A girl with incomplete Prader-Willi syndrome and negative MS-PCR, found to have mosaic maternal UPD-15 at SNP array.

PubMed

Morandi, Anita; Bonnefond, Amélie; Lobbens, Stéphane; Carotenuto, Marco; Del Giudice, Emanuele Miraglia; Froguel, Philippe; Maffeis, Claudio

2015-11-01

The Prader-Willi syndrome (PWS) is caused by lack of expression of paternal allele of the 15q11.2-q13 region, due to deletions at paternal 15q11.2-q13 (<70%), maternal uniparental disomy of chromosome 15 (mat-UPD 15) (30%) or imprinting defects (1%). Hyperphagia, intellectual disabilities/behavioral disorders, neonatal hypotonia, and hypogonadism are cardinal features for PWS. Methylation sensitive PCR (MS-PCR) of the SNRPN locus, which assesses the presence of both the unmethylated (paternal) and the methylated (maternal) allele of 15q11.2-q13, is considered a sensitive reference technique for PWS diagnosis regardless of genetic subtype. We describe a 17-year-old girl with severe obesity, short stature, and intellectual disability, without hypogonadism and history of neonatal hypotonia, who was suspected to have an incomplete PWS. The MS-PCR showed a normal pattern with similar maternal and paternal electrophoretic bands. Afterwards, a SNP array showed the presence of iso-UPD 15, that is, UPD15 with two copies of the same chromosome 15, in about 50% of cells, suggesting a diagnosis of partial PWS due to mosaic maternal iso-UPD15 arisen as rescue of a post-fertilization error. A quantitative methylation analysis confirmed the presence of mosaic UPD15 in about 50% of cells. We propose that complete clinical criteria for PWS and MS-PCR should not be considered sensitive in suspecting and diagnosing partial PWS due to mosaic UPD15. In contrast, clinical suspicion based on less restrictive criteria followed by SNP array is a more powerful approach to diagnose atypical PWS due to UPD15 mosaicism. © 2015 Wiley Periodicals, Inc.

Drosophila glypicans Dally and Dally-like are essential regulators for JAK/STAT signaling and Unpaired distribution in eye development

PubMed Central

Zhang, Yan; You, Jia; Ren, Wenyan; Lin, Xinhua

2013-01-01

The highly conserved janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway is a well-known signaling system that is involved in many biological processes. In Drosophila, this signaling cascade is activated by ligands of the Unpaired (Upd) family. Therefore, the regulation of Upd distribution is one of the key issues in controlling the JAK/STAT signaling activity and function. Heparan sulfate proteoglycans (HSPGs) are macromolecules that regulate the distribution of many ligand proteins including Wingless, Hedgehog and Decapentaplegic (Dpp). Here we show that during Drosophila eye development, HSPGs are also required in normal Upd distribution and JAK/STAT signaling activity. Loss of HSPG biosynthesis enzyme Brother of tout-velu (Botv), Sulfateless (Sfl), or glypicans Division abnormally delayed (Dally) and Dally-like protein (Dlp) led to reduced levels of extracellular Upd and reduction in JAK/STAT signaling activity. Overexpression of dally resulted in the accumulation of Upd and up-regulation of the signaling activity. Luciferase assay also showed that Dally promotes JAK/STAT signaling activity, and is dependent on its heparin sulfate chains. These data suggest that Dally and Dlp are essential for Upd distribution and JAK/STAT signaling activity. PMID:23313126

Uniparental disomy and prenatal phenotype

PubMed Central

Li, Xiaofei; Liu, Yan; Yue, Song; Wang, Li; Zhang, Tiejuan; Guo, Cuixia; Hu, Wenjie; Kagan, Karl-Oliver; Wu, Qingqing

2017-01-01

Abstract Rationale: Uniparental disomy (UPD) gives a description of the inheritance of both homologues of a chromosome pair from the same parent. The consequences of UPD depend on the specific chromosome/segment involved and its parental origin. Patient concerns: We report prenatal phenotypes of 2 rare cases of UPD. Diagnoses: The prenatal phenotype of case 1 included sonographic markers such as enlarged nuchal translucency (NT), absent nasal bone, short femur and humerus length, and several structural malformations involving Dandy–Walker malformation and congenital heart defects. The prenatal phenotype of Case 2 are sonographic markers, including enlarged NT, thickened nuchal fold, ascites, and polyhydramnios without apparent structural malformations. Interventions: Conventional G-band karyotype appears normal in case 1, while it shows normal chromosomes with a small supernumerary marker chromosome (sSMC) in case 2. Genetic etiology was left unknown until single-nucleotide polymorphism-based array (SNP-array) was performed, and segmental paternal UPD 22 was identified in case 1 and segmental paternal UPD 14 was found in case 2. Outcomes: The parents of case 1 chose termination of pregnancy. The neonate of case 2 was born prematurely with a bellshaped small thorax and died within a day. Lessons: UPD cases are rare and the phenotypes are different, which depend on the origin and affected chromosomal part. If a fetus shows multiple anomalies that cannot be attributed to a common aneuploidy or a genetic syndrome, or manifests some features possibly related to an UPD syndrome, such as detection of sSMC, SNP-array should be considered. PMID:29137034

Uniparental disomy and prenatal phenotype: Two case reports and review.

