rosenwald, Anne G; Burg, Martin G; Adams, Stephanie J; Baker, Morgan; Botsford, Bobbi; Brinkley, Briana; Brown, Carter; Emiah, Shadie; Enoch, Erica; Gier, Chad; Greenwell, Alyson; Hoogenboom, Lindsay; Matthews, Jordan E; McDonald, Mitchell; Mercer, Amanda; Monsma, Nicholaus; Ostby, Kristine; Ramic, Alen; Shallman, Devon; Simon, Matthew; Spencer, Eric; Tomkins, Trisha; Wendland, Pete; Wylie, Anna; Wolyniak, Michael J; Robertson, Gregory M; Smith, Samuel I; DiAngelo, Justin R; Sassu, Eric D; Bhalla, Satish C; Sharif, Karim A; Choeying, Tenzin; Macias, Jason S; Sanusi, Fareed; Torchon, Karvyn; Bednarski, April E; Alvarez, Consuelo J; Davis, Kristen C; Dunham, Carrie A; Grantham, Alaina J; Hare, Amber N; Schottler, Jennifer; Scott, Zackary W; Kuleck, Gary A; Yu, Nicole S; Kaehler, Marian M; Jipp, Jacob; Overvoorde, Paul J; Shoop, Elizabeth; Cyrankowski, Olivia; Hoover, Betsy; Kusner, Matt; Lin, Devry; Martinov, Tijana; Misch, Jonathan; Salzman, Garrett; Schiedermayer, Holly; Snavely, Michael; Zarrasola, Stephanie; Parrish, Susan; Baker, Atlee; Beckett, Alissa; Belella, Carissa; Bryant, Julie; Conrad, Turner; Fearnow, Adam; Gomez, Carolina; Herbstsomer, Robert A; Hirsch, Sarah; Johnson, Christen; Jones, Melissa; Kabaso, Rita; Lemmon, Eric; Vieira, Carolina Marques Dos Santos; McFarland, Darryl; McLaughlin, Christopher; Morgan, Abbie; Musokotwane, Sepo; Neutzling, William; Nietmann, Jana; Paluskievicz, Christina; Penn, Jessica; Peoples, Emily; Pozmanter, Caitlin; Reed, Emily; Rigby, Nichole; Schmidt, Lasse; Shelton, Micah; Shuford, Rebecca; Tirasawasdichai, Tiara; Undem, Blair; Urick, Damian; Vondy, Kayla; Yarrington, Bryan; Eckdahl, Todd T; Poet, Jeffrey L; Allen, Alica B; Anderson, John E; Barnett, Jason M; Baumgardner, Jordan S; Brown, Adam D; Carney, Jordan E; Chavez, Ramiro A; Christgen, Shelbi L; Christie, Jordan S; Clary, Andrea N; Conn, Michel A; Cooper, Kristen M; Crowley, Matt J; Crowley, Samuel T; Doty, Jennifer S; Dow, Brian A; Edwards, Curtis R; Elder, Darcie D; Fanning, John P; Janssen, Bridget M; Lambright, Anthony K; Lane, Curtiss E; Limle, Austin B; Mazur, Tammy; McCracken, Marly R; McDonough, Alexa M; Melton, Amy D; Minnick, Phillip J; Musick, Adam E; Newhart, William H; Noynaert, Joseph W; Ogden, Bradley J; Sandusky, Michael W; Schmuecker, Samantha M; Shipman, Anna L; Smith, Anna L; Thomsen, Kristen M; Unzicker, Matthew R; Vernon, William B; Winn, Wesley W; Woyski, Dustin S; Zhu, Xiao; Du, Chunguang; Ament, Caitlin; Aso, Soham; Bisogno, Laura Simone; Caronna, Jason; Fefelova, Nadezhda; Lopez, Lenin; Malkowitz, Lorraine; Marra, Jonathan; Menillo, Daniella; Obiorah, Ifeanyi; Onsarigo, Eric Nyabeta; Primus, Shekerah; Soos, Mahdi; Tare, Archana; Zidan, Ameer; Jones, Christopher J; Aronhalt, Todd; Bellush, James M; Burke, Christa; DeFazio, Steve; Does, Benjamin R; Johnson, Todd D; Keysock, Nicholas; Knudsen, Nelson H; Messler, James; Myirski, Kevin; Rekai, Jade Lea; Rempe, Ryan Michael; Salgado, Michael S; Stagaard, Erica; Starcher, Justin R; Waggoner, Andrew W; Yemelyanova, Anastasia K; Hark, Amy T; Bertolet, Anne; Kuschner, Cyrus E; Parry, Kesley; Quach, Michael; Shantzer, Lindsey; Shaw, Mary E; Smith, Mary A; Glenn, Omolara; Mason, Portia; Williams, Charlotte; Key, S Catherine Silver; Henry, Tyneshia C P; Johnson, Ashlee G; White, Jackie X; Haberman, Adam; Asinof, Sam; Drumm, Kelly; Freeburg, Trip; Safa, Nadia; Schultz, Darrin; Shevin, Yakov; Svoronos, Petros; Vuong, Tam; Wellinghoff, Jules; Hoopes, Laura L M; Chau, Kim M; Ward, Alyssa; Regisford, E Gloria C; Augustine, LaJerald; Davis-Reyes, Brionna; Echendu, Vivienne; Hales, Jasmine; Ibarra, Sharon; Johnson, Lauriaun; Ovu, Steven; Braverman, John M; Bahr, Thomas J; Caesar, Nicole M; Campana, Christopher; Cassidy, Daniel W; Cognetti, Peter A; English, Johnathan D; Fadus, Matthew C; Fick, Cameron N; Freda, Philip J; Hennessy, Bryan M; Hockenberger, Kelsey; Jones, Jennifer K; King, Jessica E; Knob, Christopher R; Kraftmann, Karen J; Li, Linghui; Lupey, Lena N; Minniti, Carl J; Minton, Thomas F; Moran, Joseph V; Mudumbi, Krishna; Nordman, Elizabeth C; Puetz, William J; Robinson, Lauren M; Rose, Thomas J; Sweeney, Edward P; Timko, Ashley S; Paetkau, Don W; Eisler, Heather L; Aldrup, Megan E; Bodenberg, Jessica M; Cole, Mara G; Deranek, Kelly M; DeShetler, Megan; Dowd, Rose M; Eckardt, Alexandra K; Ehret, Sharon C; Fese, Jessica; Garrett, Amanda D; Kammrath, Anna; Kappes, Michelle L; Light, Morgan R; Meier, Anne C; O'Rouke, Allison; Perella, Mallory; Ramsey, Kimberley; Ramthun, Jennifer R; Reilly, Mary T; Robinett, Deirdre; Rossi, Nadine L; Schueler, Mary Grace; Shoemaker, Emma; Starkey, Kristin M; Vetor, Ashley; Vrable, Abby; Chandrasekaran, Vidya; Beck, Christopher; Hatfield, Kristen R; Herrick, Douglas A; Khoury, Christopher B; Lea, Charlotte; Louie, Christopher A; Lowell, Shannon M; Reynolds, Thomas J; Schibler, Jeanine; Scoma, Alexandra H; Smith-Gee, Maxwell T; Tuberty, Sarah; Smith, Christopher D; Lopilato, Jane E; Hauke, Jeanette; Roecklein-Canfield, Jennifer A; Corrielus, Maureen; Gilman, Hannah; Intriago, Stephanie; Maffa, Amanda; Rauf, Sabya A; Thistle, Katrina; Trieu, Melissa; Winters, Jenifer; Yang, Bib; Hauser, Charles R; Abusheikh, Tariq; Ashrawi, Yara; Benitez, Pedro; Boudreaux, Lauren R; Bourland, Megan; Chavez, Miranda; Cruz, Samantha; Elliott, GiNell; Farek, Jesse R; Flohr, Sarah; Flores, Amanda H; Friedrichs, Chelsey; Fusco, Zach; Goodwin, Zane; Helmreich, Eric; Kiley, John; Knepper, John Mark; Langner, Christine; Martinez, Megan; Mendoza, Carlos; Naik, Monal; Ochoa, Andrea; Ragland, Nicolas; Raimey, England; Rathore, Sunil; Reza, Evangelina; Sadovsky, Griffin; Seydoux, Marie-Isabelle B; Smith, Jonathan E; Unruh, Anna K; Velasquez, Vicente; Wolski, Matthew W; Gosser, Yuying; Govind, Shubha; Clarke-Medley, Nicole; Guadron, Leslie; Lau, Dawn; Lu, Alvin; Mazzeo, Cheryl; Meghdari, Mariam; Ng, Simon; Pamnani, Brad; Plante, Olivia; Shum, Yuki Kwan Wa; Song, Roy; Johnson, Diana E; Abdelnabi, Mai; Archambault, Alexi; Chamma, Norma; Gaur, Shailly; Hammett, Deborah; Kandahari, Adrese; Khayrullina, Guzal; Kumar, Sonali; Lawrence, Samantha; Madden, Nigel; Mandelbaum, Max; Milnthorp, Heather; Mohini, Shiv; Patel, Roshni; Peacock, Sarah J; Perling, Emily; Quintana, Amber; Rahimi, Michael; Ramirez, Kristen; Singhal, Rishi; Weeks, Corinne; Wong, Tiffany; Gillis, Aubree T; Moore, Zachary D; Savell, Christopher D; Watson, Reece; Mel, Stephanie F; Anilkumar, Arjun A; Bilinski, Paul; Castillo, Rostislav; Closser, Michael; Cruz, Nathalia M; Dai, Tiffany; Garbagnati, Giancarlo F; Horton, Lanor S; Kim, Dongyeon; Lau, Joyce H; Liu, James Z; Mach, Sandy D; Phan, Thu A; Ren, Yi; Stapleton, Kenneth E; Strelitz, Jean M; Sunjed, Ray; Stamm, Joyce; Anderson, Morgan C; Bonifield, Bethany Grace; Coomes, Daniel; Dillman, Adam; Durchholz, Elaine J; Fafara-Thompson, Antoinette E; Gross, Meleah J; Gygi, Amber M; Jackson, Lesley E; Johnson, Amy; Kocsisova, Zuzana; Manghelli, Joshua L; McNeil, Kylie; Murillo, Michael; Naylor, Kierstin L; Neely, Jessica; Ogawa, Emmy E; Rich, Ashley; Rogers, Anna; Spencer, J Devin; Stemler, Kristina M; Throm, Allison A; Van Camp, Matt; Weihbrecht, Katie; Wiles, T Aaron; Williams, Mallory A; Williams, Matthew; Zoll, Kyle; Bailey, Cheryl; Zhou, Leming; Balthaser, Darla M; Bashiri, Azita; Bower, Mindy E; Florian, Kayla A; Ghavam, Nazanin; Greiner-Sosanko, Elizabeth S; Karim, Helmet; Mullen, Victor W; Pelchen, Carly E; Yenerall, Paul M; Zhang, Jiayu; Rubin, Michael R; Arias-Mejias, Suzette M; Bermudez-Capo, Armando G; Bernal-Vega, Gabriela V; Colon-Vazquez, Mariela; Flores-Vazquez, Arelys; Gines-Rosario, Mariela; Llavona-Cartagena, Ivan G; Martinez-Rodriguez, Javier O; Ortiz-Fuentes, Lionel; Perez-Colomba, Eliezer O; Perez-Otero, Joseph; Rivera, Elisandra; Rodriguez-Giron, Luke J; Santiago-Sanabria, Arnaldo J; Senquiz-Gonzalez, Andrea M; delValle, Frank R Soto; Vargas-Franco, Dorianmarie; Velázquez-Soto, Karla I; Zambrana-Burgos, Joan D; Martinez-Cruzado, Juan Carlos; Asencio-Zayas, Lillyann; Babilonia-Figueroa, Kevin; Beauchamp-Pérez, Francis D; Belén-Rodríguez, Juliana; Bracero-Quiñones, Luciann; Burgos-Bula, Andrea P; Collado-Méndez, Xavier A; Colón-Cruz, Luis R; Correa-Muller, Ana I; Crooke-Rosado, Jonathan L; Cruz-García, José M; Defendini-Ávila, Marianna; Delgado-Peraza, Francheska M; Feliciano-Cancela, Alex J; Gónzalez-Pérez, Valerie M; Guiblet, Wilfried; Heredia-Negrón, Aldo; Hernández-Muñiz, Jennifer; Irizarry-González, Lourdes N; Laboy-Corales, Ángel L; Llaurador-Caraballo, Gabriela A; Marín-Maldonado, Frances; Marrero-Llerena, Ulises; Martell-Martínez, Héctor A; Martínez-Traverso, Idaliz M; Medina-Ortega, Kiara N; Méndez-Castellanos, Sonya G; Menéndez-Serrano, Krizia C; Morales-Caraballo, Carol I; Ortiz-DeChoudens, Saryleine; Ortiz-Ortiz, Patricia; Pagán-Torres, Hendrick; Pérez-Afanador, Diana; Quintana-Torres, Enid M; Ramírez-Aponte, Edwin G; Riascos-Cuero, Carolina; Rivera-Llovet, Michelle S; Rivera-Pagán, Ingrid T; Rivera-Vicéns, Ramón E; Robles-Juarbe, Fabiola; Rodríguez-Bonilla, Lorraine; Rodríguez-Echevarría, Brian O; Rodríguez-García, Priscila M; Rodríguez-Laboy, Abneris E; Rodríguez-Santiago, Susana; Rojas-Vargas, Michael L; Rubio-Marrero, Eva N; Santiago-Colón, Albeliz; Santiago-Ortiz, Jorge L; Santos-Ramos, Carlos E; Serrano-González, Joseline; Tamayo-Figueroa, Alina M; Tascón-Peñaranda, Edna P; Torres-Castillo, José L; Valentín-Feliciano, Nelson A; Valentín-Feliciano, Yashira M; Vargas-Barreto, Nadyan M; Vélez-Vázquez, Miguel; Vilanova-Vélez, Luis R; Zambrana-Echevarría, Cristina; MacKinnon, Christy; Chung, Hui-Min; Kay, Chris; Pinto, Anthony; Kopp, Olga R; Burkhardt, Joshua; Harward, Chris; Allen, Robert; Bhat, Pavan; Chang, Jimmy Hsiang-Chun; Chen, York; Chesley, Christopher; Cohn, Dara; DuPuis, David; Fasano, Michael; Fazzio, Nicholas; Gavinski, Katherine; Gebreyesus, Heran; Giarla, Thomas; Gostelow, Marcus; Greenstein, Rachel; Gunasinghe, Hashini; Hanson, Casey; Hay, Amanda; He, Tao Jian; Homa, Katie; Howe, Ruth; Howenstein, Jeff; Huang, Henry; Khatri, Aaditya; Kim, Young Lu; Knowles, Olivia; Kong, Sarah; Krock, Rebecca; Kroll, Matt; Kuhn, Julia; Kwong, Matthew; Lee, Brandon; Lee, Ryan; Levine, Kevin; Li, Yedda; Liu, Bo; Liu, Lucy; Liu, Max; Lousararian, Adam; Ma, Jimmy; Mallya, Allyson; Manchee, Charlie; Marcus, Joseph; McDaniel, Stephen; Miller, Michelle L; Molleston, Jerome M; Diez, Cristina Montero; Ng, Patrick; Ngai, Natalie; Nguyen, Hien; Nylander, Andrew; Pollack, Jason; Rastogi, Suchita; Reddy, Himabindu; Regenold, Nathaniel; Sarezky, Jon; Schultz, Michael; Shim, Jien; Skorupa, Tara; Smith, Kenneth; Spencer, Sarah J; Srikanth, Priya; Stancu, Gabriel; Stein, Andrew P; Strother, Marshall; Sudmeier, Lisa; Sun, Mengyang; Sundaram, Varun; Tazudeen, Noor; Tseng, Alan; Tzeng, Albert; Venkat, Rohit; Venkataram, Sandeep; Waldman, Leah; Wang, Tracy; Yang, Hao; Yu, Jack Y; Zheng, Yin; Preuss, Mary L; Garcia, Angelica; Juergens, Matt; Morris, Robert W; Nagengast, Alexis A; Azarewicz, Julie; Carr, Thomas J; Chichearo, Nicole; Colgan, Mike; Donegan, Megan; Gardner, Bob; Kolba, Nik; Krumm, Janice L; Lytle, Stacey; MacMillian, Laurell; Miller, Mary; Montgomery, Andrew; Moretti, Alysha; Offenbacker, Brittney; Polen, Mike; Toth, John; Woytanowski, John; Kadlec, Lisa; Crawford, Justin; Spratt, Mary L; Adams, Ashley L; Barnard, Brianna K; Cheramie, Martin N; Eime, Anne M; Golden, Kathryn L; Hawkins, Allyson P; Hill, Jessica E; Kampmeier, Jessica A; Kern, Cody D; Magnuson, Emily E; Miller, Ashley R; Morrow, Cody M; Peairs, Julia C; Pickett, Gentry L; Popelka, Sarah A; Scott, Alexis J; Teepe, Emily J; TerMeer, Katie A; Watchinski, Carmen A; Watson, Lucas A; Weber, Rachel E; Woodard, Kate A; Barnard, Daron C; Appiah, Isaac; Giddens, Michelle M; McNeil, Gerard P; Adebayo, Adeola; Bagaeva, Kate; Chinwong, Justina; Dol, Chrystel; George, Eunice; Haltaufderhyde, Kirk; Haye, Joanna; Kaur, Manpreet; Semon, Max; Serjanov, Dmitri; Toorie, Anika; Wilson, Christopher; Riddle, Nicole C; Buhler, Jeremy; Mardis, Elaine R; Elgin, Sarah C R

2015-03-04

The Muller F element (4.2 Mb, ~80 protein-coding genes) is an unusual autosome of Drosophila melanogaster; it is mostly heterochromatic with a low recombination rate. To investigate how these properties impact the evolution of repeats and genes, we manually improved the sequence and annotated the genes on the D. erecta, D. mojavensis, and D. grimshawi F elements and euchromatic domains from the Muller D element. We find that F elements have greater transposon density (25-50%) than euchromatic reference regions (3-11%). Among the F elements, D. grimshawi has the lowest transposon density (particularly DINE-1: 2% vs. 11-27%). F element genes have larger coding spans, more coding exons, larger introns, and lower codon bias. Comparison of the Effective Number of Codons with the Codon Adaptation Index shows that, in contrast to the other species, codon bias in D. grimshawi F element genes can be attributed primarily to selection instead of mutational biases, suggesting that density and types of transposons affect the degree of local heterochromatin formation. F element genes have lower estimated DNA melting temperatures than D element genes, potentially facilitating transcription through heterochromatin. Most F element genes (~90%) have remained on that element, but the F element has smaller syntenic blocks than genome averages (3.4-3.6 vs. 8.4-8.8 genes per block), indicating greater rates of inversion despite lower rates of recombination. Overall, the F element has maintained characteristics that are distinct from other autosomes in the Drosophila lineage, illuminating the constraints imposed by a heterochromatic milieu. Copyright © 2015 Leung et al.

Augmenting Qualitative Text Analysis with Natural Language Processing: Methodological Study.

PubMed

Guetterman, Timothy C; Chang, Tammy; DeJonckheere, Melissa; Basu, Tanmay; Scruggs, Elizabeth; Vydiswaran, V G Vinod

2018-06-29

Qualitative research methods are increasingly being used across disciplines because of their ability to help investigators understand the perspectives of participants in their own words. However, qualitative analysis is a laborious and resource-intensive process. To achieve depth, researchers are limited to smaller sample sizes when analyzing text data. One potential method to address this concern is natural language processing (NLP). Qualitative text analysis involves researchers reading data, assigning code labels, and iteratively developing findings; NLP has the potential to automate part of this process. Unfortunately, little methodological research has been done to compare automatic coding using NLP techniques and qualitative coding, which is critical to establish the viability of NLP as a useful, rigorous analysis procedure. The purpose of this study was to compare the utility of a traditional qualitative text analysis, an NLP analysis, and an augmented approach that combines qualitative and NLP methods. We conducted a 2-arm cross-over experiment to compare qualitative and NLP approaches to analyze data generated through 2 text (short message service) message survey questions, one about prescription drugs and the other about police interactions, sent to youth aged 14-24 years. We randomly assigned a question to each of the 2 experienced qualitative analysis teams for independent coding and analysis before receiving NLP results. A third team separately conducted NLP analysis of the same 2 questions. We examined the results of our analyses to compare (1) the similarity of findings derived, (2) the quality of inferences generated, and (3) the time spent in analysis. The qualitative-only analysis for the drug question (n=58) yielded 4 major findings, whereas the NLP analysis yielded 3 findings that missed contextual elements. The qualitative and NLP-augmented analysis was the most comprehensive. For the police question (n=68), the qualitative-only analysis yielded 4 primary findings and the NLP-only analysis yielded 4 slightly different findings. Again, the augmented qualitative and NLP analysis was the most comprehensive and produced the highest quality inferences, increasing our depth of understanding (ie, details and frequencies). In terms of time, the NLP-only approach was quicker than the qualitative-only approach for the drug (120 vs 270 minutes) and police (40 vs 270 minutes) questions. An approach beginning with qualitative analysis followed by qualitative- or NLP-augmented analysis took longer time than that beginning with NLP for both drug (450 vs 240 minutes) and police (390 vs 220 minutes) questions. NLP provides both a foundation to code qualitatively more quickly and a method to validate qualitative findings. NLP methods were able to identify major themes found with traditional qualitative analysis but were not useful in identifying nuances. Traditional qualitative text analysis added important details and context. ©Timothy C Guetterman, Tammy Chang, Melissa DeJonckheere, Tanmay Basu, Elizabeth Scruggs, VG Vinod Vydiswaran. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 29.06.2018.

Tibia shaft fractures: costly burden of nonunions

PubMed Central

2013-01-01

Background Tibia shaft fractures (TSF) are common for men and women and cause substantial morbidity, healthcare use, and costs. The impact of nonunions on healthcare use and costs is poorly described. Our goal was to investigate patient characteristics and healthcare use and costs associated with TSF in patients with and without nonunion. Methods We retrospectively analyzed medical claims in large U.S. managed care claims databases (Thomson Reuters MarketScan®, 16 million lives). We studied patients ≥ 18 years old with a TSF diagnosis (ICD-9 codes: 823.20, 823.22, 823.30, 823.32) in 2006 with continuous pharmaceutical and medical benefit enrollment 1 year prior and 2 years post-fracture. Nonunion was defined by ICD-9 code 733.82 (after the TSF date). Results Among the 853 patients with TSF, 99 (12%) had nonunion. Patients with nonunion had more comorbidities (30 vs. 21, pre-fracture) and were more likely to have their TSF open (87% vs. 70%) than those without nonunion. Patients with nonunion were more likely to have additional fractures during the 2-year follow-up (of lower limb [88.9% vs. 69.5%, P < 0.001], spine or trunk [16.2% vs. 7.2%, P = 0.002], and skull [5.1% vs. 1.3%, P = 0.008]) than those without nonunion. Nonunion patients were more likely to use various types of surgical care, inpatient care (tibia and non-tibia related: 65% vs. 40%, P < 0.001) and outpatient physical therapy (tibia-related: 60% vs. 42%, P < 0.001) than those without nonunion. All categories of care (except emergency room costs) were more expensive in nonunion patients than in those without nonunion: median total care cost $25,556 vs. $11,686, P < 0.001. Nonunion patients were much more likely to be prescribed pain medications (99% vs. 92%, P = 0.009), especially strong opioids (90% vs. 76.4%, P = 0.002) and had longer length of opioid therapy (5.4 months vs. 2.8 months, P < 0.001) than patients without nonunion. Tibia fracture patterns in men differed from those in women. Conclusions Nonunions in TSF’s are associated with substantial healthcare resource use, common use of strong opioids, and high per-patient costs. Open fractures are associated with higher likelihood of nonunion than closed ones. Effective screening of nonunion risk may decrease this morbidity and subsequent healthcare resource use and costs. PMID:23351958

The Expenditures for Academic Inpatient Care of Inflammatory Bowel Disease Patients Are Almost Double Compared with Average Academic Gastroenterology and Hepatology Cases and Not Fully Recovered by Diagnosis-Related Group (DRG) Proceeds.

PubMed

Baumgart, Daniel C; le Claire, Marie

2016-01-01

Crohn's disease (CD) and ulcerative colitis (UC) challenge economies worldwide. Detailed health economic data of DRG based academic inpatient care for inflammatory bowel disease (IBD) patients in Europe is unavailable. IBD was identified through ICD-10 K50 and K51 code groups. We took an actual costing approach, compared expenditures to G-DRG and non-DRG proceeds and performed detailed cost center and type accounting to identify coverage determinants. Of all 3093 hospitalized cases at our department, 164 were CD and 157 UC inpatients in 2012. On average, they were 44.1 (CD 44.9 UC 43.3 all 58) years old, stayed 10.1 (CD 11.8 UC 8.4 vs. all 8) days, carried 5.8 (CD 6.4 UC 5.2 vs. all 6.8) secondary diagnoses, received 7.4 (CD 7.7 UC 7 vs. all 6.2) procedures, had a higher cost weight (CD 2.8 UC 2.4 vs. all 1.6) and required more intense nursing. Their care was more costly (means: total cost IBD 8477€ CD 9051€ UC 7903€ vs. all 5078€). However, expenditures were not fully recovered by DRG proceeds (means: IBD 7413€, CD 8441€, UC 6384€ vs all 4758€). We discovered substantial disease specific mismatches in cost centers and types and identified the medical ward personnel and materials budgets to be most imbalanced. Non-DRG proceeds were almost double (IBD 16.1% vs. all 8.2%), but did not balance deficits at total coverage analysis, that found medications (antimicrobials, biologics and blood products), medical materials (mostly endoscopy items) to contribute most to the deficit. DRGs challenge sophisticated IBD care.

Dissociation energies of the hydrogen-bonded dimers RCN-HF (R = CH3, HCC) determined by rotational spectroscopy

NASA Astrophysics Data System (ADS)

Legon, A. C.; Millen, D. J.; North, Hazel M.

1987-03-01

The zero-point and equilibrium dissociation energies (D0 and De) of the hydrogen-bonded dimers CH3CN-HF and HCCCN-HF are determined experimentally on the basis of absolute intensity measurements of selected rotational transitions. A Stark-modulated microwave spectrometer is employed with the cooled absorption cell described by Legon et al. (1980). The results are presented in tables and analyzed. Energies determined are D0 = 26.1(0.6) kJ/mol and De = 29.0(0.9) kJ/mol for CH3CN-HF and D0 = 20.4(0.7) kJ/mol and De = 23.4(0.9) kJ/mol for HCCCN-HF. Theoretical De values calculated using the Morse potential function are found to be in much better agreement with the experimental results than those calculated with the Lennard-Jones potential function.

Comparison of Transferred Versus Nontransferred Pediatric Patients Admitted for Sepsis.

PubMed

Hsu, Benson S; Schimelpfenig, Michelle; Lakhani, Saquib

2016-01-01

Little is known about the characteristics of pediatric patients transferred for medical care. Thus, we aimed to compare pediatric patients admitted for sepsis as transfers versus those who were not admitted as transfers. Retrospective study using The Agency for Healthcare Research and Quality 2009 Kids' Inpatient Database. Inclusion diagnosis of sepsis based on an All Patient Refined Diagnosis-Related Group of 720: Septicemia & Disseminated Infections resulted in 16,894 patients. Transfer status was based on admission codes. Weighted statistical analysis was conducted using STATA 12.1 (Stata Corporation, College Station, TX). Institutional review board approval was obtained. Weighted analysis found significant differences between transferred versus nontransferred patients in the following areas: highest severity of illness subclass (45.1% vs. 18.7%, P < .001), number of chronic conditions (2.0 vs. 1.5, P < .001), teaching hospital status (85.9% vs. 54.8%, P < .001), length of stay (10.8 vs. 6.5, p<.001), number of procedures (2.9 vs. 1.4, P < .001), mortality (8.4% vs. 3.2%, P < .001), total costs ($30,626 vs. $13,677, P < .001), and daily costs ($2,901 vs. $1,887, P < .001). Our study found that patients diagnosed with sepsis and transferred are more severely ill with a higher number of chronic conditions, longer lengths of stay, more procedures performed, higher mortality, and higher total and daily costs. Copyright © 2016 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

Polyomavirus BK non-coding control region rearrangements in health and disease.

PubMed

Sharma, Preety M; Gupta, Gaurav; Vats, Abhay; Shapiro, Ron; Randhawa, Parmjeet S

2007-08-01

BK virus is an increasingly recognized pathogen in transplanted patients. DNA sequencing of this virus shows considerable genomic variability. To understand the clinical significance of rearrangements in the non-coding control region (NCCR) of BK virus (BKV), we report a meta-analysis of 507 sequences, including 40 sequences generated in our own laboratory, for associations between rearrangements and disease, tissue tropism, geographic origin, and viral genotype. NCCR rearrangements were less frequent in (a) asymptomatic BKV viruria compared to patients viral nephropathy (1.7% vs. 22.5%), and (b) viral genotype 1 compared to other genotypes (2.4% vs. 11.2%). Rearrangements were commoner in malignancy (78.6%), and Norwegians (45.7%), and less common in East Indians (0%), and Japanese (4.3%). A surprising number of rearranged sequences were reported from mononuclear cells of healthy subjects, whereas most plasma sequences were archetypal. This difference could not be related to potential recombinase activity in lymphocytes, as consensus recombination signal sequences could not be found in the NCCR region. NCCR rearrangements are neither required nor a sufficient condition to produce clinical disease. BKV nephropathy and hemorrhagic cystitis are not associated with any unique NCCR configuration or nucleotide sequence.

Economic burden of gouty arthritis attacks for employees with frequent and infrequent attacks.

PubMed

Lynch, Wendy; Chan, Wing; Kleinman, Nathan; Andrews, L M; Yadao, Anthony M

2013-04-01

The objective of this study was to compare episode-related and annual costs and work absence days for employees with <3 versus ≥ 3 annual gout attacks. Human Capital Management Services data (2009-2010) from adult employees with gout (International Classification of Diseases, Ninth Revision code 274.x) and ≥ 12 months of medical and pharmacy benefits were studied. Outcomes of interest included medical and drug costs, number of emergency department and urgent care visits, number of inpatient days, short- and long-term disability, sick leave, workers' compensation costs, and work absence days. An algorithm based on diagnosis code and antigout medication use identified acute gout treatment episodes. Multivariate analysis compared annual and pre-episode vs. during-episode outcomes for employees with ≥ 3 vs. <3 gout annual attacks. Of 3361 employees with gout, 76 had ≥ 3 attacks; these employees had higher short-term disability costs ($1663 vs. $643, P=0.06) and days (11.68 versus 4.61, P<0.05), more emergency room visits (0.55 vs. 0.23, P<0.0001), and urgent care visits (0.07 vs. 0.04, P<0.01), and lower pharmacy costs ($1677 vs. $1108, P<0.0001) than those with <3 attacks. Medical costs both before ($203 higher) and during attacks ($136 higher) were significantly higher for those with ≥ 3 attacks than for those with <3 attacks. Additionally, a quadratic increasing relationship was found between number of attacks and cost. Frequency of acute gout attacks (≥ 3 episodes per year) among employees with gout was associated with greater short-term disability cost, absence days, and emergency department and urgent care visits, and trends toward higher overall costs.

Treatment plan comparison in acute and chronic respiratory tract diseases: an observational study of doxophylline vs. theophylline.

PubMed

Mennini, F S; Sciattella, P; Marcellusi, A; Marcobelli, A; Russo, A; Caputi, A P

2017-10-01

The main objective of this article is to estimate the global cost related to the use of the two drugs (associated drugs, specialist visits, hospital admissions, plasma drug monitoring). The drug prescriptions were extracted from the Information System of the Pharmaceutical Prescriptions of the Marche Region for each ATC code in the years 2008-2012 and the number of patients per year and other outcomes measure were obtained. 13,574 patients were treated with theophylline and 19,426 patients with doxophylline. The number of patients treated was approximately 5,000 per year. Co-prescription with other drugs, use of corticosteroids, mean number of visits and hospital admissions (per 100 patients) were lower for doxophylline vs theophylline (1.55vs5.50, 0.3vs0.7, 2.05vs3.73 and 1.57vs3.3 respectively). The annual mean cost per patient was €187.4 for those treated with doxophylline and €513.5 for theophylline. In our study, doxophylline resulted to be associated with a reduction of the overall cost.

Seacole statue is a triumph for hope over hate.

PubMed

2016-07-06

During the RCN congress debate on whether the UK should leave the European Union, prominent college activist Jason Warriner said that nurses would play a vital role in 'healing the nation' after the vote, whatever the outcome. Unfortunately his prophecy has proved to be correct, with the UK being divided in way that few of us have experienced before.

From demons to professionals.

PubMed

2008-04-01

Nursing Older People is the proud sponsor of a fringe event at this year's annual RCN congress which opens in Bournemouth this month. The title of the seminar is Angels and demons - dignity at the heart of nursing* and it aims to discuss the metamorphosis of nurses from 'angels' to 'demons' in the eyes of the media and the public over the past year.

Essential Concepts and Underlying Theories from Physics, Chemistry, and Mathematics for "Biochemistry and Molecular Biology" Majors

ERIC Educational Resources Information Center

Wright, Ann; Provost, Joseph; Roecklein-Canfield, Jennifer A.; Bell, Ellis

2013-01-01

Over the past two years, through an NSF RCN UBE grant, the ASBMB has held regional workshops for faculty members from around the country. The workshops have focused on developing lists of Core Principles or Foundational Concepts in Biochemistry and Molecular Biology, a list of foundational skills, and foundational concepts from Physics, Chemistry,…

Challenging the balance of power: patient empowerment.

PubMed

Hewitt-Taylor, Jaquelina

Empowering patients is a central element of nursing care, according to the RCN (2003). This article discusses the reality of changing the balance of power in health care, awareness of types of knowledge and the ways in which power may consciously or subconsciously be used. It also includes awareness of the financial and political aspects of health care and how these affect patient choice.

PubMed

2007-07-01

Award winning: A&E staff nurse Linsey Sheerin is among the four nurses who last month received commendations as part of the RCN Northern Ireland Nurse of the Year awards 2007. Ms Sheering, who works at the Mater Hospital, Belfast, was commended for her involvement in a project to enhance the knowledge and skills of A&E nursing staff in assessing and providing care to people with learning disabilities.

Evaluation of clinical coding data to determine causes of critical bleeding in patients receiving massive transfusion: a bi-national, multicentre, cross-sectional study.

PubMed

McQuilten, Z K; Zatta, A J; Andrianopoulos, N; Aoki, N; Stevenson, L; Badami, K G; Bird, R; Cole-Sinclair, M F; Hurn, C; Cameron, P A; Isbister, J P; Phillips, L E; Wood, E M

2017-04-01

To evaluate the use of routinely collected data to determine the cause(s) of critical bleeding in patients who receive massive transfusion (MT). Routinely collected data are increasingly being used to describe and evaluate transfusion practice. Chart reviews were undertaken on 10 randomly selected MT patients at 48 hospitals across Australia and New Zealand to determine the cause(s) of critical bleeding. Diagnosis-related group (DRG) and International Classification of Diseases (ICD) codes were extracted separately and used to assign each patient a cause of critical bleeding. These were compared against chart review using percentage agreement and kappa statistics. A total of 427 MT patients were included with complete ICD and DRG data for 427 (100%) and 396 (93%), respectively. Good overall agreement was found between chart review and ICD codes (78·3%; κ = 0·74, 95% CI 0·70-0·79) and only fair overall agreement with DRG (51%; κ = 0·45, 95% CI 0·40-0·50). Both ICD and DRG were sensitive and accurate for classifying obstetric haemorrhage patients (98% sensitivity and κ > 0·94). However, compared with the ICD algorithm, DRGs were less sensitive and accurate in classifying bleeding as a result of gastrointestinal haemorrhage (74% vs 8%; κ = 0·75 vs 0·1), trauma (92% vs 62%; κ = 0·78 vs 0·67), cardiac (80% vs 57%; κ = 0·79 vs 0·60) and vascular surgery (64% vs 56%; κ = 0·69 vs 0·65). Algorithms using ICD codes can determine the cause of critical bleeding in patients requiring MT with good to excellent agreement with clinical history. DRG are less suitable to determine critical bleeding causes. © 2016 British Blood Transfusion Society.

Hydrocarbons in the ISM: Their Evolution and the Grain-to-Molecule Transition

NASA Astrophysics Data System (ADS)

Jones, Anthony P.

The evolution of hydrocarbon grains in the ISM is determined, principally, by the effects of photo-processing (annealing) which lead to a progressive loss of hydrogen from the structure and an associated 'graphitisation' of the material. Eventually this 'graphitisation' results in a low-density, highly aromatic material that can disaggregate into its aromatic-rich molecular components. These changes are followed through the use of an extended random covalent network (RCN) model for the hydrocarbon structure. This type of 'top down' process could be a significant source of the large molecular infrared band carriers in photon dominated regions. On the basis of this simple model there should thus be a relationship between the small grain and large molecule infrared emission bands across, and within, astrophysical boundaries such as photo-dissociation regions. 1. Introduction Carbon is the most abundant dust-forming element in the ISM and a large fraction of this carbon is in the form of grains comprised, principally, of hydrocarbon materials, including those where the hydrogen content is minimal. Interstellar hydrocarbon grains include: graphite, hydrogenated amorphous aliphatic and/or aromatic hydrocarbons (a-C, a-C:H) and (nano)diamond. These hydrocarbon dusts play a pivotal role in determining, amongst other things, the interstellar extinction, the dust thermal emission and the photo-electric heating of the gas in the ISM. 2. Hydrocarbon grains in the ISM Hydrocarbon grains are formed in the circumstellar shells around C-rich evolved stars, in supernova ejecta and also in the ISM itself via accretion and solid-state chemistry. The physical and chemical properties of hydrocarbon grains are indeed complex and vary in response to the ambient conditions (density, temperature, radiation field, ...). For example they can undergo both chemical and physical processing (growth and changes in chemical composition through accretion and reaction, erosion via inertial or chemi-sputtering, photo-darkening or 'graphitisation', photo-disruption in intense radiation fields and fragmentation in interstellar shock waves). Recently, using laboratory simulations of carbon dust analogues, Dartois, Muñoz Caro, Deboffle, et al. (2004,2005) have shown that hydrogen-rich (> 50 atomic % H) hydrocarbon solids can explain the observed interstellar absorption bands at 3.4, 6.85 and 7.25 μm. They also show that the thermal annealing of this material is accompanied by an increase in the aromatic component, i.e., a 'graphitisation'. Such a transformation and evolution of interstellar hydrocarbons was proposed by Duley, Jones & Williams (1989) and Jones, Duley & Wiliams (1990). This photon-driven process, acting on the hydrogen-rich hydrocarbon grains in the ISM that originate predominantly from carbon-rich evolved stars, will lead to a progressive loss of hydrogen and an associated 'graphitisation' and 'openingup' of the structure. The end point of the 'graphitisation' process is then a low-density material that will disaggregate into its constituent aromatic molecular components and the necessarily-associated sp3 and sp2 carbon and hydrogen atom bridging structures, e.g., Duley (2000), Petrie, Stranger & Duley (2003). In this work we follow the 'graphitisation' process using a random covalent network (RCN) approach that extends the work of Jones (1990). To summarise, the RCN model characterises a series of hydrocarbons based upon the sp3/sp2 carbon atom ratio (R) and the atomic fraction of hydrogen (XH) within the material. This model allows an essentially one-parameter determination of the a-C:H structure and a prediction of the major infrared bands. We find that the large hydrocarbon grains, with temperatures in equilibrium with the local radiation field, will be rather hydrogen-rich and that the smaller grains, which undergo stochastic heating to high temperatures, will be converted into hydrogen-poorer and more graphitic materials. The photo-fragmentation of the smaller aromatic grains can be an important source of molecular aromatic species. The infrared spectrum of a given RCN hydrocarbon depends, principally, upon only its hydrogen content XH. The spectra predicted from this RCN model can then be compared with the interstellar absorption and emission bands in the 32 μm range. The compositional changes of a-C:H, and its constituent 'molecular' components, can then be mapped across a given region. 3. Conclusions The physics and chemistry of hydrocarbon grains is complex. Interstellar hydrocarbon grains will be a mixture of many different forms arising from many different sources and modified in many different regions of the ISM. Nevertheless, we can appreciate how this complex material evolves chemically, structurally and physically as a function of the ambient conditions through the use of a rather simple, and extended, RCN model. The transition/evolution of hydrocarbons in the ISM is, generally, from hydrogen-rich a-C:H, in the form of large grains formed around evolved stars, through to smaller, hydrogen-poor, low-density, aromatic a-C:H materials. The subsequent photo-fragmentation of the small aromatic grains could then be the origin of the aromatic emission band carriers within the ISM. We find that the spectral and physical properties of hydrocarbons in the ISM vary in a systematic way across, and also within, astrophysical environments. However, the history of the particles, prior to their incorporation into a given region, could also play a major role in determining their physical properties in that region. Thus, the evolution of hydrocarbon grains in the ISM will be size-, time- and history-dependent. It is therefore necessary that dust models take into account this complexity in predicting the properties of hydrocarbons in the ISM.

Comparative analysis of perioperative complications between a multicenter prospective cervical deformity database and the Nationwide Inpatient Sample database.

PubMed

Passias, Peter G; Horn, Samantha R; Jalai, Cyrus M; Poorman, Gregory; Bono, Olivia J; Ramchandran, Subaraman; Smith, Justin S; Scheer, Justin K; Sciubba, Daniel M; Hamilton, D Kojo; Mundis, Gregory; Oh, Cheongeun; Klineberg, Eric O; Lafage, Virginie; Shaffrey, Christopher I; Ames, Christopher P

2017-11-01

Complication rates for adult cervical deformity are poorly characterized given the complexity and heterogeneity of cases. To compare perioperative complication rates following adult cervical deformity corrective surgery between a prospective multicenter database for patients with cervical deformity (PCD) and the Nationwide Inpatient Sample (NIS). Retrospective review of prospective databases. A total of 11,501 adult patients with cervical deformity (11,379 patients from the NIS and 122 patients from the PCD database). Perioperative medical and surgical complications. The NIS was queried (2001-2013) for cervical deformity discharges for patients ≥18 years undergoing cervical fusions using International Classification of Disease, Ninth Revision (ICD-9) coding. Patients ≥18 years from the PCD database (2013-2015) were selected. Equivalent complications were identified and rates were compared. Bonferroni correction (p<.004) was used for Pearson chi-square. Binary logistic regression was used to evaluate differences in complication rates between databases. A total of 11,379 patients from the NIS database and 122 patiens from the PCD database were identified. Patients from the PCD database were older (62.49 vs. 55.15, p<.001) but displayed similar gender distribution. Intraoperative complication rate was higher in the PCD (39.3%) group than in the NIS (9.2%, p<.001) database. The PCD database had an increased risk of reporting overall complications than the NIS (odds ratio: 2.81, confidence interval: 1.81-4.38). Only device-related complications were greater in the NIS (7.1% vs. 1.1%, p=.007). Patients from the PCD database displayed higher rates of the following complications: peripheral vascular (0.8% vs. 0.1%, p=.001), gastrointestinal (GI) (2.5% vs. 0.2%, p<.001), infection (8.2% vs. 0.5%, p<.001), dural tear (4.1% vs. 0.6%, p<.001), and dysphagia (9.8% vs. 1.9%, p<.001). Genitourinary, wound, and deep veinthrombosis (DVT) complications were similar between databases (p>.004). Based on surgicalapproach, the PCD reported higher GI and neurologic complication rates for combined anterior-posterior procedures (p<.001). For posterior-only procedures, the NIS had more device-related complications (12.4% vs. 0.1%, p=.003), whereas PCD had more infections (9.3% vs. 0.7%, p<.001). Analysis of the surgeon-maintained cervical database revealed higher overall and individual complication rates and higher data granularity. The nationwide database may underestimate complications of patients with adult cervical deformity (ACD) particularly in regard to perioperative surgical details owing to coding and deformity generalizations. The surgeon-maintained database captures the surgical details, but may underestimate some medical complications. Copyright © 2017 Elsevier Inc. All rights reserved.

Different utilization of intensive care services (ICSs) for patients dying of hemorrhagic and ischemic stroke, a hospital-based survey.

PubMed

Wang, Vinchi; Hsieh, Chieh-Chao; Huang, Yen-Ling; Chen, Chia-Ping; Hsieh, Yi-Ting; Chao, Tzu-Hao

2018-02-01

The intensive care service (ICS) saves lives and rescues the neurological function of stroke patients. We wondered the different utilization of ICS for patients with ischemic and hemorrhagic stroke, especially those who died within 30 days after stroke.Sixty-seven patients died during 2011 to 2015 due to acute stroke (42 due to intracranial hemorrhage [ICH]; 25 due to cerebral infarct [CI]). The durations of hospital stay (hospital staying days [HSDs]) and ICS staying days (ISDs) and codes of the do-not-resuscitate (DNR) were surveyed among these medical records. Statistics included chi-square and descriptive analyses.In this study, CI patients had a longer HSD (mean 14.3 days), as compared with ICH patients (mean 8.3 days); however, the ICH patients had a higher percentage of early entry within the first 24 hours of admission into ICS than CI group (95.1% vs 60.0%, P = .003). A higher rate of CI patients died in holidays or weekends than those with ICH (44.0% vs 21.4%, P = .051). DNR, requested mainly from direct descendants (children or grandchildren), was coded in all 25 CI patients (100.0%) and 38 ICH patients (90.5%). More cases with early DNR coded within 24 hours after admission occurred in ICH group (47%, 12% in CI patients, P = .003). None of the stroke patient had living wills. Withhold of endotracheal intubation (ETI) occurred among CI patients, more than for ICH patients (76.0% vs 18.4%, P < .005).In conclusion, CI patients longer HSD, ISD, higher mortality within holidays or weekends, and higher ETI withhold; but less percentage of ICS utilization expressed by a lower ISD/HSD ratio. This ICS utilization is a key issue of medical quality for stroke care.

Drosophila Muller F Elements Maintain a Distinct Set of Genomic Properties Over 40 Million Years of Evolution

PubMed Central

Leung, Wilson; Shaffer, Christopher D.; Reed, Laura K.; Smith, Sheryl T.; Barshop, William; Dirkes, William; Dothager, Matthew; Lee, Paul; Wong, Jeannette; Xiong, David; Yuan, Han; Bedard, James E. J.; Machone, Joshua F.; Patterson, Seantay D.; Price, Amber L.; Turner, Bryce A.; Robic, Srebrenka; Luippold, Erin K.; McCartha, Shannon R.; Walji, Tezin A.; Walker, Chelsea A.; Saville, Kenneth; Abrams, Marita K.; Armstrong, Andrew R.; Armstrong, William; Bailey, Robert J.; Barberi, Chelsea R.; Beck, Lauren R.; Blaker, Amanda L.; Blunden, Christopher E.; Brand, Jordan P.; Brock, Ethan J.; Brooks, Dana W.; Brown, Marie; Butzler, Sarah C.; Clark, Eric M.; Clark, Nicole B.; Collins, Ashley A.; Cotteleer, Rebecca J.; Cullimore, Peterson R.; Dawson, Seth G.; Docking, Carter T.; Dorsett, Sasha L.; Dougherty, Grace A.; Downey, Kaitlyn A.; Drake, Andrew P.; Earl, Erica K.; Floyd, Trevor G.; Forsyth, Joshua D.; Foust, Jonathan D.; Franchi, Spencer L.; Geary, James F.; Hanson, Cynthia K.; Harding, Taylor S.; Harris, Cameron B.; Heckman, Jonathan M.; Holderness, Heather L.; Howey, Nicole A.; Jacobs, Dontae A.; Jewell, Elizabeth S.; Kaisler, Maria; Karaska, Elizabeth A.; Kehoe, James L.; Koaches, Hannah C.; Koehler, Jessica; Koenig, Dana; Kujawski, Alexander J.; Kus, Jordan E.; Lammers, Jennifer A.; Leads, Rachel R.; Leatherman, Emily C.; Lippert, Rachel N.; Messenger, Gregory S.; Morrow, Adam T.; Newcomb, Victoria; Plasman, Haley J.; Potocny, Stephanie J.; Powers, Michelle K.; Reem, Rachel M.; Rennhack, Jonathan P.; Reynolds, Katherine R.; Reynolds, Lyndsey A.; Rhee, Dong K.; Rivard, Allyson B.; Ronk, Adam J.; Rooney, Meghan B.; Rubin, Lainey S.; Salbert, Luke R.; Saluja, Rasleen K.; Schauder, Taylor; Schneiter, Allison R.; Schulz, Robert W.; Smith, Karl E.; Spencer, Sarah; Swanson, Bryant R.; Tache, Melissa A.; Tewilliager, Ashley A.; Tilot, Amanda K.; VanEck, Eve; Villerot, Matthew M.; Vylonis, Megan B.; Watson, David T.; Wurzler, Juliana A.; Wysocki, Lauren M.; Yalamanchili, Monica; Zaborowicz, Matthew A.; Emerson, Julia A.; Ortiz, Carlos; Deuschle, Frederic J.; DiLorenzo, Lauren A.; Goeller, Katie L.; Macchi, Christopher R.; Muller, Sarah E.; Pasierb, Brittany D.; Sable, Joseph E.; Tucci, Jessica M.; Tynon, Marykathryn; Dunbar, David A.; Beken, Levent H.; Conturso, Alaina C.; Danner, Benjamin L.; DeMichele, Gabriella A.; Gonzales, Justin A.; Hammond, Maureen S.; Kelley, Colleen V.; Kelly, Elisabeth A.; Kulich, Danielle; Mageeney, Catherine M.; McCabe, Nikie L.; Newman, Alyssa M.; Spaeder, Lindsay A.; Tumminello, Richard A.; Revie, Dennis; Benson, Jonathon M.; Cristostomo, Michael C.; DaSilva, Paolo A.; Harker, Katherine S.; Jarrell, Jenifer N.; Jimenez, Luis A.; Katz, Brandon M.; Kennedy, William R.; Kolibas, Kimberly S.; LeBlanc, Mark T.; Nguyen, Trung T.; Nicolas, Daniel S.; Patao, Melissa D.; Patao, Shane M.; Rupley, Bryan J.; Sessions, Bridget J.; Weaver, Jennifer A.; Goodman, Anya L.; Alvendia, Erica L.; Baldassari, Shana M.; Brown, Ashley S.; Chase, Ian O.; Chen, Maida; Chiang, Scott; Cromwell, Avery B.; Custer, Ashley F.; DiTommaso, Tia M.; El-Adaimi, Jad; Goscinski, Nora C.; Grove, Ryan A.; Gutierrez, Nestor; Harnoto, Raechel S.; Hedeen, Heather; Hong, Emily L.; Hopkins, Barbara L.; Huerta, Vilma F.; Khoshabian, Colin; LaForge, Kristin M.; Lee, Cassidy T.; Lewis, Benjamin M.; Lydon, Anniken M.; Maniaci, Brian J.; Mitchell, Ryan D.; Morlock, Elaine V.; Morris, William M.; Naik, Priyanka; Olson, Nicole C.; Osterloh, Jeannette M.; Perez, Marcos A.; Presley, Jonathan D.; Randazzo, Matt J.; Regan, Melanie K.; Rossi, Franca G.; Smith, Melanie A.; Soliterman, Eugenia A.; Sparks, Ciani J.; Tran, Danny L.; Wan, Tiffany; Welker, Anne A.; Wong, Jeremy N.; Sreenivasan, Aparna; Youngblom, Jim; Adams, Andrew; Alldredge, Justin; Bryant, Ashley; Carranza, David; Cifelli, Alyssa; Coulson, Kevin; Debow, Calise; Delacruz, Noelle; Emerson, Charlene; Farrar, Cassandra; Foret, Don; Garibay, Edgar; Gooch, John; Heslop, Michelle; Kaur, Sukhjit; Khan, Ambreen; Kim, Van; Lamb, Travis; Lindbeck, Peter; Lucas, Gabi; Macias, Elizabeth; Martiniuc, Daniela; Mayorga, Lissett; Medina, Joseph; Membreno, Nelson; Messiah, Shady; Neufeld, Lacey; Nguyen, San Francisco; Nichols, Zachary; Odisho, George; Peterson, Daymon; Rodela, Laura; Rodriguez, Priscilla; Rodriguez, Vanessa; Ruiz, Jorge; Sherrill, Will; Silva, Valeria; Sparks, Jeri; Statton, Geeta; Townsend, Ashley; Valdez, Isabel; Waters, Mary; Westphal, Kyle; Winkler, Stacey; Zumkehr, Joannee; DeJong, Randall J.; Hoogewerf, Arlene J.; Ackerman, Cheri M.; Armistead, Isaac O.; Baatenburg, Lara; Borr, Matthew J.; Brouwer, Lindsay K.; Burkhart, Brandon J.; Bushhouse, Kelsey T.; Cesko, Lejla; Choi, Tiffany Y. Y.; Cohen, Heather; Damsteegt, Amanda M.; Darusz, Jess M.; Dauphin, Cory M.; Davis, Yelena P.; Diekema, Emily J.; Drewry, Melissa; Eisen, Michelle E. M.; Faber, Hayley M.; Faber, Katherine J.; Feenstra, Elizabeth; Felzer-Kim, Isabella T.; Hammond, Brandy L.; Hendriksma, Jesse; Herrold, Milton R.; Hilbrands, Julia A.; Howell, Emily J.; Jelgerhuis, Sarah A.; Jelsema, Timothy R.; Johnson, Benjamin K.; Jones, Kelly K.; Kim, Anna; Kooienga, Ross D.; Menyes, Erika E.; Nollet, Eric A.; Plescher, Brittany E.; Rios, Lindsay; Rose, Jenny L.; Schepers, Allison J.; Scott, Geoff; Smith, Joshua R.; Sterling, Allison M.; Tenney, Jenna C.; Uitvlugt, Chris; VanDyken, Rachel E.; VanderVennen, Marielle; Vue, Samantha; Kokan, Nighat P.; Agbley, Kwabea; Boham, Sampson K.; Broomfield, Daniel; Chapman, Kayla; Dobbe, Ali; Dobbe, Ian; Harrington, William; Ibrahem, Marwan; Kennedy, Andre; Koplinsky, Chad A.; Kubricky, Cassandra; Ladzekpo, Danielle; Pattison, Claire; Ramirez, Roman E.; Wande, Lucia; Woehlke, Sarah; Wawersik, Matthew; Kiernan, Elizabeth; Thompson, Jeffrey S.; Banker, Roxanne; Bartling, Justina R.; Bhatiya, Chinmoy I.; Boudoures, Anna L.; Christiansen, Lena; Fosselman, Daniel S.; French, Kristin M.; Gill, Ishwar S.; Havill, Jessen T.; Johnson, Jaelyn L.; Keny, Lauren J.; Kerber, John M.; Klett, Bethany M.; Kufel, Christina N.; May, Francis J.; Mecoli, Jonathan P.; Merry, Callie R.; Meyer, Lauren R.; Miller, Emily G.; Mullen, Gregory J.; Palozola, Katherine C.; Pfeil, Jacob J.; Thomas, Jessica G.; Verbofsky, Evan M.; Spana, Eric P.; Agarwalla, Anant; Chapman, Julia; Chlebina, Ben; Chong, Insun; Falk, I.N.; Fitzgibbons, John D.; Friedman, Harrison; Ighile, Osagie; Kim, Andrew J.; Knouse, Kristin A.; Kung, Faith; Mammo, Danny; Ng, Chun Leung; Nikam, Vinayak S.; Norton, Diana; Pham, Philip; Polk, Jessica W.; Prasad, Shreya; Rankin, Helen; Ratliff, Camille D.; Scala, Victoria; Schwartz, Nicholas U.; Shuen, Jessica A.; Xu, Amy; Xu, Thomas Q.; Zhang, Yi; Rosenwald, Anne G.; Burg, Martin G.; Adams, Stephanie J.; Baker, Morgan; Botsford, Bobbi; Brinkley, Briana; Brown, Carter; Emiah, Shadie; Enoch, Erica; Gier, Chad; Greenwell, Alyson; Hoogenboom, Lindsay; Matthews, Jordan E.; McDonald, Mitchell; Mercer, Amanda; Monsma, Nicholaus; Ostby, Kristine; Ramic, Alen; Shallman, Devon; Simon, Matthew; Spencer, Eric; Tomkins, Trisha; Wendland, Pete; Wylie, Anna; Wolyniak, Michael J.; Robertson, Gregory M.; Smith, Samuel I.; DiAngelo, Justin R.; Sassu, Eric D.; Bhalla, Satish C.; Sharif, Karim A.; Choeying, Tenzin; Macias, Jason S.; Sanusi, Fareed; Torchon, Karvyn; Bednarski, April E.; Alvarez, Consuelo J.; Davis, Kristen C.; Dunham, Carrie A.; Grantham, Alaina J.; Hare, Amber N.; Schottler, Jennifer; Scott, Zackary W.; Kuleck, Gary A.; Yu, Nicole S.; Kaehler, Marian M.; Jipp, Jacob; Overvoorde, Paul J.; Shoop, Elizabeth; Cyrankowski, Olivia; Hoover, Betsy; Kusner, Matt; Lin, Devry; Martinov, Tijana; Misch, Jonathan; Salzman, Garrett; Schiedermayer, Holly; Snavely, Michael; Zarrasola, Stephanie; Parrish, Susan; Baker, Atlee; Beckett, Alissa; Belella, Carissa; Bryant, Julie; Conrad, Turner; Fearnow, Adam; Gomez, Carolina; Herbstsomer, Robert A.; Hirsch, Sarah; Johnson, Christen; Jones, Melissa; Kabaso, Rita; Lemmon, Eric; Vieira, Carolina Marques dos Santos; McFarland, Darryl; McLaughlin, Christopher; Morgan, Abbie; Musokotwane, Sepo; Neutzling, William; Nietmann, Jana; Paluskievicz, Christina; Penn, Jessica; Peoples, Emily; Pozmanter, Caitlin; Reed, Emily; Rigby, Nichole; Schmidt, Lasse; Shelton, Micah; Shuford, Rebecca; Tirasawasdichai, Tiara; Undem, Blair; Urick, Damian; Vondy, Kayla; Yarrington, Bryan; Eckdahl, Todd T.; Poet, Jeffrey L.; Allen, Alica B.; Anderson, John E.; Barnett, Jason M.; Baumgardner, Jordan S.; Brown, Adam D.; Carney, Jordan E.; Chavez, Ramiro A.; Christgen, Shelbi L.; Christie, Jordan S.; Clary, Andrea N.; Conn, Michel A.; Cooper, Kristen M.; Crowley, Matt J.; Crowley, Samuel T.; Doty, Jennifer S.; Dow, Brian A.; Edwards, Curtis R.; Elder, Darcie D.; Fanning, John P.; Janssen, Bridget M.; Lambright, Anthony K.; Lane, Curtiss E.; Limle, Austin B.; Mazur, Tammy; McCracken, Marly R.; McDonough, Alexa M.; Melton, Amy D.; Minnick, Phillip J.; Musick, Adam E.; Newhart, William H.; Noynaert, Joseph W.; Ogden, Bradley J.; Sandusky, Michael W.; Schmuecker, Samantha M.; Shipman, Anna L.; Smith, Anna L.; Thomsen, Kristen M.; Unzicker, Matthew R.; Vernon, William B.; Winn, Wesley W.; Woyski, Dustin S.; Zhu, Xiao; Du, Chunguang; Ament, Caitlin; Aso, Soham; Bisogno, Laura Simone; Caronna, Jason; Fefelova, Nadezhda; Lopez, Lenin; Malkowitz, Lorraine; Marra, Jonathan; Menillo, Daniella; Obiorah, Ifeanyi; Onsarigo, Eric Nyabeta; Primus, Shekerah; Soos, Mahdi; Tare, Archana; Zidan, Ameer; Jones, Christopher J.; Aronhalt, Todd; Bellush, James M.; Burke, Christa; DeFazio, Steve; Does, Benjamin R.; Johnson, Todd D.; Keysock, Nicholas; Knudsen, Nelson H.; Messler, James; Myirski, Kevin; Rekai, Jade Lea; Rempe, Ryan Michael; Salgado, Michael S.; Stagaard, Erica; Starcher, Justin R.; Waggoner, Andrew W.; Yemelyanova, Anastasia K.; Hark, Amy T.; Bertolet, Anne; Kuschner, Cyrus E.; Parry, Kesley; Quach, Michael; Shantzer, Lindsey; Shaw, Mary E.; Smith, Mary A.; Glenn, Omolara; Mason, Portia; Williams, Charlotte; Key, S. Catherine Silver; Henry, Tyneshia C. P.; Johnson, Ashlee G.; White, Jackie X.; Haberman, Adam; Asinof, Sam; Drumm, Kelly; Freeburg, Trip; Safa, Nadia; Schultz, Darrin; Shevin, Yakov; Svoronos, Petros; Vuong, Tam; Wellinghoff, Jules; Hoopes, Laura L. M.; Chau, Kim M.; Ward, Alyssa; Regisford, E. Gloria C.; Augustine, LaJerald; Davis-Reyes, Brionna; Echendu, Vivienne; Hales, Jasmine; Ibarra, Sharon; Johnson, Lauriaun; Ovu, Steven; Braverman, John M.; Bahr, Thomas J.; Caesar, Nicole M.; Campana, Christopher; Cassidy, Daniel W.; Cognetti, Peter A.; English, Johnathan D.; Fadus, Matthew C.; Fick, Cameron N.; Freda, Philip J.; Hennessy, Bryan M.; Hockenberger, Kelsey; Jones, Jennifer K.; King, Jessica E.; Knob, Christopher R.; Kraftmann, Karen J.; Li, Linghui; Lupey, Lena N.; Minniti, Carl J.; Minton, Thomas F.; Moran, Joseph V.; Mudumbi, Krishna; Nordman, Elizabeth C.; Puetz, William J.; Robinson, Lauren M.; Rose, Thomas J.; Sweeney, Edward P.; Timko, Ashley S.; Paetkau, Don W.; Eisler, Heather L.; Aldrup, Megan E.; Bodenberg, Jessica M.; Cole, Mara G.; Deranek, Kelly M.; DeShetler, Megan; Dowd, Rose M.; Eckardt, Alexandra K.; Ehret, Sharon C.; Fese, Jessica; Garrett, Amanda D.; Kammrath, Anna; Kappes, Michelle L.; Light, Morgan R.; Meier, Anne C.; O’Rouke, Allison; Perella, Mallory; Ramsey, Kimberley; Ramthun, Jennifer R.; Reilly, Mary T.; Robinett, Deirdre; Rossi, Nadine L.; Schueler, Mary Grace; Shoemaker, Emma; Starkey, Kristin M.; Vetor, Ashley; Vrable, Abby; Chandrasekaran, Vidya; Beck, Christopher; Hatfield, Kristen R.; Herrick, Douglas A.; Khoury, Christopher B.; Lea, Charlotte; Louie, Christopher A.; Lowell, Shannon M.; Reynolds, Thomas J.; Schibler, Jeanine; Scoma, Alexandra H.; Smith-Gee, Maxwell T.; Tuberty, Sarah; Smith, Christopher D.; Lopilato, Jane E.; Hauke, Jeanette; Roecklein-Canfield, Jennifer A.; Corrielus, Maureen; Gilman, Hannah; Intriago, Stephanie; Maffa, Amanda; Rauf, Sabya A.; Thistle, Katrina; Trieu, Melissa; Winters, Jenifer; Yang, Bib; Hauser, Charles R.; Abusheikh, Tariq; Ashrawi, Yara; Benitez, Pedro; Boudreaux, Lauren R.; Bourland, Megan; Chavez, Miranda; Cruz, Samantha; Elliott, GiNell; Farek, Jesse R.; Flohr, Sarah; Flores, Amanda H.; Friedrichs, Chelsey; Fusco, Zach; Goodwin, Zane; Helmreich, Eric; Kiley, John; Knepper, John Mark; Langner, Christine; Martinez, Megan; Mendoza, Carlos; Naik, Monal; Ochoa, Andrea; Ragland, Nicolas; Raimey, England; Rathore, Sunil; Reza, Evangelina; Sadovsky, Griffin; Seydoux, Marie-Isabelle B.; Smith, Jonathan E.; Unruh, Anna K.; Velasquez, Vicente; Wolski, Matthew W.; Gosser, Yuying; Govind, Shubha; Clarke-Medley, Nicole; Guadron, Leslie; Lau, Dawn; Lu, Alvin; Mazzeo, Cheryl; Meghdari, Mariam; Ng, Simon; Pamnani, Brad; Plante, Olivia; Shum, Yuki Kwan Wa; Song, Roy; Johnson, Diana E.; Abdelnabi, Mai; Archambault, Alexi; Chamma, Norma; Gaur, Shailly; Hammett, Deborah; Kandahari, Adrese; Khayrullina, Guzal; Kumar, Sonali; Lawrence, Samantha; Madden, Nigel; Mandelbaum, Max; Milnthorp, Heather; Mohini, Shiv; Patel, Roshni; Peacock, Sarah J.; Perling, Emily; Quintana, Amber; Rahimi, Michael; Ramirez, Kristen; Singhal, Rishi; Weeks, Corinne; Wong, Tiffany; Gillis, Aubree T.; Moore, Zachary D.; Savell, Christopher D.; Watson, Reece; Mel, Stephanie F.; Anilkumar, Arjun A.; Bilinski, Paul; Castillo, Rostislav; Closser, Michael; Cruz, Nathalia M.; Dai, Tiffany; Garbagnati, Giancarlo F.; Horton, Lanor S.; Kim, Dongyeon; Lau, Joyce H.; Liu, James Z.; Mach, Sandy D.; Phan, Thu A.; Ren, Yi; Stapleton, Kenneth E.; Strelitz, Jean M.; Sunjed, Ray; Stamm, Joyce; Anderson, Morgan C.; Bonifield, Bethany Grace; Coomes, Daniel; Dillman, Adam; Durchholz, Elaine J.; Fafara-Thompson, Antoinette E.; Gross, Meleah J.; Gygi, Amber M.; Jackson, Lesley E.; Johnson, Amy; Kocsisova, Zuzana; Manghelli, Joshua L.; McNeil, Kylie; Murillo, Michael; Naylor, Kierstin L.; Neely, Jessica; Ogawa, Emmy E.; Rich, Ashley; Rogers, Anna; Spencer, J. Devin; Stemler, Kristina M.; Throm, Allison A.; Van Camp, Matt; Weihbrecht, Katie; Wiles, T. Aaron; Williams, Mallory A.; Williams, Matthew; Zoll, Kyle; Bailey, Cheryl; Zhou, Leming; Balthaser, Darla M.; Bashiri, Azita; Bower, Mindy E.; Florian, Kayla A.; Ghavam, Nazanin; Greiner-Sosanko, Elizabeth S.; Karim, Helmet; Mullen, Victor W.; Pelchen, Carly E.; Yenerall, Paul M.; Zhang, Jiayu; Rubin, Michael R.; Arias-Mejias, Suzette M.; Bermudez-Capo, Armando G.; Bernal-Vega, Gabriela V.; Colon-Vazquez, Mariela; Flores-Vazquez, Arelys; Gines-Rosario, Mariela; Llavona-Cartagena, Ivan G.; Martinez-Rodriguez, Javier O.; Ortiz-Fuentes, Lionel; Perez-Colomba, Eliezer O.; Perez-Otero, Joseph; Rivera, Elisandra; Rodriguez-Giron, Luke J.; Santiago-Sanabria, Arnaldo J.; Senquiz-Gonzalez, Andrea M.; delValle, Frank R. Soto; Vargas-Franco, Dorianmarie; Velázquez-Soto, Karla I.; Zambrana-Burgos, Joan D.; Martinez-Cruzado, Juan Carlos; Asencio-Zayas, Lillyann; Babilonia-Figueroa, Kevin; Beauchamp-Pérez, Francis D.; Belén-Rodríguez, Juliana; Bracero-Quiñones, Luciann; Burgos-Bula, Andrea P.; Collado-Méndez, Xavier A.; Colón-Cruz, Luis R.; Correa-Muller, Ana I.; Crooke-Rosado, Jonathan L.; Cruz-García, José M.; Defendini-Ávila, Marianna; Delgado-Peraza, Francheska M.; Feliciano-Cancela, Alex J.; Gónzalez-Pérez, Valerie M.; Guiblet, Wilfried; Heredia-Negrón, Aldo; Hernández-Muñiz, Jennifer; Irizarry-González, Lourdes N.; Laboy-Corales, Ángel L.; Llaurador-Caraballo, Gabriela A.; Marín-Maldonado, Frances; Marrero-Llerena, Ulises; Martell-Martínez, Héctor A.; Martínez-Traverso, Idaliz M.; Medina-Ortega, Kiara N.; Méndez-Castellanos, Sonya G.; Menéndez-Serrano, Krizia C.; Morales-Caraballo, Carol I.; Ortiz-DeChoudens, Saryleine; Ortiz-Ortiz, Patricia; Pagán-Torres, Hendrick; Pérez-Afanador, Diana; Quintana-Torres, Enid M.; Ramírez-Aponte, Edwin G.; Riascos-Cuero, Carolina; Rivera-Llovet, Michelle S.; Rivera-Pagán, Ingrid T.; Rivera-Vicéns, Ramón E.; Robles-Juarbe, Fabiola; Rodríguez-Bonilla, Lorraine; Rodríguez-Echevarría, Brian O.; Rodríguez-García, Priscila M.; Rodríguez-Laboy, Abneris E.; Rodríguez-Santiago, Susana; Rojas-Vargas, Michael L.; Rubio-Marrero, Eva N.; Santiago-Colón, Albeliz; Santiago-Ortiz, Jorge L.; Santos-Ramos, Carlos E.; Serrano-González, Joseline; Tamayo-Figueroa, Alina M.; Tascón-Peñaranda, Edna P.; Torres-Castillo, José L.; Valentín-Feliciano, Nelson A.; Valentín-Feliciano, Yashira M.; Vargas-Barreto, Nadyan M.; Vélez-Vázquez, Miguel; Vilanova-Vélez, Luis R.; Zambrana-Echevarría, Cristina; MacKinnon, Christy; Chung, Hui-Min; Kay, Chris; Pinto, Anthony; Kopp, Olga R.; Burkhardt, Joshua; Harward, Chris; Allen, Robert; Bhat, Pavan; Chang, Jimmy Hsiang-Chun; Chen, York; Chesley, Christopher; Cohn, Dara; DuPuis, David; Fasano, Michael; Fazzio, Nicholas; Gavinski, Katherine; Gebreyesus, Heran; Giarla, Thomas; Gostelow, Marcus; Greenstein, Rachel; Gunasinghe, Hashini; Hanson, Casey; Hay, Amanda; He, Tao Jian; Homa, Katie; Howe, Ruth; Howenstein, Jeff; Huang, Henry; Khatri, Aaditya; Kim, Young Lu; Knowles, Olivia; Kong, Sarah; Krock, Rebecca; Kroll, Matt; Kuhn, Julia; Kwong, Matthew; Lee, Brandon; Lee, Ryan; Levine, Kevin; Li, Yedda; Liu, Bo; Liu, Lucy; Liu, Max; Lousararian, Adam; Ma, Jimmy; Mallya, Allyson; Manchee, Charlie; Marcus, Joseph; McDaniel, Stephen; Miller, Michelle L.; Molleston, Jerome M.; Diez, Cristina Montero; Ng, Patrick; Ngai, Natalie; Nguyen, Hien; Nylander, Andrew; Pollack, Jason; Rastogi, Suchita; Reddy, Himabindu; Regenold, Nathaniel; Sarezky, Jon; Schultz, Michael; Shim, Jien; Skorupa, Tara; Smith, Kenneth; Spencer, Sarah J.; Srikanth, Priya; Stancu, Gabriel; Stein, Andrew P.; Strother, Marshall; Sudmeier, Lisa; Sun, Mengyang; Sundaram, Varun; Tazudeen, Noor; Tseng, Alan; Tzeng, Albert; Venkat, Rohit; Venkataram, Sandeep; Waldman, Leah; Wang, Tracy; Yang, Hao; Yu, Jack Y.; Zheng, Yin; Preuss, Mary L.; Garcia, Angelica; Juergens, Matt; Morris, Robert W.; Nagengast, Alexis A.; Azarewicz, Julie; Carr, Thomas J.; Chichearo, Nicole; Colgan, Mike; Donegan, Megan; Gardner, Bob; Kolba, Nik; Krumm, Janice L.; Lytle, Stacey; MacMillian, Laurell; Miller, Mary; Montgomery, Andrew; Moretti, Alysha; Offenbacker, Brittney; Polen, Mike; Toth, John; Woytanowski, John; Kadlec, Lisa; Crawford, Justin; Spratt, Mary L.; Adams, Ashley L.; Barnard, Brianna K.; Cheramie, Martin N.; Eime, Anne M.; Golden, Kathryn L.; Hawkins, Allyson P.; Hill, Jessica E.; Kampmeier, Jessica A.; Kern, Cody D.; Magnuson, Emily E.; Miller, Ashley R.; Morrow, Cody M.; Peairs, Julia C.; Pickett, Gentry L.; Popelka, Sarah A.; Scott, Alexis J.; Teepe, Emily J.; TerMeer, Katie A.; Watchinski, Carmen A.; Watson, Lucas A.; Weber, Rachel E.; Woodard, Kate A.; Barnard, Daron C.; Appiah, Isaac; Giddens, Michelle M.; McNeil, Gerard P.; Adebayo, Adeola; Bagaeva, Kate; Chinwong, Justina; Dol, Chrystel; George, Eunice; Haltaufderhyde, Kirk; Haye, Joanna; Kaur, Manpreet; Semon, Max; Serjanov, Dmitri; Toorie, Anika; Wilson, Christopher; Riddle, Nicole C.; Buhler, Jeremy; Mardis, Elaine R.