PubMed

Li, Xiaofei; Liu, Yan; Yue, Song; Wang, Li; Zhang, Tiejuan; Guo, Cuixia; Hu, Wenjie; Kagan, Karl-Oliver; Wu, Qingqing

2017-11-01

Uniparental disomy (UPD) gives a description of the inheritance of both homologues of a chromosome pair from the same parent. The consequences of UPD depend on the specific chromosome/segment involved and its parental origin. We report prenatal phenotypes of 2 rare cases of UPD. The prenatal phenotype of case 1 included sonographic markers such as enlarged nuchal translucency (NT), absent nasal bone, short femur and humerus length, and several structural malformations involving Dandy-Walker malformation and congenital heart defects. The prenatal phenotype of Case 2 are sonographic markers, including enlarged NT, thickened nuchal fold, ascites, and polyhydramnios without apparent structural malformations. Conventional G-band karyotype appears normal in case 1, while it shows normal chromosomes with a small supernumerary marker chromosome (sSMC) in case 2. Genetic etiology was left unknown until single-nucleotide polymorphism-based array (SNP-array) was performed, and segmental paternal UPD 22 was identified in case 1 and segmental paternal UPD 14 was found in case 2. The parents of case 1 chose termination of pregnancy. The neonate of case 2 was born prematurely with a bellshaped small thorax and died within a day. UPD cases are rare and the phenotypes are different, which depend on the origin and affected chromosomal part. If a fetus shows multiple anomalies that cannot be attributed to a common aneuploidy or a genetic syndrome, or manifests some features possibly related to an UPD syndrome, such as detection of sSMC, SNP-array should be considered.

Paternal or Maternal Uniparental Disomy of Chromosome 16 Resulting in Homozygosity of a Mutant Allele Causes Fanconi Anemia.

PubMed

Donovan, Frank X; Kimble, Danielle C; Kim, Yonghwan; Lach, Francis P; Harper, Ursula; Kamat, Aparna; Jones, MaryPat; Sanborn, Erica M; Tryon, Rebecca; Wagner, John E; MacMillan, Margaret L; Ostrander, Elaine A; Auerbach, Arleen D; Smogorzewska, Agata; Chandrasekharappa, Settara C

2016-05-01

Fanconi anemia (FA) is a rare inherited disorder caused by pathogenic variants in one of 19 FANC genes. FA patients display congenital abnormalities, and develop bone marrow failure, and cancer susceptibility. We identified homozygous mutations in four FA patients and, in each case, only one parent carried the obligate mutant allele. FANCA and FANCP/SLX4 genes, both located on chromosome 16, were the affected recessive FA genes in three and one family respectively. Genotyping with short tandem repeat markers and SNP arrays revealed uniparental disomy (UPD) of the entire mutation-carrying chromosome 16 in all four patients. One FANCA patient had paternal UPD, whereas FA in the other three patients resulted from maternal UPD. These are the first reported cases of UPD as a cause of FA. UPD indicates a reduced risk of having another child with FA in the family and has implications in prenatal diagnosis. © 2016 WILEY PERIODICALS, INC.

Paternal or maternal uniparental disomy of chromosome 16 resulting in homozygosity of a mutant allele causes Fanconi anemia

PubMed Central

Donovan, Frank X.; Kimble, Danielle C.; Kim, Yonghwan; Lach, Francis P.; Harper, Ursula; Kamat, Aparna; Jones, MaryPat; Sanborn, Erica M.; Tryon, Rebecca; Wagner, John E.; MacMillan, Margaret L.; Ostrander, Elaine A.; Auerbach, Arleen D.; Smogorzewska, Agata; Chandrasekharappa, Settara C.

2016-01-01

Fanconi anemia (FA) is a rare inherited disorder caused by pathogenic variants in one of 19 FANC genes. FA patients display congenital abnormalities, and develop bone marrow failure, and cancer susceptibility. We identified homozygous mutations in four FA patients and, in each case, only one parent carried the obligate mutant allele. FANCA and FANCP/SLX4 genes, both located on chromosome 16, were the affected recessive FA genes in three and one family respectively. Genotyping with short tandem repeat markers and single nucleotide polymorphism (SNP) arrays revealed uniparental disomy (UPD) of the entire mutation-carrying chromosome 16 in all four patients. One FANCA patient had paternal UPD, whereas FA in the other three patients resulted from maternal UPD. These are the first reported cases of UPD as a cause of FA. UPD indicates a reduced risk of having another child with FA in the family and has implications in prenatal diagnosis. PMID:26841305

The Drosophila cytokine Unpaired 2 regulates physiological homeostasis by remotely controlling Insulin secretion

PubMed Central

Rajan, Akhila; Perrimon, Norbert

2012-01-01

In Drosophila the fat body (FB), a functional analog of the vertebrate adipose tissue, is the 'nutrient sensor' that conveys the nutrient status to the insulin producing cells (IPCs) in the fly brain to release insulin-like peptides (Dilps). Dilp secretion in turn regulates energy balance and promotes systemic growth. We identify Unpaired2 (Upd2), a protein with similarities to type I cytokines, as a secreted factor produced by the FB in the ‘fed’ state. When upd2 function is perturbed specifically in the FB, it results in a systemic reduction in growth and alters energy metabolism. Upd2 activates JAK/STAT signaling in a population of GABAergic neurons that project onto the IPCs. This activation relieves the inhibitory tone of the GABAergic neurons on the IPCs, resulting in the secretion of Dilps. Strikingly, we find that human Leptin, can rescue the upd2 mutant phenotypes, suggesting that Upd2 is the functional homolog of Leptin. PMID:23021220

I Situ Structural Study of Underpotential Deposition and Electrocatalysis on GOLD(111) Electrodes

NASA Astrophysics Data System (ADS)

Chen, Chun-Hsien

This thesis work has studied systems of Bi, Pb, Ag, and Hg underpotential deposition (UPD) on Au(111) electrodes. The application of the atomic force microscope (AFM), the scanning tunneling microscope (STM), and the surface x-ray scattering (SXS) to these UPD studies has provided in situ measurements from which we investigate factors that determine UPD surface structures and correlate these structures with surface reactivity. For all the UPD systems in this thesis work, atomic level features of the electrode surface have been revealed. In the case of Pb UPD, Pb starts to deposit by forming islands which exhibit a hexagonal close packed structure of Pb adatoms, while, in the other systems, the UPD adatoms form open lattices. In the Bi and Pb studies, we correlate the activities of the modified surface toward electroreduction of H_2O_2 with the adlattice structures. A heterobimetallic bridge model for H_2O_2 on the surface could explain the enhanced reactivity. The full monolayers of Bi and Hg, rhombohedral metals, form rectangular lattice structures on the hexagonal Au(111) surfaces. The partial charge retention on the Bi and Hg adatom opens the adlayer structure when the coverage is less than a full monolayer. The structure of the first submonolayers of Ag UPD is electrolyte-dependent. The electrode surface exhibits 3 x 3 and 4 x 4 overlayer structures in solutions containing sulfate and nitrate, respectively. In perchloric acid another open structure is observed and a close-packed monolayer is formed in acetic acid. The different monolayer structures give rise to packing densities which correlate with electrolyte size. This implies that the anions participate in reducing metal ions.

Divergent structural brain abnormalities between different genetic subtypes of children with Prader-Willi syndrome.

PubMed

Lukoshe, Akvile; White, Tonya; Schmidt, Marcus N; van der Lugt, Aad; Hokken-Koelega, Anita C

2013-10-22

Prader-Willi syndrome (PWS) is a complex neurogenetic disorder with symptoms that indicate not only hypothalamic, but also a global, central nervous system (CNS) dysfunction. However, little is known about developmental differences in brain structure in children with PWS. Thus, our aim was to investigate global brain morphology in children with PWS, including the comparison between different genetic subtypes of PWS. In addition, we performed exploratory cortical and subcortical focal analyses. High resolution structural magnetic resonance images were acquired in 20 children with genetically confirmed PWS (11 children carrying a deletion (DEL), 9 children with maternal uniparental disomy (mUPD)), and compared with 11 age- and gender-matched typically developing siblings as controls. Brain morphology measures were obtained using the FreeSurfer software suite. Both children with DEL and mUPD showed smaller brainstem volume, and a trend towards smaller cortical surface area and white matter volume. Children with mUPD had enlarged lateral ventricles and larger cortical cerebrospinal fluid (CSF) volume. Further, a trend towards increased cortical thickness was found in children with mUPD. Children with DEL had a smaller cerebellum, and smaller cortical and subcortical grey matter volumes. Focal analyses revealed smaller white matter volumes in left superior and bilateral inferior frontal gyri, right cingulate cortex, and bilateral precuneus areas associated with the default mode network (DMN) in children with mUPD. Children with PWS show signs of impaired brain growth. Those with mUPD show signs of early brain atrophy. In contrast, children with DEL show signs of fundamentally arrested, although not deviant brain development and presented few signs of cortical atrophy. Our results of global brain measurements suggest divergent neurodevelopmental patterns in children with DEL and mUPD.