2015-01-01

The Muller F element (4.2 Mb, ~80 protein-coding genes) is an unusual autosome of Drosophila melanogaster; it is mostly heterochromatic with a low recombination rate. To investigate how these properties impact the evolution of repeats and genes, we manually improved the sequence and annotated the genes on the D. erecta, D. mojavensis, and D. grimshawi F elements and euchromatic domains from the Muller D element. We find that F elements have greater transposon density (25–50%) than euchromatic reference regions (3–11%). Among the F elements, D. grimshawi has the lowest transposon density (particularly DINE-1: 2% vs. 11–27%). F element genes have larger coding spans, more coding exons, larger introns, and lower codon bias. Comparison of the Effective Number of Codons with the Codon Adaptation Index shows that, in contrast to the other species, codon bias in D. grimshawi F element genes can be attributed primarily to selection instead of mutational biases, suggesting that density and types of transposons affect the degree of local heterochromatin formation. F element genes have lower estimated DNA melting temperatures than D element genes, potentially facilitating transcription through heterochromatin. Most F element genes (~90%) have remained on that element, but the F element has smaller syntenic blocks than genome averages (3.4–3.6 vs. 8.4–8.8 genes per block), indicating greater rates of inversion despite lower rates of recombination. Overall, the F element has maintained characteristics that are distinct from other autosomes in the Drosophila lineage, illuminating the constraints imposed by a heterochromatic milieu. PMID:25740935

Gender representation of cancer patients in medical treatment and psychosocial survivorship research: changes over three decades.

PubMed

Hoyt, Michael A; Rubin, Lisa R

2012-10-01

Prior studies raise concern about gender bias in cancer research, including insufficient inclusion of women or men, or studying women and men differently. The 1993 National Institutes of Health Revitalization Act aimed to eliminate gender bias in medicine. To examine changes in medical and psychological literature, this study reviews gender representation in biomedical treatment studies and psychosocial survivorship studies published in a single year. Research published in Cancer in 2007, and all empirical psychological studies about cancer published that year, provided a 15-year update to findings reported by Meyerowitz and Hart. The gender distribution and context of included articles were coded and compared with findings from 1983 and 1992. Across biomedical studies, 34.3% of subjects were women (vs 47% of new cancers and 48% of cancer deaths). Among men, 41.3% had sex-specific cancers (vs 12.5% [1983] and 12.3% [1992]). Among women, 46.1% had sex-specific cancers (vs 69.1% [1983] and 64.6% [1992]). Fewer women (36.8%) were represented in sex-nonspecific cancer studies (vs 41.4% [1983] and 42.5% [1992]); however, fewer studies had a significant (>20%) gender disparity. Across psychosocial studies, representation of men increased to 47.9% (vs 30.4% [1983] and 29.9% [1992]). The proportion of men in studies of feelings/relationships increased to 47% (vs 22.9% [1992]); the proportion of women in studies assessing physical/functional ability increased to 58.3% (vs 45.4%). Women remain under-represented in sex-nonspecific biomedical research, whereas men's representation in sex-specific research increased substantially. Psychosocial research trends suggest movement from research questions supporting traditional stereotypes that women feel and men act. Copyright © 2012 American Cancer Society.

Mortality and Costs in Clostridium difficile Infection Among the Elderly in the United States.

PubMed

Shorr, Andrew F; Zilberberg, Marya D; Wang, Li; Baser, Onur; Yu, Holly

2016-11-01

OBJECTIVE To examine attributable mortality and costs of Clostridium difficile infection (CDI) in the Medicare population. DESIGN A population-based cohort study among US adults aged at least 65 years in the 2008-2010 Medicare 5% sample, with follow-up of 12 months. PATIENTS Incident CDI episode was defined by the International Classification of Diseases, Ninth Revision, Clinical Modification code of 008.45 and no other occurrences within the preceding 12 months. To quantify the adjusted mortality and costs we developed a 1:1 propensity-matched sample of CDI and non-CDI patients. RESULTS Among 1,165,165 patients included, 6,838 (0.6%) had a CDI episode in 2009 (82.5% healthcare-associated). Patients with CDI were older (mean [SD] age, 81.0±8.0 vs 77.0±7.7 years, P<.001), were more likely to come from the Northeast (27.4% vs 18.6%, P<.001), and had a higher comorbidity burden (Charlson score, 4.6±3.3 vs 1.7±2.1, P<.001). Hospitalizations (63.2% vs 6.0%, P<.001) and antibiotics (33.9% vs 12.5%, P<.001) within the prior 90 days were more common in the group with CDI. In the propensity-adjusted analysis, CDI was associated with near doubling of both mortality (42.6% vs 23.4%, P<.001) and total healthcare costs ($64,807±$66,480 vs $38,128±$46,485, P<.001). CONCLUSIONS Among elderly patients, CDI is associated with an increase in adjusted mortality and healthcare costs following a CDI episode. Nationwide annually this equals 240,000 patients with CDI, 46,000 potential deaths, and more than $6 billion in costs. Infect Control Hosp Epidemiol 2016;1-6.

VizieR Online Data Catalog: CN and CH line strengths in 12 globulars (Pancino+, 2010)

NASA Astrophysics Data System (ADS)

Pancino, E.; Rejkuba, M.; Zoccali, M.; Carrera, R.

2010-09-01

In this first paper, we measured the strength of the CN and CH band indices, which correlate with the N and C abundances, and we investigated the anti-correlation and bimodality of these indices. We compared rCN, the ratio of stars belonging to the CN-strong and weak groups, with 15 different cluster parameters. (1 data file).

The Internet of Samples in the Earth Sciences: Providing Access to Uncurated Collections

NASA Astrophysics Data System (ADS)

Carter, M. R.; Lehnert, K. A.

2014-12-01

Vast amounts of physical samples have been collected in the Earth Sciences for studies that address a wide range of scientific questions. Only a fraction of these samples are well curated and preserved long-term in sample repositories and museums. Many samples and collections are stored in the offices and labs of investigators, or in basements and sheds of institutions and investigators' homes. These 'uncurated' collections often contain samples that have been well studied, or are unique and irreplaceable. They may also include samples that could reveal new insights if re-analyzed using new techniques, or specimens that could have unanticipated relevance to research being conducted in fields other than the one for which they were collected. Currently, these samples cannot be accessed or discovered online by the broader science community. Investigators and departments often lack the resources to properly catalog and curate the samples and respond to requests for splits. Long-term preservation of and access to these samples is usually not provided for. iSamplES, a recently-funded EarthCube Research Coordination Network (RCN), seeks to integrate scientific samples, including 'uncurated' samples, into digital data and information infrastructure in the Earth Sciences and to facilitate their curation, discovery, access, sharing, and analysis. The RCN seeks to develop and implement best practices that increase digital access to samples with the goal of establishing a comprehensive infrastructure not only for the digital, but also physical curation of samples. The RCN will engage a broad group of individuals from domain scientists to curators to publishers to computer scientists to define, articulate, and address the needs and challenges of digital sample management and recommend community-endorsed best practices and standards for registering, describing, identifying, and citing physical specimens, drawing upon other initiatives and existing or emerging software tools for digital sample and collection management. Community engagement will include surveys, in-person workshops and outreach events, the creation of the iSamplES knowledge hub (semantic wiki) and a registry of collections. iSamplES will specifically engage early career scientists to encourage that no samples go uncurated.

A comparison of the Cray-2 performance before and after the installation of memory pseudo-banking

NASA Technical Reports Server (NTRS)

Schmickley, Ronald D.; Bailey, David H.

1987-01-01

A suite of 13 large Fortran benchmark codes were run on a Cray-2 configured with memory pseudo-banking circuits, and floating point operation rates were measured for each under a variety of system load configurations. These were compared with similar flop measurements taken on the same system before installation of the pseudo-banking. A useful memory access efficiency parameter was defined and calculated for both sets of performance rates, allowing a crude quantitative measure of the improvement in efficiency due to pseudo-banking. Programs were categorized as either highly scalar (S) or highly vectorized (V) and either memory-intensive or register-intensive, giving 4 categories: S-memory, S-register, V-memory, and V-register. Using flop rates as a simple quantifier of these 4 categories, a scatter plot of efficiency gain vs Mflops roughly illustrates the improvement in floating point processing speed due to pseudo-banking. On the Cray-2 system tested this improvement ranged from 1 percent for S-memory codes to about 12 percent for V-memory codes. No significant gains were made for V-register codes, which was to be expected.

Associations of Pre-transplant Prescription Narcotic Use with Clinical Complications after Kidney Transplantation

PubMed Central

Lentine, Krista L.; Lam, Ngan N.; Xiao, Huiling; Tuttle-Newhall, Janet E.; Axelrod, David; Brennan, Daniel C.; Dharnidharka, Vikas R.; Yuan, Hui; Nazzal, Mustafa; Zheng, Jie; Schnitzler, Mark A.

2015-01-01

Background Associations of narcotic use before kidney transplantation with post-transplant clinical outcomes are not well described. Methods We examined integrated national transplant registry, pharmacy records, and Medicare billing claims to follow 16,322 kidney transplant recipients, of whom 28.3% filled a narcotic prescription in the year before transplantation. Opioid analgesic fills were normalized to morphine equivalents (ME) and expressed as mg/kg exposures (approximate quartiles: 0.1– 1.7, 1.8–5.4, 5.5–23.7, and ≥23.8 mg/kg, respectively). Post-transplant cardiovascular, respiratory, neurological, accidents, substance abuse, and non-compliance events were identified using diagnosis codes on Medicare billing claims. Adjusted associations of ME level with post-transplant complications were quantified by multivariate Cox regression. Results The incidence of complications at 3 years post-transplant among those with the highest pre-transplant ME exposure compared to no use included: ventricular arrhythmias, 1.1% vs. 0.2% (p<0.001); cardiac arrest, 4.7% vs. 2.7% (p<0.05); hypotension, 14% vs. 8% (p<0.0001); hypercapnia, 1.6% vs. 0.9% (p<0.05); mental status changes, 5.3% vs. 2.7% (p<0.001); drug abuse/dependence, 7.0% vs. 1.7% (p<0.0001); alcohol abuse, 1.8% vs. 0.6% (p=0.0001); accidents, 0.9% vs. 0.3% (p<0.05); and non-compliance, 3.5% vs. 2.3% (p<0.05). In multivariate analyses, transplant recipients with the highest level of pre-transplant narcotic use had approximately 2-to-4-times the risks of post-transplant ventricular arrhythmias, mental status changes, drug abuse, alcohol abuse, and accidents compared with non-users, and 35% to 45% higher risks of cardiac arrest and hypotension. Conclusion Although associations may reflect underlying conditions or behaviors, high-level prescription narcotic use before kidney transplantation predicts increased risk of clinical complications after transplantation. PMID:25832723

Neoadjuvant Radiotherapy: A Risk Factor for Short-Term Wound Complications after Radical Resection for Rectal Cancer?

PubMed

Holubar, Stefan D; Brickman, Rachel K; Greaves, Spencer W; Ivatury, S Joga

2016-08-01

Neoadjuvant radiotherapy (RT) for rectal cancer may increase wound complications after oncologic proctectomy. We aimed to assess the relationship between neoadjuvant RT and 30-day wound complications after radical surgery for rectal cancer. We identified rectal cancer patients (International Classification of Diseases, revision-9 [ICD-9] code 154.1) who underwent radical resection, using NSQIP from 2005 to 2010. Patients were stratified into preoperative radiation vs no radiation groups. Our primary outcome was any wound complication. The association between preoperative RT and postoperative wound complication rate was assessed by univariate, multivariable, and propensity score analyses. Of 242,670 colorectal cases, 6,297 patients were included. Of these, 2,476 (39%) received RT within 90 days preoperatively. The RT group, compared with the no RT group, received more chemotherapy within 30 days preoperatively (15.0% vs 2.5%, p < 0.0001), and had less laparoscopic (18.9% vs 25.1%, p < 0.0001) or sphincter-preserving surgery (61.8% vs 67.1%, p < 0.0001). In the univariate analyses, there was no difference in wound complications (19.6% vs 18.7%, p = 0.42) between groups. Similarly, there was no difference in overall complications (29.6% vs 29.8%, p = 0.89), return to operating room (6.7% vs 6.7%, p = 0.96), or length of stay (8.4 vs 8.4 days, p = 0.72) between the RT and no RT groups, respectively. The mortality rate in the RT group was lower on univariate analysis (0.7% vs 1.4%, p = 0.008), but was not significantly different in the multivariable analyses. Multivariable and propensity score analyses were consistent with the lack of association between preoperative RT and postoperative wound complications. Neoadjuvant radiotherapy does not appear to be an independent risk factor for wound complications after radical surgery for rectal cancer. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Outcomes of Multiple Listing for Adult Heart Transplantation in the United States: Analysis of OPTN Data from 2000 to 2013

PubMed Central

Givens, Raymond C.; Dardas, Todd; Clerkin, Kevin J.; Restaino, Susan; Schulze, P. Christian; Mancini, Donna M.

2015-01-01

Background Heart transplant (HT) candidates in the U.S. may register at multiple centers. Not all candidates have the resources and mobility needed for multiple-listing; thus this policy may advantage wealthier and less sick patients. Objectives We assessed the association of multiple-listing with waitlist outcomes and post-HT survival. Methods We identified 33,928 adult candidates for a first single-organ HT between January 1, 2000 and December 31, 2013 in the OPTN database. Results We identified 679 multiple-listed candidates (ML, 2.0%), who were younger (median age 53 years [IQR 43–60] vs. 55 [45–61], p <0.0001), more often white (76.4% vs 70.7%, p =0.0010) and privately insured (65.5% vs 56.3%, p <0.0001), and lived in ZIP codes with higher median incomes (90,153 [25,471-253,831] vs 68,986 [19,471-219,702], p =0.0015). Likelihood of ML increased with the primary center’s median waiting time. ML candidates had lower initial priority (39.0% 1A or 1B vs 55.1%, p <0.0001) and predicted 90-day waitlist mortality (2.9% [2.3–4.7] vs 3.6% [2.3–6.0], p <0.0001), but were frequently upgraded at secondary centers (58.2% 1A/1B; p <0.0001 vs ML primary listing). ML candidates had a higher HT rate (74.4% vs 70.2%, p =0.0196) and lower waitlist mortality (8.1% vs 12.2%, p =0.0011). Compared to a propensity-matched cohort, the relative ML HT rate was 3.02 (95% CI 2.59–3.52, p <0.0001). There were no post-HT survival differences. Conclusions Multiple-listing is a rational response to organ shortage but may advantage patients with the means to participate rather than the most medically needy. The multiple-listing policy should be overturned. PMID:26577617

Pediatric severe sepsis in U.S. children's hospitals.

PubMed

Balamuth, Fran; Weiss, Scott L; Neuman, Mark I; Scott, Halden; Brady, Patrick W; Paul, Raina; Farris, Reid W D; McClead, Richard; Hayes, Katie; Gaieski, David; Hall, Matt; Shah, Samir S; Alpern, Elizabeth R

2014-11-01

To compare the prevalence, resource utilization, and mortality for pediatric severe sepsis identified using two established identification strategies. Observational cohort study from 2004 to 2012. Forty-four pediatric hospitals contributing data to the Pediatric Health Information Systems database. Children 18 years old or younger. We identified patients with severe sepsis or septic shock by using two International Classification of Diseases, 9th edition, Clinical Modification-based coding strategies: 1) combinations of International Classification of Diseases, 9th edition, Clinical Modification codes for infection plus organ dysfunction (combination code cohort); 2) International Classification of Diseases, 9th edition, Clinical Modification codes for severe sepsis and septic shock (sepsis code cohort). Outcomes included prevalence of severe sepsis, as well as hospital and ICU length of stay, and mortality. Outcomes were compared between the two cohorts examining aggregate differences over the study period and trends over time. The combination code cohort identified 176,124 hospitalizations (3.1% of all hospitalizations), whereas the sepsis code cohort identified 25,236 hospitalizations (0.45%), a seven-fold difference. Between 2004 and 2012, the prevalence of sepsis increased from 3.7% to 4.4% using the combination code cohort and from 0.4% to 0.7% using the sepsis code cohort (p < 0.001 for trend in each cohort). Length of stay (hospital and ICU) and costs decreased in both cohorts over the study period (p < 0.001). Overall, hospital mortality was higher in the sepsis code cohort than the combination code cohort (21.2% [95% CI, 20.7-21.8] vs 8.2% [95% CI, 8.0-8.3]). Over the 9-year study period, there was an absolute reduction in mortality of 10.9% (p < 0.001) in the sepsis code cohort and 3.8% (p < 0.001) in the combination code cohort. Prevalence of pediatric severe sepsis increased in the studied U.S. children's hospitals over the past 9 years, whereas resource utilization and mortality decreased. Epidemiologic estimates of pediatric severe sepsis varied up to seven-fold depending on the strategy used for case ascertainment.

Pediatric Severe Sepsis in US Children’s Hospitals

PubMed Central

Balamuth, Fran; Weiss, Scott L.; Neuman, Mark I.; Scott, Halden; Brady, Patrick W.; Paul, Raina; Farris, Reid W.D.; McClead, Richard; Hayes, Katie; Gaieski, David; Hall, Matt; Shah, Samir S.; Alpern, Elizabeth R.

2014-01-01

Objective To compare the prevalence, resource utilization, and mortality for pediatric severe sepsis identified using two established identification strategies. Design Observational cohort study from 2004–2012. Setting Forty-four pediatric hospitals contributing data to the Pediatric Health Information Systems database. Patients Children ≤18 years of age. Measurements and Main Results We identified patients with severe sepsis or septic shock by using two International Classification of Diseases, 9th edition-Clinical Modification (ICD9-CM) based coding strategies: 1) combinations of ICD9-CM codes for infection plus organ dysfunction (combination code cohort); 2) ICD9-CM codes for severe sepsis and septic shock (sepsis code cohort). Outcomes included prevalence of severe sepsis, as well as hospital and intensive care unit (ICU) length of stay (LOS), and mortality. Outcomes were compared between the two cohorts examining aggregate differences over the study period and trends over time. The combination code cohort identified, 176,124 hospitalizations (3.1% of all hospitalizations), while the sepsis code cohort identified 25,236 hospitalizations (0.45%), a 7-fold difference. Between 2004 and 2012, the prevalence of sepsis increased from 3.7% to 4.4% using the combination code cohort and from 0.4% to 0.7% using the sepsis code cohort (p<0.001 for trend in each cohort). LOS (hospital and ICU) and costs decreased in both cohorts over the study period (p<0.001). Overall hospital mortality was higher in the sepsis code cohort than the combination code cohort (21.2%, (95% CI: 20.7–21.8 vs. 8.2%,(95% CI: 8.0–8.3). Over the 9 year study period, there was an absolute reduction in mortality of 10.9% (p<0.001) in the sepsis code cohort and 3.8% (p<0.001) in the combination code cohort. Conclusions Prevalence of pediatric severe sepsis increased in the studied US children’s hospitals over the past 9 years, though resource utilization and mortality decreased. Epidemiologic estimates of pediatric severe sepsis varied up to 7-fold depending on the strategy used for case ascertainment. PMID:25162514

Comparison of Outcomes of Pericardiocentesis Versus Surgical Pericardial Window in Patients Requiring Drainage of Pericardial Effusions.

PubMed

Horr, Samuel E; Mentias, Amgad; Houghtaling, Penny L; Toth, Andrew J; Blackstone, Eugene H; Johnston, Douglas R; Klein, Allan L

2017-09-01

Comparative outcomes of patients undergoing pericardiocentesis or pericardial window are limited. Development of pericardial effusion after cardiac surgery is common but no data exist to guide best management. Procedural billing codes and Cleveland Clinic surgical registries were used to identify 1,281 patients who underwent either pericardiocentesis or surgical pericardial window between January 2000 and December 2012. The 656 patients undergoing an intervention for a pericardial effusion secondary to cardiac surgery were also compared. Propensity scoring was used to identify well-matched patients in each group. In the overall cohort, in-hospital mortality was similar between the group undergoing pericardiocentesis and surgical drainage (5.3% vs 4.4%, p = 0.49). Similar outcomes were found in the propensity-matched group (4.9% vs 6.1%, p = 0.55). Re-accumulation was more common after pericardiocentesis (24% vs 10%, p <0.0001) and remained in the matched cohorts (23% vs 9%, p <0.0001). The secondary outcome of hemodynamic instability after the procedure was more common in the pericardial window group in both the unmatched (5.2% vs 2.9%, p = 0.036) and matched cohorts (6.1% vs 2.0%, p = 0.022). In the subgroup of patients with a pericardial effusion secondary to cardiac surgery, there was a lower mortality after pericardiocentesis in the unmatched group (1.5% vs 4.6%, p = 0.024); however, after adjustment, this difference in mortality was no longer present (2.6% vs 4.5%, p = 0.36). In conclusion, both pericardiocentesis and surgical pericardial window are safe and effective treatment strategies for the patient with a pericardial effusion. In our study there were no significant differences in mortality in patients undergoing either procedure. Observed differences in outcomes with regard to recurrence rates, hemodynamic instability, and in those with postcardiac surgery effusions may help to guide the clinician in management of the patient requiring therapeutic or diagnostic drainage of a pericardial effusion. Copyright © 2017 Elsevier Inc. All rights reserved.

Are hospitalized Parkinson's disease patients more likely to carry a do-not-resuscitate order?

PubMed

Mahajan, Abhimanyu; Patel, Achint; Nadkarni, Girish; Sidiropoulos, Christos

2017-03-01

While DNR utilization is a complex subjective phenomenon, the effect of such a decision can collectively influence attitudes of care. The role of palliative care in advanced PD has been under appreciated. We reviewed the Healthcare Cost and Utilization Project's National Inpatient Sample (NIS) database from 2012 for all hospitalizations ⩾65years. We identified PD by using ICD-9-CM code 332.0 and DNR status with ICD code - V49.86 entered during the same admission as a secondary diagnosis. We estimated risk of mortality by the 3M™ All Patient Refined DRG (APR DRG) classification System and generated multivariate regression models to assess associations between DNR and PD after adjusting for confounders. Finally, we tested for interaction by risk of mortality. We analyzed 12,700,000 hospitalizations with age ⩾65years in 2012, of which 246625 (1.94%) pts had PD. Proportion of DNR utilization was higher among PD patients vs. those without, 20895 (8.47%) vs. 723090 (5.8%) (p<0.01). In multivariable regression analysis, PD patients were associated with higher odds of DNR utilization [Adjusted Odds ratio (aOR): 1.26, 95% CI: 1.21, 1.30, p<0.001]. Finally, the odds of DNR utilization increased significantly with APR-DRG stage [aOR: 1 vs. 1.61 (Stage 2) vs. 2.46 (Stage 3) vs. 3.61 (Stage 4); p<0.0001]. PD patients have higher odds of DNR utilization than the general population, which worsens with increasing objective risk of mortality. This is likely correlated with perception of end of life and importance of QOL with increasing severity of overall illness. Copyright © 2016 Elsevier Ltd. All rights reserved.

Variability of segment coordination using a vector coding technique: Reliability analysis for treadmill walking and running.

PubMed

Hafer, Jocelyn F; Boyer, Katherine A

2017-01-01

Coordination variability (CV) quantifies the variety of movement patterns an individual uses during a task and may provide a measure of the flexibility of that individual's motor system. While there is growing popularity of segment CV as a marker of motor system health or adaptability, it is not known how many strides of data are needed to reliably calculate CV. This study aimed to determine the number of strides needed to reliably calculate CV in treadmill walking and running, and to compare CV between walking and running in a healthy population. Ten healthy young adults walked and ran at preferred speeds on a treadmill and a modified vector coding technique was used to calculate CV for the following segment couples: pelvis frontal plane vs. thigh frontal plane, thigh sagittal plane vs. shank sagittal plane, thigh sagittal plane vs. shank transverse plane, and shank transverse plane vs. rearfoot frontal plane. CV for each coupling of interest was calculated for 2-15 strides for each participant and gait type. Mean CV was calculated across the entire gait cycle and, separately, for 4 phases of the gait cycle. For running and walking 8 and 10 strides, respectively, were sufficient to obtain a reliable CV estimate. CV was significantly different between walking and running for the thigh vs. shank couple comparisons. These results suggest that 10 strides of treadmill data are needed to reliably calculate CV for walking and running. Additionally, the differences in CV between walking and running suggest that the role of knee (i.e., inter-thigh- shank) control may differ between these forms of locomotion. Copyright © 2016 Elsevier B.V. All rights reserved.

A sampling bias in identifying children in foster care using Medicaid data.

PubMed

Rubin, David M; Pati, Susmita; Luan, Xianqun; Alessandrini, Evaline A

2005-01-01

Prior research identified foster care children using Medicaid eligibility codes specific to foster care, but it is unknown whether these codes capture all foster care children. To describe the sampling bias in relying on Medicaid eligibility codes to identify foster care children. Using foster care administrative files linked to Medicaid data, we describe the proportion of children whose Medicaid eligibility was correctly encoded as foster child during a 1-year follow-up period following a new episode of foster care. Sampling bias is described by comparing claims in mental health, emergency department (ED), and other ambulatory settings among correctly and incorrectly classified foster care children. Twenty-eight percent of the 5683 sampled children were incorrectly classified in Medicaid eligibility files. In a multivariate logistic regression model, correct classification was associated with duration of foster care (>9 vs <2 months, odds ratio [OR] 7.67, 95% confidence interval [CI] 7.17-7.97), number of placements (>3 vs 1 placement, OR 4.20, 95% CI 3.14-5.64), and placement in a group home among adjudicated dependent children (OR 1.87, 95% CI 1.33-2.63). Compared with incorrectly classified children, correctly classified foster care children were 3 times more likely to use any services, 2 times more likely to visit the ED, 3 times more likely to make ambulatory visits, and 4 times more likely to use mental health care services (P < .001 for all comparisons). Identifying children in foster care using Medicaid eligibility files is prone to sampling bias that over-represents children in foster care who use more services.

Isoindigo-Based Small Molecules with Varied Donor Components for Solution-Processable Organic Field Effect Transistor Devices.

PubMed

Patil, Hemlata; Chang, Jingjing; Gupta, Akhil; Bilic, Ante; Wu, Jishan; Sonar, Prashant; Bhosale, Sheshanath V

2015-09-18

Two solution-processable small organic molecules, (E)-6,6'-bis(4-(diphenylamino)phenyl)-1,1'-bis(2-ethylhexyl)-(3,3'-biindolinylidene)-2,2'-dione (coded as S10) and (E)-6,6'-di(9H-carbazol-9-yl)-1,1'-bis(2-ethylhexyl)-(3,3'-biindolinylidene)-2,2'-dione (coded as S11) were successfully designed, synthesized and fully characterized. S10 and S11 are based on a donor-acceptor-donor structural motif and contain a common electron accepting moiety, isoindigo, along with different electron donating functionalities, triphenylamine and carbazole, respectively. Ultraviolet-visible absorption spectra revealed that the use of triphenylamine donor functionality resulted in an enhanced intramolecular charge transfer transition and reduction of optical band gap, when compared with its carbazole analogue. Both of these materials were designed to be donor semiconducting components, exerted excellent solubility in common organic solvents, showed excellent thermal stability, and their promising optoelectronic properties encouraged us to scrutinize charge-carrier mobilities using solution-processable organic field effect transistors. Hole mobilities of the order of 2.2 × 10(-4) cm²/Vs and 7.8 × 10(-3) cm²/Vs were measured using S10 and S11 as active materials, respectively.

The Expenditures for Academic Inpatient Care of Inflammatory Bowel Disease Patients Are Almost Double Compared with Average Academic Gastroenterology and Hepatology Cases and Not Fully Recovered by Diagnosis-Related Group (DRG) Proceeds

PubMed Central

Baumgart, Daniel C.; le Claire, Marie

2016-01-01

Background Crohn’s disease (CD) and ulcerative colitis (UC) challenge economies worldwide. Detailed health economic data of DRG based academic inpatient care for inflammatory bowel disease (IBD) patients in Europe is unavailable. Methods IBD was identified through ICD-10 K50 and K51 code groups. We took an actual costing approach, compared expenditures to G-DRG and non-DRG proceeds and performed detailed cost center and type accounting to identify coverage determinants. Results Of all 3093 hospitalized cases at our department, 164 were CD and 157 UC inpatients in 2012. On average, they were 44.1 (CD 44.9 UC 43.3 all 58) years old, stayed 10.1 (CD 11.8 UC 8.4 vs. all 8) days, carried 5.8 (CD 6.4 UC 5.2 vs. all 6.8) secondary diagnoses, received 7.4 (CD 7.7 UC 7 vs. all 6.2) procedures, had a higher cost weight (CD 2.8 UC 2.4 vs. all 1.6) and required more intense nursing. Their care was more costly (means: total cost IBD 8477€ CD 9051€ UC 7903€ vs. all 5078€). However, expenditures were not fully recovered by DRG proceeds (means: IBD 7413€, CD 8441€, UC 6384€ vs all 4758€). We discovered substantial disease specific mismatches in cost centers and types and identified the medical ward personnel and materials budgets to be most imbalanced. Non-DRG proceeds were almost double (IBD 16.1% vs. all 8.2%), but did not balance deficits at total coverage analysis, that found medications (antimicrobials, biologics and blood products), medical materials (mostly endoscopy items) to contribute most to the deficit. Conclusions DRGs challenge sophisticated IBD care. PMID:26784027

Natural killer cell-mediated innate sieve effect on HIV-1: the impact of KIR/HLA polymorphism on HIV-1 subtype-specific acquisition in east Africa.

PubMed

Koehler, Rebecca N; Alter, Galit; Tovanabutra, Sodsai; Saathoff, Elmar; Arroyo, Miguel A; Walsh, Anne M; Sanders-Buell, Eric E; Maboko, Leonard; Hoelscher, Michael; Robb, Merlin L; Michael, Nelson L; McCutchan, Francine E; Kim, Jerome H; Kijak, Gustavo H

2013-10-15

Here we explore the association between killer cell immunoglobulin-like receptor (KIR)/HLA and human immunodeficiency virus type 1 (HIV-1) acquisition with different viral subtypes circulating in East Africa. In the prospective Cohort Development (CODE) cohort (Mbeya, Tanzania), carriers of KIR3DS1 and its putative ligand (HLA-A or HLA-B Bw4-80Ile alleles) showed increased HIV-1 acquisition risk (odds ratio [OR] = 3.46; 95% confidence interval [CI], 1.12-10.63; P = .04) and a trend for enrichment for subtype A and A-containing recombinants (78% vs. 46%; OR = 4.05; 95% CI, .91-28.30; P = .09) at the expense of subtype C (11% vs. 43%; OR = 0.17; 95% CI, .01-.97; P = .08). In vitro, only natural killer cells from KIR3DS1(+)/HLA-Bw4-80Ile(+) healthy donors showed a 2-fold increased capacity to inhibit replication of subtype C vs subtype A viruses (P = .01). These findings suggest the presence of an innate sieve effect and may inform HIV-1 vaccine development.

Quality of requests for serum digoxin concentrations: experience from an Australian regional health service.

PubMed

Ellington, Chris; Grgurinovich, Nick; Miners, John O; Mangoni, Arduino A

2007-05-01

* Therapeutic drug monitoring of serum digoxin concentrations (SDC) is considered useful in enhancing the therapeutic benefits of digoxin and minimizing the incidence of adverse drug reactions. * The quality of requests for SDC has been reported to be generally unsatisfactory. However, studies have focused on few information parameters. * A better knowledge of these issues might be useful to target appropriate areas of weakness within heathcare systems. * The poor quality of the information in SDC requests involves a wide range of codes from the contact details of the requester to the time interval between the last dose of digoxin and blood sampling. * Misuse of the therapeutic drug monitoring service is common across different specialties and healthcare settings. To assess the quality of the information provided with serum digoxin concentration (SDC) requests received by a therapeutic drug monitoring service in a regional health service. We conducted a retrospective audit of a consecutive series of 685 SDC requests during a 7-month period. Information regarding (i) contact details, (ii) reasons for request, (iii) dose, (iv) route of administration, (v) concurrent therapy, (vi) treatment duration and (vii) time interval between the last dose and sampling was reviewed and coded as appropriate or inappropriate/missing. Data were analysed according to the origin of request, i.e. from different specialties/wards (emergency department and critical care, cardiology and coronary care unit, medicine and aged care, surgery, and general/private practice) and healthcare settings (teaching hospital, geriatric hospital and general/private practice). The quality of SDC requests was generally poor across different specialties and healthcare settings. The information provided for the coded parameters was appropriate only in 19.1% (i), 6.4% (ii), 54.7% (iii), 45.8% (iv), 12.8% (v), 32.9% (vi) and 47.1% (vii) of cases. No SDC request was complete in all the information codes. SDC requests from general/private practice lacked more often details regarding the dose (information provided in 46.7% of requests, P = 0.007 vs. other specialties; P = 0.02 vs. other settings) and the route of administration (20.0%, P < 0.001 vs. other specialties and vs. other settings). SDC requests from the emergency department and critical care unit lacked more often details regarding the treatment duration (22.6%, P < 0.001 vs. other specialties) and the time interval between the last dose and blood sampling (40.1%, P = 0.01 vs. other specialties). The quality of the information in SDC requests is poor across different specialties and healthcare settings. Educational strategies to ensure the appropriate use of this service are urgently needed.

Quality of requests for serum digoxin concentrations: experience from an Australian Regional Health Service

PubMed Central

Ellington, Chris; Grgurinovich, Nick; Miners, John O; Mangoni, Arduino A

2007-01-01

What is already known about this subject Therapeutic drug monitoring of serum digoxin concentrations (SDC) is considered useful in enhancing the therapeutic benefits of digoxin and minimizing the incidence of adverse drug reactions. The quality of requests for SDC has been reported to be generally unsatisfactory. However, studies have focused on few information parameters. A better knowledge of these issues might be useful to target appropriate areas of weakness within heathcare systems. What this study adds The poor quality of the information in SDC requests involves a wide range of codes from the contact details of the requester to the time interval between the last dose of digoxin and blood sampling. Misuse of the therapeutic drug monitoring service is common across different specialties and healthcare settings. Aims To assess the quality of the information provided with serum digoxin concentration (SDC) requests received by a therapeutic drug monitoring service in a regional health service. Methods We conducted a retrospective audit of a consecutive series of 685 SDC requests during a 7-month period. Information regarding (i) contact details, (ii) reasons for request, (iii) dose, (iv) route of administration, (v) concurrent therapy, (vi) treatment duration and (vii) time interval between the last dose and sampling was reviewed and coded as appropriate or inappropriate/missing. Data were analysed according to the origin of request, i.e. from different specialties/wards (emergency department and critical care, cardiology and coronary care unit, medicine and aged care, surgery, and general/private practice) and healthcare settings (teaching hospital, geriatric hospital and general/private practice). Results The quality of SDC requests was generally poor across different specialties and healthcare settings. The information provided for the coded parameters was appropriate only in 19.1% (i), 6.4% (ii), 54.7% (iii), 45.8% (iv), 12.8% (v), 32.9% (vi) and 47.1% (vii) of cases. No SDC request was complete in all the information codes. SDC requests from general/private practice lacked more often details regarding the dose (information provided in 46.7% of requests, P = 0.007 vs. other specialties; P = 0.02 vs. other settings) and the route of administration (20.0%, P < 0.001 vs. other specialties and vs. other settings). SDC requests from the emergency department and critical care unit lacked more often details regarding the treatment duration (22.6%, P < 0.001 vs. other specialties) and the time interval between the last dose and blood sampling (40.1%, P = 0.01 vs. other specialties). Conclusions The quality of the information in SDC requests is poor across different specialties and healthcare settings. Educational strategies to ensure the appropriate use of this service are urgently needed. PMID:17073890

Stroke code simulation benefits advanced practice providers similar to neurology residents.

PubMed

Khan, Muhib; Baird, Grayson L; Price, Theresa; Tubergen, Tricia; Kaskar, Omran; De Jesus, Michelle; Zachariah, Joseph; Oostema, Adam; Scurek, Raymond; Coleman, Robert R; Sherman, Wendy; Hingtgen, Cynthia; Abdelhak, Tamer; Smith, Brien; Silver, Brian

2018-04-01

Advanced practice providers (APPs) are important members of stroke teams. Stroke code simulations offer valuable experience in the evaluation and treatment of stroke patients without compromising patient care. We hypothesized that simulation training would increase APP confidence, comfort level, and preparedness in leading a stroke code similar to neurology residents. This is a prospective quasi-experimental, pretest/posttest study. Nine APPs and 9 neurology residents participated in 3 standardized simulated cases to determine need for IV thrombolysis, thrombectomy, and blood pressure management for intracerebral hemorrhage. Emergency medicine physicians and neurologists were preceptors. APPs and residents completed a survey before and after the simulation. Generalized mixed modeling assuming a binomial distribution was used to evaluate change. On a 5-point Likert scale (1 = strongly disagree and 5 = strongly agree), confidence in leading a stroke code increased from 2.4 to 4.2 ( p < 0.05) among APPs. APPs reported improved comfort level in rapidly assessing a stroke patient for thrombolytics (3.1-4.2; p < 0.05), making the decision to give thrombolytics (2.8 vs 4.2; p < 0.05), and assessing a patient for embolectomy (2.4-4.0; p < 0.05). There was no difference in the improvement observed in all the survey questions as compared to neurology residents. Simulation training is a beneficial part of medical education for APPs and should be considered in addition to traditional didactics and clinical training. Further research is needed to determine whether simulation education of APPs results in improved treatment times and outcomes of acute stroke patients.

Considering Climate Change in Road and Building Design

NASA Astrophysics Data System (ADS)

Jacobs, Jennifer M.; Kirshen, Paul H.; Daniel, Jo Sias

2013-07-01

What is the role of climate in infrastructure design? How can engineers design for a changing climate? How can climate scientists better inform the design process? These were the questions posed at the first Infrastructure and Climate Network (ICNet) Steering Committee Workshop, which was sponsored by a U.S. National Science Foundation research grant (CBET-1231326) from the Research Coordination Networks-Science, Engineering and Education for Sustainability (RCN-SEES) program.

Cu(I)-mediated Allosteric Switching in a Copper-sensing Operon Repressor (CsoR)*

PubMed Central

Chang, Feng-Ming James; Coyne, H. Jerome; Cubillas, Ciro; Vinuesa, Pablo; Fang, Xianyang; Ma, Zhen; Ma, Dejian; Helmann, John D.; García-de los Santos, Alejandro; Wang, Yun-Xing; Dann, Charles E.; Giedroc, David P.

2014-01-01

The copper-sensing operon repressor (CsoR) is representative of a major Cu(I)-sensing family of bacterial metalloregulatory proteins that has evolved to prevent cytoplasmic copper toxicity. It is unknown how Cu(I) binding to tetrameric CsoRs mediates transcriptional derepression of copper resistance genes. A phylogenetic analysis of 227 DUF156 protein members, including biochemically or structurally characterized CsoR/RcnR repressors, reveals that Geobacillus thermodenitrificans (Gt) CsoR characterized here is representative of CsoRs from pathogenic bacilli Listeria monocytogenes and Bacillus anthracis. The 2.56 Å structure of Cu(I)-bound Gt CsoR reveals that Cu(I) binding induces a kink in the α2-helix between two conserved copper-ligating residues and folds an N-terminal tail (residues 12–19) over the Cu(I) binding site. NMR studies of Gt CsoR reveal that this tail is flexible in the apo-state with these dynamics quenched upon Cu(I) binding. Small angle x-ray scattering experiments on an N-terminally truncated Gt CsoR (Δ2–10) reveal that the Cu(I)-bound tetramer is hydrodynamically more compact than is the apo-state. The implications of these findings for the allosteric mechanisms of other CsoR/RcnR repressors are discussed. PMID:24831014

Simulation of Infrared Spectra of Carbonaceous Grains

NASA Astrophysics Data System (ADS)

Dadswell, G.; Duley, W. W.

1997-02-01

Random covalent network (RCN) theory is applied to describe the infrared spectroscopic properties of carbonaceous solids with compositions containing a mixture of aromatic, aliphatic, and diamond-like hydrocarbons. Application of this technique to carbonaceous dust is equivalent to the synthesis of solids whose structure and bonding satisfy stoicheometry while minimizing strain energy. The result involves a range of compositions compatible with carbon bonding and the hydrogen concentration incorporated in the network. In general, only a limited range of compositions is available rather than the infinite number of possible compositions expected without the inclusion of these constraints. When compositions have been defined in this way, infrared spectra may be synthesized for comparison with astronomical spectra of interstellar carbonaceous solids. Such spectra contain components corresponding to absorption by CHn groups in which n = 1-3. We find, however, that additional spectral features, not included in our simple chemical model, must be present also in dust. We give plots of such spectra in the 3100-2800 cm-1 (3.2-3.6 μm) region for comparison with infrared spectra of interstellar dust. We have also developed an RCN formalism that incorporates oxygen into the carbon network as OH groups, and we show that this inclusion introduces a strong additional absorption band in the 3300 cm-1 (3.0 μm) region.

Glucose control of root growth direction in Arabidopsis thaliana.

PubMed

Singh, Manjul; Gupta, Aditi; Laxmi, Ashverya

2014-07-01

Directional growth of roots is a complex process that is modulated by various environmental signals. This work shows that presence of glucose (Glc) in the medium also extensively modulated seedling root growth direction. Glc modulation of root growth direction was dramatically enhanced by simultaneous brassinosteroid (BR) application. Glc enhanced BR receptor BRASSINOSTEROID INSENSITIVE1 (BRI1) endocytosis from plasma membrane to early endosomes. Glc-induced root deviation was highly enhanced in a PP2A-defective mutant, roots curl in naphthyl phthalamic acid 1-1 (rcn1-1) suggesting that there is a role of phosphatase in Glc-induced root-growth deviation. RCN1, therefore, acted as a link between Glc and the BR-signalling pathway. Polar auxin transport worked further downstream to BR in controlling Glc-induced root deviation response. Glc also affected other root directional responses such as root waving and coiling leading to altered root architecture. High light intensity mimicked the Glc-induced changes in root architecture that were highly reduced in Glc-signalling mutants. Thus, under natural environmental conditions, changing light flux in the environment may lead to enhanced Glc production/response and is a way to manipulate root architecture for optimized development via integrating several extrinsic and intrinsic signalling cues. © The Author 2014. Published by Oxford University Press on behalf of the Society for Experimental Biology.

CISN ShakeAlert: Faster Warning Information Through Multiple Threshold Event Detection in the Virtual Seismologist (VS) Early Warning Algorithm

NASA Astrophysics Data System (ADS)

Cua, G. B.; Fischer, M.; Caprio, M.; Heaton, T. H.; Cisn Earthquake Early Warning Project Team

2010-12-01

The Virtual Seismologist (VS) earthquake early warning (EEW) algorithm is one of 3 EEW approaches being incorporated into the California Integrated Seismic Network (CISN) ShakeAlert system, a prototype EEW system that could potentially be implemented in California. The VS algorithm, implemented by the Swiss Seismological Service at ETH Zurich, is a Bayesian approach to EEW, wherein the most probable source estimate at any given time is a combination of contributions from a likehihood function that evolves in response to incoming data from the on-going earthquake, and selected prior information, which can include factors such as network topology, the Gutenberg-Richter relationship or previously observed seismicity. The VS codes have been running in real-time at the Southern California Seismic Network since July 2008, and at the Northern California Seismic Network since February 2009. We discuss recent enhancements to the VS EEW algorithm that are being integrated into CISN ShakeAlert. We developed and continue to test a multiple-threshold event detection scheme, which uses different association / location approaches depending on the peak amplitudes associated with an incoming P pick. With this scheme, an event with sufficiently high initial amplitudes can be declared on the basis of a single station, maximizing warning times for damaging events for which EEW is most relevant. Smaller, non-damaging events, which will have lower initial amplitudes, will require more picks to initiate an event declaration, with the goal of reducing false alarms. This transforms the VS codes from a regional EEW approach reliant on traditional location estimation (and the requirement of at least 4 picks as implemented by the Binder Earthworm phase associator) into an on-site/regional approach capable of providing a continuously evolving stream of EEW information starting from the first P-detection. Real-time and offline analysis on Swiss and California waveform datasets indicate that the multiple-threshold approach is faster and more reliable for larger events than the earlier version of the VS codes. In addition, we provide evolutionary estimates of the probability of false alarms (PFA), which is an envisioned output stream of the CISN ShakeAlert system. The real-time decision-making approach envisioned for CISN ShakeAlert users, where users specify a threshhold PFA in addition to thresholds on peak ground motion estimates, has the potential to increase the available warning time for users with high tolerance to false alarms without compromising the needs of users with lower tolerances to false alarms.

Health-Care Utilization and Complications of Endoscopic Esophageal Dilation in a National Population

PubMed Central

Goyal, Abhinav; Chatterjee, Kshitij; Yadlapati, Sujani; Singh, Shailender

2017-01-01

Background/Aims Esophageal stricture is usually managed with outpatient endoscopic dilation. However, patients with food impaction or failure to thrive undergo inpatient dilation. Esophageal perforation is the most feared complication, and its risk in inpatient setting is unknown. Methods We used National Inpatient Sample (NIS) database for 2007–2013. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes were used to identify patients with esophageal strictures. Logistic regression was used to assess association between hospital/patient characteristics and utilization of esophageal dilation. Results There were 591,187 hospitalizations involving esophageal stricture; 4.2% were malignant. Endoscopic dilation was performed in 28.7% cases. Dilation was more frequently utilized (odds ratio [OR], 1.36; p<0.001), had higher in-hospital mortality (3.1% vs. 1.4%, p<0.001), and resulted in longer hospital stays (5 days vs. 4 days, p=0.01), among cases of malignant strictures. Esophageal perforation was more common in the malignant group (0.9% vs. 0.5%, p=0.007). Patients with malignant compared to benign strictures undergoing dilation were more likely to require percutaneous endoscopic gastrostomy or jejunostomy (PEG/J) tube (14.1% vs. 4.5%, p<0.001). Palliative care services were utilized more frequently in malignant stricture cases not treated with dilation compared to those that were dilated. Conclusions Inpatient endoscopic dilation was utilized in 29% cases of esophageal stricture. Esophageal perforation, although infrequent, is more common in malignant strictures. PMID:28301921

A Novel Approach for Effectively Treating SCI Pain, Improving Opioid Efficacy, and Preventing Opioid-Induced Constipation: Key Role of Toll-Like Receptor 4 (TLR4)

DTIC Science & Technology

2014-10-01

RESPONSIBLE PERSON USAMRMC a. REPORT U b. ABSTRACT U c. THIS PAGE U UU 17 19b. TELEPHONE NUMBER (include area code ) 2 Table of Contents...after dorsal root avulsion, during the acute stages of injury? 3b. SNAP surgery and testing (Hargreaves, motor function and constipation tests during the...first week post- surgery with co-administration of morphine and (+)-naltrexone (vs. vehicles) starting 1 or 24 hr post surgery ; von Frey and motor

Creatine kinase and alpha-actin mRNA levels decrease in diabetic rat hearts

DOE Office of Scientific and Technical Information (OSTI.GOV)

Popovich, B.; Barrieux, A.; Dillmann, W.H.

1987-05-01

Diabetic cardiomyopathy is associated with cardiac atrophy and isoenzyme redistribution. To determine if tissue specific changes occur in mRNAs coding for ..cap alpha..-actin and creatine kinase (CK), they performed RNA blot analysis. Total ventricular RNA from control (C) and 4 wk old diabetic (D) rats were hybridized with /sup 32/P cDNA probes for ..cap alpha..-actin and CK. A tissue independent cDNA probe, CHOA was also used. Signal intensity was quantified by photodensitometry. D CK mRNA was 47 +/- 16% lower in D vs C. Insulin increases CK mRNA by 20% at 1.5 hs, and completely reverses the deficit after 4more » wks. D ..cap alpha..-actin mRNA is 66 +/- 18% lower in D vs C. Insulin normalized ..cap alpha..-actin mRNA by 5 hs. CHOA mRNA is unchanged in D vs C, but D + insulin CHOA mRNA is 30 +/- 2% lower than C. In rats with diabetic cardiomyopathy, muscle specific CK and ..cap alpha..-actin mRNAs are decreased. Insulin treatment reverses these changes.« less

Effect of change in coding rules on recording diabetes in hospital administrative datasets.

PubMed

Assareh, Hassan; Achat, Helen M; Guevarra, Veth M; Stubbs, Joanne M

2016-10-01

During 2008-2011 Australian Coding Standards mandated a causal relationship between diabetes and inpatient care as a criterion for recording diabetes as a comorbidity in hospital administrative datasets. We aim to measure the effect of the causality mandate on recorded diabetes and associated inter-hospital variations. For patients with diabetes, all admissions between 2004 and 2013 to all New South Wales acute public hospitals were investigated. Poisson mixed models were employed to derive adjusted rates and variations. The non-recorded diabetes incidence rate was 20.7%. The causality mandate increased the incidence rate four fold during the change period, 2008-2011, compared to the pre- or post-change periods (32.5% vs 8.4% and 6.9%). The inter-hospital variation was also higher, with twice the difference in the non-recorded rate between hospitals with the highest and lowest rates (50% vs 24% and 27% risk gap). The variation decreased during the change period (29%), while the rate continued to rise (53%). Admission characteristics accounted for over 44% of the variation compared with at most two per cent attributable to patient or hospital characteristics. Contributing characteristics explained less of the variation within the change period compared to pre- or post-change (46% vs 58% and 53%). Hospital relative performance was not constant over time. The causality mandate substantially increased the non-recorded diabetes rate and associated inter-hospital variation. Longitudinal accumulation of clinical information at the patient level, and the development of appropriate adoption protocols to achieve comprehensive and timely implementation of coding changes are essential to supporting the integrity of hospital administrative datasets. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Evaluation of liquefaction potential for building code

NASA Astrophysics Data System (ADS)

Nunziata, C.; De Nisco, G.; Panza, G. F.

2008-07-01

The standard approach for the evaluation of the liquefaction susceptibility is based on the estimation of a safety factor between the cyclic shear resistance to liquefaction and the earthquake induced shear stress. Recently, an updated procedure based on shear-wave velocities (Vs) has been proposed which could be more easily applied. These methods have been applied at La Plaja beach of Catania, that experienced liquefaction because of the 1693 earthquake. The detailed geotechnical and Vs information and the realistic ground motion computed for the 1693 event let us compare the two approaches. The successful application of the Vs procedure, slightly modified to fit historical and safety factor information, even if additional field performances are needed, encourages the development of a guide for liquefaction potential analysis, based on well defined Vs profiles to be included in the italian seismic code.

[Prevalence of dementia of insured persons with and without German citizenship : A study based on statuatory health insurance data].

PubMed

Stock, Stephanie; Ihle, Peter; Simic, Dusan; Rupprecht, Christoph; Schubert, Ingrid; Lappe, Veronika; Kalbe, Elke; Tebest, Ralf; Lorrek, Kristina

2018-04-01

Elderly people with a non-German background are a fast growing population in Germany. Is administrative prevalence of dementia and uptake of nursing-home care similar in the German and non-German insured? Based on routine data, administrative prevalence rates for dementia were calculated for 2013 from a full census of data from one large sickness fund. Patients with dementia (PWD) were identified via ICD-10 codes (F00; F01; F03; F05; G30). Administrative prevalence of dementia was 2.67% in the study population; 3.06% in Germans, and 0.96% in non-Germans (p value <0.001). Age and sex adjusted prevalence was comparable in the insured with and without German citizenship, except in women aged 80-84 (17.2 vs. 15.4) and for men in the age groups 80-84 (16.5 vs. 14.2), 85-89 years (23.4 vs. 21.5), and above 90 years of age (32.3 vs. 26.3). Standardized to the population of all investigated insured, 31.4% of all Germans with dementia had no longterm care entitlement vs. 35.5% of all patients without German citizenship. Of German patients, 55.1% were institutionalized vs. 39.5% of all patients without German citizenship. There was a higher prevalence of dementia in the very old insured without German citizenship compared to those with German citizenship, especially in men. Non-Germans showed lower uptake of nursing home care compared to Germans. Additionally, Germans had slightly higher nursing care entitlements. It should be investigated further how much of the difference is due to underdiagnosis, cultural differences, or lack of adequate diagnostic work-up.

Amino acid codes in mitochondria as possible clues to primitive codes

NASA Technical Reports Server (NTRS)

Jukes, T. H.

1981-01-01

Differences between mitochondrial codes and the universal code indicate that an evolutionary simplification has taken place, rather than a return to a more primitive code. However, these differences make it evident that the universal code is not the only code possible, and therefore earlier codes may have differed markedly from the previous code. The present universal code is probably a 'frozen accident.' The change in CUN codons from leucine to threonine (Neurospora vs. yeast mitochondria) indicates that neutral or near-neutral changes occurred in the corresponding proteins when this code change took place, caused presumably by a mutation in a tRNA gene.

Minithoracotomy for mitral valve repair improves inpatient and postdischarge economic savings.

PubMed

Grossi, Eugene A; Goldman, Scott; Wolfe, J Alan; Mehall, John; Smith, J Michael; Ailawadi, Gorav; Salemi, Arash; Moore, Matt; Ward, Alison; Gunnarsson, Candace

2014-12-01

Small series of thoracotomy for mitral valve repair have demonstrated clinical benefit. This multi-institutional administrative database analysis compares outcomes of thoracotomy and sternotomy approaches for mitral repair. The Premier database was queried from 2007 to 2011 for mitral repair hospitalizations. Premier contains billing, cost, and coding data from more than 600 US hospitals, totaling 25 million discharges. Thoracotomy and sternotomy approaches were identified through expert rules; robotics were excluded. Propensity matching on baseline characteristics was performed. Regression analysis of surgical approach on outcomes and costs was modeled. Expert rule analysis positively identified thoracotomy in 847 and sternotomy in 566. Propensity matching created 2 groups of 367. Mortalities were similar (thoracotomy 1.1% vs sternotomy 1.9%). Sepsis and other infections were significantly lower with thoracotomy (1.1% vs 4.4%). After adjustment for hospital differences, thoracotomy carried a 17.2% lower hospitalization cost (-$8289) with a 2-day stay reduction. Readmission rates were significantly lower with thoracotomy (26.2% vs 35.7% at 30 days and 31.6% vs 44.1% at 90 days). Thoracotomy was more common in southern and northeastern hospitals (63% vs 37% and 64% vs 36%, respectively), teaching hospitals (64% vs 36%) and larger hospitals (>600 beds, 78% vs 22%). Relative to sternotomy, thoracotomy for mitral repairs provides similar mortality, less morbidity, fewer infections, shorter stay, and significant cost savings during primary admission. The markedly lower readmission rates for thoracotomy will translate into additional institutional cost savings when a penalty on hospitals begins under the Affordable Care Act's Hospital Readmissions Reduction Program. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Transfusion strategy for weak D type 4.0 based on RHD alleles and RH haplotypes in Tunisia

PubMed Central

Ouchari, Mouna; Srivastava, Kshitij; Romdhane, Houda; Yacoub, Saloua Jemni; Flegel, Willy Albert

2017-01-01

Background With more than 460 RHD alleles, this gene is the most complex and polymorphic among all blood group systems. The Tunisian population has the largest known prevalence of weak D type 4.0 alleles, occurring in 1 of 105 RH haplotypes. We aimed to establish a rationale for the transfusion strategy of weak D type 4.0 in Tunisia. Study design and methods Donors were randomly screened for the serological weak D phenotype. The RHD coding sequence and parts of the introns were sequenced. To establish the RH haplotype, the RHCE gene was tested for characteristic single nucleotide positions. Results We determined all RHD alleles and the RH haplotypes coding for the serologic weak D phenotype among 13,431 Tunisian donations. A serologic weak D phenotype was found in 67 individuals (0.50%). Among them, 60 carried a weak D type 4 allele: 53 weak D type 4.0, 6 weak D type 4.2.2 (DAR), and 1 weak D type 4.1. Another 4 donors had 1 variant allele each: DVII, weak D type 1, weak D type 3, and weak D type 100, while 3 donors showed a normal RHD sequence. The weak D type 4.0 was most often linked to RHCE*ceVS.04.01, weak D type 4.2.2 to RHCE*ceAR, and weak D type 4.1 to RHCE*ceVS.02, while the other RHD alleles were linked to one of the common RHCE alleles. Conclusions Among the weak D phenotypes in Tunisia, no novel RHD allele was found and almost 90% were caused by alleles of the weak D type 4 cluster, of which 88% represented the weak D type 4.0 allele. Based on established RH haplotypes for variant RHD and RHCE alleles and the lack of adverse clinical reports, we recommend D positive transfusions for patients with weak D type 4.0 in Tunisia. PMID:29193104

Analysis of economic and social costs of adverse events associated with blood transfusions in Spain.

PubMed

Ribed-Sánchez, Borja; González-Gaya, Cristina; Varea-Díaz, Sara; Corbacho-Fabregat, Carlos; Bule-Farto, Isabel; Pérez de-Oteyza, Jaime

To calculate, for the first time, the direct and social costs of transfusion-related adverse events in order to include them in the National Healthcare System's budget, calculation and studies. In Spain more than 1,500 patients yearly are diagnosed with such adverse events. Blood transfusion-related adverse events recorded yearly in Spanish haemovigilance reports were studied retrospectively (2010-2015). The adverse events were coded according to the classification of Diagnosis-Related Groups. The direct healthcare costs were obtained from public information sources. The productivity loss (social cost) associated with adverse events was calculated using the human capital and hedonic salary methodologies. In 2015, 1,588 patients had adverse events that resulted in direct health care costs (4,568,914€) and social costs due to hospitalization (200,724€). Three adverse reactions resulted in patient death (at a social cost of 1,364,805€). In total, the cost of blood transfusion-related adverse events was 6,134,443€ in Spain. For the period 2010-2015: the trends show a reduction in the total amount of transfusions (2 vs. 1.91M€; -4.4%). The number of adverse events increased (822 vs. 1,588; +93%), as well as their related direct healthcare cost (3.22 vs. 4.57M€; +42%) and the social cost of hospitalization (110 vs 200M€; +83%). Mortality costs decreased (2.65 vs. 1.36M€; -48%). This is the first time that the costs of post-transfusion adverse events have been calculated in Spain. These new figures and trends should be taken into consideration in any cost-effectiveness study or trial of new surgical techniques or sanitary policies that influence blood transfusion activities. Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

The NSF-RCN Urban Heat Island Network

NASA Astrophysics Data System (ADS)

Snyder, P. K.; Twine, T. E.; Hamilton, P.; Shepherd, M.; Stone, B., Jr.