Genetic subtype differences in neural circuitry of food motivation in Prader-Willi syndrome.

PubMed

Holsen, L M; Zarcone, J R; Chambers, R; Butler, M G; Bittel, D C; Brooks, W M; Thompson, T I; Savage, C R

2009-02-01

Differences in behavioral phenotypes between the two most common subtypes of Prader-Willi syndrome (PWS) (chromosome 15q deletions and maternal uniparental disomy 15 (UPD) indicate that distinct neural networks may be affected. Though both subtypes display hyperphagia, the deletion subgroup shows reduced behavioral inhibition around food, whereas those with UPD are generally more able to maintain cognitive control over food intake impulses. To examine the neural basis of phenotypic differences to better understand relationships between genetic subtypes and behavioral outcomes. We predicted greater food motivation circuitry activity in the deletion subtype and greater activity in higher order cognitive regions in the UPD group, especially after eating. Nine individuals with PWS due to UPD and nine individuals with PWS due to (type 2) deletion, matched for age, gender and body mass index, underwent functional magnetic resonance imaging (fMRI) while viewing food images during two food motivation states: one before (pre-meal) and one after (post-meal) eating a standardized 500 kcal meal. Both PWS subgroups showed greater activity in response to food pre- and post-meal compared with the healthy-weight group. Compared with UPD, the deletion subtype showed increased food motivation network activation both pre- and post-meal, especially in the medial prefrontal cortex (mPFC) and amygdala. In contrast, the UPD group showed greater activation than the deletion subtype post-meal in the dorsolateral prefrontal cortex (DLPFC) and parahippocampal gyrus (PHG). These preliminary findings are the first functional neuroimaging findings to support divergent neural mechanisms associated with behavioral phenotypes in genetic subtypes of PWS. Results are discussed within the framework of genetic mechanisms such as haploinsufficiency and gene dosage effects and their differential influence on deletion and UPD subtypes, respectively.

Divergent structural brain abnormalities between different genetic subtypes of children with Prader–Willi syndrome

PubMed Central

2013-01-01

Background Prader–Willi syndrome (PWS) is a complex neurogenetic disorder with symptoms that indicate not only hypothalamic, but also a global, central nervous system (CNS) dysfunction. However, little is known about developmental differences in brain structure in children with PWS. Thus, our aim was to investigate global brain morphology in children with PWS, including the comparison between different genetic subtypes of PWS. In addition, we performed exploratory cortical and subcortical focal analyses. Methods High resolution structural magnetic resonance images were acquired in 20 children with genetically confirmed PWS (11 children carrying a deletion (DEL), 9 children with maternal uniparental disomy (mUPD)), and compared with 11 age- and gender-matched typically developing siblings as controls. Brain morphology measures were obtained using the FreeSurfer software suite. Results Both children with DEL and mUPD showed smaller brainstem volume, and a trend towards smaller cortical surface area and white matter volume. Children with mUPD had enlarged lateral ventricles and larger cortical cerebrospinal fluid (CSF) volume. Further, a trend towards increased cortical thickness was found in children with mUPD. Children with DEL had a smaller cerebellum, and smaller cortical and subcortical grey matter volumes. Focal analyses revealed smaller white matter volumes in left superior and bilateral inferior frontal gyri, right cingulate cortex, and bilateral precuneus areas associated with the default mode network (DMN) in children with mUPD. Conclusions Children with PWS show signs of impaired brain growth. Those with mUPD show signs of early brain atrophy. In contrast, children with DEL show signs of fundamentally arrested, although not deviant brain development and presented few signs of cortical atrophy. Our results of global brain measurements suggest divergent neurodevelopmental patterns in children with DEL and mUPD. PMID:24144356

Comparison of perinatal factors in deletion versus uniparental disomy in Prader-Willi syndrome.

PubMed

Gold, June-Anne; Mahmoud, Ranim; Cassidy, Suzanne B; Kimonis, Virginia

2018-05-01

Prader-Willi syndrome (PWS) is caused by a deficiency of imprinted genes in the 15q11-q13 region and is characterized by prenatal onset of hypotonia, poor feeding, childhood-onset obesity, hyperphagia, short stature, facial dysmorphism, intellectual disability, and behavioral problems. We studied perinatal factors in a cohort of 64 people with PWS resulting from paternal deletion of 15q11-q13 and maternal uniparental disomy (UPD) for chromosome 15. We recruited 34 individuals with deletion and 30 with UPD. We compared the frequency of multiple prenatal and neonatal factors with the general population as well as between the two genetic subtypes. Of the 64 individuals with PWS, fetal movements were decreased in 82.8%, 31.7% were born prematurely, 42.1% by Cesarean section, and 35.9% required oxytocin induction. Apgar scores were low in 34.6%, 96.8% had feeding difficulty, 50% needed tube feeding, and 6.2% subsequently had gastrostomy tube placement. On comparing findings in the deletion versus the UPD groups, we did not find many significant differences. We, however, found a higher maternal age, and also later age at diagnosis in the UPD versus the deletion group. PWS subjects have higher rates of perinatal complications, especially Cesarean section rate, hypotonia, and low Apgar scores compared to the general population. We did not find many differences between the genetic subtypes, except for later age of diagnosis of the UPD 15 group suggesting a milder phenotype. We also found that the mothers in the UPD were older, supporting the hypothesis that UPD results from nondisjunction associated trisomy rescue. © 2018 Wiley Periodicals, Inc.

Performance analysis of PPP ambiguity resolution with UPD products estimated from different scales of reference station networks

NASA Astrophysics Data System (ADS)

Wang, Siyao; Li, Bofeng; Li, Xingxing; Zang, Nan

2018-01-01

Integer ambiguity fixing with uncalibrated phase delay (UPD) products can significantly shorten the initialization time and improve the accuracy of precise point positioning (PPP). Since the tracking arcs of satellites and the behavior of atmospheric biases can be very different for the reference networks with different scales, the qualities of corresponding UPD products may be also various. The purpose of this paper is to comparatively investigate the influence of different scales of reference station networks on UPD estimation and user ambiguity resolution. Three reference station networks with global, wide-area and local scales are used to compute the UPD products and analyze their impact on the PPP-AR. The time-to-first-fix, the unfix rate and the incorrect fix rate of PPP-AR are analyzed. Moreover, in order to further shorten the convergence time for obtaining precise positioning, a modified partial ambiguity resolution (PAR) and corresponding validation strategy are presented. In this PAR method, the ambiguity subset is determined by removing the ambiguity one by one in the order of ascending elevations. Besides, for static positioning mode, a coordinate validation strategy is employed to enhance the reliability of the fixed coordinate. The experiment results show that UPD products computed by smaller station network are more accurate and lead to a better coordinate solution; the PAR method used in this paper can shorten the convergence time and the coordinate validation strategy can improve the availability of high precision positioning.

Molecular genetic classification in Prader-Willi syndrome: a multisite cohort study.

PubMed

Butler, Merlin G; Hartin, Samantha N; Hossain, Waheeda A; Manzardo, Ann M; Kimonis, Virginia; Dykens, Elisabeth; Gold, June Anne; Kim, Soo-Jeong; Weisensel, Nicolette; Tamura, Roy; Miller, Jennifer L; Driscoll, Daniel J

2018-05-05

Prader-Willi syndrome (PWS) is due to errors in genomic imprinting. PWS is recognised as the most common known genetic cause of life-threatening obesity. This report summarises the frequency and further characterises the PWS molecular classes and maternal age effects. High-resolution microarrays, comprehensive chromosome 15 genotyping and methylation-specific multiplex ligation probe amplification were used to describe and further characterise molecular classes of maternal disomy 15 (UPD15) considering maternal age. We summarised genetic data from 510 individuals with PWS and 303 (60%) had the 15q11-q13 deletion; 185 (36%) with UPD15 and 22 (4%) with imprinting defects. We further characterised UPD15 findings into subclasses based on the presence (size, location) or absence of loss of heterozygosity (LOH). Additionally, significantly older mothers (mean age=32.5 years vs 27.7 years) were found in the UPD15 group (n=145) compared with the deletion subtype (n=200). We report on molecular classes in PWS using advanced genomic technology in the largest cohort to date. LOH patterns in UPD15 may impact the risk of having a second genetic condition if the mother carries a recessive mutant allele in the isodisomic region on chromosome 15. The risk of UPD15 may also increase with maternal age. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

(Epi)genotype–phenotype correlations in Beckwith–Wiedemann syndrome

PubMed Central

Mussa, Alessandro; Russo, Silvia; De Crescenzo, Agostina; Freschi, Andrea; Calzari, Luciano; Maitz, Silvia; Macchiaiolo, Marina; Molinatto, Cristina; Baldassarre, Giuseppina; Mariani, Milena; Tarani, Luigi; Bedeschi, Maria Francesca; Milani, Donatella; Melis, Daniela; Bartuli, Andrea; Cubellis, Maria Vittoria; Selicorni, Angelo; Cirillo Silengo, Margherita; Larizza, Lidia; Riccio, Andrea; Ferrero, Giovanni Battista