2016-12-01

In much of the world cities are warming at twice the rate of outlying rural areas. The frequency of urban heat waves is projected to increase with climate change through the 21st century. Addressing the economic, environmental, and human costs of urban heat islands requires a better understanding of their behavior from many disciplinary perspectives. The goal of this four-year Urban Heat Island Network is to (1) bring together scientists studying the causes and impacts of urban warming, (2) advance multidisciplinary understanding of urban heat islands, (3) examine how they can be ameliorated through engineering and design practices, and (4) share these new insights with a wide array of stakeholders responsible for managing urban warming to reduce their health, economic, and environmental impacts. The NSF-RCN Urban Heat Island Network involves atmospheric scientists, engineers, architects, landscape designers, urban planners, public health experts, and education and outreach experts, who will share knowledge, evaluate research directions, and communicate knowledge and research recommendations to the larger research community as well as stakeholders engaged in developing strategies to adapt to and mitigate urban warming. The first Urban Climate Institute was held in Saint Paul, MN in July 2013 and focused on the characteristics of urban heat islands. Scientists engaged with local practitioners to improve communication pathways surrounding issues of understanding, adapting to, and mitigating urban warming. The second Urban Climate Institute was held in Atlanta, Georgia in July 2014 and focused on urban warming and public health. The third Urban Climate Institute was held in Athens, GA in July 2015 and focused on urban warming and the role of the built environment. Scientists and practitioners discussed strategies for mitigation and adaptation. The fourth Institute was held in Saint Paul, MN in July 2016 and focused on putting research to practice. Evaluation experts at the Science Museum of Minnesota have extensively evaluated the Institutes to inform other research coordination networks and to identify effective ways that researchers and practitioners can share knowledge and communicate more effectively.

Transfusion strategy for weak D Type 4.0 based on RHD alleles and RH haplotypes in Tunisia.

PubMed

Ouchari, Mouna; Srivastava, Kshitij; Romdhane, Houda; Jemni Yacoub, Saloua; Flegel, Willy Albert

2018-02-01

With more than 460 RHD alleles, this gene is the most complex and polymorphic among all blood group systems. The Tunisian population has the largest known prevalence of weak D Type 4.0 alleles, occurring in one of 105 RH haplotypes. We aimed to establish a rationale for the transfusion strategy of weak D Type 4.0 in Tunisia. Donors were randomly screened for the serologic weak D phenotype. The RHD coding sequence and parts of the introns were sequenced. To establish the RH haplotype, the RHCE gene was tested for characteristic single-nucleotide positions. We determined all RHD alleles and the RH haplotypes coding for the serologic weak D phenotype among 13,431 Tunisian donations. A serologic weak D phenotype was found in 67 individuals (0.50%). Among them, 60 carried a weak D Type 4 allele: 53 weak D Type 4.0, six weak D Type 4.2.2 (DAR), and one weak D Type 4.1. An additional four donors had one variant allele each: DVII, weak D Type 1, weak D Type 3, and weak D type 100, while three donors showed a normal RHD sequence. The weak D Type 4.0 was most often linked to RHCE*ceVS.04.01, weak D Type 4.2.2 to RHCE*ceAR, and weak D Type 4.1 to RHCE*ceVS.02, while the other RHD alleles were linked to one of the common RHCE alleles. Among the weak D phenotypes in Tunisia, no novel RHD allele was found and almost 90% were caused by alleles of the weak D Type 4 cluster, of which 88% represented the weak D Type 4.0 allele. Based on established RH haplotypes for variant RHD and RHCE alleles and the lack of adverse clinical reports, we recommend D+ transfusions for patients with weak D Type 4.0 in Tunisia. © 2017 AABB.

A Primer on Choosing the Medium for Multimedia: Videodisc vs. Videotape.

ERIC Educational Resources Information Center

Shamp, Scott A.

1993-01-01

Discusses videodisc and videotape basic needs, software development issues, user workstation issues, appropriate applications for the different audio/visual storage media, counter vs. time-code VCRs, and implications for student development. (MDH)

Hospital days, hospitalization costs, and inpatient mortality among patients with mucormycosis: a retrospective analysis of US hospital discharge data

PubMed Central

2014-01-01

Background Mucormycosis is a rare and potentially fatal fungal infection occurring primarily in severely immunosuppressed patients. Because it is so rare, reports in the literature are mainly limited to case reports or small case series. The aim of this study was to evaluate inpatient mortality, length of stay (LOS), and costs among a matched sample of high-risk patients with and without mucormycosis in a large nationally representative database. Methods We conducted a retrospective analysis using the 2003–2010 Healthcare Cost and Utilization Project – Nationwide Inpatient Sample (HCUP-NIS). The NIS is a nationally representative 20% sample of hospitalizations from acute care United States (US) hospitals, with survey weights available to compute national estimates. We classified hospitalizations into four mutually exclusive risk categories for mucormycosis: A- severely immunocompromised, B- critically ill, C- mildly/moderately immunocompromised, D- major surgery or pneumonia. Mucormycosis hospitalizations (“cases”) were identified by ICD-9-CM code 117.7. Non-mucormycosis hospitalizations (“non-cases”) were propensity-score matched to cases 3:1. We examined demographics, clinical characteristics, and hospital outcomes (mortality, LOS, costs). Weighted results were reported. Results From 319,366,817 total hospitalizations, 5,346 cases were matched to 15,999 non-cases. Cases and non-cases did not differ significantly in age (49.6 vs. 49.7 years), female sex (40.5% vs. 41.0%), White race (53.3% vs. 55.9%) or high-risk group (A-49.1% vs. 49.0%, B-20.0% vs. 21.8%, C-25.5% vs. 23.8%, D-5.5% vs. 5.4%). Cases experienced significantly higher mortality (22.1% vs. 4.4%, P < 0.001), with mean LOS and total costs more than 3-fold higher (24.5 vs. 8.0 days and $90,272 vs. $25,746; both P < 0.001). Conclusions In a national hospital database, hospitalizations with mucormycosis had significantly higher inpatient mortality, LOS, and hospital costs than matched hospitalizations without mucormycosis. Findings suggest that interventions to prevent or more effectively treat mucormycosis are needed. PMID:24903188

A tribute to the Omagh nurses.

PubMed

1998-10-01

I admit that when I rang Robert Sowney, Clinical Nurse Specialist in South Tyrone Hospital A&E department and a member of the RCN A&E Nursing Association Steering Group, I did so with some trepidation. How do you convey support in the aftermath of the Omagh bombing without feeling intrusive? Where is the boundary between empathy and voyeurism? We spoke long into the evening about Saturday, 15 August and the days that followed.

Elucidating the clinical characteristics of patients captured using different definitions of massive transfusion.

PubMed

Zatta, A J; McQuilten, Z K; Mitra, B; Roxby, D J; Sinha, R; Whitehead, S; Dunkley, S; Kelleher, S; Hurn, C; Cameron, P A; Isbister, J P; Wood, E M; Phillips, L E

2014-07-01

The type and clinical characteristics of patients identified with commonly used definitions of massive transfusion (MT) are largely unknown. The objective of this study was to define the clinical characteristics of patients meeting different definitions of MT for the purpose of patient recruitment in observational studies. Data were extracted on all patients who received red blood cell (RBC) transfusions in 2010 at three tertiary Australian hospitals. MT patients were identified according to three definitions: ≥10 units RBC in 24 h (10/24 h), ≥6 units RBC in 6 h (6/6 h) and ≥5 units RBC in 4 h (5/4 h). Clinical coding data were used to assign bleeding context. Data on in-hospital mortality were also extracted. Five hundred and forty-two patients met at least one MT definition, with 236 (44%) included by all definitions. The most inclusive definition was 5/4 h (508 patients, 94%) followed by 6/6 h (455 patients, 84%) and 10/24 h (251 patients, 46%). Importantly, 40-55% of most types of critical bleeding events and 82% of all obstetric haemorrhage cases were excluded by the 10/24 h definition. Patients who met both the 5/4 h and 10/24 h definitions were transfused more RBCs (19 vs. 8 median total RBC units; P < 0·001), had longer ventilation time (120 vs. 55 h; P < 0·001), median ICU (149 vs. 99 h; P < 0·001) and hospital length of stay (23 vs. 18 h; P = 0·006) and had a higher in-hospital mortality rate (23·3% vs. 16·4%; P = 0·050). The 5/4 h MT definition was the most inclusive, but combination with the 10/24 h definition appeared to identify a clinically important patient cohort. © 2014 International Society of Blood Transfusion.

Determining mode excitations of vacuum electronics devices via three-dimensional simulations using the SOS code

NASA Technical Reports Server (NTRS)

Warren, Gary

1988-01-01

The SOS code is used to compute the resonance modes (frequency-domain information) of sample devices and separately to compute the transient behavior of the same devices. A code, DOT, is created to compute appropriate dot products of the time-domain and frequency-domain results. The transient behavior of individual modes in the device is then plotted. Modes in a coupled-cavity traveling-wave tube (CCTWT) section excited beam in separate simulations are analyzed. Mode energy vs. time and mode phase vs. time are computed and it is determined whether the transient waves are forward or backward waves for each case. Finally, the hot-test mode frequencies of the CCTWT section are computed.

How does the robot affect outcomes? A retrospective review of open, laparoscopic, and robotic Heller myotomy for achalasia.

PubMed

Shaligram, Abhijit; Unnirevi, Jayaraj; Simorov, Anton; Kothari, Vishal M; Oleynikov, Dmitry

2012-04-01

Robotic techniques are routinely used in urological and gynecological procedures; however, their role in general surgical procedures is limited. A robotic technique has been successfully adopted for a minimally invasive Heller myotomy procedure for achalasia. This study aims to compare perioperative outcomes following open, laparoscopic, and robotic Heller myotomy. This study is a multicenter, retrospective analysis utilizing a large administrative database. The University Health System Consortium (UHC) is an alliance between academic medical centers and affiliate hospitals. The UHC database was accessed using International Classification of Diseases, Ninth Revision, Clinical Modification codes and analyzed. 2,683 patients with achalasia underwent Heller myotomy between October 2007 and June 2011. Myotomy was performed by open surgery (OM) in 418 patients, by laparoscopic approach (LM) in 2,116, and by robotic approach (RM) in 149. Comparison between LM and RM groups demonstrated no significant difference in mortality (0.14 vs. 0.0%; P = 1), morbidity (5.19 vs. 4.02%; P = 0.7), intensive care unit (ICU) admission (6.62 vs. 3.36%; P = 0.12), length of stay (LOS) (2.70 ± 3.87 days vs. 2.42 ± 2.69 days; P = 0.34), or 30-day readmission (1.41 vs. 2.84%; P = 0.27). However, hospital costs were significantly lower for the LM group (US $7,441 ± 7,897 vs. US $9,415 ± 5,515; P = 0.0028). Comparison between OM and RM demonstrated significant lower morbidity (9.08 vs. 4.02%; P = 0.02), ICU admission rate (14.01 vs. 3.36%, P = 0.0002), and LOS (4.42 ± 5.25 days vs. 2.42 ± 2.69 days; P = 0.0001). The perioperative outcomes are superior in LM and RM groups when compared with OM. The outcomes for the LM and RM group are comparable, with the robotic group having slightly improved results, although with increased costs. We conclude that robotic surgery is equivalent in safety and efficacy to laparoscopic Heller myotomy, and feel that the increased cost should come down as surgeons and manufacturers work together on cost reduction strategies.

Least Reliable Bits Coding (LRBC) for high data rate satellite communications

NASA Technical Reports Server (NTRS)

Vanderaar, Mark; Wagner, Paul; Budinger, James

1992-01-01

An analysis and discussion of a bandwidth efficient multi-level/multi-stage block coded modulation technique called Least Reliable Bits Coding (LRBC) is presented. LRBC uses simple multi-level component codes that provide increased error protection on increasingly unreliable modulated bits in order to maintain an overall high code rate that increases spectral efficiency. Further, soft-decision multi-stage decoding is used to make decisions on unprotected bits through corrections made on more protected bits. Using analytical expressions and tight performance bounds it is shown that LRBC can achieve increased spectral efficiency and maintain equivalent or better power efficiency compared to that of Binary Phase Shift Keying (BPSK). Bit error rates (BER) vs. channel bit energy with Additive White Gaussian Noise (AWGN) are given for a set of LRB Reed-Solomon (RS) encoded 8PSK modulation formats with an ensemble rate of 8/9. All formats exhibit a spectral efficiency of 2.67 = (log2(8))(8/9) information bps/Hz. Bit by bit coded and uncoded error probabilities with soft-decision information are determined. These are traded with with code rate to determine parameters that achieve good performance. The relative simplicity of Galois field algebra vs. the Viterbi algorithm and the availability of high speed commercial Very Large Scale Integration (VLSI) for block codes indicates that LRBC using block codes is a desirable method for high data rate implementations.

A Cost-Benefit Between Pyxis and Bar Coding for the Brooke Army Medical Center Operating Room

DTIC Science & Technology

2005-04-29

38 C onclusions ...................................................................................... 39 A ppendices ...designed for the care of patients Pyxis vs. Bar Coding 8 by surgical practitioners, namely the acute care hospitals. Thus, hospital facilities began to

The impact of three discharge coding methods on the accuracy of diagnostic coding and hospital reimbursement for inpatient medical care.

PubMed

Tsopra, Rosy; Peckham, Daniel; Beirne, Paul; Rodger, Kirsty; Callister, Matthew; White, Helen; Jais, Jean-Philippe; Ghosh, Dipansu; Whitaker, Paul; Clifton, Ian J; Wyatt, Jeremy C

2018-07-01

Coding of diagnoses is important for patient care, hospital management and research. However coding accuracy is often poor and may reflect methods of coding. This study investigates the impact of three alternative coding methods on the inaccuracy of diagnosis codes and hospital reimbursement. Comparisons of coding inaccuracy were made between a list of coded diagnoses obtained by a coder using (i)the discharge summary alone, (ii)case notes and discharge summary, and (iii)discharge summary with the addition of medical input. For each method, inaccuracy was determined for the primary, secondary diagnoses, Healthcare Resource Group (HRG) and estimated hospital reimbursement. These data were then compared with a gold standard derived by a consultant and coder. 107 consecutive patient discharges were analysed. Inaccuracy of diagnosis codes was highest when a coder used the discharge summary alone, and decreased significantly when the coder used the case notes (70% vs 58% respectively, p < 0.0001) or coded from the discharge summary with medical support (70% vs 60% respectively, p < 0.0001). When compared with the gold standard, the percentage of incorrect HRGs was 42% for discharge summary alone, 31% for coding with case notes, and 35% for coding with medical support. The three coding methods resulted in an annual estimated loss of hospital remuneration of between £1.8 M and £16.5 M. The accuracy of diagnosis codes and percentage of correct HRGs improved when coders used either case notes or medical support in addition to the discharge summary. Further emphasis needs to be placed on improving the standard of information recorded in discharge summaries. Copyright © 2018 Elsevier B.V. All rights reserved.

The PAX2-null immunophenotype defines multiple lineages with common expression signatures in benign and neoplastic oviductal epithelium

PubMed Central

Ning, Gang; Bijron, Jonathan G.; Yamamoto, Yusuke; Wang, Xia; Howitt, Brooke E.; Herfs, Michael; Yang, Eric; Hong, Yue; Cornille, Maxence; Wu, Lingyan; Hanamornroongruang, Suchanan; McKeon, Frank D.; Crum, Christopher P.; Xian, Wa

2014-01-01

The oviducts contain high grade serous cancer (HGSC) precursors (serous tubal intraepithelial neoplasia or STINs), which are γ-H2AXp- and TP53 mutation-positive. Although they express wild type p53, secretory cell outgrowths (SCOUTs) are associated with older age and serous cancer; moreover both STINs and SCOUTs share a loss of PAX2 expression (PAX2n). We evaluated PAX2 expression in proliferating adult and embryonic oviductal cells, normal mucosa, SCOUTs, Walthard cell nests (WCNs), STINs and HGSCs, and the expression of genes chosen empirically or from SCOUT expression arrays. Clones generated in vitro from embryonic gynecologic tract and adult fallopian tube were Krt7p/PAX2n/EZH2p and underwent ciliated (PAX2n/EZH2n/FOXJ1p) and basal (Krt7n/EZH2n/Krt5p) differentiation. Similarly non-ciliated cells in normal mucosa were PAX2p but became PAX2n in multilayered epithelium undergoing ciliated or basal (Walthard cell nests or WCN) cell differentiation. PAX2n SCOUTs fell into two groups; Type I were secretory or secretory/ciliated with a “tubal” phenotype and were ALDH1n and β-cateninmem (membraneous only). Type II displayed a columnar to pseudostratified (endometrioid) phenotype, with an EZH2p, ALDH1p, β-cateninnc (nuclear and cytoplasmic), stathminp, LEF1p, RCN1p and RUNX2p expression signature. STINs and HGSCs shared the Type I immunophenotype of PAX2n, ALDH1n, β-cateninmem, but highly expressed EZH2p, LEF1p, RCN1p, and stathminp. This study, for the first time, links PAX2n with proliferating fetal and adult oviductal cells undergoing basal and ciliated differentiation and shows that this expression state is maintained in SCOUTs, STINs and HGSCs. All three entities can demonstrate a consistent perturbation of genes involved in potential tumor suppressor gene silencing (EZH2), transcriptional regulation (LEF1), regulation of differentiation (RUNX2), calcium binding (RCN1) and oncogenesis (stathmin). This shared expression signature between benign and neoplastic entities links normal progenitor cell expansion to abnormal and neoplastic outgrowth in the oviduct and exposes a common pathway that could be a target for early prevention. PMID:25130537

Regulating nutrient allocation in plants

DOEpatents

Udvardi, Michael; Yang, Jiading; Worley, Eric

2014-12-09

The invention provides coding and promoter sequences for a VS-1 and AP-2 gene, which affects the developmental process of senescence in plants. Vectors, transgenic plants, seeds, and host cells comprising heterologous VS-1 and AP-2 genes are also provided. Additionally provided are methods of altering nutrient allocation and composition in a plant using the VS-1 and AP-2 genes.

Bibliography of Testing and Evaluation Reference Material

DTIC Science & Technology

1989-08-01

Society. ** [Basl84a] Basili, V.R., and J. Ramsey . September 1984. Structural Coverage of Functional Testing . University of Maryland. Technical Report TR...r’V1 r~CN <T { L Copy 2 0 of 36 copies N FINAL cc CID It- IDA MEMORANDUM REPORT M-496 BIBLIOGRAPHY OF TESTING AND EVALUATION REFERENCE MATERIAL Bill...blank) 2. REPORT DATE 3. REPORT TYPE AND DATES COVERED August 1989 Final -TITLE AND SUBTITLE 5. FUNDING NUMBERS * Bibliography of Testing and

45th Annual Targets, UAVs and Range Operations Symposium and Exhibition - Tools and Technologies for the Warfighter. Volume 1

DTIC Science & Technology

2007-10-30

Flight Test wmv format Joint Ground Robotics Program, Mr. Duane Gotvald, Deputy Project Manager , PEO GCS Robotic Systems Joint Program 1...Mr. Al Brown, TMO Deputy Director, PMITTS, PEO STRI 1. Targets Management Office wmv format Strength through Industry & Technology National...Ferguson, RCN, NDHQ 10:20AM DTRMC, OSD Strategic Plan Jerry Christensen, DOT&E 10:40 Target Management Initiative Ken McCormick, DOT&E 11:10AM

Legal issues surrounding consent and capacity: the key to autonomy.

PubMed

Griffith, Richard; Tengnah, Cassam

2011-12-01

With campaigns from the RCN, Nursing Times and Patients' Association promoting dignity and choice in healthcare district nurses need to be aware of the legal principle that lie at the heart of autonomy, consent. In the first of a series of articles on the principles of patient consent Richard Griffith and Cassam Tengnah outline the elements of a valid consent and how important obtaining consent is to the propriety of a district nurse's practice.

Co-producing a digital educational programme for registered children's nurses to improve care of children and young people admitted with self-harm.

PubMed

Latif, Asam; Carter, Timothy; Rychwalska-Brown, Lucy; Wharrad, Heather; Manning, Joseph

2017-06-01

Despite the increasing prevalence of hospital admissions for self-harm in children and young people (CYP), there is paucity of registered children's nurse (rCN) training or involvement of children to improve care for this often stigmatized patient group. This article describes a participatory approach towards using co-production with CYP and rCN to develop a digital educational programme to improve nurses' knowledge, attitudes and confidence in caring for CYP with self-harm injuries. A priority-setting workshop with rCNs was used to establish consensus of information needs. This was followed by an e-learning content development workshop undertaken with CYP whom had previously experienced hospital admissions for self-harm injuries. Findings from the nurse priority-setting workshop identified three educational priorities: (1) knowledge of self-harm, (2) effective communication and (3) risk management. The CYP subsequently developed these topic areas to ensure the contents and design of the e-learning resource had fidelity by reflecting the experiences of CYP and needs when cared for in hospital. This article illustrates that involving service users to co-develop educational materials is a feasible and important step in designing educational resources and ensures the content is relevant, appropriate and sensitive to both the recipient of care and those responsible for its delivery.

A partnership approach to leadership development for Directors of Nursing in Older People's services in Ireland - articulating the impact.

PubMed

Ford, Pauline; Wynne, Mary; Rice, Matthew; Grogan, Carol

2008-03-01

This paper outlines the approach undertaken by the Royal College of Nursing to design, deliver and evaluate a programme of leadership development for Directors of Nursing in Older People's services commissioned by the Nursing and Midwifery Planning Development Unit Dublin, Kildare and Wicklow. The programme was developed to support Nurse Directors of these services to enhance their leadership capabilities at a time of significant health service reform and investment. The programme was underpinned by the Office of Health Management's Nursing Competency Framework (Rush et al. 2000). The key influences for the programme were the significant contemporary policy and organizational developments directly experienced by Directors of Nursing. This paper will focus on the benefits for participants, commissioners and service users alike in adopting this kind of partnership approach to the design, delivery and evaluation of a bespoke RCN leadership development programme which combined the experience of RCN Gerontology alongside Leadership. Specifically, the paper focuses on the context of the commissioned work and the ways of working between the members of the delivery team and the commissioners, their roles and responsibilities and the importance of these interrelationships in the delivery of a development programme which would meet the specific needs of this key group of nurse leaders. The key learning and experiences of the Directors of Nursing are highlighted.

Cascading failures in complex networks with community structure

NASA Astrophysics Data System (ADS)

Lin, Guoqiang; di, Zengru; Fan, Ying

2014-12-01

Much empirical evidence shows that when attacked with cascading failures, scale-free or even random networks tend to collapse more extensively when the initially deleted node has higher betweenness. Meanwhile, in networks with strong community structure, high-betweenness nodes tend to be bridge nodes that link different communities, and the removal of such nodes will reduce only the connections among communities, leaving the networks fairly stable. Understanding what will affect cascading failures and how to protect or attack networks with strong community structure is therefore of interest. In this paper, we have constructed scale-free Community Networks (SFCN) and Random Community Networks (RCN). We applied these networks, along with the Lancichinett-Fortunato-Radicchi (LFR) benchmark, to the cascading-failure scenario to explore their vulnerability to attack and the relationship between cascading failures and the degree distribution and community structure of a network. The numerical results show that when the networks are of a power-law distribution, a stronger community structure will result in the failure of fewer nodes. In addition, the initial removal of the node with the highest betweenness will not lead to the worst cascading, i.e. the largest avalanche size. The Betweenness Overflow (BOF), an index that we developed, is an effective indicator of this tendency. The RCN, however, display a different result. In addition, the avalanche size of each node can be adopted as an index to evaluate the importance of the node.

Ethylene-dependent aerenchyma formation in adventitious roots is regulated differently in rice and maize.

PubMed

Yamauchi, Takaki; Tanaka, Akihiro; Mori, Hitoshi; Takamure, Itsuro; Kato, Kiyoaki; Nakazono, Mikio

2016-10-01

In roots of gramineous plants, lysigenous aerenchyma is created by the death and lysis of cortical cells. Rice (Oryza sativa) constitutively forms aerenchyma under aerobic conditions, and its formation is further induced under oxygen-deficient conditions. However, maize (Zea mays) develops aerenchyma only under oxygen-deficient conditions. Ethylene is involved in lysigenous aerenchyma formation. Here, we investigated how ethylene-dependent aerenchyma formation is differently regulated between rice and maize. For this purpose, in rice, we used the reduced culm number1 (rcn1) mutant, in which ethylene biosynthesis is suppressed. Ethylene is converted from 1-aminocyclopropane-1-carboxylic acid (ACC) by the action of ACC oxidase (ACO). We found that OsACO5 was highly expressed in the wild type, but not in rcn1, under aerobic conditions, suggesting that OsACO5 contributes to aerenchyma formation in aerated rice roots. By contrast, the ACO genes in maize roots were weakly expressed under aerobic conditions, and thus ACC treatment did not effectively induce ethylene production or aerenchyma formation, unlike in rice. Aerenchyma formation in rice roots after the initiation of oxygen-deficient conditions was faster and greater than that in maize. These results suggest that the difference in aerenchyma formation in rice and maize is due to their different mechanisms for regulating ethylene biosynthesis. © 2016 John Wiley & Sons Ltd.

Novel exon 1 protein-coding regions N-terminally extend human KCNE3 and KCNE4.

PubMed

Abbott, Geoffrey W

2016-08-01

The 5 human (h)KCNE β subunits each regulate various cation channels and are linked to inherited cardiac arrhythmias. Reported here are previously undiscovered protein-coding regions in exon 1 of hKCNE3 and hKCNE4 that extend their encoded extracellular domains by 44 and 51 residues, which yields full-length proteins of 147 and 221 residues, respectively. Full-length hKCNE3 and hKCNE4 transcript and protein are expressed in multiple human tissues; for hKCNE4, only the longer protein isoform is detectable. Two-electrode voltage-clamp electrophysiology revealed that, when coexpressed in Xenopus laevis oocytes with various potassium channels, the newly discovered segment preserved conversion of KCNQ1 by hKCNE3 to a constitutively open channel, but prevented its inhibition of Kv4.2 and KCNQ4. hKCNE4 slowing of Kv4.2 inactivation and positive-shifted steady-state inactivation were also preserved in the longer form. In contrast, full-length hKCNE4 inhibition of KCNQ1 was limited to 40% at +40 mV vs. 80% inhibition by the shorter form, and augmentation of KCNQ4 activity by hKCNE4 was entirely abolished by the additional segment. Among the genome databases analyzed, the longer KCNE3 is confined to primates; full-length KCNE4 is widespread in vertebrates but is notably absent from Mus musculus Findings highlight unexpected KCNE gene diversity, raise the possibility of dynamic regulation of KCNE partner modulation via splice variation, and suggest that the longer hKCNE3 and hKCNE4 proteins should be adopted in future mechanistic and genetic screening studies.-Abbott, G. W. Novel exon 1 protein-coding regions N-terminally extend human KCNE3 and KCNE4. © FASEB.

Increased pediatric sub-specialization is associated with decreased surgical complication rates for inpatient pediatric urology procedures

PubMed Central

Tejwani, R.; Wang, H-H. S.; Young, B. J.; Greene, N. H.; Wolf, S.; Wiener, J. S.; Routh, J. C.

2016-01-01

Summary Introduction Increased case volumes and training are associated with better surgical outcomes. However, the impact of pediatric urology sub-specialization on perioperative complication rates is unknown. Objectives To determine the presence and magnitude of difference in rates of common postoperative complications for elective pediatric urology procedures between specialization levels of urologic surgeons. The Nationwide Inpatient Sample (NIS), a nationally representative administrative database, was used. Study Design The NIS (1998–2009) was retrospectively reviewed for pediatric (≤18 years) admissions, using ICD-9-CM codes to identify urologic surgeries and National Surgical Quality Improvement Program (NSQIP) inpatient postoperative complications. Degree of pediatric sub-specialization was calculated using a Pediatric Proportion Index (PPI), defined as the ratio of children to total patients operated on by each provider. The providers were grouped into PPI quartiles: Q1, 0–25% specialization; Q2, 25–50%; Q3, 50–75%; Q4, 75–100%. Weighted multivariate analysis was performed to test for associations between PPI and surgical complications. Results A total of 71,479 weighted inpatient admissions were identified. Patient age decreased with increasing specialization: Q1, 7.9 vs Q2, 4.8 vs Q3, 4.8 vs Q4, 4.6 years, P<0.01). Specialization was not associated with race (P>0.20), gender (P>0.50), or comorbidity scores (P=0.10). Mortality (1.5% vs 0.2% vs 0.3% vs 0.4%, P<0.01) and complication rates (15.5% vs 11.7% vs 9.6% vs 10.9%, P<0.0001) both decreased with increasing specialization. Patients treated by more highly specialized surgeons incurred slightly higher costs (Q2, +4%; Q3, +1%; Q4 + 2%) but experienced shorter length of hospital stay (Q2, –5%; Q3, –10%; Q4, –3%) compared with the least specialized providers. A greater proportion of patients treated by Q1 and Q3 specialized urologists had CCS ≥2 than those seen by Q2 or Q4 urologists (12.5% and 12.2%, respectively vs 8.4% and 10.9%, respectively, P=0.04). Adjusting for confounding effects, increased pediatric specialization was associated with decreased postoperative complications: Q2 OR 0.78, CI 0.58–1.05; Q3 OR 0.60, CI 0.44–0.84; Q4 OR 0.70, CI 0.58–0.84; P<0.01. Discussion Providers with proportionally higher volumes of pediatric patients achieved better postoperative outcomes than their less sub-specialized counterparts. This may have arisen from increased exposure to pediatric anatomy and physiology, and greater familiarity with pediatric techniques. Limitation The NIS admission-based retrospective design did not enable assessment of long-term outcomes, repeated admissions, or to track a particular patient across time. The study was similarly limited in evaluating the effect of pre-surgical referral patterns on patient distributions. Conclusions Increased pediatric sub-specialization among urologists was associated with a decreased risk of mortality and surgical complications in children undergoing inpatient urologic procedures. PMID:27363329

Increased pediatric sub-specialization is associated with decreased surgical complication rates for inpatient pediatric urology procedures.

PubMed

Tejwani, R; Wang, H-H S; Young, B J; Greene, N H; Wolf, S; Wiener, J S; Routh, J C

2016-12-01

Increased case volumes and training are associated with better surgical outcomes. However, the impact of pediatric urology sub-specialization on perioperative complication rates is unknown. To determine the presence and magnitude of difference in rates of common postoperative complications for elective pediatric urology procedures between specialization levels of urologic surgeons. The Nationwide Inpatient Sample (NIS), a nationally representative administrative database, was used. The NIS (1998-2009) was retrospectively reviewed for pediatric (≤18 years) admissions, using ICD-9-CM codes to identify urologic surgeries and National Surgical Quality Improvement Program (NSQIP) inpatient postoperative complications. Degree of pediatric sub-specialization was calculated using a Pediatric Proportion Index (PPI), defined as the ratio of children to total patients operated on by each provider. The providers were grouped into PPI quartiles: Q1, 0-25% specialization; Q2, 25-50%; Q3, 50-75%; Q4, 75-100%. Weighted multivariate analysis was performed to test for associations between PPI and surgical complications. A total of 71,479 weighted inpatient admissions were identified. Patient age decreased with increasing specialization: Q1, 7.9 vs Q2, 4.8 vs Q3, 4.8 vs Q4, 4.6 years, P < 0.01). Specialization was not associated with race (P > 0.20), gender (P > 0.50), or comorbidity scores (P = 0.10). Mortality (1.5% vs 0.2% vs 0.3% vs 0.4%, P < 0.01) and complication rates (15.5% vs 11.7% vs 9.6% vs 10.9%, P < 0.0001) both decreased with increasing specialization. Patients treated by more highly specialized surgeons incurred slightly higher costs (Q2, +4%; Q3, +1%; Q4 + 2%) but experienced shorter length of hospital stay (Q2, -5%; Q3, -10%; Q4, -3%) compared with the least specialized providers. A greater proportion of patients treated by Q1 and Q3 specialized urologists had CCS ≥2 than those seen by Q2 or Q4 urologists (12.5% and 12.2%, respectively vs 8.4% and 10.9%, respectively, P = 0.04). Adjusting for confounding effects, increased pediatric specialization was associated with decreased postoperative complications: Q2 OR 0.78, CI 0.58-1.05; Q3 OR 0.60, CI 0.44-0.84; Q4 OR 0.70, CI 0.58-0.84; P < 0.01. Providers with proportionally higher volumes of pediatric patients achieved better postoperative outcomes than their less sub-specialized counterparts. This may have arisen from increased exposure to pediatric anatomy and physiology, and greater familiarity with pediatric techniques. The NIS admission-based retrospective design did not enable assessment of long-term outcomes, repeated admissions, or to track a particular patient across time. The study was similarly limited in evaluating the effect of pre-surgical referral patterns on patient distributions. Increased pediatric sub-specialization among urologists was associated with a decreased risk of mortality and surgical complications in children undergoing inpatient urologic procedures. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Phonological Codes Constrain Output of Orthographic Codes via Sublexical and Lexical Routes in Chinese Written Production

PubMed Central

Wang, Cheng; Zhang, Qingfang

2015-01-01

To what extent do phonological codes constrain orthographic output in handwritten production? We investigated how phonological codes constrain the selection of orthographic codes via sublexical and lexical routes in Chinese written production. Participants wrote down picture names in a picture-naming task in Experiment 1or response words in a symbol—word associative writing task in Experiment 2. A sublexical phonological property of picture names (phonetic regularity: regular vs. irregular) in Experiment 1and a lexical phonological property of response words (homophone density: dense vs. sparse) in Experiment 2, as well as word frequency of the targets in both experiments, were manipulated. A facilitatory effect of word frequency was found in both experiments, in which words with high frequency were produced faster than those with low frequency. More importantly, we observed an inhibitory phonetic regularity effect, in which low-frequency picture names with regular first characters were slower to write than those with irregular ones, and an inhibitory homophone density effect, in which characters with dense homophone density were produced more slowly than those with sparse homophone density. Results suggested that phonological codes constrained handwritten production via lexical and sublexical routes. PMID:25879662

Rising Billing for Intermediate Intensive Care among Hospitalized Medicare Beneficiaries between 1996 and 2010

PubMed Central

Valley, Thomas S.; Prescott, Hallie C.; Wunsch, Hannah; Iwashyna, Theodore J.; Cooke, Colin R.

2016-01-01

Rationale: Intermediate care (i.e., step-down or progressive care) is an alternative to the intensive care unit (ICU) for patients with moderate severity of illness. The adoption and current use of intermediate care is unknown. Objectives: To characterize trends in intermediate care use among U.S. hospitals. Methods: We examined 135 million acute care hospitalizations among elderly individuals (≥65 yr) enrolled in fee-for-service Medicare (U.S. federal health insurance program) from 1996 to 2010. We identified patients receiving intermediate care as those with intensive care or coronary care room and board charges labeled intermediate ICU. Measurements and Main Results: In 1996, a total of 960 of the 3,425 hospitals providing critical care billed for intermediate care (28%), and this increased to 1,643 of 2,783 hospitals (59%) in 2010 (P < 0.01). Only 8.2% of Medicare hospitalizations in 1996 were billed for intermediate care, but billing steadily increased to 22.8% by 2010 (P < 0.01), whereas the percentage billed for ICU care and ward-only care declined. Patients billed for intermediate care had more acute organ failures diagnoses codes compared with general ward patients (22.4% vs. 15.8%). When compared with patients billed for ICU care, those billed for intermediate care had fewer organ failures (22.4% vs. 43.4%), less mechanical ventilation (0.9% vs. 16.7%), lower mean Medicare spending ($8,514 vs. $18,150), and lower 30-day mortality (5.6% vs. 16.5%) (P < 0.01 for all comparisons). Conclusions: Intermediate care billing increased markedly between 1996 and 2010. These findings highlight the need to better define the value, specific practices, and effective use of intermediate care for patients and hospitals. PMID:26372779

Rising Billing for Intermediate Intensive Care among Hospitalized Medicare Beneficiaries between 1996 and 2010.

PubMed

Sjoding, Michael W; Valley, Thomas S; Prescott, Hallie C; Wunsch, Hannah; Iwashyna, Theodore J; Cooke, Colin R

2016-01-15

Intermediate care (i.e., step-down or progressive care) is an alternative to the intensive care unit (ICU) for patients with moderate severity of illness. The adoption and current use of intermediate care is unknown. To characterize trends in intermediate care use among U.S. hospitals. We examined 135 million acute care hospitalizations among elderly individuals (≥65 yr) enrolled in fee-for-service Medicare (U.S. federal health insurance program) from 1996 to 2010. We identified patients receiving intermediate care as those with intensive care or coronary care room and board charges labeled intermediate ICU. In 1996, a total of 960 of the 3,425 hospitals providing critical care billed for intermediate care (28%), and this increased to 1,643 of 2,783 hospitals (59%) in 2010 (P < 0.01). Only 8.2% of Medicare hospitalizations in 1996 were billed for intermediate care, but billing steadily increased to 22.8% by 2010 (P < 0.01), whereas the percentage billed for ICU care and ward-only care declined. Patients billed for intermediate care had more acute organ failures diagnoses codes compared with general ward patients (22.4% vs. 15.8%). When compared with patients billed for ICU care, those billed for intermediate care had fewer organ failures (22.4% vs. 43.4%), less mechanical ventilation (0.9% vs. 16.7%), lower mean Medicare spending ($8,514 vs. $18,150), and lower 30-day mortality (5.6% vs. 16.5%) (P < 0.01 for all comparisons). Intermediate care billing increased markedly between 1996 and 2010. These findings highlight the need to better define the value, specific practices, and effective use of intermediate care for patients and hospitals.

Dynamics of Large Systems of Nonlinearly Evolving Units

NASA Astrophysics Data System (ADS)

Lu, Zhixin

The dynamics of large systems of many nonlinearly evolving units is a general research area that has great importance for many areas in science and technology, including biology, computation by artificial neural networks, statistical mechanics, flocking in animal groups, the dynamics of coupled neurons in the brain, and many others. While universal principles and techniques are largely lacking in this broad area of research, there is still one particular phenomenon that seems to be broadly applicable. In particular, this is the idea of emergence, by which is meant macroscopic behaviors that "emerge" from a large system of many "smaller or simpler entities such that...large entities" [i.e., macroscopic behaviors] arise which "exhibit properties the smaller/simpler entities do not exhibit." In this thesis we investigate mechanisms and manifestations of emergence in four dynamical systems consisting many nonlinearly evolving units. These four systems are as follows. (a) We first study the motion of a large ensemble of many noninteracting particles in a slowly changing Hamiltonian system that undergoes a separatrix crossing. In such systems, we find that separatrix-crossing induces a counterintuitive effect. Specifically, numerical simulation of two sets of densely sprinkled initial conditions on two energy curves appears to suggest that the two energy curves, one originally enclosing the other, seemingly interchange their positions. This, however, is topologically forbidden. We resolve this paradox by introducing a numerical simulation method we call "robust" and study its consequences. (b) We next study the collective dynamics of oscillatory pacemaker neurons in Suprachiasmatic Nucleus (SCN), which, through synchrony, govern the circadian rhythm of mammals. We start from a high-dimensional description of the many coupled oscillatory neuronal units within the SCN. This description is based on a forced Kuramoto model. We then reduce the system dimensionality by using the Ott Antonsen Ansatz and obtain a low-dimensional macroscopic description. Using this reduced macroscopic system, we explain the east-west asymmetry of jet-lag recovery and discus the consequences of our findings. (c) Thirdly, we study neuron firing in integrate-and-fire neural networks. We build a discrete-state/discrete-time model with both excitatory and inhibitory neurons and find a phase transition between avalanching dynamics and ceaseless firing dynamics. Power-law firing avalanche size/duration distributions are observed at critical parameter values. Furthermore, in this critical regime we find the same power law exponents as those observed from experiments and previous, more restricted, simulation studies. We also employ a mean-field method and show that inhibitory neurons in this system promote robustness of the criticality (i.e., an enhanced range of system parameter where power-law avalanche statistics applies). (d) Lastly, we study the dynamics of "reservoir computing networks" (RCN's), which is a recurrent neural network (RNN) scheme for machine learning. The advantage of RCN's over traditional RNN's is that the training is done only on the output layer, usually via a simple least-square method. We show that RCN's are very effective for inferring unmeasured state variables of dynamical systems whose system state is only partially measured. Using the examples of the Lorenz system and the Rossler system we demonstrate the potential of an RCN to perform as an universal model-free "observer".

Complete genome analysis of porcine kobuviruses from the feces of pigs in Japan.

PubMed

Akagami, Masataka; Ito, Mika; Niira, Kazutaka; Kuroda, Moegi; Masuda, Tsuneyuki; Haga, Kei; Tsuchiaka, Shinobu; Naoi, Yuki; Kishimoto, Mai; Sano, Kaori; Omatsu, Tsutomu; Aoki, Hiroshi; Katayama, Yukie; Oba, Mami; Oka, Tomoichiro; Ichimaru, Toru; Yamasato, Hiroshi; Ouchi, Yoshinao; Shirai, Junsuke; Katayama, Kazuhiko; Mizutani, Tetsuya; Nagai, Makoto

2017-08-01

Porcine kobuviruses (PoKoVs) are ubiquitously distributed in pig populations worldwide and are thought to be enteric viruses in swine. Although PoKoVs have been detected in pigs in Japan, no complete genome data for Japanese PoKoVs are available. In the present study, 24 nearly complete or complete sequences of the PoKoV genome obtained from 10 diarrheic feces and 14 non-diarrheic feces of Japanese pigs were analyzed using a metagenomics approach. Japanese PoKoVs shared 85.2-100% identity with the complete coding nucleotide (nt) sequences and the closest relationship of 85.1-98.3% with PoKoVs from other countries. Twenty of 24 Japanese PoKoVs carried a deletion of 90 nt in the 2B coding region. Phylogenetic tree analyses revealed that PoKoVs were not grouped according to their geographical region of origin and the phylogenetic trees of the L, P1, P2, and P3 genetic regions showed topologies different from each other. Similarity plot analysis using strains from a single farm revealed partially different similarity patterns among strains from identical farm origins, suggesting that recombination events had occurred. These results indicate that various PoKoV strains are prevalent and not restricted geographically on pig farms worldwide and the coexistence of multiple strains leads to recombination events of PoKoVs and contributes to the genetic diversity and evolution of PoKoVs.

Rocketdyne Safety Algorithm: Space Shuttle Main Engine Fault Detection

NASA Technical Reports Server (NTRS)

Norman, Arnold M., Jr.

1994-01-01

The Rocketdyne Safety Algorithm (RSA) has been developed to the point of use on the TTBE at MSFC on Task 4 of LeRC contract NAS3-25884. This document contains a description of the work performed, the results of the nominal test of the major anomaly test cases and a table of the resulting cutoff times, a plot of the RSA value vs. time for each anomaly case, a logic flow description of the algorithm, the algorithm code, and a development plan for future efforts.

High-Fidelity Modeling of Computer Network Worms

DTIC Science & Technology

2004-06-22

plots the propagation of the TCP-based worm. This execution is among the largest TCP worm models simulated to date at packet-level. TCP vs . UDP Worm...the mapping of the virtual IP addresses to honeyd’s MAC address in the proxy’s ARP table. The proxy server listens for packets from both sides of...experimental setup, we used two ntium-4 ThinkPad , and an IBM Pentium-III ThinkPad ), running the proxy server and honeyd respectively. The Code Red II worm

Hematologic Manifestations of Brucellosis in Children.

PubMed

Justman, Naphtali; Fruchtman, Yariv; Greenberg, David; Ben-Shimol, Shalom

2018-06-01

Brucellosis is a common zoonosis in the Bedouin population of southern Israel. Limited data exist for the rate and risk factors of hematologic complication of brucellosis in children. We assessed anemia, leukopenia, thrombocytopenia and pancytopenia in childhood brucellosis in southern Israel. Our medical center is the sole hospital in southern Israel. All medical files of brucellosis, 2005-2014, identified through positive blood cultures or International Classification of Diseases 9th revision coding with positive serology, were reviewed retrospectively. Overall, 511 brucellosis episodes were identified; 42% (N = 214) with ≥1 cytopenia, including 13% (N = 68) anemia, 28% (N = 144) leukopenia, 14% (N = 74) thrombocytopenia and 2% (N = 9) pancytopenia. Overall, 99.8% of episodes were in Bedouin children and 70% in males. In 79% of episodes, blood culture was positive for Brucella melitensis. Acute infections comprised 84% of all episodes. In univariate analysis, older age (10.49 ± 4.81 vs. 9.25 ± 4.89 years), fever (92% vs. 78%), positive blood culture (84% vs. 75%) and IgM ≥1:640 levels (50% vs. 39%) were associated with cytopenia. In contrast, arthralgia was associated with noncytopenic episodes. In multivariate analyses, older age (odds ratio = 1.063) and fever (odds ratio = 3.127) were associated with cytopenia. Brucellosis is commonly presented with cytopenia, especially in bacteremic episodes with fever. However, pancytopenia is uncommon and its finding should alert the physician to look for other possible etiologies.

Death Certification Errors and the Effect on Mortality Statistics.

PubMed

McGivern, Lauri; Shulman, Leanne; Carney, Jan K; Shapiro, Steven; Bundock, Elizabeth

Errors in cause and manner of death on death certificates are common and affect families, mortality statistics, and public health research. The primary objective of this study was to characterize errors in the cause and manner of death on death certificates completed by non-Medical Examiners. A secondary objective was to determine the effects of errors on national mortality statistics. We retrospectively compared 601 death certificates completed between July 1, 2015, and January 31, 2016, from the Vermont Electronic Death Registration System with clinical summaries from medical records. Medical Examiners, blinded to original certificates, reviewed summaries, generated mock certificates, and compared mock certificates with original certificates. They then graded errors using a scale from 1 to 4 (higher numbers indicated increased impact on interpretation of the cause) to determine the prevalence of minor and major errors. They also compared International Classification of Diseases, 10th Revision (ICD-10) codes on original certificates with those on mock certificates. Of 601 original death certificates, 319 (53%) had errors; 305 (51%) had major errors; and 59 (10%) had minor errors. We found no significant differences by certifier type (physician vs nonphysician). We did find significant differences in major errors in place of death ( P < .001). Certificates for deaths occurring in hospitals were more likely to have major errors than certificates for deaths occurring at a private residence (59% vs 39%, P < .001). A total of 580 (93%) death certificates had a change in ICD-10 codes between the original and mock certificates, of which 348 (60%) had a change in the underlying cause-of-death code. Error rates on death certificates in Vermont are high and extend to ICD-10 coding, thereby affecting national mortality statistics. Surveillance and certifier education must expand beyond local and state efforts. Simplifying and standardizing underlying literal text for cause of death may improve accuracy, decrease coding errors, and improve national mortality statistics.

Screening pregnant women for suicidal behavior in electronic medical records: diagnostic codes vs. clinical notes processed by natural language processing.

PubMed

Zhong, Qiu-Yue; Karlson, Elizabeth W; Gelaye, Bizu; Finan, Sean; Avillach, Paul; Smoller, Jordan W; Cai, Tianxi; Williams, Michelle A

2018-05-29

We examined the comparative performance of structured, diagnostic codes vs. natural language processing (NLP) of unstructured text for screening suicidal behavior among pregnant women in electronic medical records (EMRs). Women aged 10-64 years with at least one diagnostic code related to pregnancy or delivery (N = 275,843) from Partners HealthCare were included as our "datamart." Diagnostic codes related to suicidal behavior were applied to the datamart to screen women for suicidal behavior. Among women without any diagnostic codes related to suicidal behavior (n = 273,410), 5880 women were randomly sampled, of whom 1120 had at least one mention of terms related to suicidal behavior in clinical notes. NLP was then used to process clinical notes for the 1120 women. Chart reviews were performed for subsamples of women. Using diagnostic codes, 196 pregnant women were screened positive for suicidal behavior, among whom 149 (76%) had confirmed suicidal behavior by chart review. Using NLP among those without diagnostic codes, 486 pregnant women were screened positive for suicidal behavior, among whom 146 (30%) had confirmed suicidal behavior by chart review. The use of NLP substantially improves the sensitivity of screening suicidal behavior in EMRs. However, the prevalence of confirmed suicidal behavior was lower among women who did not have diagnostic codes for suicidal behavior but screened positive by NLP. NLP should be used together with diagnostic codes for future EMR-based phenotyping studies for suicidal behavior.

Structure of sodium cyanide by molecular beam electric resonance spectroscopy

NASA Astrophysics Data System (ADS)

van Vaals, J. J.; Meerts, W. Leo; Dymanus, A.

1982-11-01

The results of the first successful observations of the microwave spectrum of sodium cyanide are presented. Twenty rotational transitions between 9.5 and 40 GHz were used to determine the rotational constants and the effective structure of the free molecule in the ground vibrational state. The structure was found to be T-shaped and the results (in Å) are: rCN=1.169(6), rNaC=2.366(29), and rNaN=2.243(27). (AIP)

PubMed

2004-09-01

Drink drive: emergency care alcohol liaison nurse at Selly Oak Hospital, Birmingham, Sarah Needham has secured funding from University Hospital Birmingham NHS Trust to set up a nine-month alcohol liaison pilot project. Ms Needham, whose work won her the Tyco Healthcare UK and RCN A&E Nursing Association award in 2000, is due to speak on the topic next month at a conference in Birmingham on tackling alcohol abuse. For details of the conference on October 11, call 0121 765 4222 or email castle.comm@which.net.

CBE awarded to DoH officer (england).

PubMed

2000-02-01

Julie Hartley-Jones, Department of Health (England) nursing officer with responsibilities for acute and specialist services including A & E, has been awarded a CBE in the New Year's honours list. Ms Hartley-Jones, who was awarded her CBE for services to renal nursing, is also a former president of the European Dialysis and Transplant Nurses Association/European Renal Care Association. She recently spoke at the RCN A & E Nursing Association Conference on 'Making a Difference' and has a keen interest in emergency nursing issues.

Time's up.

PubMed

2001-03-07

IT'S NEARLY 18 months since Nursing Standard and the RCN launched Making Time, the campaign designed to arm nurses and their managers with the information they need to implement employee-friendly policies. The campaign was designed to give impetus to the many fine words and policy statements (see box right) coming from government ministers as they tried to confront desperate staff shortages. It became more and more apparent that a better life-work balance would result in improved staff retention, more returners to the profession and even enhanced recruitment.

Sylvatic plague vaccine: combating plague in prairie dogs and black-footed ferrets

USGS Publications Warehouse

Rocke, Tonie E.; Abbott, Rachel C.

2012-01-01

After achieving promising results in laboratory trials, researchers at the USGS National Wildlife Health Center (NWHC) and University of Wisconsin at Madison will soon begin field testing a new oral vaccine for sylvatic plague, a devastating disease affecting prairie dogs and other mammals, particularly the endangered black-footed ferret. Our team has developed and is currently registering a sylvatic plague vaccine (SPV) that uses raccoon poxvirus (RCN) to express two key antigens of the Yersinia pestis bacterium, the causative agent of plague.

The positive financial impact of using an Intensive Care Information System in a tertiary Intensive Care Unit.

PubMed

Levesque, Eric; Hoti, Emir; de La Serna, Sofia; Habouchi, Houssam; Ichai, Philippe; Saliba, Faouzi; Samuel, Didier; Azoulay, Daniel

2013-03-01

In the French healthcare system, the intensive care budget allocated is directly dependent on the activity level of the center. To evaluate this activity level, it is necessary to code the medical diagnoses and procedures performed on Intensive Care Unit (ICU) patients. The aim of this study was to evaluate the effects of using an Intensive Care Information System (ICIS) on the incidence of coding errors and its impact on the ICU budget allocated. Since 2005, the documentation on and monitoring of every patient admitted to our ICU has been carried out using an ICIS. However, the coding process was performed manually until 2008. This study focused on two periods: the period of manual coding (year 2007) and the period of computerized coding (year 2008) which covered a total of 1403 ICU patients. The time spent on the coding process, the rate of coding errors (defined as patients missed/not coded or wrongly identified as undergoing major procedure/s) and the financial impact were evaluated for these two periods. With computerized coding, the time per admission decreased significantly (from 6.8 ± 2.8 min in 2007 to 3.6 ± 1.9 min in 2008, p<0.001). Similarly, a reduction in coding errors was observed (7.9% vs. 2.2%, p<0.001). This decrease in coding errors resulted in a reduced difference between the potential and real ICU financial supplements obtained in the respective years (€194,139 loss in 2007 vs. a €1628 loss in 2008). Using specific computer programs improves the intensive process of manual coding by shortening the time required as well as reducing errors, which in turn positively impacts the ICU budget allocation. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Racial and economic disparities in the treatment of penile squamous cell carcinoma: Results from the National Cancer Database.

PubMed

Sharma, Pranav; Ashouri, Kenan; Zargar-Shoshtari, Kamran; Luchey, Adam M; Spiess, Philippe E

2016-03-01

We evaluated sociodemographic and economic differences in overall survival (OS) of patients with penile SCC using the National Cancer Data Base (NCDB). We identified 5,412 patients with a diagnosis of penile squamous cell carcinoma from 1998 to 2011 with clinically nonmetastatic disease and available pathologic tumor and nodal staging. OS was estimated using the Kaplan-Meier method, and differences were determined using the log-rank test. Cox proportional hazard regression was performed to identify independent predictors of OS. Estimated median OS was 91.9 months (interquartile range: 25.8-not reached) at median follow-up of 44.7 months (interquartile range: 17.2-81.0). Survival did not change over the study period (P = 0.28). Black patients presented with a higher stage of disease (pT3/T4: 16.6 vs. 13.2%, P = 0.027) and had worse median OS (68.6 vs. 93.7 months, P<0.01). Patients with private insurance and median income≥$63,000 based on zip code presented with a lower stage of disease (pT3/T4: 11.6 vs. 14.7%, P = 0.002 and 12.0 vs. 14.0%, P = 0.042, respectively) and had better median OS (163.2 vs. 70.8 months, P<0.01 and 105.3 vs. 86.4 months, p = 0.001, respectively). On multivariate analysis, black race (hazard ratio [HR]: 1.39, 95% confidence interval [CI]: 1.21-1.58; P<0.01) was independently associated with worse OS, whereas private insurance (HR = 0.79, 95% CI: 0.63-0.98; P = 0.028) and higher median income≥$63,000 (HR = 0.82; 95% CI: 0.72-0.93; P = 0.001) were independently associated with better OS. Racial and economic differences in the survival of patients with penile cancer exist. An understanding of these differences may help minimize disparities in cancer care. Copyright © 2016 Elsevier Inc. All rights reserved.

Preliminary study of prevalence for bladder cancer in Isfahan Province, Iran.

PubMed

Mazdak, Hamid; Tolou-Ghamari, Zahra

2018-06-01

To clarify period prevalence (PP), incidence rate (Ir), and reported mortality for patients with bladder cancer (BC) in Isfahan Province/Iran, as BC is the most common cancer of the urinary tract in Iran and other parts of the world. Data from 21 March 2011 to 3 March 2015 was obtained from the Isfahan Cancer Registry. BC was distinguished by the related established topography code (C67). Ir and PP were calculated and expressed per 100 000 persons. In all, 279 females and 1376 males were identified. For the total population the PP was calculated as 33.2. This value corresponded to a PP of 54.4 for males and 11.4 for females ( P  < 0.001). Histologically, 63% of patients had invasive BC. Irs versus mortality rates were calculated for each year, i.e. 2011-2012, 2012-2013, 2013-2014, and 2014-2015, as 7.7 vs 0.56, 8.1 vs 0.74, 7.4 vs 0.98, and 9.9 vs 0.84, respectively. The mean (SD, range) age of the patients was 65.2 (13.9, 3-100) years. In relation to the age of the study population, BC occurred in 12% of patients aged <50 years and in 15% of those aged ≥80 years. The PP for BC in the male population was 4.8-times higher than females. There was a 28.6% increase in the Ir over the study period. Further study concerning environmental exposure, genetic factors, job-related exposure to various chemical carcinogens, and geographical distribution in Isfahan and its' rural provinces would seem to be valuable.

Costs and clinical outcomes in individuals without known coronary artery disease undergoing coronary computed tomographic angiography from an analysis of Medicare category III transaction codes.

PubMed

Min, James K; Shaw, Leslee J; Berman, Daniel S; Gilmore, Amanda; Kang, Ning

2008-09-15

Multidetector coronary computed tomographic angiography (CCTA) demonstrates high accuracy for the detection and exclusion of coronary artery disease (CAD) and predicts adverse prognosis. To date, opportunity costs relating the clinical and economic outcomes of CCTA compared with other methods of diagnosing CAD, such as myocardial perfusion single-photon emission computed tomography (SPECT), remain unknown. An observational, multicenter, patient-level analysis of patients without known CAD who underwent CCTA or SPECT was performed. Patients who underwent CCTA (n = 1,938) were matched to those who underwent SPECT (n = 7,752) on 8 demographic and clinical characteristics and 2 summary measures of cardiac medications and co-morbidities and were evaluated for 9-month expenditures and clinical outcomes. Adjusted total health care and CAD expenditures were 27% (p <0.001) and 33% (p <0.001) lower, respectively, for patients who underwent CCTA compared with those who underwent SPECT, by an average of $467 (95% confidence interval $99 to $984) for CAD expenditures per patient. Despite lower total health care expenditures for CCTA, no differences were observed for rates of adverse cardiovascular events, including CAD hospitalizations (4.2% vs 4.1%, p = NS), CAD outpatient visits (17.4% vs 13.3%, p = NS), myocardial infarction (0.4% vs 0.6%, p = NS), and new-onset angina (3.0% vs 3.5%, p = NS). Patients without known CAD who underwent CCTA, compared with matched patients who underwent SPECT, incurred lower overall health care and CAD expenditures while experiencing similarly low rates of CAD hospitalization, outpatient visits, myocardial infarction, and angina. In conclusion, these data suggest that CCTA may be a cost-efficient alternative to SPECT for the initial coronary evaluation of patients without known CAD.

Atherosclerotic involvement in patients with left or right dominant coronary circulation.

PubMed

Balci, Bahattin; Yilmaz, Ozcan

2004-06-01

There are variations in the anatomy of the coronary arteries in patients with left dominant circulation. The influence of anatomical variations in patients with left dominant circulation on coronary arteriosclerosis is not clear. We investigated whether atherosclerotic involvement in patients with left dominant circulation differs from that in patients with right dominant circulation. We retrospectively compared 38 consecutive angiograms with left coronary dominance with 459 consecutive angiograms with right coronary dominance. By using the 29-segment coding system of the American College of Cardiology/American Heart Association, numerical values were given to each segment, according to the percentage of the decrease in luminary diameter. Using, the sum of numerical values in each coronary artery, LAD score, LCx score, RCA score, and left main coronary artery (LMCA) score were obtained. Using the sum of these 4 vessel scores, the coronary artery disease (CAD) score was calculated. Total LAD score (49+/-48 vs 47+/-57), total LCx score (29+/-45 vs 41+/-58), total RCA score (32+/-68 vs 30+/-51), total LMCA score (1.8+/-11.3 vs 2.9+/-13.6) and total CAD score (108+/-108 vs 108+/-123) were similar in patients with left and right dominant circulation (all differences NS). The extent of coronary atherosclerosis does not depend on the type of dominant coronary circulation.

High-resolution infrared spectrum of cyanogen

NASA Astrophysics Data System (ADS)

Maki, Arthur G.

2011-10-01

The high-resolution spectrum of cyanogen ( 14N 12C 12C 14N) has been measured from 500 to 4900 cm -1. For this isotopomer many combination levels with both degenerate fundamentals, ν4 and ν5, have been measured for the first time and the effects of vibrational l-type resonance are observed as well as rotational l-type resonance. The effects of the vibrational resonance coupling ν2 and 2 ν4 have also been studied. The data have been combined with earlier measurements below 500 cm -1 to give a comprehensive catalog of the vibrational energy levels and the rovibrational constants for the normal isotopomer of cyanogen. A comparison of the term value constants for the three major symmetric isotopomers is given and they are compared with a recent ab initio calculation. The present data were combined with earlier work on the two symmetric isotopomers, 13C 214N 2 and 12C 215N 2, to obtain the equilibrium bond lengths, rCC = 138.109(60) pm and rCN = 115.976(40) pm.

Ensemble coding of face identity is present but weaker in congenital prosopagnosia.

PubMed

Robson, Matthew K; Palermo, Romina; Jeffery, Linda; Neumann, Markus F

2018-03-01

Individuals with congenital prosopagnosia (CP) are impaired at identifying individual faces but do not appear to show impairments in extracting the average identity from a group of faces (known as ensemble coding). However, possible deficits in ensemble coding in a previous study (CPs n = 4) may have been masked because CPs relied on pictorial (image) cues rather than identity cues. Here we asked whether a larger sample of CPs (n = 11) would show intact ensemble coding of identity when availability of image cues was minimised. Participants viewed a "set" of four faces and then judged whether a subsequent individual test face, either an exemplar or a "set average", was in the preceding set. Ensemble coding occurred when matching (vs. mismatching) averages were mistakenly endorsed as set members. We assessed both image- and identity-based ensemble coding, by varying whether test faces were either the same or different images of the identities in the set. CPs showed significant ensemble coding in both tasks, indicating that their performance was independent of image cues. As a group, CPs' ensemble coding was weaker than controls in both tasks, consistent with evidence that perceptual processing of face identity is disrupted in CP. This effect was driven by CPs (n= 3) who, in addition to having impaired face memory, also performed particularly poorly on a measure of face perception (CFPT). Future research, using larger samples, should examine whether deficits in ensemble coding may be restricted to CPs who also have substantial face perception deficits. Copyright © 2018 Elsevier Ltd. All rights reserved.

Assessing the Viability of Social Media for Disseminating Evidence-Based Nutrition Practice Guideline Through Content Analysis of Twitter Messages and Health Professional Interviews: An Observational Study

PubMed Central

Kenne, Deric; Wolfram, Taylor M; Abram, Jenica K; Fleming, Michael

2016-01-01

Background Given the high penetration of social media use, social media has been proposed as a method for the dissemination of information to health professionals and patients. This study explored the potential for social media dissemination of the Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guideline (EBNPG) for Heart Failure (HF). Objectives The objectives were to (1) describe the existing social media content on HF, including message content, source, and target audience, and (2) describe the attitude of physicians and registered dietitian nutritionists (RDNs) who care for outpatient HF patients toward the use of social media as a method to obtain information for themselves and to share this information with patients. Methods The methods were divided into 2 parts. Part 1 involved conducting a content analysis of tweets related to HF, which were downloaded from Twitonomy and assigned codes for message content (19 codes), source (9 codes), and target audience (9 codes); code frequency was described. A comparison in the popularity of tweets (those marked as favorites or retweeted) based on applied codes was made using t tests. Part 2 involved conducting phone interviews with RDNs and physicians to describe health professionals’ attitude toward the use of social media to communicate general health information and information specifically related to the HF EBNPG. Interviews were transcribed and coded; exemplar quotes representing frequent themes are presented. Results The sample included 294 original tweets with the hashtag “#heartfailure.” The most frequent message content codes were “HF awareness” (166/294, 56.5%) and “patient support” (97/294, 33.0%). The most frequent source codes were “professional, government, patient advocacy organization, or charity” (112/277, 40.4%) and “patient or family” (105/277, 37.9%). The most frequent target audience codes were “unable to identify” (111/277, 40.1%) and “other” (55/277, 19.9%). Significant differences were found in the popularity of tweets with (mean 1, SD 1.3 favorites) or without (mean 0.7, SD 1.3 favorites), the content code being “HF research” (P=.049). Tweets with the source code “professional, government, patient advocacy organizations, or charities” were significantly more likely to be marked as a favorite and retweeted than those without this source code (mean 1.2, SD 1.4 vs mean 0.8, SD 1.2, P=.03) and (mean 1.5, SD 1.8 vs mean 0.9, SD 2.0, P=.03). Interview participants believed that social media was a useful way to gather professional information. They did not believe that social media was useful for communicating with patients due to privacy concerns and the fact that the information had to be kept general rather than be tailored for a specific patient and the belief that their patients did not use social media or technology. Conclusions Existing Twitter content related to HF comes from a combination of patients and evidence-based organizations; however, there is little nutrition content. That gap may present an opportunity for EBNPG dissemination. Health professionals use social media to gather information for themselves but are skeptical of its value when communicating with patients, particularly due to privacy concerns and misconceptions about the characteristics of social media users. PMID:27847349

Assessing the Viability of Social Media for Disseminating Evidence-Based Nutrition Practice Guideline Through Content Analysis of Twitter Messages and Health Professional Interviews: An Observational Study.

PubMed

Hand, Rosa K; Kenne, Deric; Wolfram, Taylor M; Abram, Jenica K; Fleming, Michael

2016-11-15

Given the high penetration of social media use, social media has been proposed as a method for the dissemination of information to health professionals and patients. This study explored the potential for social media dissemination of the Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guideline (EBNPG) for Heart Failure (HF). The objectives were to (1) describe the existing social media content on HF, including message content, source, and target audience, and (2) describe the attitude of physicians and registered dietitian nutritionists (RDNs) who care for outpatient HF patients toward the use of social media as a method to obtain information for themselves and to share this information with patients. The methods were divided into 2 parts. Part 1 involved conducting a content analysis of tweets related to HF, which were downloaded from Twitonomy and assigned codes for message content (19 codes), source (9 codes), and target audience (9 codes); code frequency was described. A comparison in the popularity of tweets (those marked as favorites or retweeted) based on applied codes was made using t tests. Part 2 involved conducting phone interviews with RDNs and physicians to describe health professionals' attitude toward the use of social media to communicate general health information and information specifically related to the HF EBNPG. Interviews were transcribed and coded; exemplar quotes representing frequent themes are presented. The sample included 294 original tweets with the hashtag "#heartfailure." The most frequent message content codes were "HF awareness" (166/294, 56.5%) and "patient support" (97/294, 33.0%). The most frequent source codes were "professional, government, patient advocacy organization, or charity" (112/277, 40.4%) and "patient or family" (105/277, 37.9%). The most frequent target audience codes were "unable to identify" (111/277, 40.1%) and "other" (55/277, 19.9%). Significant differences were found in the popularity of tweets with (mean 1, SD 1.3 favorites) or without (mean 0.7, SD 1.3 favorites), the content code being "HF research" (P=.049). Tweets with the source code "professional, government, patient advocacy organizations, or charities" were significantly more likely to be marked as a favorite and retweeted than those without this source code (mean 1.2, SD 1.4 vs mean 0.8, SD 1.2, P=.03) and (mean 1.5, SD 1.8 vs mean 0.9, SD 2.0, P=.03). Interview participants believed that social media was a useful way to gather professional information. They did not believe that social media was useful for communicating with patients due to privacy concerns and the fact that the information had to be kept general rather than be tailored for a specific patient and the belief that their patients did not use social media or technology. Existing Twitter content related to HF comes from a combination of patients and evidence-based organizations; however, there is little nutrition content. That gap may present an opportunity for EBNPG dissemination. Health professionals use social media to gather information for themselves but are skeptical of its value when communicating with patients, particularly due to privacy concerns and misconceptions about the characteristics of social media users. ©Rosa K Hand, Deric Kenne, Taylor M Wolfram, Jenica K Abram, Michael Fleming. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 15.11.2016.

Thermal-chemical Mantle Convection Models With Adaptive Mesh Refinement

NASA Astrophysics Data System (ADS)

Leng, W.; Zhong, S.

2008-12-01

In numerical modeling of mantle convection, resolution is often crucial for resolving small-scale features. New techniques, adaptive mesh refinement (AMR), allow local mesh refinement wherever high resolution is needed, while leaving other regions with relatively low resolution. Both computational efficiency for large- scale simulation and accuracy for small-scale features can thus be achieved with AMR. Based on the octree data structure [Tu et al. 2005], we implement the AMR techniques into the 2-D mantle convection models. For pure thermal convection models, benchmark tests show that our code can achieve high accuracy with relatively small number of elements both for isoviscous cases (i.e. 7492 AMR elements v.s. 65536 uniform elements) and for temperature-dependent viscosity cases (i.e. 14620 AMR elements v.s. 65536 uniform elements). We further implement tracer-method into the models for simulating thermal-chemical convection. By appropriately adding and removing tracers according to the refinement of the meshes, our code successfully reproduces the benchmark results in van Keken et al. [1997] with much fewer elements and tracers compared with uniform-mesh models (i.e. 7552 AMR elements v.s. 16384 uniform elements, and ~83000 tracers v.s. ~410000 tracers). The boundaries of the chemical piles in our AMR code can be easily refined to the scales of a few kilometers for the Earth's mantle and the tracers are concentrated near the chemical boundaries to precisely trace the evolvement of the boundaries. It is thus very suitable for our AMR code to study the thermal-chemical convection problems which need high resolution to resolve the evolvement of chemical boundaries, such as the entrainment problems [Sleep, 1988].

Characteristics of pesticide-related hospitalizations, Louisiana, 1998-2007.

PubMed

Badakhsh, Roshan; Lackovic, Michelle; Ratard, Raoult

2010-01-01

Pesticides are widely used on agricultural crops and in homes, workplaces, and public spaces. Exposure to pesticides can cause acute and chronic health effects. We analyzed data from the Louisiana Hospital Inpatient Discharge Database from 1998 through 2007 to characterize hospitalizations involving pesticides. Data for the study period consisted of 384 pesticide-related hospitalizations. We used demographic information and diagnosis codes for analysis. Males consistently had higher hospitalization rates than females (p=0.0073). Children aged 0-4 years had the highest pesticide-related hospitalization rate of all age groups (2.69 hospitalizations per 100,000); children aged 5-9 years had the lowest rate (0.36 hospitalizations per 100,000). Compared with adults, children had a higher rate of disinfectant exposure (15% vs. 5%; odds ratio [OR] = 3.41, 95% confidence interval [CI] 1.61, 7.21; p=0.0008) and rodenticide exposure (14% vs. 2%; OR=8.55, 95% CI 3.07, 23.78; p<0.0001). Rural parishes (counties) were more likely than urban parishes to have higher pesticide hospitalization rates (OR=4.72, 95% CI 2.34, 9.54; p<0.0001). Intentional poisonings accounted for 27% of cases. Only eight cases were coded as work-related. Analyzing pesticide-related hospitalization data provides important information about some of the most severe pesticide poisoning cases. Significant findings include the elevated rate of hospitalizations among young children and men, and the large proportion of self-inflicted poisonings. Health departments and health-care providers may use these findings to target outreach and prevention activities.

[Prospective DRG coding : Improvement in cost-effectiveness and documentation quality of in-patient hospital care].

PubMed

Geuss, S; Jungmeister, A; Baumgart, A; Seelos, R; Ockert, S

2018-02-01

In prospective reimbursement schemes a diagnosis-related group (DRG) is assigned to each case according to all coded diagnoses and procedures. This process can be conducted retrospectively after (DC) or prospectively during the hospitalization (PC). The use of PC offers advantages in terms of cost-effectiveness and documentation quality without impairing patient safety. A retrospective analysis including all DRG records and billing data from 2012 to 2015 of a surgical department was carried out. The use of PC was introduced into the vascular surgery unit (VS) in September 2013, while the remaining surgical units (RS) stayed with DC. Analysis focused on differences between VS and RS before and after introduction of PC. Characteristics of cost-effectiveness were earnings (EBIT-DA), length of stay (LOS), the case mix index (CMI) and the productivity in relation to the DRG benchmark (productivity index, PI). The number of recorded diagnoses/procedures (ND/NP) was an indicator for documentation quality. A total of 1703 cases with VS and 27,679 cases with RS were analyzed. After introduction of PC the EBIT-DA per case increased in VS but not in RS (+3342 Swiss francs vs. +84, respectively, p < 0.001). The CMI increased slightly in both groups (+0.10 VS vs. +0.08 RS, p > 0.05) and the LOS was more reduced in VS than in RS (-0.36 days vs. -0.03 days, p > 0.005). The PI increased in VS but decreased in RS (+0.131 vs. -0.032, p < 0.001), ND increased more in VS (+1.29 VS vs. +0.26 RS, p < 0.001) and NP remained stable in both groups. The use of PC helps to significantly improve cost-effectiveness and documentation quality of in-patient hospital care, essentially by optimizing LOS and cost weight in relation to the DRG benchmark, i. e. increasing the PI. The increasing ND indicates an improvement in documentation quality.

Health Care Costs for Adults With Congenital Heart Disease in the United States 2002 to 2012.

PubMed

Briston, David A; Bradley, Elisa A; Sabanayagam, Aarthi; Zaidi, Ali N

2016-08-15

More adults than children with congenital heart disease (CHD) are alive today. Few studies have evaluated adult congenital heart disease (ACHD) health care utilization in the United States. Data from the National Inpatient Sample from 2002 to 2012, using International Classification of Diseases, Ninth Revision, codes for moderate and complex CHD were analyzed. Hospital discharges, total billed and reimbursed amounts, length of stay, and gender/age disparities were evaluated. There was an increase in CHD discharges (moderate CHD: 4,742 vs 6,545; severe CHD: 807 vs 1,115) and total billed and reimbursed dollar amounts across all CHD (billed: $2.7 vs $7.0 billion, 155% increase; reimbursed: $1.3 vs $2.3 billion, 99% increase) and in the ACHD subgroup (billed: $543 million vs $1.5 billion, 178% increase; reimbursed: $221 vs $433 million, 95% increase). Women comprised more discharges in 2002 but not in 2012 (men:women, 2002: 6,503 vs 7,805; 2012: 7,715 vs 7,200, p = 0.39). Gender-based billed amounts followed similar trends (2002: $263 vs $280 million; 2012: $845 vs $662 million, p = 0.006) as did reimbursements (2002: $108 vs $114 million; 2012: $243 vs $190 million, p = 0.008). All age subgroups demonstrated increased health care expenditures, including the >44 versus 18- to 44-year-old age subgroup (billed: $618 vs $347 million, p <0.001; reimbursed: $136 vs $75 million, p <0.001). Our results reveal increased ACHD billed and reimbursed amounts and hospital discharges with a shift in gender-based ACHD hospitalizations: men now account for more hospitalizations in the United States. In conclusion, increased health care expenditure in older patients with ACHD is likely to increase further as health care system use and costs continue to grow. Copyright © 2016 Elsevier Inc. All rights reserved.

Next-generation sequencing of the monogenic obesity genes LEP, LEPR, MC4R, PCSK1 and POMC in a Norwegian cohort of patients with morbid obesity and normal weight controls.

PubMed

Nordang, Gry B N; Busk, Øyvind L; Tveten, Kristian; Hanevik, Hans Ivar; Fell, Anne Kristin M; Hjelmesæth, Jøran; Holla, Øystein L; Hertel, Jens K

2017-05-01

Rare sequence variants in at least five genes are known to cause monogenic obesity. In this study we aimed to investigate the prevalence of, and characterize, rare coding and splice site variants in LEP, LEPR, MC4R, PCSK1 and POMC in patients with morbid obesity and normal weight controls. Targeted next-generation sequencing of all exons in LEP, LEPR, MC4R, PCSK1 and POMC was performed in 485 patients with morbid obesity and 327 normal weight population-based controls from Norway. In total 151 variants were detected. Twenty-eight (18.5%) of these were rare, coding or splice variants and five (3.3%) were novel. All individuals, except one control, were heterozygous for the 28 variants, and the distribution of the rare variants showed a significantly higher carrier frequency among cases than controls (9.9% vs. 4.9%, p=0.011). Four variants in MC4R were classified as pathogenic or likely pathogenic. Four cases (0.8%) of monogenic obesity were detected, all due to MC4R variants previously linked to monogenic obesity. Significant differences in carrier frequencies among patients with morbid obesity and normal weight controls suggest an association between heterozygous rare coding variants in these five genes and morbid obesity. However, additional studies in larger cohorts and functional testing of the novel variants identified are required to confirm the findings. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

How complete is the information on preadmission psychotropic medications in inpatients with dementia? A comparison of hospital medical records with dispensing data.

PubMed

Pisa, Federica Edith; Palese, Francesca; Romanese, Federico; Barbone, Fabio; Logroscino, Giancarlo; Riedel, Oliver

2018-06-05

Reliable information on preadmission medications is essential for inpatients with dementia, but its quality has hardly been evaluated. We assessed the completeness of information and factors associated with incomplete recording. We compared preadmission medications recorded in hospital electronic medical records (EMRs) with community-pharmacy dispensations in hospitalizations with discharge code for dementia at the University Hospital of Udine, Italy, 2012-2014. We calculated: (a) prevalence of omissions (dispensed medication not recorded in EMRs), additions (medication recorded in EMRs not dispensed), and discrepancies (any omission or addition); (b) multivariable logistic regression odds ratio, with 95% confidence interval (95% CI), of ≥1 omission. Among 2,777 hospitalizations, 86.1% had ≥1 discrepancy for any medication (Kappa 0.10) and 33.4% for psychotropics. When psychotropics were recorded in EMR, antipsychotics were added in 71.9% (antidepressants: 29.2%, antidementia agents: 48.2%); when dispensed, antipsychotics were omitted in 54.4% (antidepressants: 52.7%, antidementia agents: 41.5%). Omissions were 92% and twice more likely in patients taking 5 to 9 and ≥10 medications (vs. 0 to 4), 17% in patients with psychiatric disturbances (vs. none), and 41% with emergency admission (vs. planned). Psychotropics, commonly used in dementia, were often incompletely recorded. To enhance information completeness, both EMRs and dispensations should be used. Copyright © 2018 John Wiley & Sons, Ltd.

3D-radiative transfer in terrestrial atmosphere: An efficient parallel numerical procedure

NASA Astrophysics Data System (ADS)

Bass, L. P.; Germogenova, T. A.; Nikolaeva, O. V.; Kokhanovsky, A. A.; Kuznetsov, V. S.

2003-04-01

Light propagation and scattering in terrestrial atmosphere is usually studied in the framework of the 1D radiative transfer theory [1]. However, in reality particles (e.g., ice crystals, solid and liquid aerosols, cloud droplets) are randomly distributed in 3D space. In particular, their concentrations vary both in vertical and horizontal directions. Therefore, 3D effects influence modern cloud and aerosol retrieval procedures, which are currently based on the 1D radiative transfer theory. It should be pointed out that the standard radiative transfer equation allows to study these more complex situations as well [2]. In recent year the parallel version of the 2D and 3D RADUGA code has been developed. This version is successfully used in gammas and neutrons transport problems [3]. Applications of this code to radiative transfer in atmosphere problems are contained in [4]. Possibilities of code RADUGA are presented in [5]. The RADUGA code system is an universal solver of radiative transfer problems for complicated models, including 2D and 3D aerosol and cloud fields with arbitrary scattering anisotropy, light absorption, inhomogeneous underlying surface and topography. Both delta type and distributed light sources can be accounted for in the framework of the algorithm developed. The accurate numerical procedure is based on the new discrete ordinate SWDD scheme [6]. The algorithm is specifically designed for parallel supercomputers. The version RADUGA 5.1(P) can run on MBC1000M [7] (768 processors with 10 Gb of hard disc memory for each processor). The peak productivity is equal 1 Tfl. Corresponding scalar version RADUGA 5.1 is working on PC. As a first example of application of the algorithm developed, we have studied the shadowing effects of clouds on neighboring cloudless atmosphere, depending on the cloud optical thickness, surface albedo, and illumination conditions. This is of importance for modern satellite aerosol retrieval algorithms development. [1] Sobolev, V. V., 1972: Light scattering in planetary atmosphere, M.:Nauka. [2] Evans, K. F., 1998: The spherical harmonic discrete ordinate method for three dimensional atmospheric radiative transfer, J. Atmos. Sci., 55, 429 446. [3] L.P. Bass, T.A. Germogenova, V.S. Kuznetsov, O.V. Nikolaeva. RADUGA 5.1 and RADUGA 5.1(P) codes for stationary transport equation solution in 2D and 3D geometries on one and multiprocessors computers. Report on seminar “Algorithms and Codes for neutron physical of nuclear reactor calculations” (Neutronica 2001), Obninsk, Russia, 30 October 2 November 2001. [4] T.A. Germogenova, L.P. Bass, V.S. Kuznetsov, O.V. Nikolaeva. Mathematical modeling on parallel computers solar and laser radiation transport in 3D atmosphere. Report on International Symposium CIS countries “Atmosphere radiation”, 18 21 June 2002, St. Peterburg, Russia, p. 15 16. [5] L.P. Bass, T.A. Germogenova, O.V. Nikolaeva, V.S. Kuznetsov. Radiative Transfer Universal 2D 3D Code RADUGA 5.1(P) for Multiprocessor Computer. Abstract. Poster report on this Meeting. [6] L.P. Bass, O.V. Nikolaeva. Correct calculation of Angular Flux Distribution in Strongly Heterogeneous Media and Voids. Proc. of Joint International Conference on Mathematical Methods and Supercomputing for Nuclear Applications, Saratoga Springs, New York, October 5 9, 1997, p. 995 1004. [7] http://www/jscc.ru

Outcomes of Multiple Listing for Adult Heart Transplantation in the United States: Analysis of OPTN Data From 2000 to 2013.

PubMed

Givens, Raymond C; Dardas, Todd; Clerkin, Kevin J; Restaino, Susan; Schulze, P Christian; Mancini, Donna M

2015-12-01

This study sought to assess the association of multiple listing with waitlist outcomes and post-heart transplant (HT) survival. HT candidates in the United States may register at multiple centers. Not all candidates have the resources and mobility needed for multiple listing; thus this policy may advantage wealthier and less sick patients. We identified 33,928 adult candidates for a first single-organ HT between January 1, 2000 and December 31, 2013 in the Organ Procurement and Transplantation Network database. We identified 679 multiple-listed (ML) candidates (2.0%) who were younger (median age, 53 years [interquartile range (IQR): 43 to 60 years] vs. 55 years [IQR: 45 to 61 years]; p < 0.0001), more often white (76.4% vs. 70.7%; p = 0.0010) and privately insured (65.5% vs. 56.3%; p < 0.0001), and lived in zip codes with higher median incomes (US$90,153 [IQR: US$25,471 to US$253,831] vs. US$68,986 [IQR: US$19,471 to US$219,702]; p = 0.0015). Likelihood of ML increased with the primary center's median waiting time. ML candidates had lower initial priority (39.0% 1A or 1B vs. 55.1%; p < 0.0001) and predicted 90-day waitlist mortality (2.9% [IQR: 2.3% to 4.7%] vs. 3.6% [IQR: 2.3% to 6.0]%; p < 0.0001), but were frequently upgraded at secondary centers (58.2% 1A/1B; p < 0.0001 vs. ML primary listing). ML candidates had a higher HT rate (74.4% vs. 70.2%; p = 0.0196) and lower waitlist mortality (8.1% vs. 12.2%; p = 0.0011). Compared with a propensity-matched cohort, the relative ML HT rate was 3.02 (95% confidence interval: 2.59 to 3.52; p < 0.0001). There were no post-HT survival differences. Multiple listing is a rational response to organ shortage but may advantage patients with the means to participate rather than the most medically needy. The multiple-listing policy should be overturned. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Conformation and dynamics of polymer chains on dirty surfaces: A discrete-to-continuum approach

NASA Astrophysics Data System (ADS)

Foo, Grace M.; Pandey, R. B.

1998-07-01

A discrete-to-continuum (DC) simulation approach is introduced to study the statics and dynamics of polymer chains in two dimensions with quenched barriers, a dirty surface. In our DC hybrid approach, the large-scale relaxation of polymer chains on a discrete disordered lattice is followed by off-lattice simulation using a bead-spring chain model with a finitely extensible nonlinear elastic (FENE) potential for covalent bonds and Lennard-Jones (LJ) potential for nonbonded interactions. Segregation/folding of chains, which occurs at low temperatures (T=0.2, 1.0) with LJ interaction, becomes more difficult as the concentration of barriers increases, due to a screening effect of the barriers. In contrast to the chains' contraction at high temperature (i.e., T=5) and their collapse in athermal systems, chains are elongated on increasing the barrier concentration—a barrier-induced stretching. Variations of the root-mean-square (rms) displacements of the center of mass (Rcm) of the chains and their center node (Rcn) with time (t) show power-law behaviors (Rcm˜tν1, Rcn˜tν2) with nonuniversal exponents in the range ν1≃0.40-0.05 and ν2≃0.30-0.05, respectively, depending on temperature and barrier concentration. The radius of gyration (Rg) and the average bond length () expand on increasing the barrier concentration at low temperature and contract at high temperature, which is consistent with the variation of the width of the radial distribution function.

Implications of DRG Classification in a Bundled Payment Initiative for COPD.

PubMed

Parekh, Trisha M; Bhatt, Surya P; Westfall, Andrew O; Wells, James M; Kirkpatrick, Denay; Iyer, Anand S; Mugavero, Michael; Willig, James H; Dransfield, Mark T

2017-12-01

Institutions participating in the Medicare Bundled Payments for Care Improvement (BPCI) initiative invest significantly in efforts to reduce readmissions and costs for patients who are included in the program. Eligibility for the BPCI initiative is determined by diagnosis-related group (DRG) classification. The implications of this methodology for chronic diseases are not known. We hypothesized that patients included in a BPCI initiative for chronic obstructive pulmonary disease (COPD) would have less severe illness and decreased hospital utilization compared with those excluded from the bundled payment initiative. Retrospective observational study. We sought to determine the clinical characteristics and outcomes of Medicare patients admitted to the University of Alabama at Birmingham Hospital with acute exacerbations of COPD between 2012 and 2014 who were included and excluded in a BPCI initiative. Patients were included in the analysis if they were discharged with a COPD DRG or with a non-COPD DRG but with an International Classification of Diseases, Ninth Revision code for COPD exacerbation. Six hundred and ninety-eight unique patients were discharged for an acute exacerbation of COPD; 239 (34.2%) were not classified into a COPD DRG and thus were excluded from the BPCI initiative. These patients were more likely to have intensive care unit (ICU) admissions (63.2% vs 4.4%, respectively; P <.001) and require noninvasive (46.9% vs 6.5%; P <.001) and invasive mechanical ventilation (41.4% vs 0.7%; P <.001) during their hospitalization than those in the initiative. They also had a longer ICU length of stay (5.2 vs 1.8 days; P = .011), longer hospital length of stay (10.3 days vs 3.9 days; P <.001), higher in-hospital mortality (14.6% vs 0.7%; P <.001), and greater hospitalization costs (median = $13,677 [interquartile range = $7489-$23,054] vs $4281 [$2718-$6537]; P <.001). The use of DRGs to identify patients with COPD for inclusion in the BPCI initiative led to the exclusion of more than one-third of patients with acute exacerbations who had more severe illness and worse outcomes and who may benefit most from the additional interventions provided by the initiative.

Implications of DRG Classification in a Bundled Payment Initiative for COPD

PubMed Central

PAREKH, TRISHA M.; BHATT, SURYA P.; WESTFALL, ANDREW O.; WELLS, JAMES M.; KIRKPATRICK, DENAY; IYER, ANAND S.; MUGAVERO, MICHAEL; WILLIG, JAMES H.; DRANSFIELD, MARK T.

2018-01-01

OBJECTIVES Institutions participating in the Medicare Bundled Payments for Care Improvement (BPCI) initiative invest significantly in efforts to reduce readmissions and costs for patients who are included in the program. Eligibility for the BPCI initiative is determined by diagnosis-related group (DRG) classification. The implications of this methodology for chronic diseases are not known. We hypothesized that patients included in a BPCI initiative for chronic obstructive pulmonary disease (COPD) would have less severe illness and decreased hospital utilization compared with those excluded from the bundled payment initiative. STUDY DESIGN Retrospective observational study. METHODS We sought to determine the clinical characteristics and outcomes of Medicare patients admitted to the University of Alabama at Birmingham Hospital with acute exacerbations of COPD between 2012 and 2014 who were included and excluded in a BPCI initiative. Patients were included in the analysis if they were discharged with a COPD DRG or with a non-COPD DRG but with an International Classification of Diseases, Ninth Revision code for COPD exacerbation. RESULTS Six hundred and ninety-eight unique patients were discharged for an acute exacerbation of COPD; 239 (34.2%) were not classified into a COPD DRG and thus were excluded from the BPCI initiative. These patients were more likely to have intensive care unit (ICU) admissions (63.2% vs 4.4%, respectively; P <.001) and require noninvasive (46.9% vs 6.5%; P <.001) and invasive mechanical ventilation (41.4% vs 0.7%; P <.001) during their hospitalization than those in the initiative. They also had a longer ICU length of stay (5.2 vs 1.8 days; P = .011), longer hospital length of stay (10.3 days vs 3.9 days; P <.001), higher in-hospital mortality (14.6% vs 0.7%; P <.001), and greater hospitalization costs (median = $13,677 [interquartile range = $7489-$23,054] vs $4281 [$2718-$6537]; P <.001). CONCLUSIONS The use of DRGs to identify patients with COPD for inclusion in the BPCI initiative led to the exclusion of more than one-third of patients with acute exacerbations who had more severe illness and worse outcomes and who may benefit most from the additional interventions provided by the initiative. PMID:29623307

Patient Centeredness in Electronic Communication: Evaluation of Patient-to-Health Care Team Secure Messaging

PubMed Central

Luger, Tana M; Volkman, Julie E; Rocheleau, Mary; Mueller, Nora; Barker, Anna M; Nazi, Kim M; Houston, Thomas K; Bokhour, Barbara G

2018-01-01

Background As information and communication technology is becoming more widely implemented across health care organizations, patient-provider email or asynchronous electronic secure messaging has the potential to support patient-centered communication. Within the medical home model of the Veterans Health Administration (VA), secure messaging is envisioned as a means to enhance access and strengthen the relationships between veterans and their health care team members. However, despite previous studies that have examined the content of electronic messages exchanged between patients and health care providers, less research has focused on the socioemotional aspects of the communication enacted through those messages. Objective Recognizing the potential of secure messaging to facilitate the goals of patient-centered care, the objectives of this analysis were to not only understand why patients and health care team members exchange secure messages but also to examine the socioemotional tone engendered in these messages. Methods We conducted a cross-sectional coding evaluation of a corpus of secure messages exchanged between patients and health care team members over 6 months at 8 VA facilities. We identified patients whose medical records showed secure messaging threads containing at least 2 messages and compiled a random sample of these threads. Drawing on previous literature regarding the analysis of asynchronous, patient-provider electronic communication, we developed a coding scheme comprising a series of a priori patient and health care team member codes. Three team members tested the scheme on a subset of the messages and then independently coded the sample of messaging threads. Results Of the 711 messages coded from the 384 messaging threads, 52.5% (373/711) were sent by patients and 47.5% (338/711) by health care team members. Patient and health care team member messages included logistical content (82.6%, 308/373 vs 89.1%, 301/338), were neutral in tone (70.2%, 262/373 vs 82.0%, 277/338), and respectful in nature (25.7%, 96/373 vs 33.4%, 113/338). Secure messages from health care team members sometimes appeared hurried (25.4%, 86/338) but also displayed friendliness or warmth (18.9%, 64/338) and reassurance or encouragement (18.6%, 63/338). Most patient messages involved either providing or seeking information; however, the majority of health care team member messages involved information provision in response to patient questions. Conclusions This evaluation is an important step toward understanding the content and socioemotional tone that is part of the secure messaging exchanges between patients and health care team members. Our findings were encouraging; however, there are opportunities for improvement. As health care organizations seek to supplement traditional encounters with virtual care, they must reexamine their use of secure messaging, including the patient centeredness of the communication, and the potential for more proactive use by health care team members. PMID:29519774

The NSF-RCN Urban Heat Island Network

NASA Astrophysics Data System (ADS)

Twine, T. E.; Snyder, P. K.; Hamilton, P.; Shepherd, M.; Stone, B., Jr.

2015-12-01

In much of the world cities are warming at twice the rate of outlying rural areas. The frequency of urban heat waves is projected to increase with climate change through the 21st century. Addressing the economic, environmental, and human costs of urban heat islands requires a better understanding of their behavior from many disciplinary perspectives. The goal of this four-year Urban Heat Island Network is to (1) bring together scientists studying the causes and impacts of urban warming, (2) advance multidisciplinary understanding of urban heat islands, (3) examine how they can be ameliorated through engineering and design practices, and (4) share these new insights with a wide array of stakeholders responsible for managing urban warming to reduce their health, economic, and environmental impacts. The NSF-RCN Urban Heat Island Network involves atmospheric scientists, engineers, architects, landscape designers, urban planners, public health experts, and education and outreach experts, who will share knowledge, evaluate research directions, and communicate knowledge and research recommendations to the larger research community as well as stakeholders engaged in developing strategies to adapt to and mitigate urban warming. The first Urban Climate Institute was held in Saint Paul, MN in July 2013 and focused on the characteristics of urban heat islands. Scientists engaged with local practitioners to improve communication pathways surrounding issues of understanding, adapting to, and mitigating urban warming. The second Urban Climate Institute was held in Atlanta, Georgia in July 2014 and focused on urban warming and public health. The third Urban Climate Institute was held in Athens, GA in July 2015 and focused on urban warming and the role of the built environment. Scientists and practitioners discussed strategies for mitigation and adaptation. Evaluation experts at the Science Museum of Minnesota have extensively evaluated the Institutes to inform other research coordination networks and to identify effective ways that researchers and practitioners can share knowledge and communicate more effectively. A final Institute is planned for July of 2016 in Saint Paul, MN. This institute will focus on synthesizing findings from the first three workshops and discuss education and outreach efforts.

Geographic Access to Specialty Mental Health Care Across High- and Low-Income US Communities.

PubMed

Cummings, Janet R; Allen, Lindsay; Clennon, Julie; Ji, Xu; Druss, Benjamin G

2017-05-01

With the future of the Affordable Care Act and Medicaid program unclear, it is critical to examine the geographic availability of specialty mental health treatment resources that serve low-income populations across local communities. To examine the geographic availability of community-based specialty mental health treatment resources and how these resources are distributed by community socioeconomic status. Measures of the availability of specialty mental health treatment resources were derived using national data for 31 836 zip code tabulation areas from 2013 to 2015. Analyses examined the association between community socioeconomic status (assessed by median household income quartiles) and resource availability using logistic regressions. Models controlled for zip code tabulation area-level demographic characteristics and state indicators. Dichotomous indicators for whether a zip code tabulation area had any (1) outpatient mental health treatment facility (more than nine-tenths of which offer payment arrangements for low-income populations), (2) office-based practice of mental health specialist physician(s), (3) office-based practice of nonphysician mental health professionals (eg, therapists), and (4) mental health facility or office-based practice (ie, any community-based resource). Of the 31 836 zip code tabulation areas in the study, more than four-tenths (3382 of 7959 [42.5%]) of communities in the highest income quartile (mean income, $81 207) had any community-based mental health treatment resource vs 23.1% of communities (1841 of 7959) in the lowest income quartile (mean income, $30 534) (adjusted odds ratio, 1.74; 95% CI, 1.50-2.03). When examining the distribution of mental health professionals, 25.3% of the communities (2014 of 7959) in the highest income quartile had a mental health specialist physician practice vs 8.0% (637 of 7959) of those in the lowest income quartile (adjusted odds ratio, 3.04; 95% CI, 2.53-3.66). Similarly, 35.1% of the communities (2792 of 7959) in the highest income quartile had a nonphysician mental health professional practice vs 12.9% (1029 of 7959) of those in the lowest income quartile (adjusted odds ratio, 2.77; 95%, 2.35-3.26). In contrast, outpatient mental health treatment facilities were less likely to be located in the communities in the highest vs lowest income quartiles (12.9% [1025 of 7959] vs 16.5% [1317 of 7959]; adjusted odds ratio, 0.43; 95% CI, 0.37-0.51). More than seven-tenths of the lowest income communities with any resource (71.5% [1317 of 1841]) had an outpatient mental health treatment facility. Mental health treatment facilities are more likely to be located in poorer communities, whereas office-based practices of mental health professionals are more likely to be located in higher-income communities. These findings indicate that mental health treatment facilities constitute the backbone of the specialty mental health treatment infrastructure in low-income communities. Policies are needed to support and expand available resources for this critical infrastructure.

Subglacial geomorphology reveals connections between glacial dynamics and deeper hydrocarbon reservoir leakages at the Polar north Atlantic continental margin

NASA Astrophysics Data System (ADS)

Andreassen, Karin; Deryabin, Alexey; Rafaelsen, Bjarne; Richarsen, Morten

2014-05-01

Three-dimensional (3D) seismic data from the Barents Sea continental shelf and margin reveal spatial links between subsurface distributions of inferred glacitectonic geomorphic landforms and seismic indications of fluid flow from deeper hydrocarbon reservoirs. Particularly 3D seismic techniques allow detailed mapping and visualization of buried glacial geomorphology and geophysical indications of fluid flow and gas accumulations. Several subsurface glacitectonic landforms show pronounced depressions up to 200 m deep and several km wide. These appear in many locations just upstream from hills of similar sizes and volumes, and are inferred to be hill-hole pairs. The hills are interpreted as thrusted and compressed slabs of sediments and bedrock which have been removed from their original location by moving glaciers during the last glacial, leaving the holes as depressions. The mapped depressions seem often to appear in sediments of different lithology and age. The appearance of mega-scale glacial lineations indicates that fast-flowing ice streams, draining the former Barents Sea and Fennoscandian ice sheets were the main agents of these glacitectonic landforms. Mapped fluid flow migration pathways from deeper reservoirs and shallow gas accumulations show evidence of active fluid migration systems over longer time periods, and their spatial relationship with the glacitectonic landforms is documented for several areas of the Barents Sea continental shelf. A conceptual model is proposed for the depressions, where brittle glacitectonic deformation takes place along a weak layer at the base of gas-hydrate cemented sediments. Fluid flow from deeper hydrocarbon reservoirs is inferred to be associated with cycles of glaciations and unloading due to glacial erosion and ice retreat, causing gas to expand, which in turn potentially breaks the traps, reactivates faults and creates new faults. Gas hydrate stability modeling indicates that the south-western Barents Sea is today outside the stability area for methane gas hydrates of structure I, but hydrates of this type would have been stable when grounded ice covered the area. Structure II hydrates, with a few percent of heavier hydrocarbons are likely stable within the area today. Acknowledgements. This research is part of the Centre of Excellence for Gas Hydrate, Environment and Climate (CAGE) funded by the Research Council of Norway (RCN) grant 223259. It is also a contribution to the project "Glaciations in the Barents Sea area (GlaciBar)" RCN grant 20067 and to the Research Centre for Arctic Petroleum Exploration (ARCEx) RCN grant 228107.

Power Aware Signal Processing Environment (PASPE) for PAC/C

DTIC Science & Technology

2003-02-01

vs. FFT Size For our implementation , the Annapolis FFT core was radix-256, and therefore the smallest PN code length that could be processed was the...PN-64. A C- code version of correlate was compared to the FPGA 61 implementation . The results in Figure 68 show that for a PN-1024, the...12a. DISTRIBUTION / AVAILABILITY STATEMENT APPROVED FOR PUBLIC RELEASE; DISTRIBUTION UNLIMITED. 12b. DISTRIBUTION CODE 13. ABSTRACT (Maximum

Grappling with cultural differences; communication between oncologists and immigrant cancer patients with and without interpreters.

PubMed

Butow, Phyllis; Bell, Melanie; Goldstein, David; Sze, Ming; Aldridge, Lynley; Abdo, Sarah; Mikhail, Michelle; Dong, Skye; Iedema, Rick; Ashgari, Ray; Hui, Rina; Eisenbruch, Maurice

2011-09-01

Immigrants report challenges communicating with their health team. This study compared oncology consultations of immigrants with and without interpreters vs Anglo-Australian patients. Patients with newly diagnosed incurable cancer who had immigrated from Arabic, Chinese or Greek speaking countries or were Anglo-Australian, and family members, were recruited from 10 medical oncologists in 9 hospitals. Two consultations from each patient were audio-taped, transcribed, translated into English and coded. Seventy-eight patients (47 immigrant and 31 Anglo-Australian) and 115 family members (77 immigrant and 38 Anglo Australian) participated in 141 audio-taped consultations. Doctors spoke less to immigrants with interpreters than to Anglo-Australians (1443 vs. 2246 words, p=0.0001), spent proportionally less time on cancer related issues (p=0.005) and summarising and informing (p≤0.003) and more time on other medical issues (p=0.0008) and directly advising (p=0.0008). Immigrants with interpreters gave more high intensity cues (10.4 vs 7.4). Twenty percent of cues were not interpreted. Doctors tended to delay responses to or ignore more immigrant than Anglo-Australian cues (13% vs 5%, p=0.06). Immigrant cancer patients with interpreters experience different interactions with their doctors than Anglo-Australians, which may compromise their well-being and decisions. Guidelines and proven training programmes are needed to improve communication with immigrant patients, particularly those with interpreters. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Risk Factors for Clinician-Diagnosed Lyme Arthritis, Facial Palsy, Carditis, and Meningitis in Patients From High-Incidence States

PubMed Central

Kwit, Natalie A; Max, Ryan; Mead, Paul S

2018-01-01

Abstract Background Clinical features of Lyme disease (LD) range from localized skin lesions to serious disseminated disease. Information on risk factors for Lyme arthritis, facial palsy, carditis, and meningitis is limited but could facilitate disease recognition and elucidate pathophysiology. Methods Patients from high-incidence states treated for LD during 2005–2014 were identified in a nationwide insurance claims database using the International Classification of Diseases, Ninth Revision code for LD (088.81), antibiotic treatment history, and clinically compatible codiagnosis codes for LD manifestations. Results Among 88022 unique patients diagnosed with LD, 5122 (5.8%) patients with 5333 codiagnoses were identified: 2440 (2.8%) arthritis, 1853 (2.1%) facial palsy, 534 (0.6%) carditis, and 506 (0.6%) meningitis. Patients with disseminated LD had lower median age (35 vs 42 years) and higher male proportion (61% vs 50%) than nondisseminated LD. Greatest differential risks included arthritis in males aged 10–14 years (odds ratio [OR], 3.5; 95% confidence interval [CI], 3.0–4.2), facial palsy (OR, 2.1; 95% CI, 1.6–2.7) and carditis (OR, 2.4; 95% CI, 1.6–3.6) in males aged 20–24 years, and meningitis in females aged 10–14 years (OR, 3.4; 95% CI, 2.1–5.5) compared to the 55–59 year referent age group. Males aged 15–29 years had the highest risk for complete heart block, a potentially fatal condition. Conclusions The risk and manifestations of disseminated LD vary by age and sex. Provider education regarding at-risk populations and additional investigations into pathophysiology could enhance early case recognition and improve patient management. PMID:29326960

Prevalence, Comorbidities, and Risk of Perioperative Complications in Human Immunodeficiency Virus-Positive Patients Undergoing Cervical Spine Surgery.

PubMed

Lovy, Andrew J; Guzman, Javier Z; Skovrlj, Branko; Cho, Samuel K; Hecht, Andrew C; Qureshi, Sheeraz A

2015-11-01

Retrospective database analysis. To evaluate outcomes of human immunodeficiency virus (HIV) positive patients after cervical spine surgery. Highly active antiretroviral medications have qualitatively altered the natural history of HIV, thus increasing the number of HIV-positive patients seeking treatment for chronic degenerative conditions. Minimal data exist on HIV patients undergoing degenerative cervical spine surgery. The Nationwide Inpatient Sample was examined from 2002 to 2011. Hospitalizations were identified using International Classification of Diseases Ninth Revision, Clinical Modification (ICD-9-CM) procedural codes for cervical spine surgery and diagnoses codes for degenerative conditions of the cervical spine, and HIV. Statistical analysis was conducted to evaluate associations between HIV status and perioperative complications. A total of 1,602,129 patients underwent degenerative cervical spine surgery, of which 3700 patients (0.23%) had HIV. The prevalence of HIV increased over the study period from 0.19% to 0.33% (P < 0.001). Patients with HIV were younger (48.6 yrs vs. 53.4 yrs, P < 0.001) and more likely to be male (P < 0.001). HIV patients had significantly greater odds of having chronic pulmonary disease, liver disease, and drug abuse. Unadjusted analysis did not reveal increased rate of acute complications among HIV-positive patients compared with negative controls (3.8% vs. 3.7%, P = 0.62). Multivariate analysis did not identify HIV as a significant predictor of complication (odds ratio = 1.04, P = 0.84). HIV was associated with a 1.5 day increased length of stay AND 1.29 fold increase in median costs compared with controls ($14,551 vs. 18,846, P < 0.001). The prevalence of HIV patients undergoing degenerative cervical spine surgery is increasing. A diagnosis of HIV was not associated with an increased risk of perioperative complication among patients undergoing degenerative cervical spine surgery. Further clinical studies are needed to evaluate predictors of complications among HIV patients and long-term outcomes. 4.

Impact of the implementation of a Sepsis Code hospital protocol in antibiotic prescription and clinical outcomes in an intensive care unit.

PubMed

García-López, L; Grau-Cerrato, S; de Frutos-Soto, A; Bobillo-De Lamo, F; Cítores-Gónzalez, R; Diez-Gutierrez, F; Muñoz-Moreno, M F; Sánchez-Sánchez, T; Gandía-Martínez, F; Andaluz-Ojeda, D

A study was performed to analyze the impact of an in-hospital Sepsis Code (SC) program on use of antibiotic and clinical outcomes. Quasi-experimental observational retrospective study. Polyvalent 11 beds ICU belonging to a tertiary Universitary hospital. Patients admitted consecutively to the ICU with diagnosis of severe sepsis or septic shock. A post intervention group (POST-SC) (September 2012-August 2013) was compared with a historical group (PRE-SC) used as control (January-December 2010). Antibiotic treatment, therapeutic antibiotic strategy, mortality and length of stay. Antibiotic consumption was expressed as defined daily doses (DDD)/ 100 stays. 42 patients with SS/SS in POST-SC group and 50 patients in PRE-SC group were consecutively recluted and further analyzed. Total antibiotic consumption (DDD) was similar in both groups. Rate of de-escalation therapy was significantly higher in POST-SC group (75% vs 30,8%, p<0,005) while prescription of restricted antibiotics was significantly lower (74% vs 52%, p=0,031). Finally POST-SC patients showed a significantly decrease in hospital and 28 days mortality rates [23% vs 44%, (p=0,035) and 31% vs 56% (p=0,014) respectively] as well as a reduction in ICU length of stay compared to PRE-SC cohort (5 days vs 10,5 days, p=0,05). The implementation of a Sepsis Code-hospital protocol is associated to an improvement in the management of antibiotic therapy with a significant increase in de-escalation therapy and lesser utilization of restricted use antibiotics, as well as a significant reduction in mortality, and a tendency towards shorter ICU length stay. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Does hospital accreditation impact bariatric surgery safety?

PubMed

Morton, John M; Garg, Trit; Nguyen, Ninh

2014-09-01

To evaluate the impact of hospital accreditation upon bariatric surgery outcomes. Since 2004, the American College of Surgeons and the American Society of Metabolic and Bariatric Surgery have accredited bariatric hospitals. Few studies have evaluated the impact of hospital accreditation on all bariatric surgery outcomes. Bariatric surgery hospitalizations were identified using International Classification of Diseases, Ninth Revision (ICD9) codes in the 2010 Nationwide Inpatient Sample (NIS). Hospital names and American Hospital Association (AHA) codes were used to identify accredited bariatric centers. Relevant ICD9 codes were used for identifying demographics, length of stay (LOS), total charges, mortality, complications, and failure to rescue (FTR) events. There were 117,478 weighted bariatric patient discharges corresponding to 235 unique hospitals in the 2010 NIS data set. A total of 72,615 (61.8%) weighted discharges, corresponding to 145 (61.7%) named or AHA-identifiable hospitals were included. Among the 145 hospitals, 66 (45.5%) were unaccredited and 79 (54.5%) accredited. Compared with accredited centers, unaccredited centers had a higher mean LOS (2.25 vs 1.99 days, P < 0.0001), as well as total charges ($51,189 vs $42,212, P < 0.0001). Incidence of any complication was higher at unaccredited centers than at accredited centers (12.3% vs 11.3%, P = 0.001), as was mortality (0.13% vs 0.07%, P = 0.019) and FTR (0.97% vs 0.55%, P = 0.046). Multivariable logistic regression analysis identified unaccredited status as a positive predictor of incidence of complication [odds ratio (OR) = 1.08, P < 0.0001], as well as mortality (OR = 2.13, P = 0.013). Hospital accreditation status is associated with safer outcomes, shorter LOS, and lower total charges after bariatric surgery.

Does Kaniso activate CASINO?: input coding schemes and phonology in visual-word recognition.

PubMed

Acha, Joana; Perea, Manuel

2010-01-01

Most recent input coding schemes in visual-word recognition assume that letter position coding is orthographic rather than phonological in nature (e.g., SOLAR, open-bigram, SERIOL, and overlap). This assumption has been drawn - in part - by the fact that the transposed-letter effect (e.g., caniso activates CASINO) seems to be (mostly) insensitive to phonological manipulations (e.g., Perea & Carreiras, 2006, 2008; Perea & Pérez, 2009). However, one could argue that the lack of a phonological effect in prior research was due to the fact that the manipulation always occurred in internal letter positions - note that phonological effects tend to be stronger for the initial syllable (Carreiras, Ferrand, Grainger, & Perea, 2005). To reexamine this issue, we conducted a masked priming lexical decision experiment in which we compared the priming effect for transposed-letter pairs (e.g., caniso-CASINO vs. caviro-CASINO) and for pseudohomophone transposed-letter pairs (kaniso-CASINO vs. kaviro-CASINO). Results showed a transposed-letter priming effect for the correctly spelled pairs, but not for the pseudohomophone pairs. This is consistent with the view that letter position coding is (primarily) orthographic in nature.

Surveillance of paediatric traumatic brain injuries using the NEISS: choosing an appropriate case definition.

PubMed

Thompson, Meghan C; Wheeler, Krista K; Shi, Junxin; Smith, Gary A; Groner, Jonathan I; Haley, Kathryn J; Xiang, Huiyun

2014-01-01

To evaluate the definition of traumatic brain injury (TBI) in the National Electronic Injury Surveillance System (NEISS) and compare TBI case ascertainment using NEISS vs. ICD-9-CM diagnosis coding. Two data samples from a NEISS participating emergency department (ED) in 2008 were compared: (1) NEISS records meeting the recommended NEISS TBI definition and (2) Hospital ED records meeting the ICD-9-CM CDC recommended TBI definition. The sensitivity and positive predictive value were calculated for the NEISS definition using the ICD-9-CM definition as the gold standard. Further analyses were performed to describe cases characterized as TBIs in both datasets and to determine why some cases were not classified as TBIs in both datasets. There were 1834 TBI cases captured by the NEISS and 1836 TBI cases captured by the ICD-9-CM coded ED record, but only 1542 were eligible for inclusion in NEISS. There were 1403 cases classified as TBIs by both the NEISS and ICD-9-CM diagnosis codes. The NEISS TBI definition had a sensitivity of 91.0% (95% CI = 89.6-92.4%) and positive predictive value of 76.5% (95% CI = 74.6-78.4%). Using the NEISS TBI definition presented in this paper would standardize and improve the accuracy of TBI research using the NEISS.

Accuracy of Skin Cancer Diagnosis by Physician Assistants Compared With Dermatologists in a Large Health Care System.

PubMed

Anderson, Alyce M; Matsumoto, Martha; Saul, Melissa I; Secrest, Aaron M; Ferris, Laura K

2018-05-01

Physician assistants (PAs) are increasingly used in dermatology practices to diagnose skin cancers, although, to date, their diagnostic accuracy compared with board-certified dermatologists has not been well studied. To compare diagnostic accuracy for skin cancer of PAs with that of dermatologists. Medical record review of 33 647 skin cancer screening examinations in 20 270 unique patients who underwent screening at University of Pittsburgh Medical Center-affiliated dermatology offices from January 1, 2011, to December 31, 2015. International Classification of Diseases, Ninth Revision code V76.43 and International Classification of Diseases and Related Health Problems, Tenth Revision code Z12.83 were used to identify pathology reports from skin cancer screening examinations by dermatologists and PAs. Examination performed by a PA or dermatologist. Number needed to biopsy (NNB) to diagnose skin cancer (nonmelanoma, invasive melanoma, or in situ melanoma). Of 20 270 unique patients, 12 722 (62.8%) were female, mean (SD) age at the first visit was 52.7 (17.4) years, and 19 515 patients (96.3%) self-reported their race/ethnicity as non-Hispanic white. To diagnose 1 case of skin cancer, the NNB was 3.9 for PAs and 3.3 for dermatologists (P < .001). Per diagnosed melanoma, the NNB was 39.4 for PAs and 25.4 for dermatologists (P = .007). Patients screened by a PA were significantly less likely than those screened by a dermatologist to be diagnosed with melanoma in situ (1.1% vs 1.8% of visits, P = .02), but differences were not significant for invasive melanoma (0.7% vs 0.8% of visits, P = .83) or nonmelanoma skin cancer (6.1% vs 6.1% of visits, P = .98). Compared with dermatologists, PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists. Although the availability of PAs may help increase access to care and reduce waiting times for appointments, these findings have important implications for the training, appropriate scope of practice, and supervision of PAs and other nonphysician practitioners in dermatology.

Cost of Illness and Comorbidities in Adults Diagnosed With Attention-Deficit/Hyperactivity Disorder: A Retrospective Analysis

PubMed Central

Montejano, Leslie; Sasané, Rahul; Huse, Dan

2011-01-01

Objective: This retrospective study assessed the cost of illness and medical and psychiatric comorbidities in adults with attention-deficit/hyperactivity disorder (ADHD) compared with adults without ADHD (matched 1:3) and adults with depression (1:1). Individuals with depression were included as a benchmark against which the burden of ADHD could be measured. Method: Measures of health care and employment–related costs were compared to generate estimates of medical expenditures, workplace absences, and comorbidities in adults with ADHD (using ICD-9-CM codes) who were enrolled in employer-sponsored health plans throughout 2006. Individuals with ADHD (31,752) were matched with 95,256 non-ADHD controls. The majority of individuals with ADHD (n = 29,965) were also matched with an equal number of individuals with a depression diagnosis (using ICD-9-CM codes). Results: In this adult population with ADHD enrolled in an employer-sponsored health plan, medical and psychiatric comorbidities were the primary drivers of health care utilization and cost. Of note, depression was significantly prevalent among those with ADHD compared to matched non-ADHD controls (14% vs 3.2%; P ≤ .0001). Subgroup analysis demonstrated that ADHD patients with depression had a significantly higher number of medical and other psychiatric comorbid illnesses including diabetes, hypertension, asthma, irritable bowel syndrome, bipolar disorder, anxiety, alcohol abuse, and substance abuse compared to those with ADHD alone (P ≤ .0001). Patients with ADHD incurred higher total annual health care expenditures than control subjects ($4,306 vs $2,418); approximately 15% of costs were paid by the patient. The total annual costs associated with productivity losses were also higher (driven by differences in short-term disability costs) in the ADHD group compared with controls ($4,403 vs $4,209). Conclusions: Medical and psychiatric comorbidities were primary drivers of the direct health care cost associated with ADHD in adult patients. The present study demonstrated that the total costs of ADHD among adults are doubled when indirect costs associated with workplace productivity losses are included. PMID:21977356

Joint Inversion of Vp, Vs, and Resistivity at SAFOD

NASA Astrophysics Data System (ADS)

Bennington, N. L.; Zhang, H.; Thurber, C. H.; Bedrosian, P. A.

2010-12-01

Seismic and resistivity models at SAFOD have been derived from separate inversions that show significant spatial similarity between the main model features. Previous work [Zhang et al., 2009] used cluster analysis to make lithologic inferences from trends in the seismic and resistivity models. We have taken this one step further by developing a joint inversion scheme that uses the cross-gradient penalty function to achieve structurally similar Vp, Vs, and resistivity images that adequately fit the seismic and magnetotelluric MT data without forcing model similarity where none exists. The new inversion code, tomoDDMT, merges the seismic inversion code tomoDD [Zhang and Thurber, 2003] and the MT inversion code Occam2DMT [Constable et al., 1987; deGroot-Hedlin and Constable, 1990]. We are exploring the utility of the cross-gradients penalty function in improving models of fault-zone structure at SAFOD on the San Andreas Fault in the Parkfield, California area. Two different sets of end-member starting models are being tested. One set is the separately inverted Vp, Vs, and resistivity models. The other set consists of simple, geologically based block models developed from borehole information at the SAFOD drill site and a simplified version of features seen in geophysical models at Parkfield. For both starting models, our preliminary results indicate that the inversion produces a converging solution with resistivity, seismic, and cross-gradient misfits decreasing over successive iterations. We also compare the jointly inverted Vp, Vs, and resistivity models to borehole information from SAFOD to provide a "ground truth" comparison.

The use of information technology to enhance patient safety and nursing efficiency.

PubMed

Lee, Tso-Ying; Sun, Gi-Tseng; Kou, Li-Tseng; Yeh, Mei-Ling

2017-10-23

Issues in patient safety and nursing efficiency have long been of concern. Advancing the role of nursing informatics is seen as the best way to address this. The aim of this study was to determine if the use, outcomes and satisfaction with a nursing information system (NIS) improved patient safety and the quality of nursing care in a hospital in Taiwan. This study adopts a quasi-experimental design. Nurses and patients were surveyed by questionnaire and data retrieval before and after the implementation of NIS in terms of blood drawing, nursing process, drug administration, bar code scanning, shift handover, and information and communication integration. Physiologic values were easier to read and interpret; it took less time to complete electronic records (3.7 vs. 9.1 min); the number of errors in drug administration was reduced (0.08% vs. 0.39%); bar codes reduced the number of errors in blood drawing (0 vs. 10) and transportation of specimens (0 vs. 0.42%); satisfaction with electronic shift handover increased significantly; there was a reduction in nursing turnover (14.9% vs. 16%); patient satisfaction increased significantly (3.46 vs. 3.34). Introduction of NIS improved patient safety and nursing efficiency and increased nurse and patient satisfaction. Medical organizations must continually improve the nursing information system if they are to provide patients with high quality service in a competitive environment.

The MCNP6 Analytic Criticality Benchmark Suite

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brown, Forrest B.

2016-06-16

Analytical benchmarks provide an invaluable tool for verifying computer codes used to simulate neutron transport. Several collections of analytical benchmark problems [1-4] are used routinely in the verification of production Monte Carlo codes such as MCNP® [5,6]. Verification of a computer code is a necessary prerequisite to the more complex validation process. The verification process confirms that a code performs its intended functions correctly. The validation process involves determining the absolute accuracy of code results vs. nature. In typical validations, results are computed for a set of benchmark experiments using a particular methodology (code, cross-section data with uncertainties, and modeling)more » and compared to the measured results from the set of benchmark experiments. The validation process determines bias, bias uncertainty, and possibly additional margins. Verification is generally performed by the code developers, while validation is generally performed by code users for a particular application space. The VERIFICATION_KEFF suite of criticality problems [1,2] was originally a set of 75 criticality problems found in the literature for which exact analytical solutions are available. Even though the spatial and energy detail is necessarily limited in analytical benchmarks, typically to a few regions or energy groups, the exact solutions obtained can be used to verify that the basic algorithms, mathematics, and methods used in complex production codes perform correctly. The present work has focused on revisiting this benchmark suite. A thorough review of the problems resulted in discarding some of them as not suitable for MCNP benchmarking. For the remaining problems, many of them were reformulated to permit execution in either multigroup mode or in the normal continuous-energy mode for MCNP. Execution of the benchmarks in continuous-energy mode provides a significant advance to MCNP verification methods.« less

Increased cardiovascular disease, resource use, and costs before the clinical diagnosis of diabetes in veterans in the southeastern U.S.

PubMed

Olson, Darin E; Zhu, Ming; Long, Qi; Barb, Diana; Haw, Jeehea S; Rhee, Mary K; Mohan, Arun V; Watson-Williams, Phyllis I; Jackson, Sandra L; Tomolo, Anne M; Wilson, Peter W F; Narayan, K M Venkat; Lipscomb, Joseph; Phillips, Lawrence S

2015-06-01

Screening for diabetes might be more widespread if adverse associations with cardiovascular disease (CVD), resource use, and costs were known to occur earlier than conventional clinical diagnosis. The purpose of this study was to determine whether adverse effects associated with diabetes begin prior to clinical diagnosis. Veterans with diabetes were matched 1:2 with controls by follow-up, age, race/ethnicity, gender, and VA facility. CVD was obtained from ICD-9 codes, and resource use and costs from VA datasets. VA facilities in SC, GA, and AL. Patients with and without diagnosed diabetes. Diagnosed CVD, resource use, and costs. In this study, the 2,062 diabetic patients and 4,124 controls were 63 years old on average, 99 % male, and 29 % black; BMI was 30.8 in diabetic patients vs. 27.8 in controls (p<0.001). CVD prevalence was higher and there were more outpatient visits in Year -4 before diagnosis through Year +4 after diagnosis among diabetic vs. control patients (all p<0.01); in Year -2, CVD prevalence was 31 % vs. 24 %, and outpatient visits were 22 vs. 19 per year, respectively. Total VA costs/year/veteran were higher in diabetic than control patients from Year -4 ($4,083 vs. $2,754) through Year +5 ($8,347 vs. $5,700) (p<0.003) for each, reflecting underlying increases in outpatient, inpatient, and pharmacy costs (p<0.05 for each). Regression analysis showed that diabetes contributed an average of $1,748/year to costs, independent of CVD (p<0.001). VA costs per veteran are higher--over $1,000/year before and $2,000/year after diagnosis of diabetes--due to underlying increases in outpatient, inpatient, and pharmacy costs, greater number of outpatient visits, and increased CVD. Moreover, adverse associations with veterans' health and the VA healthcare system occur early in the natural history of the disease, several years before diabetes is diagnosed. Since adverse associations begin before diabetes is recognized, greater consideration should be given to systematic screening in order to permit earlier detection and initiation of preventive management. Keeping frequency of CVD and marginal costs in line with those of patients before diabetes is currently diagnosed has the potential to save up to $2 billion a year.

Cosmogenic radionuclides

NASA Astrophysics Data System (ADS)

Cosmic rays interact with the earth's atmosphere and surface to produce the “cosmogenic” nuclides. In many instances the radioactive ones are readily distinguished from the anthropogenic and meteoritic backgrounds. Measurements of these cosmogenic radionuclides (RCN) can contribute to the solution of a variety of geophysical problems [Lai and Peters, 1967]. Recent progress in this area was discussed at a symposium entitled Application of Cosmic-Ray-Produced Nuclides in Geophysics held May 30, 1983, at the AGU Spring Meeting in Baltimore (see Eos, May 3, 1983, pp. 282-284, for the abstracts). We summarize here the symposium presentations.

Gladys Carter - an advocate of higher education for nurses.

PubMed

Weir, R I

Gladys Carter was once well-known as an author of midwifery and nursing texts and articles. She was appointed the first Boots Scholar in Nursing Research at the University of Edinburgh in 1952. The outcome of her work, the Carter Report (unpublished) lent weight to the reform of the Nurse Tutors' course offered at that time by the RCN Scottish Board and to the establishment of the Department of Nursing Studies at the University of Edinburgh. This paper discusses the contributions made by Miss Carter to the case for higher education for nurses.

Mixed feelings.

PubMed

2001-09-01

The first time I went to the RCN A&E Nursing Association Annual Conference about ten years ago, I heard a speaker talk about patients being described as 'pond-life'. Delegates were enraged and there was practically a queue of people wishing to dissociate themselves from what they had heard. What it boiled down to was a discussion on whether or not some patients deserved care while others were less deserving. Despite the howls of outrage a decade ago, I wonder if we have moved on as far as we would like to think.

Nutritional strategies to reduce falls risk in older people.

PubMed

Nash, Louise; Bergin, Nick

2018-03-23

A literature review found an association between increased falls risk and malnutrition, sarcopenia, vitamin D deficiency and dehydration. Strategies to identify, prevent and treat these conditions can help to reduce falls risk in at-risk groups such as frail, older people. Nurses can reduce falls risk in older people by raising awareness of risk factors and embedding nutritional strategies in local falls reduction strategies. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Strengths, weaknesses, opportunities, threats.

PubMed

2002-12-01

Meeting fellow older people enthusiasts is always a pleasure and this month's encounters particularly so. The annual conference of the two RCN older people forums offered its usual blend of innovative ideas, stimulating debate, esoteric humour and a camaraderie shared with strangers as well as friends. Working with multidisciplinary colleagues on the West Midlands pilot development programme for leaders of older people services was equally inspiring. Despite the ongoing challenges of competing priorities, inadequate resources and ageist attitudes, committed teams around the UK are striving to offer high quality services to older people.

Validation of coding algorithms for the identification of patients hospitalized for alcoholic hepatitis using administrative data.

PubMed

Pang, Jack X Q; Ross, Erin; Borman, Meredith A; Zimmer, Scott; Kaplan, Gilaad G; Heitman, Steven J; Swain, Mark G; Burak, Kelly W; Quan, Hude; Myers, Robert P

2015-09-11

Epidemiologic studies of alcoholic hepatitis (AH) have been hindered by the lack of a validated International Classification of Disease (ICD) coding algorithm for use with administrative data. Our objective was to validate coding algorithms for AH using a hospitalization database. The Hospital Discharge Abstract Database (DAD) was used to identify consecutive adults (≥18 years) hospitalized in the Calgary region with a diagnosis code for AH (ICD-10, K70.1) between 01/2008 and 08/2012. Medical records were reviewed to confirm the diagnosis of AH, defined as a history of heavy alcohol consumption, elevated AST and/or ALT (<300 U/L), serum bilirubin >34 μmol/L, and elevated INR. Subgroup analyses were performed according to the diagnosis field in which the code was recorded (primary vs. secondary) and AH severity. Algorithms that incorporated ICD-10 codes for cirrhosis and its complications were also examined. Of 228 potential AH cases, 122 patients had confirmed AH, corresponding to a positive predictive value (PPV) of 54% (95% CI 47-60%). PPV improved when AH was the primary versus a secondary diagnosis (67% vs. 21%; P < 0.001). Algorithms that included diagnosis codes for ascites (PPV 75%; 95% CI 63-86%), cirrhosis (PPV 60%; 47-73%), and gastrointestinal hemorrhage (PPV 62%; 51-73%) had improved performance, however, the prevalence of these diagnoses in confirmed AH cases was low (29-39%). In conclusion the low PPV of the diagnosis code for AH suggests that caution is necessary if this hospitalization database is used in large-scale epidemiologic studies of this condition.

Chirp- and random-based coded ultrasonic excitation for localized blood-brain barrier opening

PubMed Central

Kamimura, HAS; Wang, S; Wu, S-Y; Karakatsani, ME; Acosta, C; Carneiro, AAO; Konofagou, EE

2015-01-01

Chirp- and random-based coded excitation methods have been proposed to reduce standing wave formation and improve focusing of transcranial ultrasound. However, no clear evidence has been shown to support the benefits of these ultrasonic excitation sequences in vivo. This study evaluates the chirp and periodic selection of random frequency (PSRF) coded-excitation methods for opening the blood-brain barrier (BBB) in mice. Three groups of mice (n=15) were injected with polydisperse microbubbles and sonicated in the caudate putamen using the chirp/PSRF coded (bandwidth: 1.5-1.9 MHz, peak negative pressure: 0.52 MPa, duration: 30 s) or standard ultrasound (frequency: 1.5 MHz, pressure: 0.52 MPa, burst duration: 20 ms, duration: 5 min) sequences. T1-weighted contrast-enhanced MRI scans were performed to quantitatively analyze focused ultrasound induced BBB opening. The mean opening volumes evaluated from the MRI were 9.38±5.71 mm3, 8.91±3.91 mm3 and 35.47 ± 5.10 mm3 for the chirp, random and regular sonications, respectively. The mean cavitation levels were 55.40±28.43 V.s, 63.87±29.97 V.s and 356.52±257.15 V.s for the chirp, random and regular sonications, respectively. The chirp and PSRF coded pulsing sequences improved the BBB opening localization by inducing lower cavitation levels and smaller opening volumes compared to results of the regular sonication technique. Larger bandwidths were associated with more focused targeting but were limited by the frequency response of the transducer, the skull attenuation and the microbubbles optimal frequency range. The coded methods could therefore facilitate highly localized drug delivery as well as benefit other transcranial ultrasound techniques that use higher pressure levels and higher precision to induce the necessary bioeffects in a brain region while avoiding damage to the surrounding healthy tissue. PMID:26394091

A Novel c-VEP BCI Paradigm for Increasing the Number of Stimulus Targets Based on Grouping Modulation With Different Codes.

PubMed

Wei, Qingguo; Liu, Yonghui; Gao, Xiaorong; Wang, Yijun; Yang, Chen; Lu, Zongwu; Gong, Huayuan

2018-06-01

In an existing brain-computer interface (BCI) based on code modulated visual evoked potentials (c-VEP), a method with which to increase the number of targets without increasing code length has not yet been established. In this paper, a novel c-VEP BCI paradigm, namely, grouping modulation with different codes that have good autocorrelation and crosscorrelation properties, is presented to increase the number of targets and information transfer rate (ITR). All stimulus targets are divided into several groups and each group of targets are modulated by a distinct pseudorandom binary code and its circularly shifting codes. Canonical correlation analysis is applied to each group for yielding a spatial filter and templates for all targets in a group are constructed based on spatially filtered signals. Template matching is applied to each group and the attended target is recognized by finding the maximal correlation coefficients of all groups. Based on the paradigm, a BCI with a total of 48 targets divided into three groups was implemented; 12 and 10 subjects participated in an off-line and a simulated online experiments, respectively. Data analysis of the offline experiment showed that the paradigm can massively increase the number of targets from 16 to 48 at the cost of slight compromise in accuracy (95.49% vs. 92.85%). Results of the simulated online experiment suggested that although the averaged accuracy across subjects of all three groups of targets was lower than that of a single group of targets (91.67% vs. 94.9%), the average ITR of the former was substantially higher than that of the later (181 bits/min vs. 135.6 bit/min) due to the large increase of the number of targets. The proposed paradigm significantly improves the performance of the c-VEP BCI, and thereby facilitates its practical applications such as high-speed spelling.

Impact of medical therapy on patients with Crohn’s disease requiring surgical resection

PubMed Central

Fu, YT Nancy; Hong, Thomas; Round, Andrew; Bressler, Brian

2014-01-01

AIM: To evaluate the impact of medical therapy on Crohn’s disease patients undergoing their first surgical resection. METHODS: We retrospectively evaluated all patients with Crohn’s disease undergoing their first surgical resection between years 1995 to 2000 and 2005 to 2010 at a tertiary academic hospital (St. Paul’s Hospital, Vancouver, Canada). Patients were identified from hospital administrative database using the International Classification of Diseases 9 codes. Patients’ hospital and available outpatient clinic records were independently reviewed and pertinent data were extracted. We explored relationships among time from disease diagnosis to surgery, patient phenotypes, medication usage, length of small bowel resected, surgical complications, and duration of hospital stay. RESULTS: Total of 199 patients were included; 85 from years 1995 to 2000 (cohort A) and 114 from years 2005 to 2010 (cohort B). Compared to cohort A, cohort B had more patients on immunomodulators (cohort A vs cohort B: 21.4% vs 56.1%, P < 0.0001) and less patients on 5-aminosalysilic acid (53.6% vs 29.8%, P = 0.001). There was a shift from inflammatory to stricturing and penetrating phenotypes (B1/B2/B3 38.8% vs 12.3%, 31.8% vs 45.6%, 29.4% vs 42.1%, P < 0.0001). Both groups had similar median time to surgery. Within cohort B, 38 patients (33.3%) received anti-tumor necrosis factor (TNF) agent. No patient in cohort A was exposed to anti-TNF agent. Compared to patients not on anti-TNF agent, ones exposed were younger at diagnosis (anti-TNF vs without anti-TNF: A1/A2/A3 39.5% vs 11.8%, 50% vs 73.7%, 10.5% vs 14.5%, P = 0.003) and had longer median time to surgery (90 mo vs 48 mo, P = 0.02). Combination therapy further extended median time to surgery. Using time-dependent multivariate Cox proportional hazard model, patients who were treated with anti-TNF agents had a significantly higher risk to surgery (adjusted hazard ratio 3.57, 95%CI: 1.98-6.44, P < 0.0001) compared to those without while controlling for gender, disease phenotype, smoking status, and immunomodulator use. CONCLUSION: Significant changes in patient phenotypes and medication exposures were observed between the two surgical cohorts separated by a decade. PMID:25206286

Alternative Payment Models Should Risk-Adjust for Conversion Total Hip Arthroplasty: A Propensity Score-Matched Study.