2016-01-01

Beckwith–Wiedemann syndrome (BWS) is characterized by cancer predisposition, overgrowth and highly variable association of macroglossia, abdominal wall defects, nephrourological anomalies, nevus flammeus, ear malformations, hypoglycemia, hemihyperplasia, and organomegaly. BWS molecular defects, causing alteration of expression or activity of the genes regulated by two imprinting centres (IC) in the 11p15 chromosomal region, are also heterogeneous. In this paper we define (epi)genotype–phenotype correlations in molecularly confirmed BWS patients. The characteristics of 318 BWS patients with proven molecular defect were compared among the main four molecular subclasses: IC2 loss of methylation (IC2-LoM, n=190), IC1 gain of methylation (IC1-GoM, n=31), chromosome 11p15 paternal uniparental disomy (UPD, n=87), and cyclin-dependent kinase inhibitor 1C gene (CDKN1C) variants (n=10). A characteristic growth pattern was found in each group; neonatal macrosomia was almost constant in IC1-GoM, postnatal overgrowth in IC2-LoM, and hemihyperplasia more common in UPD (P<0.001). Exomphalos was more common in IC2/CDKN1C patients (P<0.001). Renal defects were typical of UPD/IC1 patients, uretheral malformations of IC1-GoM cases (P<0.001). Ear anomalies and nevus flammeus were associated with IC2/CDKN1C genotype (P<0.001). Macroglossia was less common among UPD patients (P<0.001). Wilms' tumor was associated with IC1-GoM or UPD and never observed in IC2-LoM patients (P<0.001). Hepatoblastoma occurred only in UPD cases. Cancer risk was lower in IC2/CDKN1C, intermediate in UPD, and very high in IC1 cases (P=0.009). In conclusion, (epi)genotype–phenotype correlations define four different phenotypic BWS profiles with some degree of clinical overlap. These observations impact clinical care allowing to move toward (epi) genotype-based follow-up and cancer screening. PMID:25898929

Electrodeposition of Mg-Li-Al-La Alloys on Inert Cathode in Molten LiCl-KCl Eutectic Salt

NASA Astrophysics Data System (ADS)

Han, Wei; Chen, Qiong; Sun, Yi; Jiang, Tao; Zhang, Milin

2011-12-01

Electrochemical preparation of Mg-Li-Al-La alloys on inert electrodes was investigated in LiCl-KCl melt at 853 K (580 °C). Cyclic voltammograms (CVs) and square wave voltammograms (SWVs) show that the existence of AlCl3 or AlF3 could promote La deposition on an active Al substrate, which is predeposited on inert electrodes. All electrochemical tests show that the reduction of La3+ is a one-step reduction process with three electrons exchanged. The reduction of La(III)→La(0) occurred at -2.04 V, and the underpotential deposition (UPD) of La was detected at -1.55 V ( vs Ag/AgCl). The same phenomena concerning La UPD were observed on two inert cathodes, W and Mo. In addition, Mg-Li-Al-La alloys were obtained by galvanostatic electrolysis on the W cathode from La2O3 in LiCl-KCl-MgCl2-KF melts with aluminum as the anode. X-ray diffraction (XRD) measurements indicated that various phases like the Al2La, Al12Mg17, and βLi phase (LiMg/Li3Mg7) existed in the Mg-Li-Al-La alloys. The distribution of Mg, Al, and La in Mg-Li-Al-La alloys from the analysis of a scan electron micrograph (SEM) and energy dispersive spectrometry (EDS) indicated that the elements Mg, Al, and La distributed homogeneously in the alloys.

Clinical follow up of uniparental disomy 16: First data

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

Dworniczak, B.; Koppers, B.; Bogdanova, N.

1994-09-01

Following the introduction of the concept of uniparental disomy (UPD) in 1980 by Engel this segregational anomaly is reported in an ever increasing number of patients. So far, several groups of individuals with an increased risk for UPD have been identified including abnormal carriers of familial balanced translocations or centric fusions, carriers of mosaic trisomies, and fetuses after prenatal diagnosis of confined placental mosaicism. A major pathogenetic mechanism appears to be post-meiotic chromosome loss in trisomic conceptuses. UPD was repeatedly observed in the fetus after diagnosis of mosaic or non-mosaic trisomies in the placenta which are usually considered {open_quotes}lethal{close_quotes} (i.e.more » trisomies 15 and 16). In an ongoing study to determine the incidence and clinical consequences of UPD we investigated the parental origin of chromosomes in the disomic cell line after prenatal diagnosis of mosaicism for various trisomies (e.g. 2, 7, 14, 15, and 16). At present, two maternal disomies 16 and one maternal disomy 15 were identified. Severe intrauterine growth retardation was a common symptome which, however, was also present in some but not all mosaics with a biparental origin of the chromosomes in question. While prognosis is clear in some instances (i.e. UPD 15) counseling can be extremely difficult in others, when imprinting effects and homozygosity for unknown recessive traits present in a parent have to be considered. To assess the clinical significance, detailed follow-up studies of proven cases of uniparental disomies are essential. First data of two cases with UPD 16 are presented.« less

JAK/STAT autocontrol of ligand-producing cell number through apoptosis.