PubMed

McLawhorn, Alexander S; Schairer, William W; Schwarzkopf, Ran; Halsey, David A; Iorio, Richard; Padgett, Douglas E

2017-12-06

For Medicare beneficiaries, hospital reimbursement for nonrevision hip arthroplasty is anchored to either diagnosis-related group code 469 or 470. Under alternative payment models, reimbursement for care episodes is not further risk-adjusted. This study's purpose was to compare outcomes of primary total hip arthroplasty (THA) vs conversion THA to explore the rationale for risk adjustment for conversion procedures. All primary and conversion THAs from 2007 to 2014, excluding acute hip fractures and cancer patients, were identified in the National Surgical Quality Improvement Program database. Conversion and primary THA patients were matched 1:1 using propensity scores, based on preoperative covariates. Multivariable logistic regressions evaluated associations between conversion THA and 30-day outcomes. A total of 2018 conversions were matched to 2018 primaries. There were no differences in preoperative covariates. Conversions had longer operative times (148 vs 95 minutes, P < .001), more transfusions (37% vs 17%, P < .001), and longer length of stay (4.4 vs 3.1 days, P < .001). Conversion THA had increased odds of complications (odds ratio [OR] 1.75; 95% confidence interval [CI] 1.37-2.24), deep infection (OR 4.21; 95% CI 1.72-10.28), discharge to inpatient care (OR 1.52; 95% CI 1.34-1.72), and death (OR 2.39; 95% CI 1.04-5.47). Readmission odds were similar. Compared with primary THA, conversion THA is associated with more complications, longer length of stay, and increased discharge to continued inpatient care, implying greater resource utilization for conversion patients. As reimbursement models shift toward bundled payment paradigms, conversion THA appears to be a procedure for which risk adjustment is appropriate. Copyright © 2017 Elsevier Inc. All rights reserved.

When study participants are vulnerable: getting and keeping the right team.

PubMed

Hill, Nikki L; Mogle, Jacqueline; Wion, Rachel; Kolanowski, Ann M; Fick, Donna; Behrens, Liza; Muhall, Paula; McDowell, Jane

2017-09-19

Research assistants (RAs) are critical members of all research teams. When a study involves vulnerable populations, it is particularly important to have the right team members. To describe the motivations, personal characteristics and team characteristics that promoted the job satisfaction of RAs who worked on two multi-year, randomised clinical trials involving older adults with dementia. A survey was conducted with 41 community members who worked as RAs for up to five years. Measures included demographics, work engagement, personality and characteristics of effective teams, as well as open-ended questions about respondents' experiences of the study. Quantitative analyses and coding of open-ended responses were used to summarise results. Almost all the RAs surveyed joined the team because of previous experiences of interacting with cognitively impaired older people. The RA respondents scored higher in 'dedication to work', 'extraversion', 'agreeableness' and 'conscientiousness' than average. An important aspect of their job satisfaction was team culture, including positive interpersonal interaction and the development of supportive team relationships. A positive work culture provides RAs with an opportunity to work with a study population that they are personally driven to help, and promotes motivation and satisfaction in team members. Results from this study can guide the recruitment, screening and retention of team members for studies that include vulnerable populations. ©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Peer social support training in UK prisons.

PubMed

Stewart, Warren; Lovely, Rachel

2017-10-11

To undertake a service evaluation to assess the effect of peer social support training using two separate learning programmes, which were designed to assist prisoners to support older prisoners and prisoners with disabilities. The service evaluation used an action research approach to support planning, delivery and data collection. Eleven interviews with nine prisoners who had undertaken the peer social support training programmes and two members of prison staff (one nurse manager and one prison officer) were recorded and transcribed by the researchers. This data was coded and thematically analysed to evaluate the findings. Recommendations were made regarding the format and content of the training. The training was well received by the peer social support worker trainees and had several positive outcomes, including increased peer social support, improved relationships between peer social support workers and older prisoners and prisoners with disabilities, increased self-esteem, measured as 'social capital', among peer social support workers, and effective teamworking. The peer social support training programmes were considered to be a positive intervention and were effective in supporting peer social support roles. Recommendations for future training of prisoner peer support workers include involving existing peer social support workers in training and recruitment, and enhancing the role of peer social support workers in prisons by providing them with job descriptions. ©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Professional deontology and medical practice in prisons.

PubMed

García-Guerrero, J; Vera-Remartínez, E J

2015-01-01

To study the knowledge on professional deontology amongst doctors in prisons. Descriptive, transversal and multi-centre study. Labour, collegiate, social, demographic and deontological variables were collected. A descriptive analysis of the variables was performed. A bivariate analysis was made by binary logistic regression models, attending to the odds ratio, and assuming a 95% confidence interval. Data was processed by SPSS v.20 software. 118 doctors replied. 68 men (57.6%), with an average age of 51 years (50-53). 100 know about the Deontology Committee (84.7%), but just 77 (65.3%) know its functions properly. 42 (35.6%) know about the existence of the Deontological Code, and 37 (31.3%) have read and apply it. Those who made a correct definition of deontology do find more deontological issues in their daily work [23(46.9%) vs. 18(26.1%); OR: 2.506; IC95%: 1.153-5.451; p=0.020] and would denounce a colleague more often to the Medical Association [40(81.6%) vs. 42 (60.9%); OR: 2.857; IC95%: 1.197-6.819; p=0.018]. Older ones know more about the deontology commissions' functions [54(73%) vs. 23(52.3%); OR: 2.465; IC95%: 1.127-5.394; p=0.024] and have already denounced situations to the Medical Association [27(36.5% vs. 5(11.4%); OR: 4.481; IC95%: 1.577-12.733; p=0.005], but think that a different Care Ethics Committee is unnecessary [57(77%) vs. 42(95.5%); OR: 0.160; IC95%: 0.035- 0.729; p=0.018]. Prison doctors know little about what professional deontology really is. This knowledge increases with age in the profession and is associated with an increased perception of deontological issues in daily practice.

Outcomes after Deep Vein Thrombosis and Pulmonary Embolism in the Community: The Worcester Venous Thromboembolism Study

PubMed Central

Spencer, Frederick A.; Gore, Joel M.; Lessard, Darleen; Douketis, James D.; Emery, Cathy; Goldberg, Robert J.

2009-01-01

Background Despite advances in the management of deep vein thrombosis (DVT) and pulmonary embolism (PE), there are relatively few contemporary data describing and comparing outcomes in patients with these common conditions from a more generalizable community-based perspective. The purpose of this study was to measure and compare clinical characteristics and outcomes of patients with validated symptomatic PE and isolated DVT in a New England community. Methods The medical records of residents from the Worcester (MA) area with ICD-9 codes consistent with possible venous thromboembolism (VTE) during 1999, 2001, and 2003 were independently validated and reviewed by trained abstractors. Results Patients presenting with PE or isolated DVT experienced similar rates of subsequent PE, overall venous thromboembolism (VTE), and major bleeding during 3-year follow-up (5.9% vs. 5.1%, 15% vs. 17.9%, 15.6% vs. 12.4%, respectively). Mortality was significantly increased at 1-month follow-up in patients initially presenting with PE (13.0% vs. 5.4%) - this difference persisted at 3 years (35.3% vs. 29.6%). Patients whose course was complicated by major bleeding were more likely to suffer recurrent VTE or to die at 3 years than those without these complications. Conclusions Patients presenting with PE had similar rates of subsequent PE or recurrent VTE as patients with isolated DVT. However, rates of recurrent VTE and major bleeding following DVT and PE remain unacceptably high in the community setting. Efforts remain needed to identify patients most at risk for VTE-associated complications and development of better anticoagulation strategies conducive to long-term use in the community setting. PMID:18299499

Differences in Physicians' Verbal and Nonverbal Communication With Black and White Patients at the End of Life.

PubMed

Elliott, Andrea M; Alexander, Stewart C; Mescher, Craig A; Mohan, Deepika; Barnato, Amber E

2016-01-01

Black patients are more likely than white patients to die in the intensive care unit with life-sustaining treatments. Differences in patient- and/or surrogate-provider communication may contribute to this phenomenon. To test whether hospital-based physicians use different verbal and/or nonverbal communication with black and white simulated patients and their surrogates. We conducted a randomized factorial trial of the relationship between patient race and physician communication using high-fidelity simulation. Using a combination of probabilistic and convenience sampling, we recruited 33 hospital-based physicians in western Pennsylvania who completed two encounters with prognostically similar, critically and terminally ill black and white elders with identical treatment preferences. We then conducted detailed content analysis of audio and video recordings of the encounters, coding verbal emotion-handling and shared decision-making behaviors, and nonverbal behaviors (time interacting with the patient and/or surrogate, with open vs. closed posture, and touching the patient and physical proximity). We used a paired t-test to compare each subjects' summed verbal and nonverbal communication scores with the black patient compared to the white patient. Subject physicians' verbal communication scores did not differ by patient race (black vs. white: 8.4 vs. 8.4, P-value = 0.958). However, their nonverbal communication scores were significantly lower with the black patient than with the white patient (black vs. white: 2.7 vs. 2.9, P-value 0.014). In this small regional sample, hospital-based physicians have similar verbal communication behaviors when discussing end-of-life care for otherwise similar black and white patients but exhibit significantly fewer positive, rapport-building nonverbal cues with black patients. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Differences in Physicians’ Verbal and Nonverbal Communication With Black and White Patients at the End of Life

PubMed Central

Elliott, Andrea M.; Alexander, Stewart C.; Mescher, Craig A.; Mohan, Deepika; Barnato, Amber E.

2015-01-01

Context Black patients are more likely than white patients to die in the intensive care unit with life-sustaining treatments. Differences in patient- and/or surrogate-provider communication may contribute to this phenomenon. Objectives To test whether hospital-based physicians use different verbal and/or nonverbal communication with black and white simulated patients and their surrogates. Methods We conducted a randomized factorial trial of the relationship between patient race and physician communication using high-fidelity simulation. Using a combination of probabilistic and convenience sampling, we recruited 33 hospital-based physicians in western Pennsylvania who completed two encounters with prognostically similar, critically and terminally ill black and white elders with identical treatment preferences. We then conducted detailed content analysis of audio and video recordings of the encounters, coding verbal emotion-handling and shared decision-making behaviors, and nonverbal behaviors (time interacting with the patient and/or surrogate, with open vs. closed posture, and touching the patient and physical proximity). We used a paired t-test to compare each subjects’ summed verbal and nonverbal communication scores with the black patient compared to the white patient. Results Subject physicians’ verbal communication scores did not differ by patient race (black vs. white: 8.4 vs. 8.4, P-value = 0.958). However, their nonverbal communication scores were significantly lower with the black patient than with the white patient (black vs. white: 2.7 vs. 2.9, P-value 0.014). Conclusion In this small regional sample, hospital-based physicians have similar verbal communication behaviors when discussing end-of-life care for otherwise similar black and white patients but exhibit significantly fewer positive, rapport-building nonverbal cues with black patients. PMID:26297851

Gout in the Hmong in the United States.

PubMed

Wahedduddin, Salman; Singh, Jasvinder A; Culhane-Pera, Kathleen A; Gertner, Elie

2010-09-01

To compare characteristics of gout in Hmong patients versus whites, and examine if Hmong ethnicity is associated with risk of tophaceous gout. A retrospective chart review of Hmong and White patients with gout in a large health care system (Health Partners) in St. Paul, Minnesota, from January 2001 to March 2008, to compare clinical characteristics and risk factors for gout. Multivariable-adjusted hierarchical logistic regressions examined the association of Hmong ethnicity with risk of tophaceous gout, adjusting for age, sex, hypertension, diuretic use, and kidney function. The analytic dataset consisted of 89 Hmong patients and 84 White controls, all of whom had ethnicity confirmed, an International Classification of Diseases, ninth revision code for gout and had at least 2 physician-documented diagnoses of gout. The Hmong group was younger (58.3 vs. 66.3 years, P = 0.04), had an earlier onset of symptoms (37.4 vs. 55.0 years, P < 0.001) and higher mean serum uric acid levels during follow-up (9.1 vs. 7.6 mg/dL, P < or = 0.001). Hmong had higher rates of tophaceous gout (31.5% vs. 10.7%, P = 0.001), including hand tophi (21.3% vs. 3.6%, P < 0.001). In multivariable analyses that adjusted for age, sex, hypertension, diuretic, use, and kidney function, Hmong ethnicity was significantly associated with risk of tophaceous gout, with odds ratio 4.3 (95% confidence interval: 1.5, 12.2). Hmong patients have an earlier onset of gout symptoms. Hmong race is an independent risk factor for tophaceous gout. Future studies need to examine whether genetic or other comorbid factors predict this higher risk of more severe gout in Hmong.

A physician-led initiative to improve clinical documentation results in improved health care documentation, case mix index, and increased contribution margin.

PubMed

Aiello, Francesco A; Judelson, Dejah R; Durgin, Jonathan M; Doucet, Danielle R; Simons, Jessica P; Durocher, Dawn M; Flahive, Julie M; Schanzer, Andres

2018-05-04

Clinical documentation is the key determinant of inpatient acuity of illness and payer reimbursement. Every inpatient hospitalization is placed into a diagnosis related group with a relative value based on documented procedures, conditions, comorbidities and complications. The Case Mix Index (CMI) is an average of these diagnosis related groups and directly impacts physician profiling, medical center profiling, reimbursement, and quality reporting. We hypothesize that a focused, physician-led initiative to improve clinical documentation of vascular surgery inpatients results in increased CMI and contribution margin. A physician-led coding initiative to educate physicians on the documentation of comorbidities and conditions was initiated with concurrent chart review sessions with coding specialists for 3 months, and then as needed, after the creation of a vascular surgery documentation guide. Clinical documentation and billing for all carotid endarterectomy (CEA) and open infrainguinal procedures (OIPs) performed between January 2013 and July 2016 were stratified into precoding and postcoding initiative groups. Age, duration of stay, direct costs, actual reimbursements, contribution margin (CM), CMI, rate of complication or comorbidity, major complication or comorbidity, severity of illness, and risk of mortality assigned to each discharge were abstracted. Data were compared over time by standardizing Centers for Medicare and Medicaid Services (CMS) values for each diagnosis related group and using a CMS base rate reimbursement. Among 458 CEA admissions, postcoding initiative CEA patients (n = 253) had a significantly higher CMI (1.36 vs 1.25; P = .03), CM ($7859 vs $6650; P = .048), and CMS base rate reimbursement ($8955 vs $8258; P = .03) than precoding initiative CEA patients (n = 205). The proportion of admissions with a documented major complication or comorbidity and complication or comorbidity was significantly higher after the coding initiative (43% vs 27%; P < .01). Among 504 OIPs, postcoding initiative patients (n = 227) had a significantly higher CMI (2.23 vs 2.05; P < .01), actual reimbursement ($23,203 vs $19,909; P < .01), CM ($12,165 vs $8840; P < .01), and CMS base rate reimbursement ($14,649 vs $13,496; P < .01) than precoding initiative patients (n = 277). The proportion of admissions with a documented major complication or comorbidity and complication or comorbidity was significantly higher after the coding initiative (61% vs 43%; P < .01). For both CEA and OIPs, there were no differences in age, duration of stay, total direct costs, or primary insurance status between the precoding and postcoding patient groups. Accurate and detailed clinical documentation is required for key stakeholders to characterize the acuity of inpatient admissions and ensure appropriate reimbursement; it is also a key component of risk-adjustment methods for assessing quality of care. A physician-led documentation initiative significantly increased CMI and CM. Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

The structure and energetics of the HCN → HNC transition state

NASA Astrophysics Data System (ADS)

Lee, Timothy J.; Rendell, Alistair P.

1991-03-01

The optimum geometries and quadratic force constants of HCN, HNC and the transition state connecting them have been determined at the single and double excitation coupled-cluster (CCSD) and CCSD(T) levels of theory. Energy differences were evaluated using the CCSD and CCSD(T) methods in conjunction with large atomic natural orbital basis sets containing g-type basis functions on the heavy atoms and f-type functions on hydrogen. The most reliable structure obtained for the transition state has bond distances of 1.194, 1.188 and 1.389 Å for rCN, rCH and rNH, respectively. Including a correction for zero-point vibrational energies, the transition state is predicted to be 44.6 ± 1.0 kcal/mol above the HCN isomer, while HNC is predicted to be 14.4 ± 1.0 kcal/mol above HCN. The latter value is in excellent agreement with the most recent experimental determination (14.8 ± 2.0 kcal/mol).

Risk Factors for Melanoma in Renal Transplant Recipients.

PubMed

Ascha, Mona; Ascha, Mustafa S; Tanenbaum, Joseph; Bordeaux, Jeremy S

2017-11-01

Melanoma risk factors and incidence in renal transplant recipients can inform decision making for both patients and clinicians. To determine risk factors and characteristics of renal transplant recipients who develop melanoma. This cohort study of a large national data registry used a cohort of renal transplant recipients from the United States Renal Data System (USRDS) database from the years 2004 through 2012. Differences in baseline characteristics between those who did and did not develop melanoma were examined, and a survival analysis was performed. Patients with renal transplants who received a diagnosis of melanoma according to any inpatient or outpatient claim associated with a billing code for melanoma were included. A history of pretransplant melanoma, previous kidney transplantation, or transplantation after 2012 or before 2004 were exclusion criteria. The data analysis was conducted from 2015 to 2016. Receipt of a renal transplant. Incidence and risk factors for melanoma. Of 105 174 patients (64 151 [60.7%] male; mean [SD] age, 49.6 [15.3] years) who received kidney transplants between 2004 and 2012, 488 (0.4%) had a record of melanoma after transplantation. Significant risk factors for developing melanoma vs not developing melanoma included older age among recipients (mean [SD] age, 60.5 [10.2] vs 49.7 [15.3] years; P < .001) and donors (42.6 [15.0] vs 39.2 [15.1] years; P < .001), male sex (71.5% vs 60.7%; P < .001), recipient (96.1% vs 66.5%; P < .001) and donor (92.4% vs 82.9%; P < .001) white race, less than 4 HLA mismatches (44.9% vs 37.1%; P = .001), living donors (44.7% vs 33.7%; P < .001), and sirolimus (22.3% vs 13.2%; P < .001) and cyclosporine (4.9% vs 3.2%; P = .04) therapy. Risk factors significant on survival analysis included older recipient age (hazard ratio [HR] per year, 1.06; 95% CI, 1.05-1.06; P < .001), recipient male sex (HR, 1.53; 95% CI, 1.25-1.88; P < .001), recipient white race, living donors (HR, 1.35; 95% CI, 1.11-1.64; P = .002), and sirolimus (HR, 1.54; 95% CI, 1.22-1.94; P < .001) and cyclosporine (HR, 1.93; 95% CI, 1.24-2.99; P = .004) therapy. The age-standardized relative rate of melanoma in USRDS patients compared with Surveillance, Epidemiology, and End Results patients across all years was 4.9. A Kaplan-Meier estimate of the median time to melanoma among those patients who did develop melanoma was 1.45 years (95% CI, 1.31-1.70 years). Renal transplant recipients had greater risk of developing melanoma than the general population. We believe that the risk factors we identified can guide clinicians in providing adequate care for patients in this vulnerable group.

Use of Mechanical Circulatory Support in Percutaneous Coronary Intervention in the United States

PubMed Central

Khera, Rohan; Cram, Peter; Vaughan-Sarrazin, Mary; Horwitz, Phillip A.; Girotra, Saket

2015-01-01

Percutaneous ventricular assist devices (PVADs) and intra-aortic balloon pump (IABP) are used to provide mechanical circulatory support (MCS) for high-risk percutaneous coronary intervention (PCI). Contemporary trends in their utilization and impact on in-hospital mortality are not known. Using the National Inpatient Sample (2004–2012), we identified 5031 patients who received a PVAD and 122,333 who received an IABP on the same day as PCI using ICD9 codes. Utilization of MCS increased from 1.3% of all PCIs in 2004 to 3.4% in 2012 (P trend<0.001), with increase in the use of both PVAD (<1/10000 PCIs [2004–2007] to 38/10000 [2012]) and IABP (132/10000 PCIs [2004] to 299/10000[2012] P<0.0001 for both). PVAD recipients were older (69 vs. 65 years), more likely to have heart failure (68% vs. 41%), chronic kidney disease (27% vs. 11%, P<0.001 for all), and be admitted electively (30% vs. 11%), but less likely to have AMI (52% vs. 90%), cardiogenic shock (23% vs. 50%) or need mechanical ventilation (16% vs. 29%) compared to IABP recipients. Unadjusted in-hospital mortality was lower in PVAD compared to IABP recipients (12.8% vs. 20.9%, P<0.001). However, in propensity-matched analyses (1:2), in-hospital mortality was similar in both groups (odds ratio 0.88, 95% CI 0.70–1.09). In conclusion, there has been a marked increase in the utilization of MCS in patients undergoing PCI. Unadjusted mortality with use of PVADs is lower than IABP but may be due to their selective use in lower-risk patients. Randomized trials are necessary to establish their effectiveness in supporting high-risk PCI. PMID:26547292

Study of the modifications needed for effective operation NASTRAN on IBM virtual storage computers

NASA Technical Reports Server (NTRS)

Mccormick, C. W.; Render, K. H.

1975-01-01

The necessary modifications were determined to make NASTRAN operational under virtual storage operating systems (VS1 and VS2). Suggested changes are presented which will make NASTRAN operate more efficiently under these systems. Estimates of the cost and time involved in design, coding, and implementation of all suggested modifications are included.

Discovery of Novel Bat Coronaviruses in South China That Use the Same Receptor as Middle East Respiratory Syndrome Coronavirus.

PubMed

Luo, Chu-Ming; Wang, Ning; Yang, Xing-Lou; Liu, Hai-Zhou; Zhang, Wei; Li, Bei; Hu, Ben; Peng, Cheng; Geng, Qi-Bin; Zhu, Guang-Jian; Li, Fang; Shi, Zheng-Li

2018-07-01

Middle East respiratory syndrome coronavirus (MERS-CoV) has represented a human health threat since 2012. Although several MERS-related CoVs that belong to the same species as MERS-CoV have been identified from bats, they do not use the MERS-CoV receptor, dipeptidyl peptidase 4 (DPP4). Here, we screened 1,059 bat samples from at least 30 bat species collected in different regions in south China and identified 89 strains of lineage C betacoronaviruses, including Tylonycteris pachypus coronavirus HKU4 , Pipistrellus pipistrellus coronavirus HKU5 , and MERS-related CoVs. We sequenced the full-length genomes of two positive samples collected from the great evening bat, Ia io , from Guangdong Province. The two genomes were highly similar and exhibited genomic structures identical to those of other lineage C betacoronaviruses. While they exhibited genome-wide nucleotide identities of only 75.3 to 81.2% with other MERS-related CoVs, their gene-coding regions were highly similar to their counterparts, except in the case of the spike proteins. Further protein-protein interaction assays demonstrated that the spike proteins of these MERS-related CoVs bind to the receptor DPP4. Recombination analysis suggested that the newly discovered MERS-related CoVs have acquired their spike genes from a DPP4-recognizing bat coronavirus HKU4. Our study provides further evidence that bats represent the evolutionary origins of MERS-CoV. IMPORTANCE Previous studies suggested that MERS-CoV originated in bats. However, its evolutionary path from bats to humans remains unclear. In this study, we discovered 89 novel lineage C betacoronaviruses in eight bat species. We provide evidence of a MERS-related CoV derived from the great evening bat that uses the same host receptor as human MERS-CoV. This virus also provides evidence for a natural recombination event between the bat MERS-related CoV and another bat coronavirus, HKU4. Our study expands the host ranges of MERS-related CoV and represents an important step toward establishing bats as the natural reservoir of MERS-CoV. These findings may lead to improved epidemiological surveillance of MERS-CoV and the prevention and control of the spread of MERS-CoV to humans. Copyright © 2018 American Society for Microbiology.

Civility on Campus: Harassment Codes vs. Free Speech. ASHE Annual Meeting Paper.

ERIC Educational Resources Information Center

Nordin, Virginia Davis

In response to the resurgence of racial incidents and increased "gay-bashing" on higher education campuses in recent years, campus authorities have instituted harassment codes thereby giving rise to a conflicts with free speech. Similar conflicts and challenges to free speech have arisen recently in a municipal context such as a St. Paul…

Validation of an International Statistical Classification of Diseases and Related Health Problems 10th Revision Coding Algorithm for Hospital Encounters with Hypoglycemia.

PubMed

Hodge, Meryl C; Dixon, Stephanie; Garg, Amit X; Clemens, Kristin K

2017-06-01

To determine the positive predictive value and sensitivity of an International Statistical Classification of Diseases and Related Health Problems, 10th Revision, coding algorithm for hospital encounters concerning hypoglycemia. We carried out 2 retrospective studies in Ontario, Canada. We examined medical records from 2002 through 2014, in which older adults (mean age, 76) were assigned at least 1 code for hypoglycemia (E15, E160, E161, E162, E1063, E1163, E1363, E1463). The positive predictive value of the algorithm was calculated using a gold-standard definition (blood glucose value <4 mmol/L or physician diagnosis of hypoglycemia). To determine the algorithm's sensitivity, we used linked healthcare databases to identify older adults (mean age, 77) with laboratory plasma glucose values <4 mmol/L during a hospital encounter that took place between 2003 and 2011. We assessed how frequently a code for hypoglycemia was present. We also examined the algorithm's performance in differing clinical settings (e.g. inpatient vs. emergency department, by hypoglycemia severity). The positive predictive value of the algorithm was 94.0% (95% confidence interval 89.3% to 97.0%), and its sensitivity was 12.7% (95% confidence interval 11.9% to 13.5%). It performed better in the emergency department and in cases of more severe hypoglycemia (plasma glucose values <3.5 mmol/L compared with ≥3.5 mmol/L). Our hypoglycemia algorithm has a high positive predictive value but is limited in sensitivity. Although we can be confident that older adults who are assigned 1 of these codes truly had a hypoglycemia event, many episodes will not be captured by studies using administrative databases. Copyright © 2017 Diabetes Canada. Published by Elsevier Inc. All rights reserved.

Sex Differences in Prevalence of Emergency Department Patient Substance Use.

PubMed

Cannon, Robert D; Beauchamp, Gillian A; Roth, Paige; Stephens, Jennifer; Burmeister, David B; Richardson, David M; Balbi, Alanna M; Park, Tennessee D; Dusza, Stephen W; Greenberg, Marna Rayl

2018-02-01

Substance use and misuse is prevalent in emergency department (ED) populations. While the prevalence of substance use and misuse is reported, sex-specific trends in ED populations have not been documented. We set out to determine the sex-specific prevalence of ED patient substance use during this current epidemic. A retrospective electronic data abstraction tool, developed for quality-improvement purposes, was used to assess ED visits in 3 hospitals in northeastern Pennsylvania. All patients with ED diagnosis codes for substance use F10.000 through F 19.999 (excluding F17 codes for nicotine) were abstracted for network ED visits at all 3 hospitals. Data points included ED clinical enrollment site, primary substance used, sex, date of ED visit, disposition (including left without being seen, left against medical advice, discharged, admitted, and treatment in rehabilitation) for 18 months (January 1, 2016 through July 31, 2017). The categorical parameters of sex, clinical enrollment site, diagnosis, date of ED visit, and disposition status were summarized as a proportion of the subject group. Time series analysis was used to assess trends in substance use and misuse visits by patient sex. A total of 10,511 patients presented to the EDs during the study time period with a final diagnosis of a substance use-related reason and were included in the analysis. The mean age for these patients was 43.6 (SD 16.4) years, and the majority was male (65.6%, n = 6900). The most common substance in the final diagnosis for the ED visit was alcohol (54.3%; 95% CI, 53.3-55.2), followed by opioids (19.2%; 95% CI, 18.4-19.9) and cannabis (14.4%; 95% CI, 13.7-15.0). Females tended to be younger than males (42.4 years vs 44.3 years; P < 0.001), and were more likely to be discharged after the ED visit than males (36.1% vs 32.3%; P < 0.001). When exploring differences in age by sex and substance, males with a final diagnosis including alcohol- and cannabis-related issues were older than females, whereas females diagnosed with opioid-related reasons were older than males (41.3 vs 38.9 years; P < 0.001). There are sex-specific differences in prevalence of patients presenting with substance use in the ED setting. Copyright © 2018 Elsevier HS Journals, Inc. All rights reserved.

Death rates from human immunodeficiency virus and tuberculosis among American Indians/Alaska Natives in the United States, 1990-2009.

PubMed

Reilley, Brigg; Bloss, Emily; Byrd, Kathy K; Iralu, Jonathan; Neel, Lisa; Cheek, James

2014-06-01

We used race-corrected data and comprehensive diagnostic codes to better compare HIV and tuberculosis (TB) mortality from 1999 to 2009 between American Indian/Alaska Natives (AI/ANs) and Whites. National Vital Statistics Surveillance System mortality data were adjusted for AI/AN racial misclassification through linkage with Indian Health Service registration records. We compared average annual 1990 to 2009 HIV and TB death rates (per 100,000 people) for AI/AN persons with those for Whites; Hispanics were excluded. Although death rates from HIV in AI/AN persons were significantly lower than those in Whites from 1990 to 1998 (4.2 vs 7.0), they were significantly higher than those in Whites from 1999 to 2009 (3.6 vs 2.0). Death rates from TB in AI/AN persons were significantly higher than those in Whites, with a significant disparity during both 1990 to 1998 (3.3 vs 0.3) and 1999 to 2009 (1.5 vs 0.1). The decrease in death rates from HIV and TB was greater among Whites, and death rates remained significantly higher among AI/AN individuals. Public health interventions need to be prioritized to reduce the TB and HIV burden and mortality in AI/AN populations.

Death Rates From Human Immunodeficiency Virus and Tuberculosis Among American Indians/Alaska Natives in the United States, 1990–2009

PubMed Central

Bloss, Emily; Byrd, Kathy K.; Iralu, Jonathan; Neel, Lisa; Cheek, James

2014-01-01

Objectives. We used race-corrected data and comprehensive diagnostic codes to better compare HIV and tuberculosis (TB) mortality from 1999 to 2009 between American Indian/Alaska Natives (AI/ANs) and Whites. Methods. National Vital Statistics Surveillance System mortality data were adjusted for AI/AN racial misclassification through linkage with Indian Health Service registration records. We compared average annual 1990 to 2009 HIV and TB death rates (per 100 000 people) for AI/AN persons with those for Whites; Hispanics were excluded. Results. Although death rates from HIV in AI/AN persons were significantly lower than those in Whites from 1990 to 1998 (4.2 vs 7.0), they were significantly higher than those in Whites from 1999 to 2009 (3.6 vs 2.0). Death rates from TB in AI/AN persons were significantly higher than those in Whites, with a significant disparity during both 1990 to 1998 (3.3 vs 0.3) and 1999 to 2009 (1.5 vs 0.1). Conclusions. The decrease in death rates from HIV and TB was greater among Whites, and death rates remained significantly higher among AI/AN individuals. Public health interventions need to be prioritized to reduce the TB and HIV burden and mortality in AI/AN populations. PMID:24754664

MicroRNA-like viral small RNA from porcine reproductive and respiratory syndrome virus negatively regulates viral replication by targeting the viral nonstructural protein 2.

PubMed

Li, Na; Yan, Yunhuan; Zhang, Angke; Gao, Jiming; Zhang, Chong; Wang, Xue; Hou, Gaopeng; Zhang, Gaiping; Jia, Jinbu; Zhou, En-Min; Xiao, Shuqi

2016-12-13

Many viruses encode microRNAs (miRNAs) that are small non-coding single-stranded RNAs which play critical roles in virus-host interactions. Porcine reproductive and respiratory syndrome virus (PRRSV) is one of the most economically impactful viruses in the swine industry. The present study sought to determine whether PRRSV encodes miRNAs that could regulate PRRSV replication. Four viral small RNAs (vsRNAs) were mapped to the stem-loop structures in the ORF1a, ORF1b and GP2a regions of the PRRSV genome by bioinformatics prediction and experimental verification. Of these, the structures with the lowest minimum free energy (MFE) values predicted for PRRSV-vsRNA1 corresponded to typical stem-loop, hairpin structures. Inhibition of PRRSV-vsRNA1 function led to significant increases in viral replication. Transfection with PRRSV-vsRNA1 mimics significantly inhibited PRRSV replication in primary porcine alveolar macrophages (PAMs). The time-dependent increase in the abundance of PRRSV-vsRNA1 mirrored the gradual upregulation of PRRSV RNA expression. Knockdown of proteins associated with cellular miRNA biogenesis demonstrated that Drosha and Argonaute (Ago2) are involved in PRRSV-vsRNA1 biogenesis. Moreover, PRRSV-vsRNA1 bound specifically to the nonstructural protein 2 (NSP2)-coding sequence of PRRSV genome RNA. Collectively, the results reveal that PRRSV encodes a functional PRRSV-vsRNA1 which auto-regulates PRRSV replication by directly targeting and suppressing viral NSP2 gene expression. These findings not only provide new insights into the mechanism of the pathogenesis of PRRSV, but also explore a potential avenue for controlling PRRSV infection using viral small RNAs.

A comparison of cigarette- and hookah-related videos on YouTube.

PubMed

Carroll, Mary V; Shensa, Ariel; Primack, Brian A

2013-09-01

YouTube is now the second most visited site on the internet. The authors aimed to compare characteristics of and messages conveyed by cigarette- and hookah-related videos on YouTube. Systematic search procedures yielded 66 cigarette-related and 61 hookah-related videos. After three trained qualitative researchers used an iterative approach to develop and refine definitions for the coding of variables, two of them independently coded each video for content including positive and negative associations with smoking and major content type. Median view counts were 606,884 for cigarettes-related videos and 102,307 for hookah-related videos (p<0.001). However, the number of comments per 1000 views was significantly lower for cigarette-related videos than for hookah-related videos (1.6 vs 2.5, p=0.003). There was no significant difference in the number of 'like' designations per 100 reactions (91 vs 87, p=0.39). Cigarette-related videos were less likely than hookah-related videos to portray tobacco use in a positive light (24% vs 92%, p<0.001). In addition, cigarette-related videos were more likely to be of high production quality (42% vs 5%, p<0.001), to mention short-term consequences (50% vs 18%, p<0.001) and long-term consequences (44% vs 2%, p<0.001) of tobacco use, to contain explicit antismoking messages (39% vs 0%, p<0.001) and to provide specific information on how to quit tobacco use (21% vs 0%, p<0.001). Although internet user-generated videos related to cigarette smoking often acknowledge harmful consequences and provide explicit antismoking messages, hookah-related videos do not. It may be valuable for public health programmes to correct common misconceptions regarding hookah use.

A Comparison of Cigarette- and Hookah-Related Videos on YouTube

PubMed Central

Carroll, Mary V.; Shensa, Ariel; Primack, Brian A.

2013-01-01

Objective YouTube is now the second most visited site on the Internet. We aimed to compare characteristics of and messages conveyed by cigarette- and hookah-related videos on YouTube. Methods Systematic search procedures yielded 66 cigarette-related and 61 hookah-related videos. After 3 trained qualitative researchers used an iterative approach to develop and refine definitions for the coding of variables, 2 of them independently coded each video for content including positive and negative associations with smoking and major content type. Results Median view counts were 606,884 for cigarettes and 102,307 for hookahs (P<.001). However, the number of comments per 1,000 views was significantly lower for cigarette-related videos than for hookah-related videos (1.6 vs 2.5, P=.003). There was no significant difference in the number of “like” designations per 100 reactions (91 vs. 87, P=.39). Cigarette-related videos were less likely than hookah-related videos to portray tobacco use in a positive light (24% vs. 92%, P<.001). In addition, cigarette-related videos were more likely to be of high production quality (42% vs. 5%, P<.001), to mention short-term consequences (50% vs. 18%, P<.001) and long-term consequences (44% vs. 2%, P<.001) of tobacco use, to contain explicit antismoking messages (39% vs. 0%, P<.001), and to provide specific information on how to quit tobacco use (21% vs. 0%, P<.001). Conclusions Although Internet user–generated videos related to cigarette smoking often acknowledge harmful consequences and provide explicit antismoking messages, hookah-related videos do not. It may be valuable for public health programs to correct common misconceptions regarding hookah use. PMID:22363069

Impact of Depression on Hospitalization and Related Outcomes for Parkinson's Disease Patients: A Nationwide Inpatient Sample-Based Retrospective Study

PubMed Central

Makani, Ramkrishna; Mansuri, Zeeshan; Patel, Upenkumar; Desai, Rupak; Chopra, Amit

2017-01-01

Background Major Depressive Disorder (MDD) is a common comorbidity that significantly affects the quality of life and disease outcomes in Parkinson’s disease (PD) patients. No studies have been conducted to our knowledge to address the health care utilization and its outcomes in these patients. The aim of this study is to analyze and discern the differences in the hospitalization outcomes, comorbid conditions, and utilization of procedures in PD patients versus patients with comorbid MDD. Methods We used the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project from year’s 2010-2014. We identified PD and MDD as a primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification codes. Pearson’s chi-square test and independent sample T-test were used for categorical data and continuous data, respectively. All statistical analysis was done by SPSS 22.0 in this study. Results Extensive analysis was performed on 63,912 patients with PD and 1445 patients with PD having MDD. Patients with comorbid depression had three times greater chances of disposition to acute care hospital (3.1% vs. 1.1%, p < 0.001). Median length of hospitalization was higher in Parkinson’s patients with depression (5.85 vs. 4.08 days; p < 0.001) though the median cost of hospitalization was low ($ 31,039 vs. $ 39,464; p < 0.001). This could be because therapeutic procedures performed during the hospitalization were lower in Parkinson’s patients with depression (0.53 vs. 0.89, p < 0.001). Utilization of Deep Brain Stimulation (DBS) was lower in Parkinson’s patients with depression (9.4% vs. 25.6%, p < 0.001). In­-hospital mortality was significantly higher in Parkinson’s patients with depression (1.4% vs. 1.1%; p < 0.001). Conclusion Our study establishes the negative impact of depression in PD with regards to hospitalization-related outcomes including the illness severity, comorbid conditions, risk of mortality, utilization of diagnostic and therapeutic procedures, the length of stay and disposition as compared to PD without depression. PMID:29142796

Nicotinic Receptor Gene CHRNA4 Interacts with Processing Load in Attention

PubMed Central

Espeseth, Thomas; Sneve, Markus Handal; Rootwelt, Helge; Laeng, Bruno

2010-01-01

Background Pharmacological studies suggest that cholinergic neurotransmission mediates increases in attentional effort in response to high processing load during attention demanding tasks [1]. Methodology/Principal Findings In the present study we tested whether individual variation in CHRNA4, a gene coding for a subcomponent in α4β2 nicotinic receptors in the human brain, interacted with processing load in multiple-object tracking (MOT) and visual search (VS). We hypothesized that the impact of genotype would increase with greater processing load in the MOT task. Similarly, we predicted that genotype would influence performance under high but not low load in the VS task. Two hundred and two healthy persons (age range = 39–77, Mean = 57.5, SD = 9.4) performed the MOT task in which twelve identical circular objects moved about the display in an independent and unpredictable manner. Two to six objects were designated as targets and the remaining objects were distracters. The same observers also performed a visual search for a target letter (i.e. X or Z) presented together with five non-targets while ignoring centrally presented distracters (i.e. X, Z, or L). Targets differed from non-targets by a unique feature in the low load condition, whereas they shared features in the high load condition. CHRNA4 genotype interacted with processing load in both tasks. Homozygotes for the T allele (N = 62) had better tracking capacity in the MOT task and identified targets faster in the high load trials of the VS task. Conclusion The results support the hypothesis that the cholinergic system modulates attentional effort, and that common genetic variation can be used to study the molecular biology of cognition. PMID:21203548

Complete sequence of two tick-borne flaviviruses isolated from Siberia and the UK: analysis and significance of the 5' and 3'-UTRs.

PubMed

Gritsun, T S; Venugopal, K; Zanotto, P M; Mikhailov, M V; Sall, A A; Holmes, E C; Polkinghorne, I; Frolova, T V; Pogodina, V V; Lashkevich, V A; Gould, E A

1997-05-01

The complete nucleotide sequence of two tick-transmitted flaviviruses, Vasilchenko (Vs) from Siberia and louping ill (LI) from the UK, have been determined. The genomes were respectively, 10928 and 10871 nucleotides (nt) in length. The coding strategy and functional protein sequence motifs of tick-borne flaviviruses are presented in both Vs and LI viruses. The phylogenies based on maximum likelihood, maximum parsimony and distance analysis of the polyproteins, identified Vs virus as a member of the tick-borne encephalitis virus subgroup within the tick-borne serocomplex, genus Flavivirus, family Flaviviridae. Comparative alignment of the 3'-untranslated regions revealed deletions of different lengths essentially at the same position downstream of the stop codon for all tick-borne viruses. Two direct 27 nucleotide repeats at the 3'-end were found only for Vs and LI virus. Immediately following the deletions a region of 332-334 nt with relatively conserved primary structure (67-94% identity) was observed at the 3'-non-coding end of the virus genome. Pairwise comparisons of the nucleotide sequence data revealed similar levels of variation between the coding region, and the 5' and 3'-termini of the genome, implying an equivalent strong selective control for translated and untranslated regions. Indeed the predicted folding of the 5' and 3'-untranslated regions revealed patterns of stem and loop structures conserved for all tick-borne flaviviruses suggesting a purifying selection for preservation of essential RNA secondary structures which could be involved in translational control and replication. The possible implications of these findings are discussed.

Billing code algorithms to identify cases of peripheral artery disease from administrative data

PubMed Central

Fan, Jin; Arruda-Olson, Adelaide M; Leibson, Cynthia L; Smith, Carin; Liu, Guanghui; Bailey, Kent R; Kullo, Iftikhar J

2013-01-01

Objective To construct and validate billing code algorithms for identifying patients with peripheral arterial disease (PAD). Methods We extracted all encounters and line item details including PAD-related billing codes at Mayo Clinic Rochester, Minnesota, between July 1, 1997 and June 30, 2008; 22 712 patients evaluated in the vascular laboratory were divided into training and validation sets. Multiple logistic regression analysis was used to create an integer code score from the training dataset, and this was tested in the validation set. We applied a model-based code algorithm to patients evaluated in the vascular laboratory and compared this with a simpler algorithm (presence of at least one of the ICD-9 PAD codes 440.20–440.29). We also applied both algorithms to a community-based sample (n=4420), followed by a manual review. Results The logistic regression model performed well in both training and validation datasets (c statistic=0.91). In patients evaluated in the vascular laboratory, the model-based code algorithm provided better negative predictive value. The simpler algorithm was reasonably accurate for identification of PAD status, with lesser sensitivity and greater specificity. In the community-based sample, the sensitivity (38.7% vs 68.0%) of the simpler algorithm was much lower, whereas the specificity (92.0% vs 87.6%) was higher than the model-based algorithm. Conclusions A model-based billing code algorithm had reasonable accuracy in identifying PAD cases from the community, and in patients referred to the non-invasive vascular laboratory. The simpler algorithm had reasonable accuracy for identification of PAD in patients referred to the vascular laboratory but was significantly less sensitive in a community-based sample. PMID:24166724

Epidemiology of angina pectoris: role of natural language processing of the medical record

PubMed Central

Pakhomov, Serguei; Hemingway, Harry; Weston, Susan A.; Jacobsen, Steven J.; Rodeheffer, Richard; Roger, Véronique L.

2007-01-01

Background The diagnosis of angina is challenging as it relies on symptom descriptions. Natural language processing (NLP) of the electronic medical record (EMR) can provide access to such information contained in free text that may not be fully captured by conventional diagnostic coding. Objective To test the hypothesis that NLP of the EMR improves angina pectoris (AP) ascertainment over diagnostic codes. Methods Billing records of in- and out-patients were searched for ICD-9 codes for AP, chronic ischemic heart disease and chest pain. EMR clinical reports were searched electronically for 50 specific non-negated natural language synonyms to these ICD-9 codes. The two methods were compared to a standardized assessment of angina by Rose questionnaire for three diagnostic levels: unspecified chest pain, exertional chest pain, and Rose angina. Results Compared to the Rose questionnaire, the true positive rate of EMR-NLP for unspecified chest pain was 62% (95%CI:55–67) vs. 51% (95%CI:44–58) for diagnostic codes (p<0.001). For exertional chest pain, the EMR-NLP true positive rate was 71% (95%CI:61–80) vs. 62% (95%CI:52–73) for diagnostic codes (p=0.10). Both approaches had 88% (95%CI:65–100) true positive rate for Rose angina. The EMR-NLP method consistently identified more patients with exertional chest pain over 28-month follow-up. Conclusion EMR-NLP method improves the detection of unspecified and exertional chest pain cases compared to diagnostic codes. These findings have implications for epidemiological and clinical studies of angina pectoris. PMID:17383310

Substitution structure of cyanogen, NCCN, from high-resolution far infrared spectra

NASA Astrophysics Data System (ADS)

Grecu, John C.; Winnewisser, Brenda P.; Winnewisser, Manfred

2003-04-01

The lowest lying vibrational bands of the gas-phase spectra of cyanogen, NCCN, and four of its isotopomers, 15NCCN, N13CCN, 15NCC15N, and N13C13CN, were recorded with a Fourier transform interferometer. The resolution was limited by the maximum optical path difference (MOPD) attainable with the interferometer to FWHM=0.0012 cm-1. Rovibrational transitions of the ν5 ( ≈230 cm-1) and also the ν2- ν5 ( ≈610 cm-1) band systems were assigned for all five isotopomers. The use of an effective Hamiltonian for linear molecules to fit the data yielded precise spectroscopic vibrational and rotational constants for the vibrational states ( v1v2v3v4v5) or ( v4v5)=(00), (01), (02), (03), and (01000). These data include the first rotationally resolved transitions involving (01000). Complete substitution ( rs) structures of cyanogen, based on both single and double isotopic substitution of the parent species, were calculated. The derived structure is rCC=138.48(17) pm and rCN=115.66(13) pm. The two rs structures coincide within the errors due to remaining contributions of zero-point vibrations.

Characteristics and use of treatment modalities of patients with binge-eating disorder in the Department of Veterans Affairs.

PubMed

Bellows, Brandon K; DuVall, Scott L; Kamauu, Aaron W C; Supina, Dylan; Pawaskar, Manjiri; Babcock, Thomas; LaFleur, Joanne

2016-04-01

In 2013 binge-eating disorder (BED) was recognized as a formal diagnosis, but was historically included under the diagnosis code for eating disorder not otherwise specified (EDNOS). This study compared the characteristics and use of treatment modalities in BED patients to those with EDNOS without BED (EDNOS-only) and to matched-patients with no eating disorders (NED). Patients were identified for this study from electronic health records in the Department of Veterans Affairs from 2000 to 2011. Patients with BED were identified using natural language processing and patients with EDNOS-only were identified by ICD-9 code (307.50). First diagnosis defined index date for these groups. NED patients were frequency matched to BED patients up to 4:1, as available, on age, sex, BMI, depression, and index month encounter. Baseline characteristics and use of treatment modalities during the post-index year were compared using t-tests or chi-square tests. There were 593 BED, 1354 EDNOS-only, and 1895 matched-NED patients identified. Only 68 patients with BED had an EDNOS diagnosis. BED patients were younger (48.7 vs. 49.8years, p=0.04), more were male (72.2% vs. 62.8%, p<0.001) and obese (BMI 40.2 vs. 37.0, p<0.001) than EDNOS-only patients. In the follow-up period fewer BED (68.0%) than EDNOS-only patients (87.6%, p<0.001), but more BED than NED patients (51.9%, p<0.001) used at least one treatment modality. The characteristics of BED patients were different from those with EDNOS-only and NED as was their use of treatment modalities. These differences highlight the need for a separate identifier of BED. Copyright © 2016 Elsevier Ltd. All rights reserved.

Using Simulation to Assess the Influence of Race and Insurer on Shared Decision-making in Periviable Counseling

PubMed Central

Edmonds, Brownsyne Tucker; McKenzie, Fatima; Fadel, William F.; Matthias, Marianne S.; Salyers, Michelle P.; Barnato, Amber E.; Frankel, Richard M.

2014-01-01

Introduction Sociodemographic differences have been observed in the treatment of extremely premature (periviable) neonates, but the source of this variation is not well understood. We assessed the feasibility of using simulation to test the effect of maternal race and insurance status on shared decision-making (SDM) in periviable counseling. Methods We conducted a 2 × 2 factorial simulation experiment in which obstetricians and neonatologists counseled two consecutive standardized patients (SPs) diagnosed with ruptured membranes at 23 weeks, counterbalancing race (black/white) and insurance status using random permutation. We assessed verisimilitude of the simulation in semi-structured debriefing interviews. We coded physician communication related to resuscitation, mode of delivery, and steroid decisions using a 9-point SDM coding framework; then compared communication scores by SP race and insurer using ANOVA. Results Sixteen obstetricians and 15 neonatologists participated; 71% were women, 84% married, and 75% parents; 91% of physicians rated the simulation as highly realistic. Overall, SDM scores were relatively high, with means ranging from 6.4–7.9 (out of 9). There was a statistically significant interaction between race and insurer for SDM related to steroid use and mode of delivery (p<0.01 and p=0.01, respectively). Between group comparison revealed non-significant differences p=<0.10) between SDM scores for privately-insured black patients vs privately-insured white patients, Medicaid-insured white patients vs Medicaid-insured black patients, and privately-insured black patients vs Medicaid-insured black patients. Conclusions This study confirms that simulation is a feasible method for studying sociodemographic effects on periviable counseling. SDM may occur differentially based on patients’ sociodemographic characteristics and deserves further study. PMID:25188489

Comparing sugary drinks in the food retail environment in six NYC neighborhoods.

PubMed

Adjoian, Tamar; Dannefer, Rachel; Sacks, Rachel; Van Wye, Gretchen

2014-04-01

Obesity is a national public health concern linked to numerous chronic health conditions among Americans of all age groups. Evidence suggests that discretionary calories from sugary drink consumption have been a significant contributor to excess caloric intake among both children and adults. Research has established strong links between retail food environments and purchasing habits of consumers, but little information exists on the sugary drink retail environment in urban neighborhoods. The objective of this assessment was to compare various aspects of the sugary drink retail environment across New York City (NYC) neighborhoods with disparate self-reported sugary drink consumption patterns. In-store retail audits were conducted at 883 corner stores, chain pharmacies, and grocery stores in 12 zip codes throughout NYC. Results showed that among all beverage types assessed, sugary drinks had the most prominent presence in the retail environment overall, which was even more pronounced in higher-consumption neighborhoods. In higher- versus lower-consumption neighborhoods, the mean number of sugary drink varieties available at stores was higher (11.4 vs. 10.4 varieties), stores were more likely to feature sugary drink advertising (97 vs. 89 %) and advertising at multiple places throughout the store (78 vs. 57 %), and several sugary drinks, including 20-oz Coke® or Pepsi®, were less expensive ($1.38 vs. $1.60). These results, all statistically significant, indicate that neighborhoods characterized by higher levels of sugary drink consumption expose shoppers to sugary drinks to a greater extent than lower-consumption neighborhoods. This builds upon evidence documenting the association between the environment and individual behavior.

Continuation of Statin Therapy and Vasopressor Use in Septic Shock.

PubMed

Zechmeister, Carrie; Hurren, Jeff; McNorton, Kelly

2015-07-01

Studies have evaluated the use of statins in sepsis; however, no human studies have explored their effect on vasopressor requirements in septic shock. The primary objective was to determine the effect of prehospital statin continuation on duration of vasopressor therapy in patients with septic shock. Secondary objectives included maximum and average vasopressor dose and in-hospital mortality. This was a retrospective, institutional board-approved, observational cohort study in a community teaching hospital; 119 adult intensive care unit (ICU) patients with an ICD-9 code for septic shock and prehospital statin therapy were evaluated. Multivariate analyses were performed to address confounders. Of the 1229 patients screened, 119 (10%) met inclusion criteria; 73 patients (61%) had a statin continued within 24 hours of ICU admission. Crude analysis demonstrated no difference in vasopressor duration in the statin versus no statin group (3.3 vs 4.8 days; P = 0.21). There was no difference in either maximum (17.9 ± 16.1 vs 23.8 ± 21.7 µg/min norepinephrine equivalents [NEQs]; P = 0.1) or average vasopressor dose (9.5 ± 8.4 vs 12.1 ± 11.5 µg/min NEQ; P = 0.17). There was a decrease in mortality in the statin patients (43% vs 67 %; P = 0.05). On adjustment for potential confounders, there was no difference in any outcome, with a persistent trend toward lower mortality in the statin group. Continuation of prehospital statin therapy decreased neither duration nor dose of vasopressors in patients with septic shock but yielded a trend toward decreased mortality. © The Author(s) 2015.

Hypertension is Associated With Increased Mortality in Children Hospitalized With Arterial Ischemic Stroke.

PubMed

Adil, Malik M; Beslow, Lauren A; Qureshi, Adnan I; Malik, Ahmed A; Jordan, Lori C

2016-03-01

Recently a single-center study suggested that hypertension after stroke in children was a risk factor for mortality. Our goal was to assess the association between hypertension and outcome after arterial ischemic stroke in children from a large national sample. Using the Healthcare Cost and Utilization Project Kids' Inpatient Database, children (1-18 years) with a primary diagnosis of ischemic stroke (International Classification of Diseases, Ninth Revision [ICD-9] codes 433-437.1) who also had a diagnosis of elevated blood pressure (ICD-9 code 796.2) or hypertension (ICD-9 codes 401 and 405) from 2003, 2006, and 2009 were identified. Clinical characteristics, discharge outcomes, and length of stay were assessed. Multivariable logistic regression was used to assess the relationship between hypertension and in-hospital mortality or discharge outcomes. Of 2590 children admitted with arterial ischemic stroke, 156 (6%) also had a diagnosis of hypertension. Ten percent of children with hypertension also had renal failure. Among patients with arterial ischemic stroke, hypertension was associated with increased mortality (7.4% vs. 2.8%; P = 0.01) and increased length of stay (mean 11 ± 17 vs. 7 ± 12 days; P = 0.004) compared with those without hypertension. After adjusting for age, sex, intubation, presence of a fluid and electrolyte disorder, and renal failure, children with hypertension had an increased odds of in-hospital death (odds ratio 1.2, 95% confidence interval [1.1-3.3, P = 0.04]). Hypertension was associated with an increased risk of in-hospital death for children presenting with arterial ischemic stroke. Further prospective study of blood pressure in children with stroke is needed. Copyright © 2016 Elsevier Inc. All rights reserved.

Patient Centeredness in Electronic Communication: Evaluation of Patient-to-Health Care Team Secure Messaging.

PubMed

Hogan, Timothy P; Luger, Tana M; Volkman, Julie E; Rocheleau, Mary; Mueller, Nora; Barker, Anna M; Nazi, Kim M; Houston, Thomas K; Bokhour, Barbara G

2018-03-08

As information and communication technology is becoming more widely implemented across health care organizations, patient-provider email or asynchronous electronic secure messaging has the potential to support patient-centered communication. Within the medical home model of the Veterans Health Administration (VA), secure messaging is envisioned as a means to enhance access and strengthen the relationships between veterans and their health care team members. However, despite previous studies that have examined the content of electronic messages exchanged between patients and health care providers, less research has focused on the socioemotional aspects of the communication enacted through those messages. Recognizing the potential of secure messaging to facilitate the goals of patient-centered care, the objectives of this analysis were to not only understand why patients and health care team members exchange secure messages but also to examine the socioemotional tone engendered in these messages. We conducted a cross-sectional coding evaluation of a corpus of secure messages exchanged between patients and health care team members over 6 months at 8 VA facilities. We identified patients whose medical records showed secure messaging threads containing at least 2 messages and compiled a random sample of these threads. Drawing on previous literature regarding the analysis of asynchronous, patient-provider electronic communication, we developed a coding scheme comprising a series of a priori patient and health care team member codes. Three team members tested the scheme on a subset of the messages and then independently coded the sample of messaging threads. Of the 711 messages coded from the 384 messaging threads, 52.5% (373/711) were sent by patients and 47.5% (338/711) by health care team members. Patient and health care team member messages included logistical content (82.6%, 308/373 vs 89.1%, 301/338), were neutral in tone (70.2%, 262/373 vs 82.0%, 277/338), and respectful in nature (25.7%, 96/373 vs 33.4%, 113/338). Secure messages from health care team members sometimes appeared hurried (25.4%, 86/338) but also displayed friendliness or warmth (18.9%, 64/338) and reassurance or encouragement (18.6%, 63/338). Most patient messages involved either providing or seeking information; however, the majority of health care team member messages involved information provision in response to patient questions. This evaluation is an important step toward understanding the content and socioemotional tone that is part of the secure messaging exchanges between patients and health care team members. Our findings were encouraging; however, there are opportunities for improvement. As health care organizations seek to supplement traditional encounters with virtual care, they must reexamine their use of secure messaging, including the patient centeredness of the communication, and the potential for more proactive use by health care team members. ©Timothy P Hogan, Tana M Luger, Julie E Volkman, Mary Rocheleau, Nora Mueller, Anna M Barker, Kim M Nazi, Thomas K Houston, Barbara G Bokhour. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 08.03.2018.

The effects of recall-concurrent visual-motor distraction on picture and word recall.

PubMed

Warren, M W

1977-05-01

The dual-coding model (Paivio, 1971, 1975) predicts a larger imaginal component in the recall of pictures relative to words and a larger imaginal component in the recall of concrete words relative to abstract words. These predictions were tested by examining the effect of a recall-concurrent imagery-suppression task (pursuit-rotor tracking) on the recall of pictures vs picture labels and on the recall of concrete words vs abstract words. The results showed that recall-concurrent pursuit-rotor tracking interfered with picture recall, but not word recall (Experiments 1 and 2); however, there was no evidence of an effect of recall-concurrent tracking on the recall of concrete words (Experiment 3). The results suggested a revision of the dual-coding model.

Least reliable bits coding (LRBC) for high data rate satellite communications

NASA Technical Reports Server (NTRS)

Vanderaar, Mark; Budinger, James; Wagner, Paul

1992-01-01

LRBC, a bandwidth efficient multilevel/multistage block-coded modulation technique, is analyzed. LRBC uses simple multilevel component codes that provide increased error protection on increasingly unreliable modulated bits in order to maintain an overall high code rate that increases spectral efficiency. Soft-decision multistage decoding is used to make decisions on unprotected bits through corrections made on more protected bits. Analytical expressions and tight performance bounds are used to show that LRBC can achieve increased spectral efficiency and maintain equivalent or better power efficiency compared to that of BPSK. The relative simplicity of Galois field algebra vs the Viterbi algorithm and the availability of high-speed commercial VLSI for block codes indicates that LRBC using block codes is a desirable method for high data rate implementations.

Geographic disparities in patient travel for dialysis in the United States.

PubMed

Stephens, J Mark; Brotherton, Samuel; Dunning, Stephan C; Emerson, Larry C; Gilbertson, David T; Harrison, David J; Kochevar, John J; McClellan, Ann C; McClellan, William M; Wan, Shaowei; Gitlin, Matthew

2013-01-01

To estimate travel distance and time for US hemodialysis patients and to compare travel of rural versus urban patients. Dialysis patient residences were estimated from ZIP code-level patient counts as of February 2011 allocated within the ZIP code proportional to census tract-level population, obtained from the 2010 U.S. Census. Dialysis facility addresses were obtained from Medicare public-use files. Patients were assigned to an "original" and "replacement" facility, assuming patients used the facility closest to home and would select the next closest facility as a replacement, if a replacement facility was required. Driving distances and times were calculated between patient residences and facility locations using GIS software. The mean one-way driving distance to the original facility was 7.9 miles; for rural patients average distances were 2.5 times farther than for urban patients (15.9 vs. 6.2 miles). Mean driving distance to a replacement facility was 10.6 miles, with rural patients traveling on average 4 times farther than urban patients to a replacement facility (28.8 vs. 6.8 miles). Rural patients travel much longer distances for dialysis than urban patients. Accessing alternative facilities, if required, would greatly increase rural patient travel, while having little impact on urban patients. Increased travel could have clinical implications as longer travel is associated with increased mortality and decreased quality of life. © 2013 National Rural Health Association.

Blowing your own trumpet.

PubMed

Hunter, Judith

1994-04-20

Nursing Standard have telephoned, please ring back today, the note reads. Yes, it's that time of year, as the RCN is getting ready to 'go on the road' and Nursing Standard prepares the Congress edition of the journal. Congress seems to come around more quickly each year, this could be a sign of a busy life, or more probably ageing, it seems to be only weeks since I put away my Harrogate memorabilia and emptied the carrier bags! Now it is time to start preparing and packing for Bournemouth and Questions of Health', a contemporary theme for this years Congress.

Maintaining yields and reducing nitrogen loss in rice-wheat rotation system in Taihu Lake region with proper fertilizer management

NASA Astrophysics Data System (ADS)

Xue, Lihong; Yu, Yingliang; Yang, Linzhang

2014-11-01

In the Tailake region of China, heavy nitrogen (N) loss of rice-wheat rotation systems, due to high fertilizer-N input with low N use efficiency (NUE), was widely reported. To alleviate the detrimental impacts caused by N loss, it is necessary to improve the fertilizer management practices. Therefore, a 3 yr field experiments with different N managements including organic combined chemical N treatment (OCN, 390 kg N ha-1 yr-1, 20% organic fertilizer), control-released urea treatment (CRU, 390 kg N ha-1 yr-1, 70% resin-coated urea), reduced chemical N treatment (RCN, 390 kg N ha-1 yr-1, all common chemical fertilizer), and site-specific N management (SSNM, 333 kg N ha-1 yr-1, all common chemical fertilizer) were conducted in the Taihu Lake region with the ‘farmer’s N’ treatment (FN, 510 kg N ha-1 yr-1, all common chemical fertilizer) as a control. Grain yield, plant N uptake (PNU), NUE, and N losses via runoff, leaching, and ammonia volatilization were assessed. In the rice season, the FN treatment had the highest N loss and lowest NUE, which can be attributed to an excessive rate of N application. Treatments of OCN and RCN with a 22% reduced N rate from FN had no significant effect on PNU nor the yield of rice in the 3 yr; however, the NUE was improved and N loss was reduced 20-32%. OCN treatment achieved the highest yield, while SSNM has the lowest N loss and highest NUE due to the lowest N rate. In wheat season, N loss decreased about 28-48% with the continuous reduction of N input, but the yield also declined, with the exception of OCN treatment. N loss through runoff, leaching and ammonia volatilization was positively correlated with the N input rate. When compared with the pure chemical fertilizer treatment of RCN under the same N input, OCN treatment has better NUE, better yield, and lower N loss. 70% of the urea replaced with resin-coated urea had no significant effect on yield and NUE improvement, but decreased the ammonia volatilization loss. Soil total N and organic matter content showed a decrease after three continuous cropping years with inorganic fertilizer application alone, but there was an increase with the OCN treatment. N balance analysis showed a N surplus for FN treatment and a balanced N budget for OCN treatment. To reduce the environmental impact and maintain a high crop production, proper N reduction together with organic amendments could be sustainable in the rice-wheat rotation system in the Taihu Lake region for a long run.

Low-resolution spectroscopy of main sequence stars belonging to 12 Galactic globular clusters. I. CH and CN band strength variations

NASA Astrophysics Data System (ADS)

Pancino, E.; Rejkuba, M.; Zoccali, M.; Carrera, R.

2010-12-01

Context. Globular clusters show star-to-star abundance variations for light elements that are not yet well understood. The preferred explanation involves a self-enrichment scenario, within which two subsequent generations of stars co-exist in globular clusters. Observations of chemical abundances in the main sequence and sub-giant branch stars allow us to investigate the signature of this chemically processed material without the complicating effects caused by stellar evolution and internal mixing. Aims: Our main goal is to investigate the carbon-nitrogen anti-correlation with low-resolution spectroscopy of 20-50 stars fainter than the first dredge-up in seven Galactic globular clusters (NGC 288, NGC 1851, NGC 5927, NGC 6352, NGC 6388, and Pal 12) with different properties. We complemented our observations with 47 Tuc archival data, with four additional clusters from the literature (M 15, M 22, M 55, NGC 362), and with additional literature data on NGC 288. Methods: In this first paper, we measured the strengh of the CN and CH band indices, which correlate with the N and C abundances, and we investigated the anti-correlation and bimodality of these indices. We compared rCN, the ratio of stars belonging to the CN-strong and weak groups, with 15 different cluster parameters. Results: We clearly see bimodal anti-correlation of the CH and CN band stregths in the metal-rich clusters (Pal 12, 47 Tuc, NGC 6352, NGC 5927). Only M 15 among the metal-poor clusters shows a clearly bimodal anti-correlation. We found weak correlations (sligthly above 1σ) of rCN with the cluster orbital parameters, present-day total mass, cluster concentration, and age. Conclusions: Our findings support the self-enrichment scenario, and suggest that the occurrence of more than two major generations of stars in a GGC should be rare. Small additional generations (<10-20% of the total) would be difficult to detect with our samples. The first generation, which corresponds to the CN-weak stars, usually contains more stars than the second one ( = 0.82±0.29), as opposed to results based on the Na-O anti-correlations. Based on FORS observations collected at the European Southern Observatory, Chile, within the observing programs 68.D-0510 and 69.D-0056. Also based on data obtained from the ESO Archive, within the observing program 67.D-0153.Complete Table 2 is only available in electronic form at the CDS via anonymous ftp to cdsarc.u-strasbg.fr (130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/qcat?J/A+A/524/A44

MIZEX. A Program for Mesoscale Air-Ice-Ocean Interaction Experiments in Arctic Marginal Ice Zones. III. Modeling the Marginal Ice Zone,

DTIC Science & Technology

1984-04-01

Ii TS C]r.I2 TAB 0] Unzanro’ unoed 0 justi fica ~r: 0 April 1984 vs - ASValabilitY Codes lvyall and/or U.S. Army Cold Regions Research and Engineering...coupled model. Fig. 1. Annual average simulated velocity fields. 3 192 Aloka 190 / 902 190+ WOO S’,. o Ice OnlY Mod" D"’, 55*w F~tth Yea’ Ice Ocean Model...A more precise delinga- inflow boundary conditions. 12 4- a. [ o ll ii traspert 00 0 0- 0e a I " i i , - - I I 1161 63 15 67 69 Ti 73 75 77 1980 *= 4h

Computational Confirmation of the Carrier for the ``XCN'' Interstellar Ice Band: OCN- Charge Transfer Complexes

NASA Astrophysics Data System (ADS)

Park, Jin-Young; Woon, David E.

2004-01-01

Recent experimental studies provide evidence that the carrier for the so-called XCN feature at 2165 cm-1 (4.62 μm) in young stellar objects is an OCN-/NH+4 charge transfer (CT) complex that forms in energetically processed interstellar icy grain mantles. Although other RCN nitriles and RNC isonitriles have been considered, Greenberg's conjecture that OCN- is associated with the XCN feature has persisted for over 15 years. In this work, we report a computational investigation that thoroughly confirms the hypothesis that the XCN feature observed in laboratory studies can result from OCN-/NH+4 CT complexes arising from HNCO and NH3 in a water ice environment. Density functional theory calculations with HNCO, NH3, and up to 12 waters reproduce seven spectroscopic measurements associated with XCN: the band origin of the asymmetric stretching mode of OCN-, shifts due to isotopic substitutions of C, N, O, and H, and two weak features. However, very similar values are also found for the OCN-/NH+4 CT complex arising from HOCN and NH3. In both cases, the complex forms by barrierless proton transfer from HNCO or HOCN to NH3 during the optimization of the solvated system. Scaled B3LYP/6-31+G** harmonic frequencies for the HNCO and HOCN cases are 2181 and 2202 cm-1, respectively.

Pediatric Hospital Discharges to Home Health and Postacute Facility Care: A National Study.

PubMed

Berry, Jay G; Hall, Matt; Dumas, Helene; Simpser, Edwin; Whitford, Kathleen; Wilson, Karen M; O'Neill, Margaret; Mittal, Vineeta; Agrawal, Rishi; Dribbon, Michael; Haines, Christopher J; Traul, Christine; Marks, Michelle; O'Brien, Jane

2016-04-01

Acute care hospitals are challenged to provide efficient, high-quality care to children who have medically complex conditions and may require weeks or months for recovery. Although the use of home health care (HHC) and facility-based postacute care (PAC) after discharge is well documented for adults, to our knowledge, little is known for children. To assess the national prevalence of, characteristics of children discharged to, and variation in use across states of HHC and PAC for children. Retrospective analysis of 2,423,031 US acute care hospital discharges in 2012 for patients ages 0 to 21 years from the nationally representative Agency for Healthcare Research and Quality Kids' Inpatient Database. Discharges to HHC (eg, visiting or private-duty home nursing) and PAC (eg, rehabilitation facility) were identified from Centers for Medicare and Medicaid Services Discharge Status Codes. We compared children's characteristics (eg, race/ethnicity and number of chronic conditions) by discharge type using generalized linear regression. The median age of participants was 3 years (interquartile range, 0-13 years), and 45.6% were female. Of 2,423,031 US acute care hospital discharges in 2012 for patients ages 0 to 21 years, 122,673 discharges (5.1%) were to HHC and 26,282 (1.1%) were to PAC facilities. Neonatal care was the most common reason (44.5%, n = 54,589) for acute care hospitalization with discharge to HHC. Nonneonatal respiratory, musculoskeletal, and trauma-related problems, collectively, were the most common reasons for discharge to PAC (42.9%, n = 11,275). When compared with PAC, more discharges to HHC had no chronic condition (34.4% vs 18.0%, P < .001) and fewer discharges to HHC had 4 or more chronic conditions (22.5% vs 37.7%, P < .001). In multivariable analysis, Hispanic children were less likely to use PAC (0.8% vs 1.1%; odds ratio [OR], 0.9 [95% CI, 0.8-0.9]) or HHC (3.3% vs 5.5%; OR, 0.8 [95% CI, 0.7-0.8]) compared with other children. Children with 4 or more chronic conditions compared with no chronic conditions had a higher likelihood of HHC use (11.0% vs 4.4%; OR, 2.9 [95% CI, 2.8-3.0]) and PAC (3.9% vs 0.8%; OR, 4.5 [95% CI, 4.3-4.9]). After case-mix adjustment, there was significant (P < .001) variation across states in HHC (range, 0.4%-24.5%) and PAC (range, 0.4%-4.9%) use. Home health care and PAC use after discharge for hospitalized children is infrequent, even for children with multiple chronic conditions. It varies significantly by race/ethnicity and across states. Further investigation is needed to assess reasons for this variation and to determine for which children HHC and PAC are most effective.

Therapeutic preferences and outcomes in newly diagnosed patients with Crohn's diseases in the biological era in Hungary: a nationwide study based on the National Health Insurance Fund database.

PubMed

Kurti, Zsuzsanna; Ilias, Akos; Gonczi, Lorant; Vegh, Zsuzsanna; Fadgyas-Freyler, Petra; Korponay, Gyula; Golovics, Petra A; Lovasz, Barbara D; Lakatos, Peter L

2018-01-30

Accelerated treatment strategy, including tight disease control and early aggressive therapy with immunosuppressives (IS) and biological agents have become increasingly common in inflammatory bowel disease (IBD). The aim of the present study was to estimate the early treatment strategy and outcomes in newly diagnosed patients with Crohn's disease (CD) between 2004 and 2008 and 2009-2015 in the whole IBD population in Hungary based on the administrative database of the National Health Insurance Fund (OEP). We used the administrative database of the OEP, the only nationwide state-owned health insurance provider in Hungary. Patients were identified through previously reported algorithms using the ICD-10 codes for CD in the out-, inpatient (medical, surgical) non-primary care records and drug prescription databases between 2004 and 2015. Patients were stratified according to the year of diagnosis and maximum treatment steps during the first 3 years after diagnosis. A total of 6173 (male/female: 46.12%/53.87%) newly diagnosed CD patients with physician-diagnosed IBD were found in the period of 2004-2015. The use of 5-ASA and steroids remained common in the biological era, while immunosuppressives and biologicals were started earlier and became more frequent among patients diagnosed after 2009. The probability of biological therapy was 2.9%/6.4% and 8.4%/13.7% after 1 and 3 years in patients diagnosed in 2004-2008/2009-2015. The probability of hospitalization in the first 3 years after diagnosis was different before and after 2009, according to the maximal treatment step (overall 55.7%vs. 47.4% (p = 0.001), anti-TNF: 73%vs. 66.7% (p = 0.103), IS: 64.6% vs. 56.1% (p = 0.001), steroid: 44.2%vs. 36.8% (p < 0.007), 5-ASA: 32.6% vs. 26.7% p = 0.157)). In contrast, surgery rates were not significantly different in patients diagnosed before and after 2009 according to the maximum treatment step (overall 16.0%vs.15.3%(p = 0.672) anti-TNF 26.7%vs.27.2% (p = 0.993), IS: 24.1%vs22.2% (p = 0.565), steroid 8.1%vs.7.9% (p = 0.896), 5-ASA 10%vs. 11% (p = 0.816)). IS and biological exposure became more frequent, while hospitalization decreased and surgery remained low but constant during the observation period. Use of steroids and 5-ASA remained high after 2009. The association between the maximal treatment step and hospitalization/surgery rates suggests that maximal treatment step can be regarded as proxy severity marker in patients with IBD.

Phases of match-play in professional Australian Football: Descriptive analysis and reliability assessment.

PubMed

Rennie, Michael J; Watsford, Mark L; Spurrs, Robert W; Kelly, Stephen J; Pine, Matthew J

2018-06-01

To examine the frequency and time spent in the phases of Australian Football (AF) match-play and to assess the intra-assessor reliability of coding these phases of match-play. Observational, intra-reliability assessment. Video footage of 10 random quarters of AF match-play were coded by a single researcher. Phases of offence, defence, contested play, umpire stoppage, set shot and goal reset were coded using a set of operational definitions. Descriptive statistics were provided for all phases of match-play. Following a 6-month washout period, intra-coder reliability was assessed using typical error of measurement (TEM) and intra-class correlation coefficients (ICC). A quarter of AF match-play involved 128±20 different phases of match-play. The highest proportion of match-play involved contested play (25%), followed by offence (18%), defence (18%) and umpire stoppages (18%). The mean duration of offence, defence, contested play, umpire stoppage, set shot and goal reset were 14, 14, 10, 11, 28 and 47s, respectively. No differences were found between the two coding assessments (p>0.05). ICCs for coding the phases of play demonstrated very high reliability (r=0.902-0.992). TEM of the total time spent in each phase of play represented moderate to good reliability (TEM=1.8-9.3%). Coding of offence, defence and contested play tended to display slightly poorer TEMs than umpire stoppages, set shots and goal resets (TEM=8.1 vs 4.5%). Researchers can reliably code the phases of AF match-play which may permit the analysis of specific elements of competition. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Traumatic Fractures of the Cervical Spine: Analysis of Changes in Incidence, Cause, Concurrent Injuries, and Complications Among 488,262 Patients from 2005 to 2013.

PubMed

Passias, Peter G; Poorman, Gregory W; Segreto, Frank A; Jalai, Cyrus M; Horn, Samantha R; Bortz, Cole A; Vasquez-Montes, Dennis; Diebo, Bassel G; Vira, Shaleen; Bono, Olivia J; De La Garza-Ramos, Rafael; Moon, John Y; Wang, Charles; Hirsch, Brandon P; Zhou, Peter L; Gerling, Michael; Koller, Heiko; Lafage, Virginie

2018-02-01

The causes and epidemiology of traumatic cervical spine fracture have not been described with sufficient power or recency. Our goal is to describe demographics, incidence, cause, spinal cord injuries (SCIs), concurrent injuries, treatments, and complications of traumatic cervical spine fractures. A retrospective review was carried out of the Nationwide Inpatient Sample. International Classification of Disease, Ninth Revision E-codes identified trauma cases from 2005 to 2013. Patients with cervical fracture were isolated. Demographics, incidence, cause, fracture levels, concurrent injuries, surgical procedures, and complications were analyzed. t tests elucidated significance for continuous variables and χ 2 for categorical variables. Level of significance was P < 0.05. A total of 488,262 patients were isolated (age, 55.96 years; male, 60.0%; white, 77.5%). Incidence (2005, 4.1% vs. 2013, 5.4%), Charlson Comorbidity Index (2005, 0.6150 vs. 2013, 1.1178), and total charges (2005, $71,228.60 vs. 2013, $108,119.29) have increased since 2005, whereas length of stay decreased (2005, 9.22 vs. 2013, 7.86) (all P < 0.05). The most common causes were motor vehicle accident (29.3%), falls (23.7%), and pedestrian accidents (15.7%). The most frequent fracture types were closed at C2 (32.0%) and C7 (20.9%). Concurrent injury rates have significantly increased since 2005 (2005, 62.3% vs. 2013, 67.6%). Common concurrent injuries included fractures to the rib/sternum/larynx/trachea (19.6%). Overall fusion rates have increased since 2005 (2005, 15.7% vs. 2013, 18.0%), whereas decompressions and halo insertion rates have decreased (all P < 0.05). SCIs have significantly decreased since 2005, except for upper cervical central cord syndrome. Complication rates have significantly increased since 2005 (2005, 31.6% vs. 2013, 36.2%). Common complications included anemia (7.7%), mortality (6.6%), and acute respiratory distress syndrome (6.6%). Incidence, complications, concurrent injuries, and fusions have increased since 2005. Length of stay, SCIs, decompressions, and halo insertions have decreased. Indicated trends should guide future research in management guidelines. Copyright © 2017 Elsevier Inc. All rights reserved.

Development of a risk prediction model among professional hockey players with visible signs of concussion.

PubMed

Bruce, Jared M; Echemendia, Ruben J; Meeuwisse, Willem; Hutchison, Michael G; Aubry, Mark; Comper, Paul

2017-04-04

Little research examines how to best identify concussed athletes. The purpose of the present study was to develop a preliminary risk decision model that uses visible signs (VS) and mechanisms of injury (MOI) to predict the likelihood of subsequent concussion diagnosis. Coders viewed and documented VS and associated MOI for all NHL games over the course of the 2013-2014 and 2014-2015 regular seasons. After coding was completed, player concussions were identified from the NHL injury surveillance system and it was determined whether players exhibiting VS were subsequently diagnosed with concussions by club medical staff as a result of the coded event. Among athletes exhibiting VS, suspected loss of consciousness, motor incoordination or balance problems, being in a fight, having an initial hit from another player's shoulder and having a secondary hit on the ice were all associated with increased risk of subsequent concussion diagnosis. In contrast, having an initial hit with a stick was associated with decreased risk of subsequent concussion diagnosis. A risk prediction model using a combination of the above VS and MOI was superior to approaches that relied on individual VS and associated MOI (sensitivity=81%, specificity=72%, positive predictive value=26%). Combined use of VS and MOI significantly improves a clinician's ability to identify players who need to be evaluated for possible concussion. A preliminary concussion prediction log has been developed from these data. Pending prospective validation, the use of these methods may improve early concussion detection and evaluation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Weydert, M.; Brennan, J.G.; Andersen, R.A.

Reaction of (MeC{sub 5}H{sub 4}){sub 3}UX (X = Cl, MeC{sub 5}H{sub 4}) with t-BuLi affords the tertiary alkyl complex (MeC{sub 5}H{sub 4}){sub 3}U(t-Bu). Despite uranium(IV) generally being the preferred oxidation state in organometallic systems, (MeC{sub 5}H{sub 4}){sub 3}U(t-Bu) reacts with Lewis bases (L = PMe{sub 3}, THF, RCN, RNC) to yield the reduced uranium(III) base adducts (MeC{sub 5}H{sub 4}){sub 3}U(L). Carbon monoxide undergoes migratory insertion into the metal tertiary alkyl bond. The resulting acyl derivative decomposes at 90{degree}C to yield insoluble uranium-containing products and a mixture of tert-butyltoluenes by ring expansion of a methylcyclopentadienyl ligand. Ethylene also undergoes migratory insertionmore » into the metal tertiary alkyl bond. No subsequent insertion of ethylene into the metal carbon bond takes place after the first equivalent has inserted. In marked contrast, reaction of various (MeC{sub 5}H{sub 4}){sub 3}ThX (X = Cl, I, MeC{sub 5}H{sub 4}, O-2,6-Me{sub 2}C{sub 6}H{sub 3}, OTs) compounds with t-BuLi gave intractable materials. However, reaction of the cationic species [(RC{sub 5}H{sub 4}){sub 3}Th](BPh{sub 4}) (R = Me{sub 3}Si, t-Bu) with t-BuLi yields the new thorium hydrides (RC{sub 5}H{sub 4}){sub 3}ThH. 40 refs., 2 figs.« less

Are Models Easier to Understand than Code? An Empirical Study on Comprehension of Entity-Relationship (ER) Models vs. Structured Query Language (SQL) Code

ERIC Educational Resources Information Center

Sanchez, Pablo; Zorrilla, Marta; Duque, Rafael; Nieto-Reyes, Alicia

2011-01-01

Models in Software Engineering are considered as abstract representations of software systems. Models highlight relevant details for a certain purpose, whereas irrelevant ones are hidden. Models are supposed to make system comprehension easier by reducing complexity. Therefore, models should play a key role in education, since they would ease the…

Colon Cancer Associated Transcript-1 (CCAT1) Expression in Adenocarcinoma of the Stomach.

PubMed

Mizrahi, Ido; Mazeh, Haggi; Grinbaum, Ronit; Beglaibter, Nahum; Wilschanski, Michael; Pavlov, Vera; Adileh, Muchamad; Stojadinovic, Alexander; Avital, Itzhak; Gure, Ali Osmay; Halle, David; Nissan, Aviram

2015-01-01

Long non-coding RNAs (lncRNAs) have been shown to have functional roles in cancer biology and are dys-regulated in many tumors. Colon Cancer Associated Transcript -1 (CCAT1) is a lncRNA, previously shown to be significantly up-regulated in colon cancer. The aim of this study is to determine expression levels of CCAT1 in gastric carcinoma (GC). Tissue samples were obtained from patients undergoing resection for gastric carcinoma (n=19). For each patient, tumor tissue and normal appearing gastric mucosa were taken. Normal gastric tissues obtained from morbidly obese patients, undergoing laparoscopic sleeve gastrectomy served as normal controls (n=19). A human gastric carcinoma cell line (AGS) served as positive control. RNA was extracted from all tissue samples and CCAT1 expression was analyzed using quantitative real time-PCR (qRT-PCR). Low expression of CCAT1 was identified in normal gastric mucosa samples obtained from morbidly obese patients [mean Relative Quantity (RQ) = 1.95±0.4]. AGS human gastric carcinoma cell line showed an elevated level of CCAT1 expression (RQ=8.02). Expression levels of CCAT1 were approximately 10.8 fold higher in GC samples than in samples taken from the negative control group (RQ=21.1±5 vs. RQ=1.95±0.4, respectively, p<0.001). Interestingly, CCAT1 expression was significantly overexpressed in adjacent normal tissues when compared to the negative control group (RQ = 15.25±2 vs. RQ=1.95±0.4, respectively, p<0.001). Tissues obtained from recurrent GC cases showed the highest expression levels (RQ = 88.8±31; p<0.001). Expression levels increased with tumor stage (T4- 36.4±15, T3- 16.1±6, T2- 4.7±1), however this did not reach statistical significance (p=0.2). There was no difference in CCAT1 expression between intestinal and diffuse type GC (RQ=22.4±7 vs. 22.4±16, respectively, p=0.9). Within the normal gastric tissue samples, no significant difference in CCAT1 expression was observed in helicobacter pylori negative and positive patients (RQ= 2.4±0.9 vs. 0.93±0.2, respectively, p=0.13). CCAT1 is up-regulated in gastric cancer, and may serve as a potential bio-marker for early detection and surveillance.

Time Trends, Clinical Characteristics, and Risk Factors of Chronic Anal Fissure Among a National Cohort of Patients with Inflammatory Bowel Disease.

PubMed

Malaty, Hoda M; Sansgiry, Shubhada; Artinyan, Avo; Hou, Jason K

2016-03-01

Chronic anal fissure (CAF) is a common problem that causes significant morbidity. Little is known about the risk factors of CAF among patients with inflammatory bowel disease (IBD). To study the clinical characteristics and prevalence of CAF among a cohort of IBD patients. We performed a population-based study on IBD patients from the National Veterans Affairs administrative datasets from 1998 to 2011. IBD and AF were identified by ICD-9 diagnosis codes. We identified 60,376 patients with IBD between the ages of 18-90 years, 94% males, 59% diagnosed with ulcerative colitis (UC), and 88% were Caucasians. The overall prevalence of CAF was 4% for both males and females. African Americans (AA) were two times more likely to have CAF compared to Caucasians (8 vs. 4%; OR 2.0, 95% CI 1.6-20.2, p = 0.0001) or Hispanics (8 vs. 4.8%; OR 2.1, 95% CI 1.4-25.2, p = 0.0001). The prevalence of CAF significantly dropped with age from 7% at age group 20-50 to 1.5% at 60-90 (p = 0.0001). CD patients were two times more likely to have CAF than UC patients (6 vs. 3%; OR 1.9, 95% CI 1.5-18.2, p = 0.0001). The initial diagnosis of CAF occurred within 14 years after the initial diagnosis of IBD in 74.5% patients. CAF is more prevalent among IBD than what is reported in the general population and diagnosed after the diagnosis of IBD. CAF is more prevalent among patients with CD, younger patients, and AA. The current results lay the groundwork for further outcome studies relate to anal fissure such as utilization, hospitalization, and cost.

Prehospital factors determining regional variation in thrombolytic therapy in acute ischemic stroke.

PubMed

Lahr, Maarten M H; Vroomen, Patrick C A J; Luijckx, Gert-Jan; van der Zee, Durk-Jouke; de Vos, Ronald; Buskens, Erik

2014-10-01

Treatment rates with intravenous tissue plasminogen activator vary by region, which can be partially explained by organizational models of stroke care. A recent study demonstrated that prehospital factors determine a higher thrombolysis rate in a centralized vs. decentralized model in the north of the Netherlands. To investigate prehospital factors that may explain variation in thrombolytic therapy between a centralized and a decentralized model. A consecutive case observational study was conducted in the north of the Netherlands comparing patients arriving within 4·5 h in a centralized vs. decentralized stroke care model. Factors investigated were transportation mode, prehospital diagnostic accuracy, and preferential referral of thrombolysis candidates. Potential confounders were adjusted using logistic regression analysis. A total of 172 and 299 arriving within 4·5 h were enrolled in centralized and decentralized settings, respectively. The rate of transportation by emergency medical services was greater in the centralized model (adjusted odds ratio 3·11; 95% confidence interval, 1·59-6·06). Also, more misdiagnoses of stroke occurred in the central model (P = 0·05). In postal code areas with and without potential preferential referral of thrombolysis candidates due to overlapping catchment areas, the odds of hospital arrival within 4·5 h in the central vs. decentral model were 2·15 (95% confidence interval, 1·39-3·32) and 1·44 (95% confidence interval, 1·04-2·00), respectively. These results suggest that the larger proportion of patients arriving within 4·5 h in the centralized model might be related to a lower threshold to use emergency services to transport stroke patients and partly to preferential referral of thrombolysis candidates. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

Pediatric abdominal radiograph use, constipation, and significant misdiagnoses.

PubMed

Freedman, Stephen B; Thull-Freedman, Jennifer; Manson, David; Rowe, Margot Follett; Rumantir, Maggie; Eltorki, Mohamed; Schuh, Suzanne

2014-01-01

To determine the proportion of children diagnosed with constipation assigned a significant alternative diagnosis within 7 days (misdiagnosis), if there is an association between abdominal radiograph (AXR) performance and misdiagnosis, and features that might identify children with misdiagnoses. We conducted a retrospective cohort study of consecutive children <18 years who presented to a pediatric emergency department in Toronto, between 2008 and 2010. Children assigned an International Statistical Classification of Diseases and Related Health Problems 10th Revision code consistent with constipation were eligible. Misdiagnosis was defined as an alternative diagnosis during the subsequent 7 days that resulted in hospitalization or an outpatient procedure that included a surgical or radiologic intervention. Constipation severity was classified employing text word categorization and the Leech score. 3685 eligible visits were identified. Mean age was 6.6 ± 4.4 years. AXR was performed in 46% (1693/3685). Twenty misdiagnoses (0.5%; 95% CI 0.4, 0.8) were identified (appendicitis [7%], intussusception [2%, bowel obstruction [2%], other [9%]). AXR was performed more frequently in misdiagnosed children (75% vs 46%; P = .01). These children more often had abdominal pain (70% vs 49%; P = .04) and tenderness (60% vs 32%; P =.01). Children in both groups had similar amounts of stool on AXR (P = .38) and mean Leech scores (misdiagnosed = 7.9 ± 3.4; not misdiagnosed = 7.7 ± 2.9; P = .85). Misdiagnoses in children with constipation are more frequent in those in whom an AXR was performed and those with abdominal pain and tenderness. The performance of an AXR may indicate diagnostic uncertainty; in such cases, the presence of stool on AXR does not rule out an alternative diagnosis. Copyright © 2014 Mosby, Inc. All rights reserved.

Socioeconomic deprivation is an independent risk factor for behavioral problems in children with epilepsy.

PubMed

Carson, Joanna; Weir, Andrew; Chin, Richard F; McLellan, Ailsa

2015-04-01

The aim of this study was to examine whether socioeconomic deprivation in children with epilepsy (CWE) increases risk for behavioral problems independent of seizure factors. A cross-sectional study was done in which parents of children attending a specialist epilepsy clinic were invited to complete a child behavior checklist (CBCL) questionnaire about their child. Medical and sociodemographic data on CWE were obtained through their pediatric neurologists. Home postal code was used to obtain quintiles of Scottish Index of Multiple Deprivation 2012 (SIMD2012) scores for individuals. Lower (1-3) quintiles correspond to higher socioeconomic deprivation. Regression analysis was used to investigate whether a lower quintile was an independent risk factor for scores >63 (significant behavioral problem). Parents of 87 children (42 male, mean age of 10.5years) were enrolled. Fifty-nine percent had total scores >63. A higher proportion of children from quintiles 1-3 compared to those from quintiles 4-5 had externalizing (49% vs. 25%, p=0.02) and total (54% vs. 30%, p=0.02) scores >63. Adjusted OR of quintiles 1-3 vs. 4-5 for scores >63=14.8, 95% CI=3.0, 68.0. Fewer children with scores >63 and from quintiles 1-3 were known to the child and adolescent mental health service (CAMHS) compared to those in quintiles 4-5 (p=0.01). Socioeconomic deprivation was an independent risk factor for behavioral problems in CWE. Children with epilepsy and behavioral problems who lived in socioeconomically deprived areas received less help. Copyright © 2015 Elsevier Inc. All rights reserved.

Impact of Intravenous Immunoglobulin on Survival in Necrotizing Fasciitis With Vasopressor-Dependent Shock: A Propensity Score–Matched Analysis From 130 US Hospitals

PubMed Central

Swihart, Bruce J.; Bonne, Stephanie L.; Hohmann, Samuel F.; Hennessy, Laura V.; Louras, Peter; Evans, Heather L.; Rhee, Chanu; Suffredini, Anthony F.; Hooper, David C.; Follmann, Dean A.; Bulger, Eileen M.; Danner, Robert L.

2017-01-01

Abstract Background. Shock frequently complicates necrotizing fasciitis (NF) caused by group A Streptococcus (GAS) or Staphylococcus aureus. Intravenous immunoglobulin (IVIG) is sometimes administered for presumptive toxic shock syndrome (TSS), but its frequency of use and efficacy are unclear. Methods. Adult patients with NF and vasopressor-dependent shock undergoing surgical debridement from 2010 to 2014 were identified at 130 US hospitals. IVIG cases were propensity-matched and risk-adjusted. The primary outcome was in-hospital mortality and the secondary outcome was median length of stay (LOS). Results. Of 4127 cases of debrided NF with shock at 121 centers, only 164 patients (4%) at 61 centers received IVIG. IVIG subjects were younger with lower comorbidity indices, but higher illness severity. Clindamycin and vasopressor intensity were higher among IVIG cases, as was coding for TSS and GAS. In-hospital mortality did not differ between matched IVIG and non-IVIG groups (crude mortality, 27.3% vs 23.6%; adjusted odds ratio, 1.00 [95% confidence interval, .55–1.83]; P = .99). Early IVIG (≤2 days) did not alter this effect (P = .99). Among patients coded for TSS, GAS, and/or S. aureus, IVIG use was still unusual (59/868 [6.8%]) and lacked benefit (P = .63). Median LOS was similar between IVIG and non-IVIG groups (26 [13–49] vs 26 [11–43]; P = .84). Positive predictive values for identifying true NF and debridement among IVIG cases using our algorithms were 97% and 89%, respectively, based on records review at 4 hospitals. Conclusions. Adjunctive IVIG was administered infrequently in NF with shock and had no apparent impact on mortality or hospital LOS beyond that achieved with debridement and antibiotics. PMID:28034881

Economic and operational burden associated with malnutrition in chronic obstructive pulmonary disease.

PubMed

Hoong, Jian Ming; Ferguson, Maree; Hukins, Craig; Collins, Peter F

2017-08-01

Malnutrition is common in patients with chronic obstructive pulmonary disease (COPD). This study aimed to explore its association with all-cause mortality, emergency hospitalisation and subsequently healthcare costs. A prospective cohort observational pilot study was carried out in outpatients with COPD that attended routine respiratory clinics at a large tertiary Australian hospital during 2011. Electronic hospital records and hospital coding was used to determine nutritional status and whether a patient was coded as nourished or malnourished and information on healthcare use and 1-year mortality was recorded. Eight hundred and thirty four patients with COPD attended clinics during 2011, of those 286 went on to be hospitalised during the 12 month follow-up period. Malnourished patients had a significantly higher 1-year mortality (27.7% vs. 12.1%; p = 0.001) and were hospitalised more frequently (1.11 SD 1.24 vs. 1.51 SD 1.43; p = 0.051). Only malnutrition (OR 0.36 95% CI 0.14-0.91; p = 0.032) and emergency hospitalisation rate (OR 1.58 95% CI 1.2-2.1; p = 0.001) were independently associated with 1-year mortality. Length of hospital stay was almost twice the duration in those coded for malnutrition (11.57 SD 10.93 days vs. 6.67 SD 10.2 days; p = 0.003) and at almost double the cost (AUD $23,652 SD $26,472 vs. $12,362 SD $21,865; p = 0.002) than those who were well-nourished. Malnutrition is an independent predictor of 1-year mortality and healthcare use in patients with COPD. Malnourished patients with COPD present both an economic and operational burden. Copyright © 2016. Published by Elsevier Ltd.

The effect of emotion and physician communication behaviors on surrogates' life-sustaining treatment decisions: a randomized simulation experiment.

PubMed

Barnato, Amber E; Arnold, Robert M

2013-07-01

Surrogate decision makers for critically ill patients experience strong negative emotional states. Emotions influence risk perception, risk preferences, and decision making. We sought to explore the effect of emotional state and physician communication behaviors on surrogates' life-sustaining treatment decisions. 5 × 2 between-subject randomized factorial experiment. Web-based simulated interactive video meeting with an intensivist to discuss code status. Community-based participants 35 and older who self-identified as the surrogate for a parent or spouse recruited from eight U.S. cities through public advertisements. Block random assignment to emotion arousal manipulation and each of the four physician communication behaviors. Surrogate's code status decision (cardiopulmonary resuscitation vs do not resuscitate/allow natural death). Two hundred fifty-six of 373 respondents (69%) logged-in and were randomized: average age was 50; 70% were surrogates for a parent; 63.5% were women; 76% were white, 11% black, and 9% Asian; and 81% were college educated. When asked about code status, 56% chose cardiopulmonary resuscitation. The emotion arousal manipulation increased the score on depression-dejection scale (β = 1.76 [0.58 - 2.94]) but did not influence cardiopulmonary resuscitation choice. Physician attending to emotion and framing the decision as the patient's rather than the surrogate's did not influence cardiopulmonary resuscitation choice. Framing no cardiopulmonary resuscitation as the norm rather than cardiopulmonary resuscitation resulted in fewer surrogates choosing cardiopulmonary resuscitation (48% vs 64%, odds ratio, 0.52 [95% CI, 0.32-0.87]), as did framing the alternative to cardiopulmonary resuscitation as "allow natural death" rather than do not resuscitate (49% vs 61%, odds ratio, 0.58 [95% CI, 0.35-0.96]). Experimentally induced emotional state did not influence code status decisions, although small changes in physician communication behaviors substantially influenced this decision.

Crustal Fracturing Field and Presence of Fluid as Revealed by Seismic Anisotropy

NASA Astrophysics Data System (ADS)

Pastori, M.; Piccinini, D.; de Gori, P.; Margheriti, L.; Barchi, M. R.; di Bucci, D.

2010-12-01

In the last three years, we developed, tested and improved an automatic analysis code (Anisomat+) to calculate the shear wave splitting parameters, fast polarization direction (φ) and delay time (∂t). The code is a set of MatLab scripts able to retrieve crustal anisotropy parameters from three-component seismic recording of local earthquakes using horizontal component cross-correlation method. The analysis procedure consists in choosing an appropriate frequency range, that better highlights the signal containing the shear waves, and a length of time window on the seismogram centered on the S arrival (the temporal window contains at least one cycle of S wave). The code was compared to other two automatic analysis code (SPY and SHEBA) and tested on three Italian areas (Val d’Agri, Tiber Valley and L’Aquila surrounding) along the Apennine mountains. For each region we used the anisotropic parameters resulting from the automatic computation as a tool to determine the fracture field geometries connected with the active stress field. We compare the temporal variations of anisotropic parameters to the evolution of vp/vs ratio for the same seismicity. The anisotropic fast directions are used to define the active stress field (EDA model), finding a general consistence between fast direction and main stress indicators (focal mechanism and borehole break-out). The magnitude of delay time is used to define the fracture field intensity finding higher value in the volume where micro-seismicity occurs. Furthermore we studied temporal variations of anisotropic parameters and vp/vs ratio in order to explain if fluids play an important role in the earthquake generation process. The close association of anisotropic and vp/vs parameters variations and seismicity rate changes supports the hypothesis that the background seismicity is influenced by the fluctuation of pore fluid pressure in the rocks.

A new DWT/MC/DPCM video compression framework based on EBCOT

NASA Astrophysics Data System (ADS)

Mei, L. M.; Wu, H. R.; Tan, D. M.

2005-07-01

A novel Discrete Wavelet Transform (DWT)/Motion Compensation (MC)/Differential Pulse Code Modulation (DPCM) video compression framework is proposed in this paper. Although the Discrete Cosine Transform (DCT)/MC/DPCM is the mainstream framework for video coders in industry and international standards, the idea of DWT/MC/DPCM has existed for more than one decade in the literature and the investigation is still undergoing. The contribution of this work is twofold. Firstly, the Embedded Block Coding with Optimal Truncation (EBCOT) is used here as the compression engine for both intra- and inter-frame coding, which provides good compression ratio and embedded rate-distortion (R-D) optimization mechanism. This is an extension of the EBCOT application from still images to videos. Secondly, this framework offers a good interface for the Perceptual Distortion Measure (PDM) based on the Human Visual System (HVS) where the Mean Squared Error (MSE) can be easily replaced with the PDM in the R-D optimization. Some of the preliminary results are reported here. They are also compared with benchmarks such as MPEG-2 and MPEG-4 version 2. The results demonstrate that under specified condition the proposed coder outperforms the benchmarks in terms of rate vs. distortion.

Mapping technological and biophysical capacities of watersheds to regulate floods

USGS Publications Warehouse

Mogollón, Beatriz; Villamagna, Amy M.; Frimpong, Emmanuel A.; Angermeier, Paul

2016-01-01

Flood regulation is a widely valued and studied service provided by watersheds. Flood regulation benefits people directly by decreasing the socio-economic costs of flooding and indirectly by its positive impacts on cultural (e.g., fishing) and provisioning (e.g., water supply) ecosystem services. Like other regulating ecosystem services (e.g., pollination, water purification), flood regulation is often enhanced or replaced by technology, but the relative efficacy of natural versus technological features in controlling floods has scarcely been examined. In an effort to assess flood regulation capacity for selected urban watersheds in the southeastern United States, we: (1) used long-term flood records to assess relative influence of technological and biophysical indicators on flood magnitude and duration, (2) compared the widely used runoff curve number (RCN) approach for assessing the biophysical capacity to regulate floods to an alternative approach that acknowledges land cover and soil properties separately, and (3) mapped technological and biophysical flood regulation capacities based on indicator importance-values derived for flood magnitude and duration. We found that watersheds with high biophysical (via the alternative approach) and technological capacities lengthened the duration and lowered the peak of floods. We found the RCN approach yielded results opposite that expected, possibly because it confounds soil and land cover processes, particularly in urban landscapes, while our alternative approach coherently separates these processes. Mapping biophysical (via the alternative approach) and technological capacities revealed great differences among watersheds. Our study improves on previous mapping of flood regulation by (1) incorporating technological capacity, (2) providing high spatial resolution (i.e., 10-m pixel) maps of watershed capacities, and (3) deriving importance-values for selected landscape indicators. By accounting for technology that enhances or replaces natural flood regulation, our approach enables watershed managers to make more informed choices in their flood-control investments.

Rotational spectrum of CH3CN⋯ClF and evidence for the +I effect of a CH3 group on the ‘chlorine’ bond N⋯ClF

NASA Astrophysics Data System (ADS)

Page, M. D.; Waclawik, E. R.; Holloway, J. H.; Legon, A. C.

1999-10-01

The ground-state rotational spectra of the isotopomers CH 3C 14N⋯ 35ClF, CH 3C 14N⋯ 37ClF, CD 3C 14N⋯ 35ClF and CH 3C 15N⋯ 35ClF of a symmetric-rotor complex formed by methyl cyanide and chlorine monofluoride have been observed and analysed to give the spectroscopic constants B0, DJ, DJK, χaa( 14N), χaa(Cl) and Mbb. Interpretations of these quantities on the basis of simple models enabled the geometry and strength of binding of the complex to be determined. It is found that the atoms C-CN⋯ClF lie on the C 3 axis of this complex of C 3v symmetry and that the distance r(N⋯Cl)=2.561(2) Å. The quadratic force constants associated with the intermolecular stretching mode and with the bending motion of the CH 3CN subunit pivoted at its mass centre were determined from the centrifugal distortion constants DJ and 2 DJ+ DJK. Their values were k σ=13.9(3) N m -1 and k α=3.0(1)×10 -20 J rad -2, respectively. A comparison of r(N⋯Cl) values and of k σ values establishes that the +I effect of the CH 3 group when it replaces H in HCN leads to a similar shortening of r(N⋯Cl) and to a similar increase in k σ in the two series RCN⋯ClF and RCN⋯HCl (R=H or CH 3).

Computation and Validation of the Dynamic Response Index (DRI)

DTIC Science & Technology

2013-08-06

matplotlib plotting library. • Executed from command line. • Allows several optional arguments. • Runs on Windows, Linux, UNIX, and Mac OS X. 10... vs . Time: Triangular pulse input data with given time duration and peak acceleration: Time (s) EARTH Code: Motivation • Error Assessment of...public release • ARC provided electrothermal battery model example: • Test vs . simulation data for terminal voltage. • EARTH input parameters

Relationship between occurrence of surgical complications and hospital finances.

PubMed

Eappen, Sunil; Lane, Bennett H; Rosenberg, Barry; Lipsitz, Stuart A; Sadoff, David; Matheson, Dave; Berry, William R; Lester, Mark; Gawande, Atul A

2013-04-17

The effect of surgical complications on hospital finances is unclear. To determine the relationship between major surgical complications and per-encounter hospital costs and revenues by payer type. Retrospective analysis of administrative data for all inpatient surgical discharges during 2010 from a nonprofit 12-hospital system in the southern United States. Discharges were categorized by principal procedure and occurrence of 1 or more postsurgical complications, using International Classification of Diseases, Ninth Revision, diagnosis and procedure codes. Nine common surgical procedures and 10 major complications across 4 payer types were analyzed. Hospital costs and revenue at discharge were obtained from hospital accounting systems and classified by payer type. Hospital costs, revenues, and contribution margin (defined as revenue minus variable expenses) were compared for patients with and without surgical complications according to payer type. Of 34,256 surgical discharges, 1820 patients (5.3%; 95% CI, 4.4%-6.4%) experienced 1 or more postsurgical complications. Compared with absence of complications, complications were associated with a $39,017 (95% CI, $20,069-$50,394; P < .001) higher contribution margin per patient with private insurance ($55,953 vs $16,936) and a $1749 (95% CI, $976-$3287; P < .001) higher contribution margin per patient with Medicare ($3629 vs $1880). For this hospital system in which private insurers covered 40% of patients (13,544), Medicare covered 45% (15,406), Medicaid covered 4% (1336), and self-payment covered 6% (2202), occurrence of complications was associated with an $8084 (95% CI, $4903-$9740; P < .001) higher contribution margin per patient ($15,726 vs $7642) and with a $7435 lower per-patient total margin (95% CI, $5103-$10,507; P < .001) ($1013 vs -$6422). In this hospital system, the occurrence of postsurgical complications was associated with a higher per-encounter hospital contribution margin for patients covered by Medicare and private insurance but a lower one for patients covered by Medicaid and who self-paid. Depending on payer mix, many hospitals have the potential for adverse near-term financial consequences for decreasing postsurgical complications.

Identification of pathway-biased and deleterious melatonin receptor mutants in autism spectrum disorders and in the general population.

PubMed

Chaste, Pauline; Clement, Nathalie; Mercati, Oriane; Guillaume, Jean-Luc; Delorme, Richard; Botros, Hany Goubran; Pagan, Cécile; Périvier, Samuel; Scheid, Isabelle; Nygren, Gudrun; Anckarsäter, Henrik; Rastam, Maria; Ståhlberg, Ola; Gillberg, Carina; Serrano, Emilie; Lemière, Nathalie; Launay, Jean Marie; Mouren-Simeoni, Marie Christine; Leboyer, Marion; Gillberg, Christopher; Jockers, Ralf; Bourgeron, Thomas

2010-07-15

Melatonin is a powerful antioxidant and a synchronizer of many physiological processes. Alteration of the melatonin pathway has been reported in circadian disorders, diabetes and autism spectrum disorders (ASD). However, very little is known about the genetic variability of melatonin receptors in humans. Here, we sequenced the melatonin receptor MTNR1A and MTNR1B, genes coding for MT1 and MT2 receptors, respectively, in a large panel of 941 individuals including 295 patients with ASD, 362 controls and 284 individuals from different ethnic backgrounds. We also sequenced GPR50, coding for the orphan melatonin-related receptor GPR50 in patients and controls. We identified six non-synonymous mutations for MTNR1A and ten for MTNR1B. The majority of these variations altered receptor function. Particularly interesting mutants are MT1-I49N, which is devoid of any melatonin binding and cell surface expression, and MT1-G166E and MT1-I212T, which showed severely impaired cell surface expression. Of note, several mutants possessed pathway-selective signaling properties, some preferentially inhibiting the adenylyl cyclase pathway, others preferentially activating the MAPK pathway. The prevalence of these deleterious mutations in cases and controls indicates that they do not represent major risk factor for ASD (MTNR1A case 3.6% vs controls 4.4%; MTNR1B case 4.7% vs 3% controls). Concerning GPR50, we detected a significant association between ASD and two variations, Delta502-505 and T532A, in affected males, but it did not hold up after Bonferonni correction for multiple testing. Our results represent the first functional ascertainment of melatonin receptors in humans and constitute a basis for future structure-function studies and for interpreting genetic data on the melatonin pathway in patients.

National trends and in hospital outcomes for total hip arthroplasty in avascular necrosis in the United States.

PubMed

Mayers, William; Schwartz, Brian; Schwartz, Aaron; Moretti, Vincent; Goldstein, Wayne; Shah, Ritesh

2016-09-01

While a majority of total hip arthroplasty (THA) is performed for osteoarthritis (OA), a significant portion is performed in the setting of avascular necrosis (AVN). The purpose of this study is to evaluate recent trends, patient demographics, and in hospital outcomes for primary THA in the setting of AVN in the United States. The National Hospital Discharge Survey database was searched for patients admitted to US hospitals after a primary THA for the years 2001-2010. Patients were then separated into two groups by ICD-9 diagnosis codes for OA and AVN. The rates of THA for AVN (r = 0.65) and THA for OA (r = 0.82) both demonstrated a positive correlation with time. The mean patient age of the AVN group was significantly lower (56.9 vs 65.9 years, p < 0.01). Men accounted for 51.9 % of the AVN group and 43.0 % of the OA group (p < 0.01). The AVN group had a significantly higher percentage of African Americans (11.2 % vs 5.4 %, p < 0.01) when compared to the OA group. The AVN group had a higher rate of myocardial infarction (0.3 % vs 0.07 %, p = 0.0163) and a higher average number of medical co-morbidities (5.16 vs 4.77, p < 0.01). Patients undergoing THA for AVN were more likely to be younger, male, African American, have more medical co-morbidities, and more likely to have a myocardial infarction than those with OA. While the number of primary THAs performed for AVN in the United States has increased over the past ten years, the rate of primary THA for OA increased at a much more rapid rate.

Objective Sepsis Surveillance Using Electronic Clinical Data

PubMed Central

Rhee, Chanu; Kadri, Sameer; Huang, Susan S.; Murphy, Michael V.; Li, Lingling; Platt, Richard; Klompas, Michael

2016-01-01

OBJECTIVE To compare the accuracy of surveillance of severe sepsis using electronic health record clinical data vs claims and to compare incidence and mortality trends using both methods. DESIGN We created an electronic health record–based surveillance definition for severe sepsis using clinical indicators of infection (blood culture and antibiotic orders) and concurrent organ dysfunction (vasopressors, mechanical ventilation, and/or abnormal laboratory values). We reviewed 1,000 randomly selected medical charts to characterize the definition’s accuracy and stability over time compared with a claims-based definition requiring infection and organ dysfunction codes. We compared incidence and mortality trends from 2003–2012 using both methods. SETTING Two US academic hospitals. PATIENTS Adult inpatients. RESULTS The electronic health record–based clinical surveillance definition had stable and high sensitivity over time (77% in 2003–2009 vs 80% in 2012, P=.58) whereas the sensitivity of claims increased (52% in 2003–2009 vs 67% in 2012, P=.02). Positive predictive values for claims and clinical surveillance definitions were comparable (55% vs 53%, P=.65) and stable over time. From 2003 to 2012, severe sepsis incidence imputed from claims rose by 72% (95% CI, 57%–88%) and absolute mortality declined by 5.4% (95% CI, 4.6%–6.7%). In contrast, incidence using the clinical surveillance definition increased by 7.7% (95% CI, −1.1% to 17%) and mortality declined by 1.7% (95% CI, 1.1%–2.3%). CONCLUSIONS Sepsis surveillance using clinical data is more sensitive and more stable over time compared with claims and can be done electronically. This may enable more reliable estimates of sepsis burden and trends. PMID:26526737

Sleep abnormalities in children with Dravet syndrome.

PubMed

Dhamija, Radhika; Erickson, Maia K; St Louis, Erik K; Wirrell, Elaine; Kotagal, Suresh

2014-05-01

Mutations in the voltage-gated sodium channel SCN1A gene are responsible for the majority of Dravet syndrome cases. There is evidence that the Nav1.1 channel coded by the SCN1A gene is involved in sleep regulation. We evaluated sleep abnormalities in children with Dravet syndrome using nocturnal polysomnography. We identified six children at our institution with genetically confirmed Dravet syndrome who had also undergone formal sleep consultation with nocturnal polysomnography. Indications for polysomnography were parental concern of daytime fatigue or sleepiness, hyperactivity, inattention, disruptive behavior, nighttime awakenings, or nocturnal seizures. Sleep studies were scored according to guidelines of the American Academy of Sleep Medicine and non-rapid eye movement cyclic alternating pattern was visually identified and scored according to established methods. The mean age of the subjects at the time of polysomnography was 6 years. Standard polysomnography did not show any consistent abnormalities in the obstructive or central apnea index, arousal index, sleep efficiency, or architecture. Cyclic alternating pattern analysis on five patients showed an increased mean rate of 50.3% (vs 31% to 34% in neurological normal children) with a mild increase in A1 subtype of 89.4% (vs 84.5%). A2/A3 subtype (5.3% vs 7.3%) and B phase duration (22.4 vs 24.7 seconds) were similar to previously reported findings in neurologically normal children. Despite parental concerns for sleep disturbance in patients with Dravet syndrome, we could not identify abnormalities in sleep macroarchitecture. Non-rapid eye movement sleep microarchitecture was, however, abnormal, with increased A1 subtype, somewhat resembling a tracé alternant pattern of neonates and possibly suggestive of cortical synaptic immaturity in Dravet syndrome. Larger studies are needed to replicate these results. Copyright © 2014 Elsevier Inc. All rights reserved.

Presence of central nervous system, cardiovascular and overall co-morbidity burden in patients with overactive bladder disorder in a real-world setting.

PubMed

Asche, Carl V; Kim, Jaewhan; Kulkarni, Amit S; Chakravarti, Paula; Andersson, Karl-Erik

2012-02-01

•  To determine the proportion of patients with overactive bladder (OAB) potentially at risk for adverse events by assessing their pre-existing central nervous system (CNS), cardiovascular (CV) and other co-morbidities. •  The GE Centricity Electronic Medical Record database was utilized to identify patients with a diagnosis of OAB using International Classification of Diseases, Ninth Revision (ICD-9) codes or a prescription between 1 January 1996 and 30 March 2007 for an OAB anti-muscarinic agent. •  Matched non-OAB patients were assigned the same index date as the corresponding OAB patient. Based on the presence of ≥ one pharmacy claim for an OAB anti-muscarinic agent, the OAB cohort was stratified as treated or untreated. A random sample of age- and gender-matched patients formed a non-OAB control cohort. •  An additional and separate analysis focusing on all co-morbidities was performed examining non-OAB patients who were matched to OAB patients on 1:1 propensity score matching, based on age, body mass index (BMI) and gender at baseline. •  Charlson Comorbidity Index (CCI), using ICD-9 codes, and the Chronic Disease Score (CDS), using prescribed drugs, were calculated. •  When compared with non-OAB patients (N= 77,272; 83.2% women; median age 64 years), OAB patients (N= 41,440; 83.6% women; median age 65 years) had more overall CNS co-morbidities (45.4 vs 29.0%; P < 0.001). •  In addition, OAB patients had a higher use of medications with anti-muscarinic effects (39.6 vs 25.4%; P < 0.001). OAB patients were also more likely to have CV co-morbidities (57.6 vs 44.6%; P < 0.001). •  CNS co-morbidities were slightly more common in untreated (n= 8 106) than in treated (n= 33 334) OAB patients (47.2 vs 45.0%; P < 0.001). CV co-morbidities were higher in treated OAB patients (58.8 vs 53.7%; P < 0.001). •  In the additional separate analysis, which focused on all co-morbidities, patients with OAB had higher mean CCI and CDS scores than patients without OAB (CCI: 1.17 vs 1.11 [P < 0.001]; CDS: 2.95 vs 1.74 [P < 0.001]). •  After controlling for other covariates, the linear regressions (n= 22,544) showed that OAB patients had higher CCI and CDS than patients without OAB. •  Among OAB patients, CNS, CV and all co-morbidities were more prevalent than in non-OAB patients. •  Prior exposure to CNS medications was more prevalent in OAB patients who received anti-muscarinic treatment than in those who did not. •  Co-morbidities and concomitant medications affecting the CNS and the CV system should be taken into account when making the decision on the most appropriate OAB treatment option for each individual patient. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

There Is a Significant Discrepancy Between "Big Data" Database and Original Research Publications on Hip Arthroscopy Outcomes: A Systematic Review.

PubMed

Sochacki, Kyle R; Jack, Robert A; Safran, Marc R; Nho, Shane J; Harris, Joshua D

2018-06-01

The purpose of this study was to compare (1) major complication, (2) revision, and (3) conversion to arthroplasty rates following hip arthroscopy between database studies and original research peer-reviewed publications. A systematic review was performed using PRISMA guidelines. PubMed, SCOPUS, SportDiscus, and Cochrane Central Register of Controlled Trials were searched for studies that investigated major complication (dislocation, femoral neck fracture, avascular necrosis, fluid extravasation, septic arthritis, death), revision, and hip arthroplasty conversion rates following hip arthroscopy. Major complication, revision, and conversion to hip arthroplasty rates were compared between original research (single- or multicenter therapeutic studies) and database (insurance database using ICD-9/10 and/or current procedural terminology coding terminology) publishing studies. Two hundred seven studies (201 original research publications [15,780 subjects; 54% female] and 6 database studies [20,825 subjects; 60% female]) were analyzed (mean age, 38.2 ± 11.6 years old; mean follow-up, 2.7 ± 2.9 years). The database studies had a significantly higher age (40.6 + 2.8 vs 35.4 ± 11.6), body mass index (27.4 ± 5.6 vs 24.9 ± 3.1), percentage of females (60.1% vs 53.8%), and longer follow-up (3.1 ± 1.6 vs 2.7 ± 3.0) compared with original research (P < .0001 for all). Ninety-seven (0.6%) major complications occurred in the individual studies, and 95 (0.8%) major complications occurred in the database studies (P = .029; relative risk [RR], 1.3). There was a significantly higher rate of femoral neck fracture (0.24% vs 0.03%; P < .0001; RR, 8.0), and hip dislocation (0.17% vs 0.06%; P = .023; RR, 2.2) in the database studies. Reoperations occurred at a significantly higher rate in the database studies (11.1% vs 7.3%; P < .001; RR, 1.5). There was a significantly higher rate of conversion to arthroplasty in the database studies (8.0% vs 3.7%; P < .001; RR, 2.2). Database studies report significantly increased major complication, revision, and conversion to hip arthroplasty rates compared with original research investigations of hip arthroscopy outcomes. Level IV, systematic review of Level I-IV studies. Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Percutaneous endovascular aneurysm repair in morbidly obese patients.

PubMed

Chin, Jason A; Skrip, Laura; Sumpio, Bauer E; Cardella, Jonathan A; Indes, Jeffrey E; Sarac, Timur P; Dardik, Alan; Ochoa Chaar, Cassius I

2017-03-01

Endovascular aneurysm repair (EVAR) with percutaneous femoral access (PEVAR) has several potential advantages. Morbidly obese (MO) patients present unique anatomical challenges and have not been specifically studied. This study examines the trends in the use of PEVAR and its surgical outcomes compared with open femoral cutdown (CEVAR) in MO patients. The American College of Surgeons National Surgical Quality Improvement Program files for the years 2005 to 2013 were reviewed. The study included all MO patients (body mass index [BMI] ≥40 kg/m 2 ) undergoing EVAR. Patients were categorized as having CEVAR if they had any one of 11 selected Current Procedural Terminology (American Medical Association, Chicago, Ill) codes describing an open femoral procedure. The PEVAR group included any remaining patients who had only codes for EVAR and endovascular procedures. Linear correlation was used to evaluate temporal trends in the use of PEVAR among MO patients. Baseline comorbidities and surgical outcomes were compared between the PEVAR and CEVAR groups using χ 2 tests or t-tests. There were 833 MO patients (470 CEVAR and 363 PEVAR) constituting 3.0% of all patients undergoing EVAR. The use of PEVAR in MO patients significantly increased from 27.3% of total EVARs in the years 2005 to 2006 to 48.6% in 2013 (P = .039). The two groups had similar baseline characteristics, including age, BMI, comorbidities, and emergency procedures, except for history of severe chronic obstructive pulmonary disease (29.6% CEVAR vs 22.6% PEVAR; P = .024). PEVAR patients had shorter duration of anesthesia (244 vs 260 minutes; P = .048) and shorter total operation time (158 vs 174 minutes; P = .002). PEVAR patients had significantly decreased wound complications (5.5% vs 9.4%; P = .039). There was a trend towards PEVAR patients being more likely to be discharged home than to a facility (93.6% vs 87.8%; P = .060). There was no difference in any other complication or mortality. A subgroup analysis of 109 superobese patients with BMI ≥50 kg/mg 2 (59 CEVAR and 50 PEVAR) demonstrated no significant differences in outcomes between groups. PEVAR is increasingly used in MO patients and decreases operating time and rates of wound infection compared with CEVAR. The advantages of PEVAR seem to be lost in the superobese patients. Copyright © 2016 Society for Vascular Surgery. All rights reserved.

Comparison of charges and resource use associated with saxagliptin and sitagliptin.

PubMed

Vaidya, Varun; Adhikari, Keyuri; Sheehan, Jack; Kalsekar, Iftekhar

2016-12-01

Saxagliptin and sitagliptin are two commonly used dipeptidyl peptidase-4 (DPP-4) inhibitors. Little is known about their comparative effectiveness in the real world, particularly their impact on cost and resources use. The objective of this study was to analyze charges and resource use associated with saxagliptin and sitagliptin to understand the impact of these DPP-4 inhibitor treatment options in a real-world setting. This was a retrospective, new-user study approved by the Institutional Review Board at the University of Toledo. Data were collected from a US insurance claims dataset (OptumInsight) for patients newly initiating treatment with saxagliptin or sitagliptin between January 1, 2010 and December 31, 2011. ICD-9 code 250 was used to identify patients with T2D. Overall and diabetes-related medical and pharmacy charges were observed. Inpatient hospitalizations were also compared. Propensity score matching was used to balance the cohorts of patients prescribed saxagliptin and sitagliptin. Appropriate univariate statistical tests were applied to the propensity-matched sample to examine differences in resource utilization outcomes. Statistical significance was evaluated at P < 0.05. After the propensity score matching, each cohort included 7711 patients. Saxagliptin treatment was associated with lower overall charges ($13,292 vs $14,032; P = 0.0023) and overall medical charges ($9,540 vs $10,296; P = 0.0024) during the 6-month follow-up period compared with sitagliptin treatment. No significant differences were observed in the overall pharmacy charges ($3,751 vs $3,753; P = 0.6937) and the diabetes-related charges ($5,141 vs $5,232; P = 0.2957). All-cause and diabetes-related inpatient hospitalization rates were significantly lower with saxagliptin treatment (p = 0.0001 and p = 0.0019, respectively). All-caused inpatient charges were also significantly lower with saxagliptin ($2,917.26 vs $3445.89; P < 0.0001). Compared with patients initiating sitagliptin treatment, patients initiating saxagliptin treatment reported lower overall and medical charges and lower overall and diabetes-related hospitalization rates. These findings may aid payers in managing patients with T2D.

Increase in the incidence of severe hypoglycaemia in people with Type 2 diabetes in spite of new drugs: analysis based on health insurance data from Germany.

PubMed

Müller, N; Lehmann, T; Gerste, B; Adler, J-B; Kloos, C; Hartmann, M; Kramer, G; Kuniss, N; Müller, U A

2017-09-01

To evaluate the use of new anti-hyperglycaemic agents that offer effective glycaemic control while reducing risk of hypoglycaemia, by analysing the incidence rates of severe hypoglycaemia in 2006 vs 2011 in relation to the medication. This cross-sectional, population-based study used German health insurance data. All adults diagnosed with Type 2 diabetes mellitus (extrapolated to the German population: 6.35 million in 2006 and 7.52 million in 2011) were screened for severe hypoglycaemia. Anti-hyperglycaemic agents were identified by their Anatomical Therapeutic Chemical code, and defined daily doses of each medication were calculated. The severe hypoglycaemic event rate was 460 per 100,000 people/year in 2006 and 490 per 100,000 people/year in 2011. In 2006 and 2011, 10.9% and 7.3%, respectively, of all people with severe hypoglycaemia were on sulfonylureas, while 12.7% and 9.3%, respectively, were on a combination therapy of metformin and sulfonylureas. Among those with severe hypoglycaemia, there were no prescriptions of dipeptidyl peptidase-4 inhibitors or glucagon-like peptide-1 receptor agonists in 2006, but in 2011, 1.55% and 0.17%, of those with severe hypoglycaemia were receiving the respective treatments. In 2006 vs 2011, human insulin was prescribed for 11.3% vs 10.3% of people with severe hypoglycaemia, while insulin analogues were prescribed for 5.4% vs 8.1%, and mixed human insulins for 19.7% vs 14.0% of patients with severe hypoglycaemia. People receiving insulin analogue therapy had a higher risk of severe hypoglycaemia than those receiving metformin, after adjusting for age, gender, nephropathy diagnosis and year of survey (odds ratio 14.6; CI 13.3-15.9). The incidence of severe hypoglycaemic events in Germany increased between 2006 and 2011, despite increased use of newer anti-hyperglycaemic agents and decreased use of insulins. © 2017 Diabetes UK.

Association of neighborhood-level factors with hospitalization for community-associated methicillin-resistant Staphylococcus aureus, New York City, 2006: a multilevel observational study.

PubMed

Farr, Amanda M; Marx, Melissa A; Weiss, Don; Nash, Denis

2013-02-13

Hospitalizations with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection have increased in New York City, with substantial geographic variation across neighborhoods. While individual-level risk factors, such as age, sex, HIV infection, and diabetes have been described, the role of neighborhood-level factors (e.g., neighborhood HIV prevalence or income) has not been examined. To explore plausible neighborhood-level factors associated with CA-MRSA-related hospitalizations, a retrospective analysis was conducted using New York City hospital discharges from 2006 and New York City-specific survey and health department surveillance data. CA-MRSA-related hospitalizations were identified using diagnosis codes and admission information. Associations were determined by using sex-specific multilevel logistic regression. The CA-MRSA hospitalization rate varied by more than six-fold across New York City neighborhoods. Females hospitalized with CA-MRSA had more than twice the odds of residing in neighborhoods in the highest quintile of HIV prevalence (adjusted odds ratio [AOR](Q5 vs. Q1) 2.3, 95% CI: 1.2, 2.7). Both males and females hospitalized with CA-MRSA had nearly twice the odds of residing in neighborhoods with moderately high proportion of men who have sex with men (MSM) residing in the neighborhood (males: AOR(Q4 vs. Q1) 1.7, 95% CI: 1.1, 2.7; females: AOR(Q4 vs. Q1) 2.0, 95% CI: 1.1, 3.6); but this association did not hold for neighborhoods in the highest quintile (males: AOR(Q5 vs. Q1) 1.2, 95% CI: 0.76, 1.8; females: AOR(Q5 vs. Q1) 1.5, 95% CI: 0.82, 2.7). Neighborhood-level characteristics were associated with CA-MRSA hospitalization odds, independent of individual-level risk factors, and may contribute to the population-level burden of CA-MRSA infection.

An increased duplication of ZRS region that caused more than one supernumerary digits preaxial polydactyly in a large Chinese family.

PubMed

Wang, Bin; Diao, Yutao; Liu, Qiji; An, Hongqiang; Ma, Ruiping; Jiang, Guosheng; Lai, Nannan; Li, Ziwei; Zhu, Xiaoxiao; Zhao, Lin; Guo, Qiang; Zhang, Zhen; Sun, Rong; Li, Xia

2016-12-06

Preaxial polydactyly (PPD) is inherited in an autosomal dominant fashion and characterized by the presence of one or more supernumerary digits on the thumb side. It had been identified that point mutation or genomic duplications of the long-range limb-specific cis-regulator - zone of polarizing activity regulatory sequence (ZRS) cause PPD or other limb deformities such as syndactyly type IV (SD4) and Triphalangeal thumb-polysyndactyly syndrome (TPTPS). Most previously reported cases involved with no more than one extra finger; however, the role of the point mutation or genomic duplications of ZRS in the case of more than one redundant finger polydactyly remains unclear. In this article, we reported a family case of more than one redundant finger polydactyly on the thumb side for bilateral hands with a pedigree chart of the family. Results of quantitative PCR (qPCR) and sequence analysis suggested that the relative copy number (RCN) of ZRS but not point mutation (including insertion and deletion) was involved in all affected individuals.

Research misconduct definitions adopted by U.S. research institutions.

PubMed

Resnik, David B; Neal, Talicia; Raymond, Austin; Kissling, Grace E

2015-01-01

In 2000, the U.S. federal government adopted a uniform definition of research misconduct as fabrication, falsification, or plagiarism (FFP), which became effective in 2001. Institutions must apply this definition of misconduct to federally-funded research to receive funding. While institutions are free to adopt definitions of misconduct that go beyond the federal standard, it is not known how many do. We analyzed misconduct policies from 183 U.S. research institutions and coded them according to thirteen different types of behavior mentioned in the misconduct definition. We also obtained data on the institution's total research funding and public vs. private status, and the year it adopted the definition. We found that more than half (59%) of the institutions in our sample had misconduct policies that went beyond the federal standard. Other than FFP, the most common behaviors included in definitions were "other serious deviations" (45.4%), "significant or material violations of regulations" (23.0%), "misuse of confidential information" (15.8%), "misconduct related to misconduct" (14.8%), "unethical authorship other than plagiarism" (14.2%), "other deception involving data manipulation" (13.1%), and "misappropriation of property/theft" (10.4%). Significantly more definitions adopted in 2001 or later went beyond the federal standard than those adopted before 2001 (73.2% vs. 26.8%), and significantly more definitions adopted by institutions in the lower quartile of total research funding went beyond the federal standard than those adopted by institutions in the upper quartiles. Public vs. private status was not significantly associated with going beyond the federal standard.

The role of treatment fidelity on outcomes during a randomized field trial of an autism intervention

PubMed Central

Mandell, David S; Stahmer, Aubyn C; Shin, Sujie; Xie, Ming; Reisinger, Erica; Marcus, Steven C

2013-01-01

This randomized field trial comparing Strategies for Teaching based on Autism Research and Structured Teaching enrolled educators in 33 kindergarten-through-second-grade autism support classrooms and 119 students, aged 5–8 years in the School District of Philadelphia. Students were assessed at the beginning and end of the academic year using the Differential Ability Scales. Program fidelity was measured through video coding and use of a checklist. Outcomes were assessed using linear regression with random effects for classroom and student. Average fidelity was 57% in Strategies for Teaching based on Autism Research classrooms and 48% in Structured Teaching classrooms. There was a 9.2-point (standard deviation = 9.6) increase in Differential Ability Scales score over the 8-month study period, but no main effect of program. There was a significant interaction between fidelity and group. In classrooms with either low or high program fidelity, students in Strategies for Teaching based on Autism Research experienced a greater gain in Differential Ability Scales score than students in Structured Teaching (11.2 vs 5.5 points and 11.3 vs 8.9 points, respectively). In classrooms with moderate fidelity, students in Structured Teaching experienced a greater gain than students in Strategies for Teaching based on Autism Research (10.1 vs 4.4 points). The results suggest significant variability in implementation of evidence-based practices, even with supports, and also suggest the need to address challenging issues related to implementation measurement in community settings. PMID:23592849

Staphylococcal toxic shock syndrome 2000-2006: epidemiology, clinical features, and molecular characteristics.