PubMed

Borensztejn, Antoine; Boissoneau, Elisabeth; Fernandez, Guillaume; Agnès, François; Pret, Anne-Marie

2013-01-01

During development, specific cells are eliminated by apoptosis to ensure that the correct number of cells is integrated in a given tissue or structure. How the apoptosis machinery is activated selectively in vivo in the context of a developing tissue is still poorly understood. In the Drosophila ovary, specialised follicle cells [polar cells (PCs)] are produced in excess during early oogenesis and reduced by apoptosis to exactly two cells per follicle extremity. PCs act as an organising centre during follicle maturation as they are the only source of the JAK/STAT pathway ligand Unpaired (Upd), the morphogen activity of which instructs distinct follicle cell fates. Here we show that reduction of Upd levels leads to prolonged survival of supernumerary PCs, downregulation of the pro-apoptotic factor Hid, upregulation of the anti-apoptotic factor Diap1 and inhibition of caspase activity. Upd-mediated activation of the JAK/STAT pathway occurs in PCs themselves, as well as in adjacent terminal follicle and interfollicular stalk cells, and inhibition of JAK/STAT signalling in any one of these cell populations protects PCs from apoptosis. Thus, a Stat-dependent unidentified relay signal is necessary for inducing supernumerary PC death. Finally, blocking apoptosis of PCs leads to specification of excess adjacent border cells via excessive Upd signalling. Our results therefore show that Upd and JAK/STAT signalling induce apoptosis of supernumerary PCs to control the size of the PC organising centre and thereby produce appropriate levels of Upd. This is the first example linking this highly conserved signalling pathway with developmental apoptosis in Drosophila.

Trisomy 15 mosaicism and uniparental disomy (UPD) in a liveborn infant

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

Milunsky, J.M.; Wyandt, H.E.; Amos, J.A.

We describe a liveborn infant with UPD in association with trisomy 15 mosaicism. Third trimester amniocentesis was performed for suspected IUGR. Results revealed 46,XX/47,XX,+15. The infant initially had respiratory distress and fed poorly. Symmetrical growth retardation, craniofacial dysmorphism, excess nuchal folds, a heart murmur, hypermobile joints, minor limb abnormalities, absent spontaneous movement and an abnormal cry were noted. Further study showed complex heart defects, including VSD and PDA, a left choroid plexus cyst, 13 ribs bilaterally, abnormal optic discs, abnormal visual evoked potentials and abnormal auditory brain stem responses. The infant died at 6 weeks of life from cardio-respiratory complications.more » Blood chromosomes were normal, 46,XX in 100 cells. Parental blood chromosomes were normal. Skin biopsy revealed 46,XX/47,XX,+15 in 40/50 (80%) cells as did autopsy lung tissue. Molecular analysis of the infant`s blood revealed maternal uniparental heterodisomy for chromosome 15 in the 46,XX cell line. Microsatellite analysis demonstrated that the extra chromosome originated from a maternal meiosis I nondisjunction. To our knowledge, this is the first liveborn infant with mosaic trisomy 15 and UPD in the diploid cells. Trisomy 15, heretofore, has been regarded as nonviable, even in mosaic form. While maternal UPD is associated with the Prader-Willi syndrome phenotype, mosaicism for trisomy 15 has been reported only when confined to the placenta. UPD in this case generally complicated prediction of the phenotype and raises the question whether all cases with UPD 15 should have more than one tissue studied to determine undetected trisomy 15.« less

Multi-GNSS phase delay estimation and PPP ambiguity resolution: GPS, BDS, GLONASS, Galileo

NASA Astrophysics Data System (ADS)

Li, Xingxing; Li, Xin; Yuan, Yongqiang; Zhang, Keke; Zhang, Xiaohong; Wickert, Jens