PubMed

DeVries, Aaron S; Lesher, Lindsey; Schlievert, Patrick M; Rogers, Tyson; Villaume, Lourdes G; Danila, Richard; Lynfield, Ruth

2011-01-01

Circulating strains of Staphylococcus aureus (SA) have changed in the last 30 years including the emergence of community-associated methicillin-resistant SA (MRSA). A report suggested staphylococcal toxic shock syndrome (TSS) was increasing over 2000-2003. The last population-based assessment of TSS was 1986. Population-based active surveillance for TSS meeting the CDC definition using ICD-9 codes was conducted in the Minneapolis-St. Paul area (population 2,642,056) from 2000-2006. Medical records of potential cases were reviewed for case criteria, antimicrobial susceptibility, risk factors, and outcome. Superantigen PCR testing and PFGE were performed on available isolates from probable and confirmed cases. Of 7,491 hospitalizations that received one of the ICD-9 study codes, 61 TSS cases (33 menstrual, 28 non-menstrual) were identified. The average annual incidence per 100,000 of all, menstrual, and non-menstrual TSS was 0.52 (95% CI, 0.32-0.77), 0.69 (0.39-1.16), and 0.32 (0.12-0.67), respectively. Women 13-24 years had the highest incidence at 1.41 (0.63-2.61). No increase in incidence was observed from 2000-2006. MRSA was isolated in 1 menstrual and 3 non-menstrual cases (7% of TSS cases); 1 isolate was USA400. The superantigen gene tst-1 was identified in 20 (80%) of isolates and was more common in menstrual compared to non-menstrual isolates (89% vs. 50%, p = 0.07). Superantigen genes sea, seb and sec were found more frequently among non-menstrual compared to menstrual isolates [100% vs 25% (p = 0.4), 60% vs 0% (p<0.01), and 25% vs 13% (p = 0.5), respectively]. TSS incidence remained stable across our surveillance period of 2000-2006 and compared to past population-based estimates in the 1980s. MRSA accounted for a small percentage of TSS cases. tst-1 continues to be the superantigen associated with the majority of menstrual cases. The CDC case definition identifies the most severe cases and has been consistently used but likely results in a substantial underestimation of the total TSS disease burden.

The Relationship of PTSD and Communication with Intimate Partners in a Sample of Vietnam Veterans

DTIC Science & Technology

2011-08-08

developed reactions simply in response to daily life stressors. They also noted that married veterans were typically better adjusted than unmarried men...sequences were compared based on PTSD severity, status (PTSD vs non-PTSD), and conversation topic. Increasing PTSD severity was related to fewer overall...self- report, and by coding the richer details of communication instead of relying entirely on positive vs . negative variables. This introduction

Coding of obesity in administrative hospital discharge abstract data: accuracy and impact for future research studies.

PubMed

Martin, Billie-Jean; Chen, Guanmin; Graham, Michelle; Quan, Hude

2014-02-13

Obesity is a pervasive problem and a popular subject of academic assessment. The ability to take advantage of existing data, such as administrative databases, to study obesity is appealing. The objective of our study was to assess the validity of obesity coding in an administrative database and compare the association between obesity and outcomes in an administrative database versus registry. This study was conducted using a coronary catheterization registry and an administrative database (Discharge Abstract Database (DAD)). A Body Mass Index (BMI) ≥30 kg/m2 within the registry defined obesity. In the DAD obesity was defined by diagnosis codes E65-E68 (ICD-10). The sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of an obesity diagnosis in the DAD was determined using obesity diagnosis in the registry as the referent. The association between obesity and outcomes was assessed. The study population of 17380 subjects was largely male (68.8%) with a mean BMI of 27.0 kg/m2. Obesity prevalence was lower in the DAD than registry (2.4% vs. 20.3%). A diagnosis of obesity in the DAD had a sensitivity 7.75%, specificity 98.98%, NPV 80.84% and PPV 65.94%. Obesity was associated with decreased risk of death or re-hospitalization, though non-significantly within the DAD. Obesity was significantly associated with an increased risk of cardiac procedure in both databases. Overall, obesity was poorly coded in the DAD. However, when coded, it was coded accurately. Administrative databases are not an optimal datasource for obesity prevalence and incidence surveillance but could be used to define obese cohorts for follow-up.

Evaluation of Factors Influencing Accuracy of Principal Procedure Coding Based on ICD-9-CM: An Iranian Study

PubMed Central

Farzandipour, Mehrdad; Sheikhtaheri, Abbas

2009-01-01

To evaluate the accuracy of procedural coding and the factors that influence it, 246 records were randomly selected from four teaching hospitals in Kashan, Iran. “Recodes” were assigned blindly and then compared to the original codes. Furthermore, the coders' professional behaviors were carefully observed during the coding process. Coding errors were classified as major or minor. The relations between coding accuracy and possible effective factors were analyzed by χ2 or Fisher exact tests as well as the odds ratio (OR) and the 95 percent confidence interval for the OR. The results showed that using a tabular index for rechecking codes reduces errors (83 percent vs. 72 percent accuracy). Further, more thorough documentation by the clinician positively affected coding accuracy, though this relation was not significant. Readability of records decreased errors overall (p = .003), including major ones (p = .012). Moreover, records with no abbreviations had fewer major errors (p = .021). In conclusion, not using abbreviations, ensuring more readable documentation, and paying more attention to available information increased coding accuracy and the quality of procedure databases. PMID:19471647

Measuring hospital performance in congenital heart surgery: Administrative vs. clinical registry data

PubMed Central

Pasquali, Sara K.; He, Xia; Jacobs, Jeffrey P.; Jacobs, Marshall L.; Gaies, Michael G.; Shah, Samir S.; Hall, Matthew; Gaynor, J. William; Peterson, Eric D.; Mayer, John E.; Hirsch-Romano, Jennifer C.

2015-01-01

Background In congenital heart surgery, hospital performance has historically been assessed using widely available administrative datasets. Recent studies have demonstrated inaccuracies in case ascertainment (coding and inclusion of eligible cases) in administrative vs. clinical registry data, however it is unclear whether this impacts assessment of performance on a hospital-level. Methods Merged data from the Society of Thoracic Surgeons (STS) Database (clinical registry), and Pediatric Health Information Systems Database (administrative dataset) on 46,056 children undergoing heart surgery (2006–2010) were utilized to evaluate in-hospital mortality for 33 hospitals based on their administrative vs. registry data. Standard methods to identify/classify cases were used: Risk Adjustment in Congenital Heart Surgery (RACHS-1) in the administrative data, and STS–European Association for Cardiothoracic Surgery (STAT) methodology in the registry. Results Median hospital surgical volume based on the registry data was 269 cases/yr; mortality was 2.9%. Hospital volumes and mortality rates based on the administrative data were on average 10.7% and 4.7% lower, respectively, although this varied widely across hospitals. Hospital rankings for mortality based on the administrative vs. registry data differed by ≥ 5 rank-positions for 24% of hospitals, with a change in mortality tertile classification (high, middle, or low mortality) for 18%, and change in statistical outlier classification for 12%. Higher volume/complexity hospitals were most impacted. Agency for Healthcare Quality and Research methods in the administrative data yielded similar results. Conclusions Inaccuracies in case ascertainment in administrative vs. clinical registry data can lead to important differences in assessment of hospital mortality rates for congenital heart surgery. PMID:25624057

Tweaked residual convolutional network for face alignment

NASA Astrophysics Data System (ADS)

Du, Wenchao; Li, Ke; Zhao, Qijun; Zhang, Yi; Chen, Hu

2017-08-01

We propose a novel Tweaked Residual Convolutional Network approach for face alignment with two-level convolutional networks architecture. Specifically, the first-level Tweaked Convolutional Network (TCN) module predicts the landmark quickly but accurately enough as a preliminary, by taking low-resolution version of the detected face holistically as the input. The following Residual Convolutional Networks (RCN) module progressively refines the landmark by taking as input the local patch extracted around the predicted landmark, particularly, which allows the Convolutional Neural Network (CNN) to extract local shape-indexed features to fine tune landmark position. Extensive evaluations show that the proposed Tweaked Residual Convolutional Network approach outperforms existing methods.

Rare coding variation in paraoxonase-1 is associated with ischemic stroke in the NHLBI Exome Sequencing Project.

PubMed

Kim, Daniel Seung; Crosslin, David R; Auer, Paul L; Suzuki, Stephanie M; Marsillach, Judit; Burt, Amber A; Gordon, Adam S; Meschia, James F; Nalls, Mike A; Worrall, Bradford B; Longstreth, W T; Gottesman, Rebecca F; Furlong, Clement E; Peters, Ulrike; Rich, Stephen S; Nickerson, Deborah A; Jarvik, Gail P

2014-06-01

HDL-associated paraoxonase-1 (PON1) is an enzyme whose activity is associated with cerebrovascular disease. Common PON1 genetic variants have not been consistently associated with cerebrovascular disease. Rare coding variation that likely alters PON1 enzyme function may be more strongly associated with stroke. The National Heart, Lung, and Blood Institute Exome Sequencing Project sequenced the coding regions (exomes) of the genome for heart, lung, and blood-related phenotypes (including ischemic stroke). In this sample of 4,204 unrelated participants, 496 had verified, noncardioembolic ischemic stroke. After filtering, 28 nonsynonymous PON1 variants were identified. Analysis with the sequence kernel association test, adjusted for covariates, identified significant associations between PON1 variants and ischemic stroke (P = 3.01 × 10(-3)). Stratified analyses demonstrated a stronger association of PON1 variants with ischemic stroke in African ancestry (AA) participants (P = 5.03 × 10(-3)). Ethnic differences in the association between PON1 variants with stroke could be due to the effects of PON1Val109Ile (overall P = 7.88 × 10(-3); AA P = 6.52 × 10(-4)), found at higher frequency in AA participants (1.16% vs. 0.02%) and whose protein is less stable than the common allele. In summary, rare genetic variation in PON1 was associated with ischemic stroke, with stronger associations identified in those of AA. Increased focus on PON1 enzyme function and its role in cerebrovascular disease is warranted.

The Impact on Quality of Service When Using Security-Enabling Filters to Provide for the Security of Run-Time Virtual Environments

DTIC Science & Technology

2002-09-01

Secure Multicast......................................................................24 i. Message Digests and Message Authentication Codes ( MACs ...that is, the needs of the VE will determine what the design will look like (e.g., reliable vs . unreliable data communications). In general, there...Molva00] and [Abdalla00]. i. Message Digests and Message Authentication Codes ( MACs ) Message digests and MACs are used for data integrity verification

CISN ShakeAlert: Improving the Virtual Seismologist (VS) earthquake early warning framework to provide faster, more robust warning information

NASA Astrophysics Data System (ADS)

Meier, M.; Cua, G. B.; Wiemer, S.; Fischer, M.

2011-12-01

The Virtual Seismologist (VS) method is a Bayesian approach to regional network-based earthquake early warning (EEW) that uses observed phase arrivals, ground motion amplitudes and selected prior information to estimate earthquake magnitude, location and origin time, and predict the distribution of peak ground motion throughout a region using envelope attenuation relationships. Implementation of the VS algorithm in California is an on-going effort of the Swiss Seismological Service (SED) at ETH Zürich. VS is one of three EEW algorithms - the other two being ElarmS (Allen and Kanamori, 2003) and On-Site (Wu and Kanamori, 2005; Boese et al., 2008) - that form the basis of the California Integrated Seismic Network ShakeAlert system, a prototype end-to-end EEW system that could potentially be implemented in California. The current prototype version of VS in California requires picks at 4 stations to initiate an event declaration. On average, taking into account data latency, variable station distribution, and processing time, this initial estimate is available about 20 seconds after the earthquake origin time, corresponding to a blind zone of about 70 km around the epicenter which would receive no warning, but where it would be the most useful. To increase the available warning time, we want to produce EEW estimates faster (with less than 4 stations). However, working with less than 4 stations with our current approach would increase the number of false alerts, for which there is very little tolerance in a useful EEW system. We explore the use of back-azimuth estimations and the Voronoi-based concept of not-yet-arrived data for reducing false alerts of the earliest VS estimates. The concept of not-yet-arrived data was originally used to provide evolutionary location estimates in EEW (Horiuchi, 2005; Cua and Heaton, 2007; Satriano et al. 2008). However, it can also be applied in discriminating between earthquake and non-earthquake signals. For real earthquakes, the constraints on earthquake location from the not-yet-arrived data and the back-azimuth estimations are consistent with location constraints from the available picks. For non-earthquake signals, these different location constraints are in most cases inconsistent. We use archived event data from the Northern and Southern California Seismic Networks as well as archived continuous waveform data from where the current VS codes erroneously declared events to quantify how using a combination of pick-based and not-yet-arrived data constraints can reduce VS false alert rates while providing faster warning information. The consistency of the pick-based and not-yet-arrived data constraints are mapped into the VS likelihood parameter, which reflects the degree of believe that the signals come from a real earthquake. This approach contributes towards improving the robustness of the Virtual Seismologist Multiple Threshold Event Detection (VS-MTED), which allows for single-station event declarations, when signal amplitudes are large enough.

Extracting information from the text of electronic medical records to improve case detection: a systematic review

PubMed Central

Carroll, John A; Smith, Helen E; Scott, Donia; Cassell, Jackie A

2016-01-01

Background Electronic medical records (EMRs) are revolutionizing health-related research. One key issue for study quality is the accurate identification of patients with the condition of interest. Information in EMRs can be entered as structured codes or unstructured free text. The majority of research studies have used only coded parts of EMRs for case-detection, which may bias findings, miss cases, and reduce study quality. This review examines whether incorporating information from text into case-detection algorithms can improve research quality. Methods A systematic search returned 9659 papers, 67 of which reported on the extraction of information from free text of EMRs with the stated purpose of detecting cases of a named clinical condition. Methods for extracting information from text and the technical accuracy of case-detection algorithms were reviewed. Results Studies mainly used US hospital-based EMRs, and extracted information from text for 41 conditions using keyword searches, rule-based algorithms, and machine learning methods. There was no clear difference in case-detection algorithm accuracy between rule-based and machine learning methods of extraction. Inclusion of information from text resulted in a significant improvement in algorithm sensitivity and area under the receiver operating characteristic in comparison to codes alone (median sensitivity 78% (codes + text) vs 62% (codes), P = .03; median area under the receiver operating characteristic 95% (codes + text) vs 88% (codes), P = .025). Conclusions Text in EMRs is accessible, especially with open source information extraction algorithms, and significantly improves case detection when combined with codes. More harmonization of reporting within EMR studies is needed, particularly standardized reporting of algorithm accuracy metrics like positive predictive value (precision) and sensitivity (recall). PMID:26911811

Agreement between hospital discharge diagnosis codes and medical records to identify metastatic colorectal cancer and associated comorbidities in elderly patients.

PubMed

Gouverneur, A; Dolatkhani, D; Rouyer, M; Grelaud, A; Francis, F; Gilleron, V; Fourrier-Réglat, A; Noize, P

2017-08-01

Quality of coding to identify cancers and comorbidities through the French hospital diagnosis database (Programme de médicalisation des systèmes d'information, PMSI) has been little investigated. Agreement between medical records and PMSI database was evaluated regarding metastatic colorectal cancer (mCRC) and comorbidities. From 01/01/2013 to 06/30/2014, 74 patients aged≥65years at mCRC diagnosis were identified in Bordeaux teaching hospital. Data on mCRC and comorbidities were collected from medical records. All diagnosis codes (main, related and associated) registered into the PMSI were extracted. Agreement between sources was evaluated using the percent agreement for mCRC and the kappa (κ) statistic for comorbidities. Agreement for primary CRC and mCRC was higher using all types of diagnosis codes instead of the main one exclusively (respectively 95% vs. 53% for primary CRC and 91% vs. 24% for mCRC). Agreement was substantial (κ 0.65) for cardiovascular diseases, notably atrial fibrillation (κ 0.77) and hypertension (κ 0.68). It was moderate for psychiatric disorders (κ 0.49) and respiratory diseases (κ 0.48), although chronic obstructive pulmonary disease had a good agreement (κ 0.75). Within the class of endocrine, nutritional and metabolic diseases (κ 0.55), agreement was substantial for diabetes (κ 0.91), obesity (κ 0.82) and hypothyroidism (κ 0.72) and moderate for hypercholesterolemia (κ 0.51) and malnutrition (κ 0.42). These results are reassuring with regard to detection through PMSI of mCRC if all types of diagnosis codes are considered and useful to better choose comorbidities in elderly mCRC patients that could be well identified through hospital diagnosis codes. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Rolling-refresher simulation improves performance and retention of paediatric intensive care unit nurse code cart management.

PubMed

Singleton, Marcy N; Allen, Kimberly F; Li, Zhongze; McNerney, Kevin; Naber, Urs H; Braga, Matthew S

2018-04-01

Paediatric Intensive Care Unit Nurses (PICU RNs) manage the code cart during paediatric emergencies at the Children's Hospital at Dartmouth-Hitchcock. These are low -frequency, high-stakes events. An uncontrolled intervention study with 6-month follow-up. A collaboration of physician and nursing experts developed a rolling-refresher training programme consisting of five simulated scenarios, including 22 code cart skills, to establish nursing code cart competency. The cohort of PICU RNs underwent a competency assessment in training 1. To achieve competence, the participating RN received immediate feedback and instruction and repeated each task until mastery during training 1. The competencies were repeated 6 months later, designated training 2. Thirty-two RNs participated in training 1. Sixteen RNs (50%) completed the second training. Our rolling-refresher training programme resulted in a 43% reduction in the odds of first attempt failures between training 1 and training 2 (p=0.01). Multivariate linear regression evaluating the difference in first attempt failure between training 1 and training 2 revealed that the following covariates were not significantly associated with this improvement: interval Paediatric Advanced Life Support training, interval use of the code cart or defibrillator (either real or simulated) and time between training sessions. Univariate analysis between the two trainings revealed a statistically significant reduction in first attempt failures for: preparing an epinephrine infusion (72% vs 41%, p=0.04) and providing bag-mask ventilation (28% vs 0%, p=0.02). Our rolling-refresher training programme demonstrated significant improvement in performance for low-frequency, high-risk skills required to manage a paediatric code cart with retention after initial training.

Minimally invasive repair of pectus excavatum: Analysis of the NSQIP database and the use of thoracoscopy.

PubMed

Tetteh, Oswald; Rhee, Daniel S; Boss, Emily; Alaish, Samuel M; Garcia, Alejandro V

2018-03-07

The minimally invasive repair of pectus excavatum (MIRPE) has been widely accepted and has become a viable alternative to the open Ravitch technique. MIRPE has evolved over time with some advocating that a safe repair can be accomplished without direct visualization utilizing thoracoscopy. The MIRPE with and without a thoracoscopic approach has not been previously analyzed from a nationwide database to determine differences in safety and short-term outcomes. The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) 2012-2015 database was used in identifying patients that had MIRPE using Current Procedural Terminology (CPT) codes and ICD-9CM/ICD-10CM postoperative diagnosis codes. Outcomes of interest were readmissions, reoperations, complications, cardiothoracic injury, operative time, and duration of hospital stay after surgery for MIRPE with and without thoracoscopy. Descriptive statistics, simple and multivariable logistic regressions, Fisher's exact, and Wilcoxon rank sum test were used to determine any differences in 30-day postoperative outcomes. There were 1569 MIRPE cases included. 15.9% (N=249) of MIRPE were done without thoracoscopy. There were no significant differences with the use of thoracoscopy compared to without thoracoscopy in the rate of readmissions (2.5 vs 4.8%; p=0.06), reoperations (1.4 vs 2.0%; p=0.57), postoperative complications (2.6% vs 3.2%; p=0.52), and cardiothoracic injuries (0.2% vs 0.0%; p=1.00). Unadjusted odds ratios (ORs) for readmission and reoperation comparing MIRPE with thoracoscopy to MIRPE without thoracoscopy were 0.51 (p<0.05) and 0.71 (p=0.50), respectively. Adjusted ORs were 0.49 (p=0.04) and 0.71 (p=0.50), respectively. There were no reported deaths, but two cardiothoracic injuries were recorded in the group with thoracoscopy. MIRPE with thoracoscopy was associated with longer operative time (mean 13.0min; p=0.00) and longer hospital stay (mean 0.37days; p<0.01) compared to MIRPE without thoracoscopy. No data were available for the severity of the pectus defect. MIRPE has a low adverse event rate with no difference in reoperations, postoperative complications, and cardiothoracic injuries with or without the use of thoracoscopy. There may be a higher rate of readmissions in the nonthoracoscopic group. While the technique used remains the surgeon's decision, the use of thoracoscopy may be unnecessary and is at an added cost. Treatment study (retrospective comparative study). Level III. Copyright © 2018 Elsevier Inc. All rights reserved.

Antibiotics Prophylaxis for Operative Hysteroscopy.

PubMed

Muzii, Ludovico; Di Donato, Violante; Boni, Terenzio; Gaglione, Raffaele; Marana, Riccardo; Mazzon, Ivan; Imperiale, Ludovica; De Medici, Caterina; Ruggiero, Alfonso; Panici, Pierluigi Benedetti

2017-04-01

To evaluate the incidence of infectious complications and effect of prophylactic antibiotic administration during operative hysteroscopic procedures. A multicentric randomized controlled trial was conducted between January 2012 and December 2013. Women (n = 180) affected by endometrial hyperplasia, myomas, or endometrial polyps undergoing operative hysteroscopy were randomized to receive cefazolin 2 g intravenously 30 minutes prior to the procedure (n = 91) and no treatment (n = 89). No statistical difference in terms of postoperative fever (2.4% vs 2.3%, P = .99), endometritis (0% vs 0%), pain (6.0% vs 10.4%, P = .40), cervicitis-vaginitis (0% vs 0%), pelvic abscess (0% vs 0%), pelvic inflammatory disease (0% vs 0%), and bleeding (0% vs 0%) was noticed. No statistical difference in terms of side effects attributable to antibiotic prophylaxis such as allergy (0% vs 4.8%, P = .12), nausea (10.7% vs 17.4%, P = .27), vomiting (3.6% vs 4.6%, P = .99), diarrhea (4.8% vs 5.4%, P = .99), cephalea (9.5% vs 3.5%, P = .13), dizziness (4.8% vs 2.3%, P = .44), and meteorism (5.4% vs 3.4%, P = .99) was noticed. The results of the current study support the recommendation not to prescribe routine antibiotic prophylaxis prior to operative hysteroscopy.

Biochemical characteristics of neonatal cholestasis induced by citrin deficiency

PubMed Central

Wang, Jian-She; Wang, Xiao-Hong; Zheng, Ying-Jie; Fu, Hai-Yan; Chen, Rui; Lu, Yi; Fang, Ling-Juan; Saheki, Takeyori; Kobayashi, Keiko

2012-01-01

AIM: To explore differences in biochemical indices between neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) and that with other etiologies. METHODS: Patients under 6 mo of age who were referred for investigation of conjugated hyperbilirubinaemia from June 2003 to December 2010 were eligible for this study. After excluding diseases affecting the extrahepatic biliary system, all patients were screened for the two most common SLC25A13 mutations; the coding exons of the entire SLC25A13 gene was sequenced and Western blotting of citrin protein performed in selected cases. Patients in whom homozygous or compound heterozygous SLC25A13 mutation and/or absence of normal citrin protein was detected were defined as having NICCD. Cases in which no specific etiological factor could be ascertained after a comprehensive conjugated hyperbilirubinaemia work-up were defined as idiopathic neonatal cholestasis (INC). Thirty-two NICCD patients, 250 INC patients, and 39 infants with cholangiography-confirmed biliary atresia (BA) were enrolled. Laboratory values at their first visit were abstracted from medical files and compared. RESULTS: Compared with BA and INC patients, the NICCD patients had significantly higher levels of total bile acid (TBA) [all measures are expressed as median (inter-quartile range): 178.0 (111.2-236.4) μmol/L in NICCD vs 112.0 (84.9-153.9) μmol/L in BA and 103.0 (70.9-135.3) μmol/L in INC, P = 0.0001]. The NICCD patients had significantly lower direct bilirubin [D-Bil 59.6 (43.1-90.9) μmol/L in NICCD vs 134.0 (115.9-151.2) μmol/L in BA and 87.3 (63.0-123.6) μmol/L in INC, P = 0.0001]; alanine aminotransferase [ALT 34.0 (23.0-55.0) U/L in NICCD vs 108.0 (62.0-199.0) U/L in BA and 84.5 (46.0-166.0) U/L in INC, P = 0.0001]; aspartate aminotransferase [AST 74.0 (53.5-150.0) U/L in NICCD vs 153.0 (115.0-239.0) U/L in BA and 130.5 (81.0-223.0) U/L in INC, P = 0.0006]; albumin [34.9 (30.7-38.2) g/L in NICCD vs 38.4 (36.3-42.2) g/L in BA and 39.9 (37.0-42.3) g/L in INC, P = 0.0001]; glucose [3.2 (2.0-4.4) mmol/L in NICCD vs 4.1 (3.4-5.1) mmol/L in BA and 4.0 (3.4-4.6) mmol/L in INC, P = 0.0014] and total cholesterol [TCH 3.33 (2.97-4.00) mmol/L in NICCD vs 4.57 (3.81-5.26) mmol/L in BA and 4.00 (3.24-4.74) mmol/L in INC, P = 0.0155] levels. The D-Bil to total bilirubin (T-Bil) ratio was significantly lower in NICCD patients [all measures are expressed as median (inter-quartile range): 0.54 (0.40-0.74)] than that in BA patients [0.77 (0.72-0.81), P = 0.001] and that in INC patients [0.74 (0.59-0.80), P = 0.0045]. A much higher AST/ALT ratio was found in NICCD patients [2.46 (1.95-3.63)] compared to BA patients [1.38 (0.94-1.97), P = 0.0001] and INC patients [1.48 (1.10-2.26), P = 0.0001]. NICCD patients had significantly higher TBA/D-Bil ratio [3.36 (1.98-4.43) vs 0.85 (0.72-1.09) in BA patients and 1.04 (0.92-1.14) in INC patients, P = 0.0001], and TBA/TCH ratio [60.7 (32.4-70.9) vs 24.7 (19.8-30.2) in BA patients and 24.2 (21.4-26.9) in INC patients, P = 0.0001] compared to the BA and INC groups. CONCLUSION: NICCD has significantly different biochemical indices from BA or INC. TBA excretion in NICCD appeared to be more severely disturbed than that of bilirubin and cholesterol. PMID:23112554

Smoking in Movies and Adolescent Smoking Initiation: A Longitudinal Study among Argentinian Adolescents.

PubMed

Mejia, Raul; Pérez, Adriana; Peña, Lorena; Kollath-Cattano, Christy; Morello, Paola; Braun, Sandra; Hardin, James W; Thrasher, James F; Sargent, James D

2017-01-01

To assess whether exposure to movie smoking is associated with cigarette smoking among Argentinian adolescents. A school-based longitudinal study involving 33 secondary schools in Argentina was performed. The sample included 2502 never smokers (average age at entry = 12.5 years), 1700 (67.9%) of whom completed follow-up surveys 17 months later. Exposure to the top 100 highest-grossing films for each year between 2009 and 2013 was assessed by content-coding films for tobacco and then by asking adolescents whether they had seen each of 50 titles, randomly selected from the larger pool, then parsing exposure into tertiles. Logistic regression models estimated aOR for the following transitions: nonsusceptible to susceptible never smoker, never smoker to ever smoker, and never smoker to current smoking (last 30 days). At follow-up, 34.4% of nonsusceptible never smokers became susceptible, 24.1% reported having tried smoking, and 9.4% were current smokers. Most exposure to movie smoking was from US-produced films (average 60.3 minutes compared with only 3.4 minutes from Argentine films). Greater exposure to smoking in movies was significantly associated with increased odds of becoming susceptible (aOR first vs third tertile  1.77, 95% CI 1.30-2.41), of trying smoking (aOR first vs third tertile  1.54, 1.14-2.08), and marginally associated with current smoking (AOR first vs third tertile  1.54, 0.99-2.40). Exposure to smoking in US- or Argentine-produced films had similar associations. In Argentina, exposure to smoking in the movies predicted future smoking transitions among early adolescents, with most exposure coming from viewing US movies. Copyright © 2016 Elsevier Inc. All rights reserved.

Increased utilization of emergency department and inpatient care by patients with hidradenitis suppurativa.

PubMed

Khalsa, Amrit; Liu, Guodong; Kirby, Joslyn S

2015-10-01

Hidradenitis suppurativa (HS) is a chronic cutaneous disease with acutely painful flares. In a prior study of all-cause utilization, patients with HS had higher utilization of emergency department (ED) and inpatient care. We sought to assess utilization of medical care specifically related to HS, especially high-cost settings. The MarketScan medical claims database was examined for participants with either HS or psoriasis based on International Classification of Diseases, Ninth Revision codes, during the study period, January 2008 to December 2012. This was a cohort cost-identification study with analyses of utilization measures and direct costs. The proportion of the HS cohort hospitalized was 5.1% and was higher than the psoriasis cohort (1.6%) (P < .0001). The proportion of patients who used the ED was also higher in the HS cohort (7.4% vs 2.6%, P < .0001). When compared with a subset of patients with severe psoriasis, the proportions of patients with HS who used the ED (7.4% vs 4.2%, P < .0001) or inpatient care (5.1% vs 2.5%, P < .0001) remained elevated. The study sample may not be generalizable to other patient populations and may represent those with more severe disease. Pharmaceutical costs were not included and confounding factors such as race, socioeconomic status, and insurance type were not investigated. Patients with HS had increased utilization of high-cost settings, such as the ED and inpatient care, compared with patients with psoriasis, another chronic inflammatory disease. Both patients and providers should be aware of this finding and further work is needed to incorporate assessment of patient outcomes. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Presence or absence of intestinal metaplasia but not its burden is associated with prevalent high-grade dysplasia and cancer in Barrett's esophagus.

PubMed

Bansal, A; McGregor, D H; Anand, O; Singh, M; Rao, D; Cherian, R; Wani, S B; Rastogi, A; Singh, V; House, J; Jones, P G; Sharma, P

2014-01-01

Universal agreement on the inclusion of intestinal metaplasia to diagnose Barrett's esophagus (BE) is lacking. Our aim was to determine the association of intestinal metaplasia and its density with the prevalence of dysplasia/cancer in columnar lined esophagus (CLE). Patients with CLE but no intestinal metaplasia (CLE-no IM) were identified by querying the clinical pathology database using SNOMED codes for distal esophageal biopsies. CLE-IM patients were identified from a prospectively maintained database of BE patients. Subsequently, relative risks for prevalent dysplasia and cancer were calculated. Since patients with CLE-no IM are not usually enrolled in surveillance, only prevalent dysplasia/cancer on index endoscopy was analyzed. Goblet cell density and percent intestinal metaplasia were estimated. All biopsy slides were reviewed for dysplasia by two experienced gastrointestinal pathologists. Two hundred sixty-two CLE-IM and 260 CLE-no IM patients were included (age 64±12 vs. 60±11 years, P=0.001; whites 92% vs. 82%, P=0.001; males 99.7% vs. 99.3%, P=NS; CLE length 3.4±3.2 vears 1.4±0.4 cm, P=0.001 and hiatus hernia 64% vs. 56%, P=0.013). The odds of finding low-grade dysplasia and of high-grade dysplasia (HGD)/cancer were 12.5-fold (2.9-53.8, P=0.007) and 4.2-fold (95% CI 1.4-13, P=0.01) higher, respectively, in the CLE-IM group. Reanalysis after controlling for important variables of age, race, and length did not significantly alter the overall results. In CLE-IM group, when patients with high (>50/LPF) versus low goblet cell density (<50/LPF) and <10% versus >10% intestinal metaplasia were compared, the odds of HGD/cancer, OR 1.5 (0.5-4.9, P=0.5) and 1.97 (0.54-7.22), respectively, were not significantly higher. Demonstration of intestinal metaplasia continues to be an essential element in the definition of BE, but its quantification may not be useful for risk stratification of HGD/cancer in BE. © 2013 Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

Opioid Abuse or Dependence Increases 30-day Readmission Rates after Major Operating Room Procedures: A National Readmissions Database Study.

PubMed

Gupta, Atul; Nizamuddin, Junaid; Elmofty, Dalia; Nizamuddin, Sarah L; Tung, Avery; Minhaj, Mohammed; Mueller, Ariel; Apfelbaum, Jeffrey; Shahul, Sajid

2018-05-01

Although opioids remain the standard therapy for the treatment of postoperative pain, the prevalence of opioid misuse is rising. The extent to which opioid abuse or dependence affects readmission rates and healthcare utilization is not fully understood. It was hypothesized that surgical patients with a history of opioid abuse or dependence would have higher readmission rates and healthcare utilization. A retrospective cohort analysis was performed of patients undergoing major operating room procedures in 2013 and 2014 using the National Readmission Database. Patients with opioid abuse or dependence were identified using International Classification of Diseases codes. The primary outcome was 30-day hospital readmission rate. Secondary outcomes included hospital length of stay and estimated hospital costs. Among the 16,016,842 patients who had a major operating room procedure whose death status was known, 94,903 (0.6%) had diagnoses of opioid abuse or dependence. After adjustment for potential confounders, patients with opioid abuse or dependence had higher 30-day readmission rates (11.1% vs. 9.1%; odds ratio 1.26; 95% CI, 1.22 to 1.30), longer mean hospital length of stay at initial admission (6 vs. 4 days; P < 0.0001), and higher estimated hospital costs during initial admission ($18,528 vs. $16,617; P < 0.0001). Length of stay was also higher at readmission (6 days vs. 5 days; P < 0.0001). Readmissions for infection (27.0% vs. 18.9%; P < 0.0001), opioid overdose (1.0% vs. 0.1%; P < 0.0001), and acute pain (1.0% vs. 0.5%; P < 0.0001) were more common in patients with opioid abuse or dependence. Opioid abuse and dependence are associated with increased readmission rates and healthcare utilization after surgery. An online visual overview is available for this article at http://links.lww.com/ALN/B704.

Contamination Analysis Tools

NASA Technical Reports Server (NTRS)

Brieda, Lubos

2015-01-01

This talk presents 3 different tools developed recently for contamination analysis:HTML QCM analyzer: runs in a web browser, and allows for data analysis of QCM log filesJava RGA extractor: can load in multiple SRS.ana files and extract pressure vs. time dataC++ Contamination Simulation code: 3D particle tracing code for modeling transport of dust particulates and molecules. Uses residence time to determine if molecules stick. Particulates can be sampled from IEST-STD-1246 and be accelerated by aerodynamic forces.

An Evaluation of New York City's 2015 Birth Certificate Gender Marker Regulation.

PubMed

Lee, Erica J; Gurr, Danielle; Van Wye, Gretchen

2017-10-01

In 1971, the New York City (NYC) Department of Health and Mental Hygiene amended Section 207.05 of the NYC Health Code to allow individuals who had undergone "convertive surgery" (interpreted by the code to mean genital surgery) to amend the gender on their birth certificates. This surgery requirement was removed in 2015. In a survey evaluating the regulation change, we sought to characterize the transgender population newly eligible to obtain a gender-congruent NYC birth certificate by comparing respondents with and without genital surgery. We mailed a 42-question survey with each newly issued birth certificate. We compared respondents across current gender identity, race, Hispanic ethnicity, age, insurance status, income, current general health status, other transition-related care obtained, and healthcare access, stigma, and discrimination. Of 642 applicants, 219 responded and were thus enrolled in our 5-year study (34.1%). Most (n = 158 out of 203 who answered, 77.8%) had not received genital surgery. Compared to respondents with genital surgery, respondents without surgery were significantly more likely to be transgender men (50.0% vs. 20.0%); younger (median age 32 vs. 56.5); on Medicaid (31.6% vs. 11.1%); identify as Hispanic (28.5% vs. 8.9%); and live in households making <$20,000 annually (35.3% vs. 12.8%). Removing a genital surgery requirement more equitably enables transgender men and those with limited resources to obtain a gender-congruent birth certificate. Jurisdictions with such requirements should consider similar regulation changes to address the inequities that this requirement likely imposes in accessing birth certificates.

Impact of the implementation of the Infarction Code strategy in patients with acute myocardial infarction diagnosis in the Hospital de Cardiología of the Centro Médico Nacional Siglo XXI

PubMed

Sánchez, Gabriela Borrayo; Covarrubias, Héctor Álvarez; Rodríguez, Gilberto Pérez; Uribe, Efraín Arizmendi; Ramírez-Arias, Erick; Peralta, Martín Rosas; Dávila, Jesús Arriaga

2017-01-01

To evaluate the impact of the implementation of the Infarction Code strategy in patients with acute myocardial infarction diagnosis. Consecutive patients with ST-elevation acute myocardial infarction ≤12 hours of evolution, were included in the infarction code strategy, before (Group I) and after (Group II). Times of medical attention and major cardiovascular events during hospitalization were analyzed. 1227 patients were included, 919 men (75%) and 308 women (25%) with an average age of 62 ± 11 years. Among Group I and Group II, percutaneous coronary intervention reperfusion therapy changed (16.6% to 42.6%), fibrinolytic therapy (39.3% to 25%), and patients who did not receive any form of reperfusion therapy (44% to 32.6%; p < 0.0001). Times of medical attention decreased significantly (door-to-needle time decreased from 92 to 72 minutes, p = 0.004; door-to-balloon time decreased from 140 to 92 minutes, p < 0.0001). Kidney failure (24.6% vs. 17.9%; p = 0.006), major complications (35.3% to 29.3%), and death (21% vs. 12%; odds ratio: 0.52; 95% confidence interval: 0.38-0.71; p = 0.004). also decreased. The Infarction Code strategy improved treatment, times of medical attention and decreased complications and death in these patients.

The Effectiveness of the Italian Seismic Code NT08 Prescriptions in Reproducing the Observed Site Amplification: the City of Rome and the Acquasanta Terme Town, Italy, Case Study

NASA Astrophysics Data System (ADS)

Caserta, A.; Doumaz, F.; Pischiutta, M.; Costanzo, A.

2017-12-01

In the European design code EU08 used in Italy as NT08, site effects are accounted through several scaling factors, depending on the Vs30 and topographic conditions. The effectiveness of such approach has been tested in two case studies. The first one is located in the Tiber valley, the main sedimentary basin of the city of Rome. The second one is located in Acquasanta Terme town (central Appennines). In both cases, the expected amplification levels according to the Italian design code, was calculated on the basis of the velocity profile and other geological information collected in-situ. The expected values were compared in the former case (Rome) with data recorded during the seismic sequence following the 2009 April 6th, Mw=6.3 L'Aquila earthquake (mainshock, and aftershocks) and in the latter case (Acquasanta Terme) with moderate-magnitude aftershocks following the 2016 August 24th, Mw = 6.0, Amatrice missed main shock. Our results highlight that the parameterizations adopted by the design code are not sufficient to reproduce the real ground shaking occurring during earthquakes. These means that the Vs30 parameter ignores three-dimensional and frequency-dependent effects, as well as the influence of the near surface geology deeper than 30 meters.

Soccer small-sided games in young players: rule modification to induce higher physiological responses

PubMed Central

Chtourou, H; Dellal, A; Chaouachi, A; Chamari, K

2017-01-01

The aim of this study was to identify the physiological responses of 3 forms of players’ numbers during two different games rules of small-sided games (SSG: stop-ball vs. small-goals rules). Eighteen youth amateur soccer players (age 13.5±0.7 years; height 168.9±6.1cm; body mass 63.1±7.7 kg) participated in this study and performed 3 SSGs with varying players’ number (2vs.2; 3vs.3 and 4vs.4): stop-ball SSG (SB-SSG) vs. small-goals SSG (SG-SSG) in a randomized and counter-balanced order on a constant pitch dimension (20×25m). The players performed 4×4 min SSG with 2-min of passive recovery in-between. Heart rate (HR), (expressed in bpm and % HRmax), lactate ([La-]), and rating of perceived exertion (RPE) were collected during each session. SB-SSG induced the higher HR values in comparison with the SG-SSG for the 3 game formats (2vs.2; 3vs.3 and 4vs.4). Also, compared with SG-SSG, SB-SSG induced the higher HR values during 2vs.2 compared with 4vs.4 games rules (178 vs. 174 and 175 vs. 171 bpm, respectively). However, the SB-SSG was more intense compared with SG-SSG in the 2 vs. 2 game rule compared with the two others (3 vs.3 and 4 vs. 4) for [La-] and RPE (7.58 vs. 7; 7.25 vs. 6.75 and 6.5 vs. 6.16 mmol ∙ L-1, and 7.75 vs. 7.33; 7.41 vs. 7.08 and 7.16 vs. 6.83, respectively). Therefore, the use of 2 vs. 2 and 3 vs. 3 SSG with SB-SSG seems to represent an alternative to coaches to increase cardiovascular and metabolic demands in youth soccer players. PMID:28566810

Seismic tomography of the Canterbury Plains and the geometry and evolution of seismicity of the Greendale fault system, New Zealand

NASA Astrophysics Data System (ADS)

Syracuse, E. M.; Thurber, C. H.; Savage, M. K.

2012-12-01

The previously unknown Greendale fault produced the September 4, 2010 M 7.1 Darfield earthquake and later triggered the destructive February 22, 2011 M 6.3 Christchurch earthquake, as well as later M>5 aftershocks east of Christchurch. Surface rupture from the Darfield earthquake indicates up to 5 m of strike-slip motion along the main portion of the Greendale fault, while various geodetic and seismic models also indicate reverse faulting on surrounding smaller faults. We combine seismic data from a variety of sources (permanent network seismometers and strong motion instruments, temporary intermediate to broadband seismometers) to understand the geometry of these various sections of faults and the evolution of seismicity along them for the first four months of aftershocks from the Darfield earthquake. We identify 4 to 5 fault segments that were likely active in the Darfield earthquake and an additional 5 to 6 segments that were active during the study period, prior to the Christchurch earthquake. While relocating hypocenters, we also jointly invert for 3D Vp, Vs, and Vp/Vs in the Canterbury region using an extended version of the double-difference tomography code tomoDD (Zhang et al., 2009). In the area of the Greendale and associated faults, Vp, Vs, and Vp/Vs are generally reduced from the top 8 km of the average velocity model for the Canterbury region of New Zealand. from the surface to ~8 km depth, below which the resolution begins to decline. Beneath Christchurch and areas immediately to the south and west, Vp and Vs are elevated and Vp/Vs is reduced from the surface to ~8 km depth, corresponding to the location of a negative Bouguer gravity anomaly and an increase in depth to basement (Hicks, 1989). In the northwest portion of the model, Vp and Vs increase when approaching the foothills of the Southern Alps. There are no clearly defined features in the velocity model that cross or are offset by the Greendale fault and no apparent contrast in velocities across the fault, preventing us from conjecturing about the age or total offset along the fault over its lifespan based on the velocity models alone.

Controlled longitudinal emittance blow-up using band-limited phase noise in CERN PSB

NASA Astrophysics Data System (ADS)

Quartullo, D.; Shaposhnikova, E.; Timko, H.

2017-07-01

Controlled longitudinal emittance blow-up (from 1 eVs to 1.4 eVs) for LHC beams in the CERN PS Booster is currently achievied using sinusoidal phase modulation of a dedicated high-harmonic RF system. In 2021, after the LHC injectors upgrade, 3 eVs should be extracted to the PS. Even if the current method may satisfy the new requirements, it relies on low-power level RF improvements. In this paper another method of blow-up was considered, that is the injection of band-limited phase noise in the main RF system (h=1), never tried in PSB but already used in CERN SPS and LHC, under different conditions (longer cycles). This technique, which lowers the peak line density and therefore the impact of intensity effects in the PSB and the PS, can also be complementary to the present method. The longitudinal space charge, dominant in the PSB, causes significant synchrotron frequency shifts with intensity, and its effect should be taken into account. Another complication arises from the interaction of the phase loop with the injected noise, since both act on the RF phase. All these elements were studied in simulations of the PSB cycle with the BLonD code, and the required blow-up was achieved.

The LIFE Cognition Study: design and baseline characteristics

PubMed Central

Sink, Kaycee M; Espeland, Mark A; Rushing, Julia; Castro, Cynthia M; Church, Timothy S; Cohen, Ronald; Gill, Thomas M; Henkin, Leora; Jennings, Janine M; Kerwin, Diana R; Manini, Todd M; Myers, Valerie; Pahor, Marco; Reid, Kieran F; Woolard, Nancy; Rapp, Stephen R; Williamson, Jeff D

2014-01-01

Observational studies have shown beneficial relationships between exercise and cognitive function. Some clinical trials have also demonstrated improvements in cognitive function in response to moderate–high intensity aerobic exercise; however, these have been limited by relatively small sample sizes and short durations. The Lifestyle Interventions and Independence for Elders (LIFE) Study is the largest and longest randomized controlled clinical trial of physical activity with cognitive outcomes, in older sedentary adults at increased risk for incident mobility disability. One LIFE Study objective is to evaluate the effects of a structured physical activity program on changes in cognitive function and incident all-cause mild cognitive impairment or dementia. Here, we present the design and baseline cognitive data. At baseline, participants completed the modified Mini Mental Status Examination, Hopkins Verbal Learning Test, Digit Symbol Coding, Modified Rey–Osterrieth Complex Figure, and a computerized battery, selected to be sensitive to changes in speed of processing and executive functioning. During follow up, participants completed the same battery, along with the Category Fluency for Animals, Boston Naming, and Trail Making tests. The description of the mild cognitive impairment/dementia adjudication process is presented here. Participants with worse baseline Short Physical Performance Battery scores (prespecified at ≤7) had significantly lower median cognitive test scores compared with those having scores of 8 or 9 with modified Mini Mental Status Examination score of 91 versus (vs) 93, Hopkins Verbal Learning Test delayed recall score of 7.4 vs 7.9, and Digit Symbol Coding score of 45 vs 48, respectively (all P<0.001). The LIFE Study will contribute important information on the effects of a structured physical activity program on cognitive outcomes in sedentary older adults at particular risk for mobility impairment. In addition to its importance in the area of prevention of cognitive decline, the LIFE Study will also likely serve as a model for exercise and other behavioral intervention trials in older adults. PMID:25210447

The Patient Protection and Affordable Care Act dependent coverage expansion: Disparities in impact among young adult oncology patients.

PubMed

Alvarez, Elysia M; Keegan, Theresa H; Johnston, Emily E; Haile, Robert; Sanders, Lee; Wise, Paul H; Saynina, Olga; Chamberlain, Lisa J

2018-01-01

Private health insurance is associated with improved outcomes in patients with cancer. However, to the authors' knowledge, little is known regarding the impact of the Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA-DCE), which extended private insurance to young adults (to age 26 years) beginning in 2010, on the insurance status of young adults with cancer. The current study was a retrospective, population-based analysis of hospitalized young adult oncology patients (aged 22-30 years) in California during 2006 through 2014 (11,062 patients). Multivariable regression analyses examined factors associated with having private insurance. Results were presented as adjusted odds ratios and 95% confidence intervals. A difference-in-difference analysis examined the influence of the ACA-DCE on insurance coverage by race/ethnicity and federal poverty level. Multivariable regression demonstrated that patients of black and Hispanic race/ethnicity were less likely to have private insurance before and after the ACA-DCE, compared with white patients. Younger age (22-25 years) was associated with having private insurance after implementation of the ACA-DCE (odds ratio, 1.20; 95% confidence interval, 1.06-1.35). In the difference-in-difference analysis, private insurance increased among white patients aged 22 to 25 years who were living in medium-income (2006-2009: 64.6% vs 2011-2014: 69.1%; P = .003) and high-income (80.4% vs 82%; P = .043) zip codes and among Asians aged 22 to 25 years living in high-income zip codes (73.2 vs 85.7%; P = .022). Private insurance decreased for all Hispanic patients aged 22 to 25 years between the 2 time periods. The ACA-DCE provision increased insurance coverage, but not among all patients. Private insurance increased for white and Asian patients in higher income neighborhoods, potentially widening social disparities in private insurance coverage among young adults with cancer. Cancer 2018;124:110-7. © 2017 American Cancer Society. © 2017 American Cancer Society.

Colon Cancer Associated Transcript-1 (CCAT1) Expression in Adenocarcinoma of the Stomach

PubMed Central

Mizrahi, Ido; Mazeh, Haggi; Grinbaum, Ronit; Beglaibter, Nahum; Wilschanski, Michael; Pavlov, Vera; Adileh, Muchamad; Stojadinovic, Alexander; Avital, Itzhak; Gure, Ali Osmay; Halle, David; Nissan, Aviram

2015-01-01

Background: Long non-coding RNAs (lncRNAs) have been shown to have functional roles in cancer biology and are dys-regulated in many tumors. Colon Cancer Associated Transcript -1 (CCAT1) is a lncRNA, previously shown to be significantly up-regulated in colon cancer. The aim of this study is to determine expression levels of CCAT1 in gastric carcinoma (GC). Methods: Tissue samples were obtained from patients undergoing resection for gastric carcinoma (n=19). For each patient, tumor tissue and normal appearing gastric mucosa were taken. Normal gastric tissues obtained from morbidly obese patients, undergoing laparoscopic sleeve gastrectomy served as normal controls (n=19). A human gastric carcinoma cell line (AGS) served as positive control. RNA was extracted from all tissue samples and CCAT1 expression was analyzed using quantitative real time-PCR (qRT-PCR). Results: Low expression of CCAT1 was identified in normal gastric mucosa samples obtained from morbidly obese patients [mean Relative Quantity (RQ) = 1.95±0.4]. AGS human gastric carcinoma cell line showed an elevated level of CCAT1 expression (RQ=8.02). Expression levels of CCAT1 were approximately 10.8 fold higher in GC samples than in samples taken from the negative control group (RQ=21.1±5 vs. RQ=1.95±0.4, respectively, p<0.001). Interestingly, CCAT1 expression was significantly overexpressed in adjacent normal tissues when compared to the negative control group (RQ = 15.25±2 vs. RQ=1.95±0.4, respectively, p<0.001). Tissues obtained from recurrent GC cases showed the highest expression levels (RQ = 88.8±31; p<0.001). Expression levels increased with tumor stage (T4- 36.4±15, T3- 16.1±6, T2- 4.7±1), however this did not reach statistical significance (p=0.2). There was no difference in CCAT1 expression between intestinal and diffuse type GC (RQ=22.4±7 vs. 22.4±16, respectively, p=0.9). Within the normal gastric tissue samples, no significant difference in CCAT1 expression was observed in helicobacter pylori negative and positive patients (RQ= 2.4±0.9 vs. 0.93±0.2, respectively, p=0.13). Conclusion: CCAT1 is up-regulated in gastric cancer, and may serve as a potential bio-marker for early detection and surveillance. PMID:25561974

Study on Site Conditions Based on Topographic Slope

NASA Astrophysics Data System (ADS)

Wu, X.; Wang, X.; Yuan, X.; Chen, M.; Dou, A.

2018-04-01

The travel-time averaged shear-wave velocity to a depth of 30m (Vs30) below the Earth's surface is widely used to classify sites in many building codes. Vs30 is also used to estimate site classification in recent ground-motion prediction equations (GMPEs), and the distribution of Vs30 has been mapped in a region or country. An alternative method has recently been proposed for evaluating global seismic site conditions or Vs30, from the SRTM (Shuttle Radar Topography Mission) DEMs (digital elevation models). The basic premise of the method is that the topographic slope can be used as a reliable proxy for Vs30 in the absence of geologically and geotechnically based site-condition maps through correlations between Vs30 measurements and topographic gradient. Here, we use different resolutions (3 arcsec, 30 arcsec) DEM data to get Vs30 data separately, analyze and compare the difference of Vs30 data and site conditions obtained from different resolution DEM data. Shandong Province in eastern China and Sichuan Province in Western China are studied respectively. It is found that the higher resolution data is better at defining spatial topographic features than the 30c data, but less improvement in its correlation with Vs30.

Palonosetron versus other 5-HT₃ receptor antagonists for prevention of chemotherapy-induced nausea and vomiting in patients with hematologic malignancies treated with emetogenic chemotherapy in a hospital outpatient setting in the United States.

PubMed

Craver, Chris; Gayle, Julie; Balu, Sanjeev; Buchner, Deborah

2011-01-01

This study evaluated the rate of uncontrolled chemotherapy-induced nausea and vomiting (CINV) after initiating antiemetic prophylaxis with palonosetron versus other 5-HT₃ receptor antagonists (RAs) in patients diagnosed with hematologic malignancies (lymphoma and leukemia) and receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC) in a hospital outpatient setting. Patients aged ≥ 18 years and diagnosed with hematologic malignancies initiating HEC or MEC and antiemetic prophylaxis with palonosetron (Group 1) and other 5-HT₃ RAs (Group 2) for the first time in a hospital outpatient setting between 4/1/2007 and 3/31/2009 were identified from the Premier Perspective Database. Within each cycle, CINV events were identified (in the hospital outpatient, inpatient, and emergency room settings) through ICD-9 codes for nausea, vomiting, and/or volume depletion (from each CT administration day 1 until the end of the CT cycle), or use of rescue medications (day 2 until the end of the CT cycle). Negative binomial distribution generalized linear multivariate regression model estimating the CINV event rate on CT, specific CT cycles, and cancer diagnosis (leukemia/lymphoma)-matched groups in the follow-up period (first of 8 cycles or 6 months) was developed. Of 971 identified patients, 211 initiated palonosetron (Group 1). Group 1 patients comprised of more females [50.2 vs. 41.4%; p = 0.0226], Whites [74.4 vs. 70.4%, and Hispanics [7.6 vs. 6.3%; all races p = 0.0105], received more HEC treatments [89.6 vs. 84.2%; all CT types p = 0.0129], and had more lymphoma diagnosed patients [89.6 vs. 76.3%; all cancer types p = 0.0033] at baseline. After controlling for differences in several demographic and clinical variables, the regression model predicted a 20.4% decrease in CINV event rate per CT cycle for Group 1 versus Group 2 patients. Study limitations include potential lack of generalizability, absence of data on certain confounders including alcohol consumption and prior history of motion sickness, potential underestimation of incidence of uncontrolled CINV, and inability to draw conclusions pertaining to cause and effect relationship. In this retrospective hospital study, patients with hematologic malignancies treated with HEC or MEC and initiated on antiemetic prophylaxis with palonosetron in the hospital outpatient setting were more likely to experience significantly lower CINV event rates (in the hospital outpatient, inpatient, and emergency room settings) versus patients initiated on other 5-HT₃ RAs.

Impact of the 80-hour workweek on surgical exposure and national in-training examination scores in an orthopedic residency program.

PubMed

Froelich, John; Milbrandt, Joseph C; Allan, D Gordon

2009-01-01

This study examines the impact of the 80-hour workweek on the number of surgical cases performed by PGY-2 through PGY-5 orthopedic residents. We also evaluated orthopedic in-training examination (OITE) scores during the same time period. Data were collected from the Accreditation Council for Graduate Medical Education (ACGME) national database for 3 academic years before and 5 years after July 1, 2003. CPT surgical procedure codes logged by all residents 3 years before and 5 years after implementation of the 80-hour workweek were compared. The average raw OITE scores for each class obtained during the same time period were also evaluated. Data were reported as the mean +/- standard deviation (SD), and group means were compared using independent t-tests. No statistical difference was noted in the number of surgical procedure codes logged before or after the institution of the 80-hour week during any single year of training. However, an increase in the number of CPT codes logged in the PGY-3 years after 2003 did approach significance (457.7 vs 551.9, p = 0.057). Overall, the average number of cases performed per resident increased each year after implementation of the work-hour restriction (464.4 vs 515.5 cases). No statistically significant difference was noted in the raw OITE scores before or after work-hour restrictions for our residents or nationally. We found no statistical difference for each residency class in the average number of cases performed or OITE scores, although the total number of cases performed has increased after implementation of the work-hour restrictions. We also found no statistical difference in the national OITE scores. Our data suggest that the impact of the 80-hour workweek has not had a detrimental effect on these 2 resident training measurements.

A combined paging alert and web-based instrument alters clinician behavior and shortens hospital length of stay in acute pancreatitis.

PubMed

Dimagno, Matthew J; Wamsteker, Erik-Jan; Rizk, Rafat S; Spaete, Joshua P; Gupta, Suraj; Sahay, Tanya; Costanzo, Jeffrey; Inadomi, John M; Napolitano, Lena M; Hyzy, Robert C; Desmond, Jeff S

2014-03-01

There are many published clinical guidelines for acute pancreatitis (AP). Implementation of these recommendations is variable. We hypothesized that a clinical decision support (CDS) tool would change clinician behavior and shorten hospital length of stay (LOS). Observational study, entitled, The AP Early Response (TAPER) Project. Tertiary center emergency department (ED) and hospital. Two consecutive samplings of patients having ICD-9 code (577.0) for AP were generated from the emergency department (ED) or hospital admissions. Diagnosis of AP was based on conventional Atlanta criteria. The Pre-TAPER-CDS-Tool group (5/30/06-6/22/07) had 110 patients presenting to the ED with AP per 976 ICD-9 (577.0) codes and the Post-TAPER-CDS-Tool group (5/30/06-6/22/07) had 113 per 907 ICD-9 codes (7/14/10-5/5/11). The TAPER-CDS-Tool, developed 12/2008-7/14/2010, is a combined early, automated paging-alert system, which text pages ED clinicians about a patient with AP and an intuitive web-based point-of-care instrument, consisting of seven early management recommendations. The pre- vs. post-TAPER-CDS-Tool groups had similar baseline characteristics. The post-TAPER-CDS-Tool group met two management goals more frequently than the pre-TAPER-CDS-Tool group: risk stratification (P<0.0001) and intravenous fluids >6L/1st 0-24 h (P=0.0003). Mean (s.d.) hospital LOS was significantly shorter in the post-TAPER-CDS-Tool group (4.6 (3.1) vs. 6.7 (7.0) days, P=0.0126). Multivariate analysis identified four independent variables for hospital LOS: the TAPER-CDS-Tool associated with shorter LOS (P=0.0049) and three variables associated with longer LOS: Japanese severity score (P=0.0361), persistent organ failure (P=0.0088), and local pancreatic complications (<0.0001). The TAPER-CDS-Tool is associated with changed clinician behavior and shortened hospital LOS, which has significant financial implications.

Sensemaking: Conceptualizing and Coding for “Good” Student Reasoning

NASA Astrophysics Data System (ADS)

Elby, Andrew; Scherr, R.; Bing, T.

2006-12-01

Physics instructors’ goals often go beyond improving students’ conceptual understanding and problem solving. Instructors also want students to engage in inquiry, become scientific/critical thinkers, understand the scientific process, and so on. We see two problems with these “non-content” goals. First, notions such as inquiry and scientific thinking are often defined vaguely or inconsistently across the literature. Second, even when like-minded instructors share a vision of what we’d love to see our students do, descriptions of that vision are often too squishy to communicate, debate, or assess: “We know it when we see it!” In this talk and poster, we address these problems by introducing sensemaking vs. answermaking, two mindsets with which students can approach physics. Our definitions of those notions benefit from a theoretical base, and our coding scheme for sensemaking vs. answermaking displays high interrater reliability and rests upon a list of specific indicators.

Trends in surgical management and pre-operative urodynamics in female medicare beneficiaries with mixed incontinence.

PubMed

Chughtai, Bilal; Hauser, Nicholas; Anger, Jennifer; Asfaw, Tirsit; Laor, Leanna; Mao, Jialin; Lee, Richard; Te, Alexis; Kaplan, Steven; Sedrakyan, Art

2017-02-01

We sought to examine the surgical trends and utilization of treatment for mixed urinary incontinence among female Medicare beneficiaries. Data was obtained from a 5% national random sample of outpatient and carrier claims from 2000 to 2011. Included were female patients 65 and older, diagnosed with mixed urinary incontinence, who underwent surgical treatment identified by Current Procedural Terminology, Fourth Edition (CPT-4) codes. Urodynamics (UDS) before initial and secondary procedure were also identified using CPT-4 codes. Procedural trends and utilization of UDS were analyzed. Utilization of UDS increased during the study period, from 38.4% to 74.0% prior to initial surgical intervention, and from 28.6% to 62.5% preceding re-intervention. Sling surgery (63.0%) and injectable bulking agents (28.0%) were the most common surgical treatments adopted, followed by sacral nerve stimulation (SNS) (4.8%) and Burch (4.0%) procedures. Re-intervention was performed in 4.0% of patients initially treated with sling procedures and 21.3% of patients treated with bulking agents, the majority of whom (51.7% and 76.3%, respectively) underwent injection of a bulking agent. Risk of re-intervention was not different among those who did or did not receive urodynamic tests prior to the initial procedure (8.5% vs. 9.3%) CONCLUSIONS: Sling and bulk agents are the most common treatment for MUI. Preoperative urodynamic testing was not related to risk of re-intervention following surgery for mixed urinary incontinence in this cohort. Neurourol. Urodynam. 36:422-425, 2017. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

(Re)engineering Earth System Models to Expose Greater Concurrency for Ultrascale Computing: Practice, Experience, and Musings

NASA Astrophysics Data System (ADS)

Mills, R. T.

2014-12-01

As the high performance computing (HPC) community pushes towards the exascale horizon, the importance and prevalence of fine-grained parallelism in new computer architectures is increasing. This is perhaps most apparent in the proliferation of so-called "accelerators" such as the Intel Xeon Phi or NVIDIA GPGPUs, but the trend also holds for CPUs, where serial performance has grown slowly and effective use of hardware threads and vector units are becoming increasingly important to realizing high performance. This has significant implications for weather, climate, and Earth system modeling codes, many of which display impressive scalability across MPI ranks but take relatively little advantage of threading and vector processing. In addition to increasing parallelism, next generation codes will also need to address increasingly deep hierarchies for data movement: NUMA/cache levels, on node vs. off node, local vs. wide neighborhoods on the interconnect, and even in the I/O system. We will discuss some approaches (grounded in experiences with the Intel Xeon Phi architecture) for restructuring Earth science codes to maximize concurrency across multiple levels (vectors, threads, MPI ranks), and also discuss some novel approaches for minimizing expensive data movement/communication.

Strong Effects of Vs30 Heterogeneity on Physics-Based Scenario Ground-Shaking Computations

NASA Astrophysics Data System (ADS)

Louie, J. N.; Pullammanappallil, S. K.

2014-12-01

Hazard mapping and building codes worldwide use the vertically time-averaged shear-wave velocity between the surface and 30 meters depth, Vs30, as one predictor of earthquake ground shaking. Intensive field campaigns a decade ago in Reno, Los Angeles, and Las Vegas measured urban Vs30 transects with 0.3-km spacing. The Clark County, Nevada, Parcel Map includes urban Las Vegas and comprises over 10,000 site measurements over 1500 km2, completed in 2010. All of these data demonstrate fractal spatial statistics, with a fractal dimension of 1.5-1.8 at scale lengths from 0.5 km to 50 km. Vs measurements in boreholes up to 400 m deep show very similar statistics at 1 m to 200 m lengths. When included in physics-based earthquake-scenario ground-shaking computations, the highly heterogeneous Vs30 maps exhibit unexpectedly strong influence. In sensitivity tests (image below), low-frequency computations at 0.1 Hz display amplifications (as well as de-amplifications) of 20% due solely to Vs30. In 0.5-1.0 Hz computations, the amplifications are a factor of two or more. At 0.5 Hz and higher frequencies the amplifications can be larger than what the 1-d Building Code equations would predict from the Vs30 variations. Vs30 heterogeneities at one location have strong influence on amplifications at other locations, stretching out in the predominant direction of wave propagation for that scenario. The sensitivity tests show that shaking and amplifications are highly scenario-dependent. Animations of computed ground motions and how they evolve with time suggest that the fractal Vs30 variance acts to trap wave energy and increases the duration of shaking. Validations of the computations against recorded ground motions, possible in Las Vegas Valley due to the measurements of the Clark County Parcel Map, show that ground motion levels and amplifications match, while recorded shaking has longer duration than computed shaking. Several mechanisms may explain the amplification and increased duration of shaking in the presence of heterogeneous spatial distributions of Vs: conservation of wave energy across velocity changes; geometric focusing of waves by low-velocity lenses; vertical resonance and trapping; horizontal resonance and trapping; and multiple conversion of P- to S-wave energy.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vogel, E.A.F.

A series of new tetranuclear molybdenum(II) nitrile cluster derivatives is reported. Improvements in the synthetic routes to these and other derivatives is also reported. The single crystal x-ray structure of Mo/sub 4/Cl/sub 12//sup 4/minus// is modeled. New tetrameric nitrile derivatives with the stoichiometry Mo/sub 4/Cl/sub 8/(RCN)/sub 4/ (R = Pr/sup n/, Pr/sup i/, Bu/sup t/, PhCH/sub 2/) have been isolated by ligand exchange from Mo/sub 4/Cl/sub 8/(EtCN)/sub 4/ and/or direct synthesis from Mo/sub 4/Cl/sub 8/(PBu/sup n/sub 3//)/sub 4/. Mo/sub 4/Cl/sub 8/(Pr/sup n/CN)/sub 4/ was synthesized with higher yields and with simpler reaction conditions than Mo/sub 4/Cl/sub 8/(EtCN)/sub 4/. Improved syntheticmore » routes for R/sub 4/Mo/sub 4/Cl/sub 12/ (R = Et/sub 4/N, Pr/sub 4/N) have been developed. (Et/sub 4/N)/sub 4/Mo/sub 4/Cl/sub 12/ can be directly synthesized from the phosphine tetramer, circumventing the preparation of the reactive species-Mo/sub 4/Cl/sub 8/(EtCN)/sub 4/, which is the most difficult precursor to prepare. A change in reaction solvent, from dichloromethane or dichloroethane to chlorobenzene, in the preparation of (Pr/sub 4/N)/sub 4/Mo/sub 4/Cl/sub 12/ has permitted its isolation under less rigorous conditions and in high yield. A single crystal structure determination has been done on a sample of (Ph/sub 4/P)/sub 4/Mo/sub 4/Cl/sub 12/. Although, the quality of the data is poor, the structure of the Mo/sub 4/Cl/sub 12/ cluster core was refined. Four complex types have been found to fit the data. 22 refs., 12 figs., 7 tabs.« less

A search for new CYP3A4 variants as determinants of tacrolimus dose requirements in renal-transplanted patients.

PubMed

Tavira, Beatriz; Coto, Eliecer; Diaz-Corte, Carmen; Alvarez, Victoria; López-Larrea, Carlos; Ortega, Francisco

2013-08-01

The CYP3A5*3 and CYP3A4*1B alleles have been related with tacrolimus (Tac) dose requirements. The rare CYP3A4*22 variant has also been associated with a significantly lower Tac dose. We genotyped the three single-nucleotide polymorphisms in 206 kidney-transplanted patients who received Tac as the primary immunosuppressor. CYP3A5*1 and CYP3A4*1B allele carriers received a significantly higher Tac dose (P<0.01) compared with wild-type homozygotes. We did not find significant differences between the CYP3A4*22 genotypes, either nominally or according to the CYP3A5 genotype (expressers vs. nonexpressers). Sequencing of CYP3A4 coding exons in a total of 15 patients revealed only one nonreported missense change (p.P227>T) in one patient. We concluded that CYP3A5*3 and CYP3A4*1B were the main determinants of the Tac dose-adjusted blood concentration in our cohort of renal-transplanted patients.

Expectation and Surprise Determine Neural Population Responses in the Ventral Visual Stream

PubMed Central

Egner, Tobias; Monti, Jim M.; Summerfield, Christopher

2014-01-01

Visual cortex is traditionally viewed as a hierarchy of neural feature detectors, with neural population responses being driven by bottom-up stimulus features. Conversely, “predictive coding” models propose that each stage of the visual hierarchy harbors two computationally distinct classes of processing unit: representational units that encode the conditional probability of a stimulus and provide predictions to the next lower level; and error units that encode the mismatch between predictions and bottom-up evidence, and forward prediction error to the next higher level. Predictive coding therefore suggests that neural population responses in category-selective visual regions, like the fusiform face area (FFA), reflect a summation of activity related to prediction (“face expectation”) and prediction error (“face surprise”), rather than a homogenous feature detection response. We tested the rival hypotheses of the feature detection and predictive coding models by collecting functional magnetic resonance imaging data from the FFA while independently varying both stimulus features (faces vs houses) and subjects’ perceptual expectations regarding those features (low vs medium vs high face expectation). The effects of stimulus and expectation factors interacted, whereby FFA activity elicited by face and house stimuli was indistinguishable under high face expectation and maximally differentiated under low face expectation. Using computational modeling, we show that these data can be explained by predictive coding but not by feature detection models, even when the latter are augmented with attentional mechanisms. Thus, population responses in the ventral visual stream appear to be determined by feature expectation and surprise rather than by stimulus features per se. PMID:21147999

Morbidity associated with 30-day surgical site infection following nonshunt pediatric neurosurgery

PubMed Central

Sherrod, Brandon A.; Rocque, Brandon G.

2017-01-01

Objective Morbidity associated with surgical site infection (SSI) following nonshunt pediatric neurosurgical procedures is poorly understood. The purpose of this study was to analyze acute morbidity and mortality associated with SSI after nonshunt pediatric neurosurgery using a nationwide cohort. Methods The authors reviewed data from the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) 2012–2014 database, including all neurosurgical procedures performed on pediatric patients. Procedures were categorized by Current Procedural Terminology (CPT) codes. CSF shunts were excluded. Deep and superficial SSIs occurring within 30 days of an index procedure were identified. Deep SSIs included deep wound infections, intracranial abscesses, meningitis, osteomyelitis, and ventriculitis. The following outcomes occurring within 30 days of an index procedure were analyzed, along with postoperative time to complication development: sepsis, wound disruption, length of postoperative stay, readmission, reoperation, and death. Results A total of 251 procedures associated with a 30-day SSI were identified (2.7% of 9296 procedures). Superficial SSIs were more common than deep SSIs (57.4% versus 42.6%). Deep SSIs occurred more frequently after epilepsy or intracranial tumor procedures. Superficial SSIs occurred more frequently after skin lesion, spine, Chiari decompression, craniofacial, and myelomeningocele closure procedures. The mean (± SD) postoperative length of stay for patients with any SSI was 9.6 ± 14.8 days (median 4 days). Post-SSI outcomes significantly associated with previous SSI included wound disruption (12.4%), sepsis (15.5%), readmission (36.7%), and reoperation (43.4%) (p < 0.001 for each). Post-SSI sepsis rates (6.3% vs 28.0% for superficial versus deep SSI, respectively; p < 0.001), wound disruption rates (4.9% vs 22.4%, p < 0.001), and reoperation rates (23.6% vs 70.1%, p < 0.001) were significantly greater for patients with deep SSIs. Postoperative length of stay in patients discharged before SSI development was not significantly different for deep versus superficial SSI (4.2 ± 2.7 vs 3.6 ± 2.4 days, p = 0.094). No patient with SSI died within the first 30 days after surgery. Conclusions Thirty-day SSI is associated with significant 30-day morbidity in pediatric patients undergoing nonshunt neurosurgery. Rates of SSI-associated complications are significantly lower in patients with superficial infection than in those with deep infection. There were no cases of SSI-related mortality within 30 days of the index procedure. PMID:28186474

1DTempPro V2: new features for inferring groundwater/surface-water exchange

USGS Publications Warehouse

Koch, Franklin W.; Voytek, Emily B.; Day-Lewis, Frederick D.; Healy, Richard W.; Briggs, Martin A.; Lane, John W.; Werkema, Dale D.

2016-01-01

A new version of the computer program 1DTempPro extends the original code to include new capabilities for (1) automated parameter estimation, (2) layer heterogeneity, and (3) time-varying specific discharge. The code serves as an interface to the U.S. Geological Survey model VS2DH and supports analysis of vertical one-dimensional temperature profiles under saturated flow conditions to assess groundwater/surface-water exchange and estimate hydraulic conductivity for cases where hydraulic head is known.

Naval Weapons Center Plume Radar Frequency Interference Code

DTIC Science & Technology

1982-10-01

ppm sodium. Both equilibrium and finite rate chemistry during the expansion from the chamber were tried as initial conditions for the plume. In...was too large. The difference between the.e two sets of initial conditions diminished downstream as the chemistry in the plume mixing region began to...Rerkirre Arvliral I Comirlnrnde!- ir.C h ic 1. tVS. Pacific Hice ((Code 3251 1 Corimu tinde r. ’n, r-d I leer. Pearl I atar I Coimniaide r. Sevent

Clinical events in a large prospective cohort of children with sickle cell disease in Nagpur, India: evidence against a milder clinical phenotype in India.

PubMed

Jain, Dipty; Arjunan, Aishwarya; Sarathi, Vijaya; Jain, Harshwardhan; Bhandarwar, Amol; Vuga, Marike; Krishnamurti, Lakshmanan

2016-10-01

The clinical phenotype of sickle cell disease (SCD) has been reported to be milder in India than in the United States. The objective of this large single-center study was to examine the rate of complications to define the phenotype of SCD in India. The rate of complications per 100 person-years in 833 pediatric SCD patients for 1954 person-years in Nagpur, India including those diagnosed on newborn screen (NBS) and those presenting later in childhood (non-NBS) was compared to those reported in the cooperative study of sickle cell disease (CSSCD). Event rates were also compared between patients belonging to scheduled castes (SCs), scheduled tribes (STs), and other backward classes (OBC). Comparison of CSSCD versus Nagpur NBS versus Nagpur non-NBS for rates of pain (32.4 vs. 85.2 vs. 62.4), severe anemia (7.1 vs. 27 vs. 6.6), stroke (0.7 vs. 0.8 vs. 1.4), splenic sequestration (3.4 vs. 6.7 vs. 1.6), acute chest syndrome (24.5 vs. 23.6 vs. 1.0), and meningitis (0.8 vs. 0 vs. 0.1) revealed more frequent complications in Nagpur compared to CSSCD. Comparison of ST, SC, and OBC for rates of pain (84.6 vs. 71.9 vs. 63.5), acute chest syndrome (3.6 vs. 2.8 vs. 2.2), severe anemia (5.4 vs. 9.5 vs. 11.4), stroke (1.2 vs. 0.4 vs. 0.3), splenic sequestration (0.6 vs. 2.4 vs. 1.9), and meningitis (0.8 vs. 0 vs. 0.1) revealed significantly more frequent complications among ST. SCD-related complications are more frequent in Indian children than that observed in CSSCD. Further study is indicated to define SCD phenotype in India. © 2016 Wiley Periodicals, Inc.

Research Misconduct Definitions Adopted by U.S. Research Institutions

PubMed Central

Resnik, David B.; Neal, Talicia; Raymond, Austin; Kissling, Grace E.

2014-01-01

In 2000, the US federal government adopted a uniform definition of research misconduct as fabrication, falsification, or plagiarism (FFP), which became effective in 2001. Institutions must apply this definition of misconduct to federally-funded research to receive funding. While institutions are free to adopt definitions of misconduct that go beyond the federal standard, it is not known how may do. We analyzed misconduct policies from 183 US research institutions and coded them according to thirteen different types of behavior mentioned in the misconduct definition. We also obtained data on the institution’s total research funding and public vs. private status, and the year it adopted the definition. We found that more than half (59%) of the institutions in our sample had misconduct policies that went beyond the federal standard. Other than FFP, the most common behaviors included in definitions were “other serious deviations” (45.4%), “significant or material violations of regulations” (23.0%), “misuse of confidential information” (15.8%), “misconduct related to misconduct” (14.8%), “unethical authorship other than plagiarism” (14.2%), “other deception involving data manipulation” (13.1%), and “misappropriation of property/theft” (10.4%). Significantly more definitions adopted in 2001 or later went beyond the federal standard than those adopted before 2001 (73.2% vs. 26.8%), and significantly more definitions adopted by institutions in the lower quartile of total research funding went beyond the federal standard than those adopted by institutions in the upper quartiles. Public vs. private status was not significantly associated with going beyond the federal standard. PMID:25275621

Effectiveness of a Model Bundle Payment Initiative for Femur Fracture Patients.

PubMed

Lott, Ariana; Belayneh, Rebekah; Haglin, Jack; Konda, Sanjit; Egol, Kenneth A

2018-05-28

Analyze the effectiveness of a BPCI (Bundle Payments for Care Improvement) initiative for patients who would be included in a future potential Surgical Hip and Femur Fracture Treatment (SHFFT) bundle. Retrospective cohort SETTING:: Single Academic Institution PATIENTS/PARTICIPANTS:: Patients discharged with operative fixation of a hip or femur fracture (DRG codes 480-482) between 1/2015-10/2016 were included. A BPCI initiative based upon an established program for BPCI Total Joint Arthroplasty (TJA) was initiated for patients with hip and femur fractures in January 2016. Patients were divided into non-bundle (care before initiative) and bundle (care with initiative) cohorts. Application of BPCI principles MAIN OUTCOME MEASURES:: Length of stay, location of discharge, readmissions RESULTS:: 116 patients participated in the "institutional bundle," and 126 received care prior to the initiative. There was a trend towards decreased mean length of stay, (7.3 ± 6.3 days vs. 6.8 ± 4.0 days, p=0.457) and decreased readmission within 90 days (22.2% vs. 18.1%, p=0.426). The number of patients discharged home doubled (30.2% vs. 14.3%, p=0.008). There was no difference in readmission rates in bundle vs. non-bundle patients based on discharged home status; however, bundle patients discharged to SNF trended towards less readmissions than non-bundle patients discharged to SNF (37.3% vs. 50.6%, p=0.402). Mean episode cost reduction due to initiative was estimated to be $6,450 using Medicare reimbursement data. This study demonstrates the potential success of a BPCI initiative at one institution in decreasing post-acute care facility utilization and cost of care when used for a hip and femur fracture population. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Pediatric hospitalizations for inflammatory bowel disease based on annual case volume: results from the Kids' Inpatient Database 2012.

PubMed

Pant, Chaitanya; Deshpande, Abhishek; Sferra, Thomas J; Almadhoun, Osama; Batista, Daisy; Pervez, Asad; Nutalapati, Venkat; Olyaee, Mojtaba

2017-01-01

To study differences related to pediatric inflammatory bowel disease (IBD) care among hospitals that were stratified based on annual case volume. This is a cross-sectional study using data from the United States Healthcare Cost and Utilization Project Kids' Inpatient Database (KID). IBD-related hospitalizations were identified using International Classification of Diseases-9-Clinical Modification codes. Hospital volume was divided into low or high by assigning cut-off values of 1-20 and >20 annual IBD hospitalizations. We assessed a total of 8647 pediatric IBD discharges during 2012 from 660 hospitals in the USA. 107 of these hospitals were classified as high-volume centers (HVCs) for pediatric IBD care and 553 low-volume centers (LVCs). HVCs were more likely to be associated with an academic teaching status compared to LVCs (97.1% vs 67.6%, p<0.001). The incidence of transfer of medical care from LVCs to other hospitals was 5.5% but only 0.7% for HVCs (p<0.001). The median number of procedures (medical and surgical) performed on children admitted with IBD was higher at HVCs (2 vs 1, p<0.001). IBD admissions at HVCs were more likely to undergo surgical procedures compared to LVCs (17% vs 10%, p<0.001). The incidence of postoperative complications was not significantly different. There were significantly greater hospital costs (median US$11,000 vs US$6,000, p<0.001) and lengths of stay (median 5 days vs 4 days, p<0.001) associated with HVCs compared to LVCs. Pediatric admissions to HVCs for IBD undergo a greater number of medical and surgical procedures and are associated with higher costs and lengthier hospital stays. Copyright © 2016 American Federation for Medical Research.

Cervical spine injuries and helmet laws: a population-based study.

PubMed

Dao, Haisar; Lee, Justin; Kermani, Reza; Minshall, Christian; Eriksson, Evert A; Gross, Ronald; Doben, Andrew R

2012-03-01

To assess the incidence of cervical spine (C-spine) injuries in patients admitted after motorcycle crash in states with mandatory helmet laws (MHL) compared with states without helmet laws or selective helmet laws. The Nationwide Inpatient Sample from the Healthcare and Utilization Project for the year 2008 was analyzed. International Classification of Diseases and Health Related Problems, Ninth Edition codes were used to identify patients with a diagnosis of motorcycle crash and C-spine injuries. National estimates were generated based on weighted analysis of the data. Outcome variables investigated were as follows: length of stay (LOS), in-hospital mortality, hospital teaching status, and discharge disposition. States were then stratified into states with MHL or selective helmet laws. A total of 30,117 discharges were identified. Of these, 2,041 (6.7%) patients had a C-spine injury. Patients in MHL states had a lower incidence of C-spine injuries (5.6 vs. 6.4%; p = 0.003) and less in-hospital mortality (1.8 vs. 2.6%; p = 0.0001). Patients older than 55 years were less likely to be discharged home (57.5% vs. 72.5%; p = 0.0001), more likely to die in-hospital (3.0% vs. 2.1%; p = 0.0001), and more likely to have a hospital LOS more than 21 days (7.7% vs. 6.2%; p = 0.0001). Patients admitted to the hospital in states with MHLs have decreased rate of C-spine injuries than those patients admitted in states with more flexible helmet laws. Patients older than 55 years are more likely to die in the hospital, have a prolonged LOS, and require services after discharge. III.

Unmet Needs of African Americans and Whites at the Time of Palliative Care Consultation.

PubMed

Kamal, Arif H; Bull, Janet; Wolf, Steven P; Portman, Diane; Strand, Jacob; Johnson, Kimberly S

2017-06-01

Differences among patient populations that present to consultative palliative care are not known. Such an appreciation would inform health-care delivery tailored to unique populations. We aimed to compare characteristics and palliative care needs of African Americans (AAs) and whites during initial palliative care consultation. We analyzed patient-reported, clinician-entered clinical encounter data from a large, multisite community-based, nonhospice palliative care collaborative. We included first specialty palliative care consultations from January 1, 2014, to July 2, 2015, across 15 sites within the Global Palliative Care Quality Alliance registry. Demographics, disease, performance status, advance care planning, and symptom prevalence/severity were compared. Of 775 patients, 12.9% (N = 100) were AA. African Americans were younger (63 vs 75.4 years, P < .0001). A larger proportion of AAs had a diagnosis of cancer (45.0% vs 36.3%, P = .09) and in the hospital (71% vs 61.8%, P = .07). African Americans were more likely to have a Palliative Performance Score of 0 to 30 (35.6% vs 23.7%, P = .049). Around 50% in both racial groups were full code; slightly more than 40% had an advance directive. Nearly two-thirds in both racial groups reported 3 or more symptoms of any severity; one-third reported 3 or more moderate or severe symptoms. A larger proportion of Africans than whites reported pain of any severity (66.0% vs 56.1%, P = .06). All patients present to palliative care consultations with significant symptom and advance care planning needs. Further research is needed to identify how to deliver palliative care: earlier, in noncancer conditions, and improve pain management in AA populations.

Frequency and complications after operative fixation of clavicular fractures.

PubMed

Navarro, Ronald A; Gelber, Jonathan D; Harrast, John J; Seiler, John G; Jackson, Kent R; Garcia, Ivan A

2016-05-01

The purpose of this study was to analyze whether a recent trend in evidence supporting operative treatment of clavicular fractures is matched with an increase in operative fixation and complication rates in the United States. The American Board of Orthopaedic Surgery database was reviewed for cases with Current Procedural Terminology (American Medical Association, Chicago, IL, USA) code 23515 (clavicle open reduction internal fixation [ORIF]) from 1999 to 2010. The procedure rate for each year and the number of procedures for each candidate performing clavicle ORIF were calculated to determine if a change had occurred in the frequency of ORIF for clavicular fractures. Complication and outcome data were also reviewed. In 2010 vs, 1999, there were statistically significant increases in the mean number of clavicle ORIF performed among all candidates (0.89 vs. 0.13; P < .0001) and in the mean number of clavicle ORIF per candidate performing clavicle ORIF (2.47 vs. 1.20, P < .0473). The difference in the percentage of part II candidates performing clavicle ORIF from the start to the end of the study (11% vs. 36%) was significant (P < .0001). There was a significant increase in the clavicle ORIF percentage of total cases (0.11% vs. 0.74%, P < .0001). The most common complication was hardware failure (4%). The rate of ORIF of clavicular fractures has increased in candidates taking part II of the American Board of Orthopaedic Surgery, with a low complication rate. The increase in operative fixation during this interval may have been influenced by literature suggesting improved outcomes in patients treated with operative stabilization of their clavicular fracture. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Upper-gastrointestinal bleeding secondary to peptic ulcer disease: incidence and outcomes.

PubMed

Quan, Samuel; Frolkis, Alexandra; Milne, Kaylee; Molodecky, Natalie; Yang, Hong; Dixon, Elijah; Ball, Chad G; Myers, Robert P; Ghosh, Subrata; Hilsden, Robert; van Zanten, Sander Veldhuyzen; Kaplan, Gilaad G

2014-12-14

To evaluate the incidence, surgery, mortality, and readmission of upper gastrointestinal bleeding (UGIB) secondary to peptic ulcer disease (PUD). Administrative databases identified all hospitalizations for UGIB secondary to PUD in Alberta, Canada from 2004 to 2010 (n = 7079) using the International Classification of Diseases Codes (ICD-10). A subset of the data was validated using endoscopy reports. Positive predictive value and sensitivity with 95% confidence intervals (CI) were calculated. Incidence of UGIB secondary to PUD was calculated. Logistic regression was used to evaluate surgery, in-hospital mortality, and 30-d readmission to hospital with recurrent UGIB secondary to PUD. Co-variants accounted for in our logistic regression model included: age, sex, area of residence (i.e., urban vs rural), number of Charlson comorbidities, presence of perforated PUD, undergoing upper endoscopy, year of admission, and interventional radiological attempt at controlling bleeding. A subgroup analysis (n = 6356) compared outcomes of patients with gastric ulcers to those with duodenal ulcers. Adjusted estimates are presented as odds ratios (OR) with 95%CI. The positive predictive value and sensitivity of ICD-10 coding for UGIB secondary to PUD were 85.2% (95%CI: 80.2%-90.2%) and 77.1% (95%CI: 69.1%-85.2%), respectively. The annual incidence between 2004 and 2010 ranged from 35.4 to 41.2 per 100000. Overall risk of surgery, in-hospital mortality, and 30-d readmission to hospital for UGIB secondary to PUD were 4.3%, 8.5%, and 4.7%, respectively. Interventional radiology to control bleeding was performed in 0.6% of patients and 76% of these patients avoided surgical intervention. Thirty-day readmission significantly increased from 3.1% in 2004 to 5.2% in 2010 (OR = 1.07; 95%CI: 1.01-1.14). Rural residents (OR rural vs urban: 2.35; 95%CI: 1.83-3.01) and older individuals (OR ≥ 65 vs < 65: 1.57; 95%CI: 1.21-2.04) were at higher odds of being readmitted to hospital. Patients with duodenal ulcers had higher odds of dying (OR = 1.27; 95%CI: 1.05-1.53), requiring surgery (OR = 1.73; 95%CI: 1.34-2.23), and being readmitted to hospital (OR = 1.54; 95%CI: 1.19-1.99) when compared to gastric ulcers. UGIB secondary to PUD, particularly duodenal ulcers, was associated with significant morbidity and mortality. Early readmissions increased over time and occurred more commonly in rural areas.

An integrative review of absenteeism in newly graduated nurses.

PubMed

Craft, Judy; Christensen, Martin; Wirihana, Lisa; Bakon, Shannon; Barr, Jennie; Tsai, Lily

2017-10-30

Managing sickness and absenteeism in the workplace is challenging, and nurse managers must consider their various causes so they can implement effective management strategies. It is also vital to consider the factors that influence absenteeism and turnover among newly graduated registered nurses (RNs), whose retention can help to address staff shortages. This article describes a literature review that aimed to identify the potential causes of sickness absence in newly graduated RNs. It also discusses strategies that nurse managers can use to retain and maintain their workforce. ©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Efficient Use of AUVs in the Maritime Environment

NASA Astrophysics Data System (ADS)

Slămnoiu, G.; Radu, O.; Roşca, V.; Pascu, C.; Surdu, G.; Curcă, E.; Damian, R. G.; Rădulescu, A.

2017-06-01

Autonomous underwater vehicle (AUV) a.k.a. underwater drones are subsea vehicles which operate in the underwater environment independently of direct human input. There is a growing interest in underwater data collection by using autonomous underwater vehicles within the oceanographic research community. In this paper, the Iver 2 AUV is examined to accomplish accurate side-scan data while executing well planned missions. Therefore, this papers goal is to establish the optimal use conditions for the AUV that RCN has so that we maximize the detection probability of sea bottom objects that can be risk factors and at the same time to cover a surface as large as possible during a single mission.

Collaborative communication: learning from advanced clinical practice patient consultations.

PubMed

Barratt, Julian

2018-04-28

Advanced nurse practitioners, and nurses aspiring to this role, are required to understand how to communicate effectively and on a collaborative basis with patients and carers during consultations, with the aim of enhancing patient outcomes such as improved patient satisfaction, ability to self-manage healthcare needs and adherence to care plans. This article explores collaborative communication in consultations and how best to achieve this, using the author's doctoral observational research based on the findings of a mixed methods observational study of communication in advanced clinical practice patient consultations. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Macro-microangiopathy and endothelial dysfunction in NIDDM patients with and without diabetic nephropathy.

PubMed

Parving, H H; Nielsen, F S; Bang, L E; Smidt, U M; Svendsen, T L; Chen, J W; Gall, M A; Rossing, P

1996-12-01

The Steno hypothesis suggests that albuminuria reflects widespread vascular damage (proliferative retinopathy and severe macroangiopathy) due to a generalized vascular (endothelial) dysfunction. We assessed this concept in NIDDM (non-insulin-dependent diabetic) patients with (13 female/ 39 male, age 60 +/- 7 years, group 1) and without (12 female /41 male, age 61 +/- 7 years, group 2) diabetic nephropathy compared to matched non-diabetic subjects (7 female/15 male, age 58 +/- 8 years, group 3). A 12-lead ECG was recorded and coded blindly using the Minnesota Rating Scale; the World Health Organization cardiovascular questionnaire was used to assess past and present evidence of myocardial infarction, angina pectoris, stroke, and peripheral vascular disease (digital systolic blood pressure determination). The degree of diabetic retinopathy was scored from fundus photography. The following variables were measured: transcapillary escape rate of albumin (initial disappearance of intravenously injected 125I-labelled human serum albumin), plasma concentrations of prorenin (radioimmunoassay) and serum concentrations of von Willebrand factor (enzyme-linked immunoadsorbent assay). Prevalence of ischaemic heart disease (ECG reading) (49/20/5)% and peripheral vascular disease as indicated by reduced systolic blood pressure on big toe (69/30/ 14)% was significantly higher in group 1 vs group 2 (p < 0.01) and in group 2 vs group 3 (p < 0.01), respectively. The prevalence and severity of retinopathy was higher in group 1 vs 2 (p < 0.01). Transcapillary escape rate of albumin (%/h) was elevated in group 1 and 2 as compared to control subjects: 7.9 (4.3-13.7); 7.4 (3.7-16.4) vs 6.0 (3.4-8.7), (p < 0.005), respectively. Plasma prorenin activity (IU/ml) was raised in group 1 and group 2 as compared to group 3: 272 (59-2405); 192 (18-813), and 85 (28-246), p < 0.001, respectively. Serum von Willebrand factor (IU/ ml) was elevated in group 1 as compared to group 2 and 3: 2.07 (0.83-4.34); 1.60 (0.30-2.99) and 1.50 (1.00-2.38), p < 0.001, respectively. Our study demonstrated that NIDDM patients with and without albuminuria had increased transcapillary escape of albumin and raised prorenin activity, whereas only those with albuminuria had increased von Willebrand factor. Patients with NIDDM may have abnormal endothelial function in the absence of albuminuria.

Risk of Injury Associated With Attention-Deficit/Hyperactivity Disorder in Adults Enrolled in Employer-Sponsored Health Plans: A Retrospective Analysis

PubMed Central

Montejano, Leslie; Sasané, Rahul; Huse, Dan

2011-01-01

Objective: Attention-deficit/hyperactivity disorder (ADHD) is linked to an increased risk of injury in children. This retrospective analysis evaluated the risk and type of injury associated with ADHD in adults. Method: Data were taken from the MarketScan databases, which provide details of health care claims and productivity data for individuals and their dependents with access to employer-sponsored health plans. Adults (aged 18–64 years) with ≥ 2 ADHD-related diagnostic claims (using ICD-9-CM codes) between 2002 and 2007 and evidence of ADHD treatment in 2006 (n = 31,752) were matched to controls without ADHD (1:3; n = 95,256) or individuals with a depression diagnosis (using ICD-9-CM codes; 1:1; n = 29,965). Injury claims were compared between cohorts, and multivariate analyses controlled for differences that remained after matching. Results: Injury claims were more common in individuals with ADHD than in non-ADHD controls (21.5% vs 15.7%; P < .0001) or individuals with depression (21.4% vs 20.5%; P = .008). Multivariate analyses indicated that the relative risk of injury claims was higher in individuals with ADHD than in the non-ADHD control (odds ratio [OR] = 1.32; 95% CI, 1.27–1.37; P < .01) and depression (OR = 1.13; 95% CI, 1.07–1.18; P < .01) groups. Injury claims increased total direct health care expenditure; total expenditures for ADHD patients with injuries were $6,482 compared with $3,722 for ADHD patients without injuries (P < .0001). Comparison of injury-related costs were similar between ADHD patients and non-ADHD controls ($1,109 vs $1,041, respectively), but higher for depression patients than for ADHD patients ($1,792 vs $1,084; P < .01). Injury claim was also associated with increased short-term disability expenditures, as ADHD patients with injury incurred higher mean cost than those without injury ($1,303 vs $620; P = .0001), but lower than those with injury in the depression cohort (vs $2,152; P = .0099) Conclusions: Adults with ADHD were more likely to incur injury claims than non-ADHD controls or adults with depression in this sample selected on the basis of claims data rather than clinical referrals. Most injuries were relatively minor; however, individuals with injuries incurred higher total direct health care costs than those without injuries. Furthermore, the ratio of indirect costs due to workplace absence to direct health care costs was higher for adults with ADHD than for adults with depression, demonstrating not only the impact of ADHD in the workplace, but also the importance of accounting for productivity data in calculating the true economic burden of ADHD in adults. PMID:21977357

Rare coding variation in paraoxonase-1 is associated with ischemic stroke in the NHLBI Exome Sequencing Project[S

PubMed Central

Kim, Daniel Seung; Crosslin, David R.; Auer, Paul L.; Suzuki, Stephanie M.; Marsillach, Judit; Burt, Amber A.; Gordon, Adam S.; Meschia, James F.; Nalls, Mike A.; Worrall, Bradford B.; Longstreth, W. T.; Gottesman, Rebecca F.; Furlong, Clement E.; Peters, Ulrike; Rich, Stephen S.; Nickerson, Deborah A.; Jarvik, Gail P.

2014-01-01

HDL-associated paraoxonase-1 (PON1) is an enzyme whose activity is associated with cerebrovascular disease. Common PON1 genetic variants have not been consistently associated with cerebrovascular disease. Rare coding variation that likely alters PON1 enzyme function may be more strongly associated with stroke. The National Heart, Lung, and Blood Institute Exome Sequencing Project sequenced the coding regions (exomes) of the genome for heart, lung, and blood-related phenotypes (including ischemic stroke). In this sample of 4,204 unrelated participants, 496 had verified, noncardioembolic ischemic stroke. After filtering, 28 nonsynonymous PON1 variants were identified. Analysis with the sequence kernel association test, adjusted for covariates, identified significant associations between PON1 variants and ischemic stroke (P = 3.01 × 10−3). Stratified analyses demonstrated a stronger association of PON1 variants with ischemic stroke in African ancestry (AA) participants (P = 5.03 × 10−3). Ethnic differences in the association between PON1 variants with stroke could be due to the effects of PON1Val109Ile (overall P = 7.88 × 10−3; AA P = 6.52 × 10−4), found at higher frequency in AA participants (1.16% vs. 0.02%) and whose protein is less stable than the common allele. In summary, rare genetic variation in PON1 was associated with ischemic stroke, with stronger associations identified in those of AA. Increased focus on PON1 enzyme function and its role in cerebrovascular disease is warranted. PMID:24711634

VS{sub 2}/rGO hybrid nanosheets prepared by annealing of VS{sub 4}/rGO

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mohan, Pandurangan; Yang, Jieun; Jena, Anirudha

Layered transition metal dichalcogenides and their hybrids with reduced grpahene oxide (rGO) have attracted much interest due to many potential applications for electrode materials in Li ion batteries and supercapacitors and electro-catalysts for hydrogen evolution reaction. Among them, synthesis of VS{sub 2} sheets and VS{sub 4}/rGO hybrid via a hydrothermal reaction was recently reported, whereas VS{sub 2}/rGO hybrid sheets have not been reported. In this study, we report VS{sub 2}/rGO hybrid sheets after annealing VS{sub 4}/rGO hybrid materials at 350 °C. The conversion of VS{sub 4} to VS{sub 2} on rGO sheets after annealing is attributed to a thermal cleavagemore » of VS{sub 4}. - Highlights: • VS2/rGO hybrid sheets were obtained by annealing of VS4/rGO at 350 °C. • The phase transition from monoclinic to hexagonal is occurred. • The HER performance of VS2/rGO is investigated.« less

A novel urinary long non-coding RNA transcript improves diagnostic accuracy in patients undergoing prostate biopsy.

PubMed

Zhang, Wei; Ren, Shan-Cheng; Shi, Xiao-Lei; Liu, Ya-Wei; Zhu, Ya-Sheng; Jing, Tai-Le; Wang, Fu-Bo; Chen, Rui; Xu, Chuan-Liang; Wang, Hui-Qing; Wang, Hai-Feng; Wang, Yan; Liu, Bing; Li, Yao-Ming; Fang, Zi-Yu; Guo, Fei; Lu, Xin; Shen, Dan; Gao, Xu; Hou, Jian-Guo; Sun, Ying-Hao

2015-05-01

Long non-coding RNA (LncRNA) PCA3 has been a well-established urine biomarker for the detection of prostate cancer (PCa). Our previous study showed a novel LncRNA FR0348383 is up-regulated in over 70% of PCa compared with matched benign tissues. The aim of this study was to evaluate the diagnostic value of urinary FR0348383 for men undergoing prostate biopsy due to elevated PSA (PSA > 4.0 ng/ml) and/or abnormal digital rectal examination (DRE). Post-DRE first-catch urine specimens prior to prostate biopsies were prospectively collected. After the whole transcriptome amplification, quantitative real time polymerase chain reaction was applied to quantify urine FR0348383 and PSA levels. The FR0348383 score was calculated as the ratio of PSA and FR0348383 mRNA (PSA mRNA/FR0348383 mRNA × 1000). The diagnostic value of FR0348383 score was evaluated by logistic regression and decision curve analysis. 213 cases with urine samples containing sufficient mRNA were included, 94 cases had serum PSA level 4.0-10.0 ng/ml. PCa was identified in 72 cases. An increasing FR0348383 score was correlated with an increasing probability of a positive biopsy (P < 0.001). Multivariable logistic analysis indicated FR0348383 score (P < 0.001), PSA (P = 0.004), age (P = 0.007), prostate volume (P < 0.001) were independent predictors of PCa. ROC analysis demonstrated FR0348383 score outperformed PSA, %free PSA, and PSA Density in the prediction of PCa in the subgroup of patients with grey area PSA (AUC: 0.815 vs. 0.562 vs. 0.599 vs. 0.645). When using a probability threshold of 30% in the grey zone cohort, The FR0348383 score would save 52.0% of avoidable biopsies without missing any high grade cancers. FR0348383 transcript in post-DRE urine may be a novel biomarker for detection of PCa with great diagnostic value, especially in the grey zone cohort. The application of FR0348383 score in clinical practice might avoid unnecessary prostate biopsies and increase the specificity of PCa diagnosis. © 2015 Wiley Periodicals, Inc.

Validation of fragility fractures in primary care electronic medical records: A population-based study.

PubMed

Martinez-Laguna, Daniel; Soria-Castro, Alberto; Carbonell-Abella, Cristina; Orozco-López, Pilar; Estrada-Laza, Pilar; Nogues, Xavier; Díez-Perez, Adolfo; Prieto-Alhambra, Daniel

2017-11-28

Electronic medical records databases use pre-specified lists of diagnostic codes to identify fractures. These codes, however, are not specific enough to disentangle traumatic from fragility-related fractures. We report on the proportion of fragility fractures identified in a random sample of coded fractures in SIDIAP. Patients≥50 years old with any fracture recorded in 2012 (as per pre-specified ICD-10 codes) and alive at the time of recruitment were eligible for this retrospective observational study in 6 primary care centres contributing to the SIDIAP database (www.sidiap.org). Those with previous fracture/s, non-responders, and those with dementia or a serious psychiatric disease were excluded. Data on fracture type (traumatic vs fragility), skeletal site, and basic patient characteristics were collected. Of 491/616 (79.7%) patients with a registered fracture in 2012 who were contacted, 331 (349 fractures) were included. The most common fractures were forearm (82), ribs (38), and humerus (32), and 225/349 (64.5%) were fragility fractures, with higher proportions for classic osteoporotic sites: hip, 91.7%; spine, 87.7%; and major fractures, 80.5%. This proportion was higher in women, the elderly, and patients with a previously coded diagnosis of osteoporosis. More than 4 in 5 major fractures recorded in SIDIAP are due to fragility (non-traumatic), with higher proportions for hip (92%) and vertebral (88%) fracture, and a lower proportion for fractures other than major ones. Our data support the validity of SIDIAP for the study of the epidemiology of osteoporotic fractures. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Motivational Interviewing Support for a Behavioral Health Internet Intervention for Drivers with Type 1 Diabetes

PubMed Central

Ingersoll, Karen S.; Banton, Thomas; Gorlin, Eugenia; Vajda, Karen; Singh, Harsimran; Peterson, Ninoska; Gonder-Frederick, Linda; Cox, Daniel J.

2015-01-01

While Internet interventions can improve health behaviors, their impact is limited by program adherence. Supporting program adherence through telephone counseling may be useful, but there have been few direct tests of the impact of support. We describe a Telephone Motivational Interviewing (MI) intervention targeting adherence to an Internet intervention for drivers with Type 1 Diabetes, DD.com, and compare completion of intervention benchmarks by those randomized to DD.com plus MI vs. DD.com only. The goal of the pre-intervention MI session was to increase the participant's motivation to complete the Internet intervention and all its assignments, while the goal of the post-treatment MI session was to plan for maintaining changes made during the intervention. Sessions were semi-structured and partially scripted to maximize consistency. MI Fidelity was coded using a standard coding system, the MITI. We examined the effects of MI support vs. no support on number of days from enrollment to program benchmarks. Results show that MI sessions were provided with good fidelity. Users who received MI support completed some program benchmarks such as Core 4 (t176 df= -2.25; p<.03) and 11 of 12 monthly driving diaries significantly sooner, but support did not significantly affect time to intervention completion (t177 df= -1.69; p<. 10) or rates of completion. These data suggest that there is little benefit to therapist guidance for Internet interventions including automated email prompts and other automated minimal supports, but that a booster MI session may enhance collection of follow-up data. PMID:25774342

Status and Plans for the Vienna VLBI and Satellite Software (VieVS 3.0)

NASA Astrophysics Data System (ADS)

Gruber, Jakob; Böhm, Johannes; Böhm, Sigrid; Girdiuk, Anastasiia; Hellerschmied, Andreas; Hofmeister, Armin; Krásná, Hana; Kwak, Younghee; Landskron, Daniel; Madzak, Matthias; Mayer, David; McCallum, Jamie; Plank, Lucia; Schartner, Matthias; Shabala, Stas; Teke, Kamil; Sun, Jing

2017-04-01

The Vienna VLBI and Satellite Software (VieVS) is a geodetic analysis software developed and maintained at Technische Universität Wien (TU Wien) with contributions from groups all over the world. It is used for both academic purposes in university courses as well as for providing Very Long Baseline Interferometry (VLBI) analysis results to the geodetic community. Written in a modular structure in Matlab, VieVS offers easy access to the source code and the possibility to adapt the programs for particular purposes. The new version 3.0, released in early 2017, includes several new features, e.g., improved scheduling capabilities for observing quasars and satellites. This poster gives an overview of all VLBI-related activities in Vienna and provides an outlook to future plans concerning the Vienna VLBI and Satellite Software (VieVS).

[Deaths due to non-AIDS diseases among HIV infected patients: A 14-year study (1998-2011)].

PubMed

López, Cristina; Masiá, Mar; Padilla, Sergio; Aquilino, Ana; Bas, Cristina; Gutiérrez, Félix

2016-04-01

The objective of this study was to analyze the deaths caused by non-AIDS diseases in a cohort of HIV-infected patients treated between 1998 and 2011. Information on the causes of death was collected retrospectively, and then classified according to the deaths code (CoDe) algorithm. Patient characteristics and causes of death were compared for two periods: 1998-2004 and 2005-2011. A total of 159 out of the 1070 patients cared for in study period died, 56 (35%) due to AIDS events and 86 (54%) due to non-AIDS events (NAEs); in 17 (11%) the cause of death could not be determined. Overall, the main causes of death were infections (32%), cancer (17%), and unnatural deaths (17%). There was lower mortality from AIDS-related conditions during the second period (18.5% vs 47%; P<.001) and higher mortality from NAEs (68% vs 45%; P=.006). There was a very sharp increase in non-AIDS-defining cancers (18.5% vs 2.1%, p=001), and increased deaths from cardiovascular disease (9.2% vs 2.1%, P=.06). Patients who died in the second period were older, and had a better immunological and virological status at cohort entry and before death. They received antiretroviral therapy (ART) more often and were more often virologically suppressed before death (61.5% vs 24%; P=.001). Non-AIDS-defining cancers, unnatural deaths, and cardiovascular diseases are now major causes of death in patients with HIV. In recent years the majority of deceased patients are on ART and with virological suppression. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

HELIOS: A new open-source radiative transfer code

NASA Astrophysics Data System (ADS)

Malik, Matej; Grosheintz, Luc; Lukas Grimm, Simon; Mendonça, João; Kitzmann, Daniel; Heng, Kevin

2015-12-01

I present the new open-source code HELIOS, developed to accurately describe radiative transfer in a wide variety of irradiated atmospheres. We employ a one-dimensional multi-wavelength two-stream approach with scattering. Written in Cuda C++, HELIOS uses the GPU’s potential of massive parallelization and is able to compute the TP-profile of an atmosphere in radiative equilibrium and the subsequent emission spectrum in a few minutes on a single computer (for 60 layers and 1000 wavelength bins).The required molecular opacities are obtained with the recently published code HELIOS-K [1], which calculates the line shapes from an input line list and resamples the numerous line-by-line data into a manageable k-distribution format. Based on simple equilibrium chemistry theory [2] we combine the k-distribution functions of the molecules H2O, CO2, CO & CH4 to generate a k-table, which we then employ in HELIOS.I present our results of the following: (i) Various numerical tests, e.g. isothermal vs. non-isothermal treatment of layers. (ii) Comparison of iteratively determined TP-profiles with their analytical parametric prescriptions [3] and of the corresponding spectra. (iii) Benchmarks of TP-profiles & spectra for various elemental abundances. (iv) Benchmarks of averaged TP-profiles & spectra for the exoplanets GJ1214b, HD189733b & HD209458b. (v) Comparison with secondary eclipse data for HD189733b, XO-1b & Corot-2b.HELIOS is being developed, together with the dynamical core THOR and the chemistry solver VULCAN, in the group of Kevin Heng at the University of Bern as part of the Exoclimes Simulation Platform (ESP) [4], which is an open-source project aimed to provide community tools to model exoplanetary atmospheres.-----------------------------[1] Grimm & Heng 2015, ArXiv, 1503.03806[2] Heng, Lyons & Tsai, Arxiv, 1506.05501Heng & Lyons, ArXiv, 1507.01944[3] e.g. Heng, Mendonca & Lee, 2014, ApJS, 215, 4H[4] exoclime.net

Factors associated with perceived donation-related financial burden among living kidney donors.

PubMed

Ruck, Jessica M; Holscher, Courtenay M; Purnell, Tanjala S; Massie, Allan B; Henderson, Macey L; Segev, Dorry L

2018-03-01

The perception of living kidney donation-related financial burden affects willingness to donate and the experience of donation, yet no existing tools identify donors who are at higher risk of perceived financial burden. We sought to identify characteristics that predicted higher risk of perceived financial burden. We surveyed 51 living kidney donors (LKDs) who donated from 01/2015 to 3/2016 about socioeconomic characteristics, predonation cost concerns, and perceived financial burden. We tested associations between both self-reported and ZIP code-level characteristics and perceived burden using Fisher's exact test and bivariate modified Poisson regression. Donors who perceived donation-related financial burden were less likely to have an income above their ZIP code median (14% vs. 72%, P = .006); however, they were more likely than donors who did not perceive burden to rent their home (57% vs. 16%, P = .03), have an income <$60 000 (86% vs. 20%, P = .002), or have had predonation cost concerns (43% vs. 7%, P = .03). Perceived financial burden was 3.6-fold as likely among those with predonation cost concerns and 10.6-fold as likely for those with incomes <$60 000. Collecting socioeconomic characteristics and asking about donation-related cost concerns prior to donation might allow transplant centers to target financial support interventions toward potential donors at higher risk of perceiving donation-related financial burden. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

Impact of Intravenous Immunoglobulin on Survival in Necrotizing Fasciitis With Vasopressor-Dependent Shock: A Propensity Score-Matched Analysis From 130 US Hospitals.

PubMed

Kadri, Sameer S; Swihart, Bruce J; Bonne, Stephanie L; Hohmann, Samuel F; Hennessy, Laura V; Louras, Peter; Evans, Heather L; Rhee, Chanu; Suffredini, Anthony F; Hooper, David C; Follmann, Dean A; Bulger, Eileen M; Danner, Robert L

2017-04-01

Shock frequently complicates necrotizing fasciitis (NF) caused by group A Streptococcus (GAS) or Staphylococcus aureus. Intravenous immunoglobulin (IVIG) is sometimes administered for presumptive toxic shock syndrome (TSS), but its frequency of use and efficacy are unclear. Adult patients with NF and vasopressor-dependent shock undergoing surgical debridement from 2010 to 2014 were identified at 130 US hospitals. IVIG cases were propensity-matched and risk-adjusted. The primary outcome was in-hospital mortality and the secondary outcome was median length of stay (LOS). Of 4127 cases of debrided NF with shock at 121 centers, only 164 patients (4%) at 61 centers received IVIG. IVIG subjects were younger with lower comorbidity indices, but higher illness severity. Clindamycin and vasopressor intensity were higher among IVIG cases, as was coding for TSS and GAS. In-hospital mortality did not differ between matched IVIG and non-IVIG groups (crude mortality, 27.3% vs 23.6%; adjusted odds ratio, 1.00 [95% confidence interval, .55-1.83]; P = .99). Early IVIG (≤2 days) did not alter this effect (P = .99). Among patients coded for TSS, GAS, and/or S. aureus, IVIG use was still unusual (59/868 [6.8%]) and lacked benefit (P = .63). Median LOS was similar between IVIG and non-IVIG groups (26 [13-49] vs 26 [11-43]; P = .84). Positive predictive values for identifying true NF and debridement among IVIG cases using our algorithms were 97% and 89%, respectively, based on records review at 4 hospitals. Adjunctive IVIG was administered infrequently in NF with shock and had no apparent impact on mortality or hospital LOS beyond that achieved with debridement and antibiotics. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

An Automated Cropland Classification Algorithm (ACCA) for Tajikistan by combining Landsat, MODIS, and secondary data

USGS Publications Warehouse

Thenkabail, Prasad S.; Wu, Zhuoting

2012-01-01

The overarching goal of this research was to develop and demonstrate an automated Cropland Classification Algorithm (ACCA) that will rapidly, routinely, and accurately classify agricultural cropland extent, areas, and characteristics (e.g., irrigated vs. rainfed) over large areas such as a country or a region through combination of multi-sensor remote sensing and secondary data. In this research, a rule-based ACCA was conceptualized, developed, and demonstrated for the country of Tajikistan using mega file data cubes (MFDCs) involving data from Landsat Global Land Survey (GLS), Landsat Enhanced Thematic Mapper Plus (ETM+) 30 m, Moderate Resolution Imaging Spectroradiometer (MODIS) 250 m time-series, a suite of secondary data (e.g., elevation, slope, precipitation, temperature), and in situ data. First, the process involved producing an accurate reference (or truth) cropland layer (TCL), consisting of cropland extent, areas, and irrigated vs. rainfed cropland areas, for the entire country of Tajikistan based on MFDC of year 2005 (MFDC2005). The methods involved in producing TCL included using ISOCLASS clustering, Tasseled Cap bi-spectral plots, spectro-temporal characteristics from MODIS 250 m monthly normalized difference vegetation index (NDVI) maximum value composites (MVC) time-series, and textural characteristics of higher resolution imagery. The TCL statistics accurately matched with the national statistics of Tajikistan for irrigated and rainfed croplands, where about 70% of croplands were irrigated and the rest rainfed. Second, a rule-based ACCA was developed to replicate the TCL accurately (~80% producer’s and user’s accuracies or within 20% quantity disagreement involving about 10 million Landsat 30 m sized cropland pixels of Tajikistan). Development of ACCA was an iterative process involving series of rules that are coded, refined, tweaked, and re-coded till ACCA derived croplands (ACLs) match accurately with TCLs. Third, the ACCA derived cropland layers of Tajikistan were produced for year 2005 (ACL2005), same year as the year used for developing ACCA, using MFDC2005. Fourth, TCL for year 2010 (TCL2010), an independent year, was produced using MFDC2010 using the same methods and approaches as the one used to produce TCL2005. Fifth, the ACCA was applied on MFDC2010 to derive ACL2010. The ACLs were then compared with TCLs (ACL2005 vs. TCL2005 and ACL2010 vs. TCL2010). The resulting accuracies and errors from error matrices involving about 152 million Landsat (30 m) pixels of the country of Tajikistan (of which about 10 million Landsat size, 30 m, cropland pixels) showed an overall accuracy of 99.6% (khat = 0.97) for ACL2005 vs. TCL2005. For the 3 classes (irrigated, rainfed, and others) mapped in ACL2005, the producer’s accuracy was >86.4% and users accuracy was >93.6%. For ACL2010 vs. TCL2010, the error matrix showed an overall accuracy on 96.2% (khat = 0.96). For the 3 classes (irrigated, rainfed, and others) mapped in ACL2010, the producer’s and user’s accuracies for the irrigated areas were ≥82.9%. Any intermixing was overwhelmingly between irrigated and rainfed croplands, indicating that croplands (irrigated plus rainfed areas) as well as irrigated areas were mapped with high levels of accuracies (~90% or higher) even for the independent year. The ACL2005 and ACL2010, each, were produced using ACCA algorithm in ~30 min using a Dell Precision desktop T7400 computer for the entire country of Tajikistan once the MFDCs for the years were ready. The ACCA algorithm for Tajikistan is made available through US Geological Survey’s ScienceBase: http://www.sciencebase.gov/catalog/folder/4f79f1b7e4b0009bd827f548 or at: https://powellcenter.usgs.gov/globalcroplandwater/content/models-algorithms. The research contributes to the efforts of global food security through research on global croplands and their water use (e.g., https://powellcenter.usgs.gov/globalcroplandwater/). The above results clearly demonstrated the ability of a rule-based ACCA to rapidly and accurately produce cropland data layer year after year (hindcast, nowcast, forecast) for the country it was developed using MFDCs that consist of combining multiple sensor data and secondary data. It needs to be noted that the ACCA is applicable to the area (e.g., country, region) for which it is developed. In this case, ACCA is applicable for the Country of Tajikistan to hindcast, nowcast, and forecast agricultural cropland extent, areas, and irrigated vs. rainfed. The same fundamental concept of ACCA applies to other areas of the World where ACCA codes need to be modified to suite the area/region of interest. ACCA can also be expanded to compute other crop characteristics such as crop types, cropping intensities, and phenologies.

Exploring Modality Compatibility in the Response-Effect Compatibility Paradigm.

PubMed

Földes, Noémi; Philipp, Andrea M; Badets, Arnaud; Koch, Iring

2017-01-01

According to ideomotor theory , action planning is based on anticipatory perceptual representations of action-effects. This aspect of action control has been investigated in studies using the response-effect compatibility (REC) paradigm, in which responses have been shown to be facilitated if ensuing perceptual effects share codes with the response based on dimensional overlap (i.e., REC). Additionally, according to the notion of ideomotor compatibility, certain response-effect (R-E) mappings will be stronger than others because some response features resemble the anticipated sensory response effects more strongly than others (e.g., since vocal responses usually produce auditory effects, an auditory stimulus should be anticipated in a stronger manner following vocal responses rather than following manual responses). Yet, systematic research on this matter is lacking. In the present study, two REC experiments aimed to explore the influence of R-E modality mappings. In Experiment 1, vocal number word responses produced visual effects on the screen (digits vs. number words; i.e., visual-symbolic vs. visual-verbal effect codes). The REC effect was only marginally larger for visual-verbal than for visual-symbolic effects. Using verbal effect codes in Experiment 2, we found that the REC effect was larger with auditory-verbal R-E mapping than with visual-verbal R-E mapping. Overall, the findings support the hypothesis of a role of R-E modality mappings in REC effects, suggesting both further evidence for ideomotor accounts as well as code-specific and modality-specific contributions to effect anticipation.

Predictive values of diagnostic codes for identifying serious hypocalcemia and dermatologic adverse events among women with postmenopausal osteoporosis in a commercial health plan database.

PubMed

Wang, Florence T; Xue, Fei; Ding, Yan; Ng, Eva; Critchlow, Cathy W; Dore, David D

2018-04-10

Post-marketing safety studies of medicines often rely on administrative claims databases to identify adverse outcomes following drug exposure. Valid ascertainment of outcomes is essential for accurate results. We aim to quantify the validity of diagnostic codes for serious hypocalcemia and dermatologic adverse events from insurance claims data among women with postmenopausal osteoporosis (PMO). We identified potential cases of serious hypocalcemia and dermatologic events through ICD-9 diagnosis codes among women with PMO within claims from a large US healthcare insurer (June 2005-May 2010). A physician adjudicated potential hypocalcemic and dermatologic events identified from the primary position on emergency department (ED) or inpatient claims through medical record review. Positive predictive values (PPVs) and 95% confidence intervals (CIs) quantified the fraction of potential cases that were confirmed. Among 165,729 patients with PMO, medical charts were obtained for 40 of 55 (73%) potential hypocalcemia cases; 16 were confirmed (PPV 40%, 95% CI 25-57%). The PPV was higher for ED than inpatient claims (82 vs. 24%). Among 265 potential dermatologic events (primarily urticaria or rash), we obtained 184 (69%) charts and confirmed 128 (PPV 70%, 95% CI 62-76%). The PPV was higher for ED than inpatient claims (77 vs. 39%). Diagnostic codes for hypocalcemia and dermatologic events may be sufficient to identify events giving rise to emergency care, but are less accurate for identifying events within hospitalizations.

A novel construction scheme of QC-LDPC codes based on the RU algorithm for optical transmission systems

NASA Astrophysics Data System (ADS)

Yuan, Jian-guo; Liang, Meng-qi; Wang, Yong; Lin, Jin-zhao; Pang, Yu

2016-03-01

A novel lower-complexity construction scheme of quasi-cyclic low-density parity-check (QC-LDPC) codes for optical transmission systems is proposed based on the structure of the parity-check matrix for the Richardson-Urbanke (RU) algorithm. Furthermore, a novel irregular QC-LDPC(4 288, 4 020) code with high code-rate of 0.937 is constructed by this novel construction scheme. The simulation analyses show that the net coding gain ( NCG) of the novel irregular QC-LDPC(4 288,4 020) code is respectively 2.08 dB, 1.25 dB and 0.29 dB more than those of the classic RS(255, 239) code, the LDPC(32 640, 30 592) code and the irregular QC-LDPC(3 843, 3 603) code at the bit error rate ( BER) of 10-6. The irregular QC-LDPC(4 288, 4 020) code has the lower encoding/decoding complexity compared with the LDPC(32 640, 30 592) code and the irregular QC-LDPC(3 843, 3 603) code. The proposed novel QC-LDPC(4 288, 4 020) code can be more suitable for the increasing development requirements of high-speed optical transmission systems.

Health economic changes as a result of implementation of targeted therapy for metastatic renal cell carcinoma: national results from DARENCA study 2.

PubMed

Soerensen, Anne V; Donskov, Frede; Kjellberg, Jakob; Ibsen, Rikke; Hermann, Gregers G; Jensen, Niels V; Fode, Kirsten; Geertsen, Poul F

2015-09-01

Limited data exist on the economic consequences of implementing targeted therapy (TT) for metastatic renal cell carcinoma (RCC) in a real-world setting. To analyze health care and productivity costs for TT implementation in a national cohort of patients. Costs were measured per patient per year during a 2-yr follow-up during 2002-2005 (immunotherapy only) and 2006-2009 (TT implementation). All Danish patients with a diagnosis code for RCC and a procedure code for TT or immunotherapy were linked to the Danish National Patient Registry (contains information on all contacts with primary and secondary health sector). Health care and productivity costs were retrieved from the Danish case-mix system and Coherent Social Statistics, respectively. Drug costs were calculated separately from procedure codes and retail prices. Generalized linear models were used to analyze costs adjusted for age, gender, and civil status. A total of 439 patients were included for 2006-2009 and 192 for 2002-2005. Comparison of the health care cost per patient per year between 2006-2009 and 2002-2005 revealed lower inpatient costs (€11 899 vs €19 944, adjusted relative risk [RR] 0.64), higher outpatient costs (€14 308 vs €6209, RR 2.39), lower radiotherapy costs (€194 vs €633, RR 0.31), higher radiology costs (€676 vs €191, RR 3.73), and higher separately calculated drug costs (€12 040 vs €3103, RR 3.82, all p<0.001) for the former. Total health care costs per patient per year did not significantly differ (€27 676 vs €27 856, RR 1.05, p=0.5) between the two periods. Income from employment did not significantly differ between 2006-2009 and 2002-2005 (RR 1.11, p=0.11) and costs associated with loss of productivity were €7852 and €8265, respectively. A different pattern of health care costs were observed but total health care costs per patient per year did not significantly differ after implementation of TT for patients with mRCC. In this nationwide study, we found changes in the pattern of health care costs for patients with metastatic kidney cancer after implementation of targeted therapy compared to an immunotherapy control period; however, total health care costs and income from employment were without significant changes. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Decreased Opioid Utilization and Cost at One Year in Chronic Low Back Pain Patients Treated with Transcutaneous Electric Nerve Stimulation (TENS).

PubMed

Pivec, Robert; Minshall, Michael E; Mistry, Jaydev B; Chughtai, Morad; Elmallah, Randa K; Mont, Michael A

2015-11-01

Chronic low back pain (CLBP) may be treated without opioids through the use of transcutaneous electrical nerve stimulation (TENS). However, no study has evaluated its clinical effect and economic impact as measured by opioid utilization and costs. The purpose of this study was to evaluate patients who were given TENS for CLBP compared to a matched group without TENS at one-year follow-up, to determine differences between opioid consumption. Opioid utilization and costs in patients who did and did not receive TENS were extracted from a Medicare supplemental administrative claims database. Patients were selected if they had at least two ICD-9-CM coded claims for low back pain in a three-month period and were then propensity score matched at a 1:1 ratio between patients who received TENS and those who did not. There were 22,913 patients in each group who had a minimum follow-up of one year. There were no significant demographic or comorbidity differences with the exception that TENS patients had more episodes of back pain. Significantly fewer patients in the TENS group required opioids at final follow-up (57.7 vs. 60.3%). TENS patients also had significantly fewer annual per-patient opioid costs compared to non-TENS patients ($169 vs. $192). There were significantly lower event rates in TENS patients compared to non-TENS patients when measured by opioid utilization (characterized by frequency of prescription refills) (3.82 vs. 4.08, respectively) or pharmacy utilization (31.67 vs. 32.25). The TENS group also demonstrated a significantly lower cost of these utilization events ($44 vs. $49) and avoided more opioid events (20.4 events fewer per 100 patients annually). Treatment of CLBP with TENS demonstrated significantly fewer patients requiring opioids, fewer events where a patient required an opioid prescription, and lower per-patient costs. Since TENS is both non-invasive and a non-narcotic, it may potentially allow physicians to be more aggressive in treating CLBP patients.

Comparison of complication and conversion rates between robotic-assisted and laparoscopic rectal resection for rectal cancer: which patients and providers could benefit most from robotic-assisted surgery?

PubMed

Ackerman, Stacey J; Daniel, Shoshana; Baik, Rebecca; Liu, Emelline; Mehendale, Shilpa; Tackett, Scott; Hellan, Minia

2018-03-01

To compare (1) complication and (2) conversion rates to open surgery (OS) from laparoscopic surgery (LS) and robotic-assisted surgery (RA) for rectal cancer patients who underwent rectal resection. (3) To identify patient, physician, and hospital predictors of conversion. A US-based database study was conducted utilizing the 2012-2014 Premier Healthcare Data, including rectal cancer patients ≥18 with rectal resection. ICD-9-CM diagnosis and procedural codes were utilized to identify surgical approaches, conversions to OS, and surgical complications. Propensity score matching on patient, surgeon, and hospital level characteristics was used to create comparable groups of RA\\LS patients (n = 533 per group). Predictors of conversion from LS and RA to OS were identified with stepwise logistic regression in the unmatched sample. Post-match results suggested comparable perioperative complication rates (RA 29% vs LS 29%; p = .7784); whereas conversion rates to OS were 12% for RA vs 29% for LS (p < .0001). Colorectal surgeons (RA 9% vs LS 23%), general surgeons (RA 13% vs LS 35%), and smaller bed-size hospitals (RA 14% vs LS 33%) have reduced conversion rates for RA vs LS (p < .0001). Statistically significant predictors of conversion included LS, non-colorectal surgeon, and smaller bed-size hospitals. Retrospective observational study limitations apply. Analysis of the hospital administrative database was subject to the data captured in the database and the accuracy of coding. Propensity score matching limitations apply. RA and LS groups were balanced with respect to measured patient, surgeon, and hospital characteristics. Compared to LS, RA offers a higher probability of completing a successful minimally invasive surgery for rectal cancer patients undergoing rectal resection without exacerbating complications. Male, obese, or moderately-to-severely ill patients had higher conversion rates. While colorectal surgeons had lower conversion rates from RA than LS, the reduction was magnified for general surgeons and smaller bed-size hospitals.

Demographics, Resource Utilization, and Outcomes of Elderly Patients With Chronic Liver Disease Receiving Hospice Care in the United States.

PubMed

Fukui, Natsu; Golabi, Pegah; Otgonsuren, Munkhzul; Mishra, Alita; Venkatesan, Chapy; Younossi, Zobair M

2017-11-01

Hospice offers non-curative symptomatic management to improve patients' quality of life, satisfaction, and resource utilization. Hospice enrollment among patients with chronic liver disease (CLD) is not well studied. The aim of tis tudy is to examine the characteristics of Medicare enrollees with CLD, who were discharged to hospice. Medicare patients discharged to hospice between 2010 and 2014 were identified in Medicare Inpatient and Hospice Files. CLDs and other co-morbidities were identified by International Classification of Diseases-ninth revision codes. Generalized linear model was used to estimate regression coefficients with P-values. Logistic regression was used to calculate odds ratios and 95% confidence intervals. A total of 2,179 CLD patients and 34,986 controls without CLD met the inclusion criteria. Non-alcoholic fatty liver disease, alcoholic liver disease, and hepatitis C virus (HCV) were the most frequent cause of CLD. CLD patients were younger (70 vs. 83 years), more likely to be male (57.7 vs. 39.3%), had longer hospital stay (length of stay, LOS) (19.4 vs. 13.0 days), higher annual charges ($175,000 vs. $109,000), higher 30-day re-hospitalization rates (51.6 vs. 34.2%), and shorter hospice LOS (13.7 vs. 17.7 days) than controls (all P<0.001). Presence of HCV and congestive heart failure were the strongest contributors to increased total annual costs (34% and 31% higher, P<0.001), increased total annual LOS (26% and 43% higher, P<0.001), and increased 30-day readmission risk (2.20 and 2.19 times, respectively). Patients with CLD have longer and costly hospitalizations before hospice enrollment as compared with patients without CLD. It was highly likely that these patients were enrolled relatively late, which could potentially lead to less benefit from hospice.

Reading Aloud and Solving Simple Arithmetic Calculation Intervention (Learning Therapy) Improves Inhibition, Verbal Episodic Memory, Focus Attention and Processing Speed in Healthy Elderly People: Evidence from a Randomized Controlled Trial

PubMed Central

Nouchi, Rui; Taki, Yasuyuki; Takeuchi, Hikaru; Nozawa, Takayuki; Sekiguchi, Atsushi; Kawashima, Ryuta

2016-01-01

Background: Previous reports have described that simple cognitive training using reading aloud and solving simple arithmetic calculations, so-called “learning therapy”, can improve executive functions and processing speed in the older adults. Nevertheless, it is not well-known whether learning therapy improve a wide range of cognitive functions or not. We investigated the beneficial effects of learning therapy on various cognitive functions in healthy older adults. Methods: We used a single-blinded intervention with two groups (learning therapy group: LT and waiting list control group: WL). Sixty-four elderly were randomly assigned to LT or WL. In LT, participants performed reading Japanese aloud and solving simple calculations training tasks for 6 months. WL did not participate in the intervention. We measured several cognitive functions before and after 6 months intervention periods. Results: Compared to WL, results revealed that LT improved inhibition performance in executive functions (Stroop: LT (Mean = 3.88) vs. WL (Mean = 1.22), adjusted p = 0.013 and reverse Stroop LT (Mean = 3.22) vs. WL (Mean = 1.59), adjusted p = 0.015), verbal episodic memory (Logical Memory (LM): LT (Mean = 4.59) vs. WL (Mean = 2.47), adjusted p = 0.015), focus attention (D-CAT: LT (Mean = 2.09) vs. WL (Mean = −0.59), adjusted p = 0.010) and processing speed compared to the WL control group (digit symbol coding: LT (Mean = 5.00) vs. WL (Mean = 1.13), adjusted p = 0.015 and Symbol Search (SS): LT (Mean = 3.47) vs. WL (Mean = 1.81), adjusted p = 0.014). Discussion: This randomized controlled trial (RCT) can be showed the benefit of LT on inhibition of executive functions, verbal episodic memory, focus attention and processing speed in healthy elderly people. Our results were discussed under overlapping hypothesis. PMID:27242481

Reading Aloud and Solving Simple Arithmetic Calculation Intervention (Learning Therapy) Improves Inhibition, Verbal Episodic Memory, Focus Attention and Processing Speed in Healthy Elderly People: Evidence from a Randomized Controlled Trial.

PubMed

Nouchi, Rui; Taki, Yasuyuki; Takeuchi, Hikaru; Nozawa, Takayuki; Sekiguchi, Atsushi; Kawashima, Ryuta

2016-01-01

Previous reports have described that simple cognitive training using reading aloud and solving simple arithmetic calculations, so-called "learning therapy", can improve executive functions and processing speed in the older adults. Nevertheless, it is not well-known whether learning therapy improve a wide range of cognitive functions or not. We investigated the beneficial effects of learning therapy on various cognitive functions in healthy older adults. We used a single-blinded intervention with two groups (learning therapy group: LT and waiting list control group: WL). Sixty-four elderly were randomly assigned to LT or WL. In LT, participants performed reading Japanese aloud and solving simple calculations training tasks for 6 months. WL did not participate in the intervention. We measured several cognitive functions before and after 6 months intervention periods. Compared to WL, results revealed that LT improved inhibition performance in executive functions (Stroop: LT (Mean = 3.88) vs. WL (Mean = 1.22), adjusted p = 0.013 and reverse Stroop LT (Mean = 3.22) vs. WL (Mean = 1.59), adjusted p = 0.015), verbal episodic memory (Logical Memory (LM): LT (Mean = 4.59) vs. WL (Mean = 2.47), adjusted p = 0.015), focus attention (D-CAT: LT (Mean = 2.09) vs. WL (Mean = -0.59), adjusted p = 0.010) and processing speed compared to the WL control group (digit symbol coding: LT (Mean = 5.00) vs. WL (Mean = 1.13), adjusted p = 0.015 and Symbol Search (SS): LT (Mean = 3.47) vs. WL (Mean = 1.81), adjusted p = 0.014). This randomized controlled trial (RCT) can be showed the benefit of LT on inhibition of executive functions, verbal episodic memory, focus attention and processing speed in healthy elderly people. Our results were discussed under overlapping hypothesis.