2017-10-01

This paper focuses on the precise point positioning (PPP) ambiguity resolution (AR) using the observations acquired from four systems: GPS, BDS, GLONASS, and Galileo (GCRE). A GCRE four-system uncalibrated phase delay (UPD) estimation model and multi-GNSS undifferenced PPP AR method were developed in order to utilize the observations from all systems. For UPD estimation, the GCRE-combined PPP solutions of the globally distributed MGEX and IGS stations are performed to obtain four-system float ambiguities and then UPDs of GCRE satellites can be precisely estimated from these ambiguities. The quality of UPD products in terms of temporal stability and residual distributions is investigated for GPS, BDS, GLONASS, and Galileo satellites, respectively. The BDS satellite-induced code biases were corrected for GEO, IGSO, and MEO satellites before the UPD estimation. The UPD results of global and regional networks were also evaluated for Galileo and BDS, respectively. As a result of the frequency-division multiple-access strategy of GLONASS, the UPD estimation was performed using a network of homogeneous receivers including three commonly used GNSS receivers (TRIMBLE NETR9, JAVAD TRE_G3TH DELTA, and LEICA). Data recorded from 140 MGEX and IGS stations for a 30-day period in January in 2017 were used to validate the proposed GCRE UPD estimation and multi-GNSS dual-frequency PPP AR. Our results show that GCRE four-system PPP AR enables the fastest time to first fix (TTFF) solutions and the highest accuracy for all three coordinate components compared to the single and dual system. An average TTFF of 9.21 min with 7{°} cutoff elevation angle can be achieved for GCRE PPP AR, which is much shorter than that of GPS (18.07 min), GR (12.10 min), GE (15.36 min) and GC (13.21 min). With observations length of 10 min, the positioning accuracy of the GCRE fixed solution is 1.84, 1.11, and 1.53 cm, while the GPS-only result is 2.25, 1.29, and 9.73 cm for the east, north, and vertical components, respectively. When the cutoff elevation angle is increased to 30{°} , the GPS-only PPP AR results are very unreliable, while 13.44 min of TTFF is still achievable for GCRE four-system solutions.

Multi-GNSS phase delay estimation and PPP ambiguity resolution: GPS, BDS, GLONASS, Galileo

NASA Astrophysics Data System (ADS)

Li, Xingxing; Li, Xin; Yuan, Yongqiang; Zhang, Keke; Zhang, Xiaohong; Wickert, Jens

2018-06-01

This paper focuses on the precise point positioning (PPP) ambiguity resolution (AR) using the observations acquired from four systems: GPS, BDS, GLONASS, and Galileo (GCRE). A GCRE four-system uncalibrated phase delay (UPD) estimation model and multi-GNSS undifferenced PPP AR method were developed in order to utilize the observations from all systems. For UPD estimation, the GCRE-combined PPP solutions of the globally distributed MGEX and IGS stations are performed to obtain four-system float ambiguities and then UPDs of GCRE satellites can be precisely estimated from these ambiguities. The quality of UPD products in terms of temporal stability and residual distributions is investigated for GPS, BDS, GLONASS, and Galileo satellites, respectively. The BDS satellite-induced code biases were corrected for GEO, IGSO, and MEO satellites before the UPD estimation. The UPD results of global and regional networks were also evaluated for Galileo and BDS, respectively. As a result of the frequency-division multiple-access strategy of GLONASS, the UPD estimation was performed using a network of homogeneous receivers including three commonly used GNSS receivers (TRIMBLE NETR9, JAVAD TRE_G3TH DELTA, and LEICA). Data recorded from 140 MGEX and IGS stations for a 30-day period in January in 2017 were used to validate the proposed GCRE UPD estimation and multi-GNSS dual-frequency PPP AR. Our results show that GCRE four-system PPP AR enables the fastest time to first fix (TTFF) solutions and the highest accuracy for all three coordinate components compared to the single and dual system. An average TTFF of 9.21 min with 7{°} cutoff elevation angle can be achieved for GCRE PPP AR, which is much shorter than that of GPS (18.07 min), GR (12.10 min), GE (15.36 min) and GC (13.21 min). With observations length of 10 min, the positioning accuracy of the GCRE fixed solution is 1.84, 1.11, and 1.53 cm, while the GPS-only result is 2.25, 1.29, and 9.73 cm for the east, north, and vertical components, respectively. When the cutoff elevation angle is increased to 30{°}, the GPS-only PPP AR results are very unreliable, while 13.44 min of TTFF is still achievable for GCRE four-system solutions.

Local adjunct effect of antimicrobial photodynamic therapy for the treatment of chronic periodontitis in type 2 diabetics: split-mouth double-blind randomized controlled clinical trial.

PubMed

Castro Dos Santos, Nídia Cristina; Andere, Naira Maria Rebelatto Bechara; Araujo, Cássia Fernandes; de Marco, Andrea Carvalho; Dos Santos, Lúcio Murilo; Jardini, Maria Aparecida Neves; Santamaria, Mauro Pedrine

2016-11-01

Diabetes has become a global epidemic. Its complications can have a significant impact on quality of life, longevity, and public health costs. The presence of diabetes might impair the prognosis of periodontal treatments due to its negative influence on wound healing. Antimicrobial photodynamic therapy (aPDT) is a local approach that can promote bacterial decontamination in periodontal pockets. The aim of this study was to investigate the local effect of adjunct aPDT to ultrasonic periodontal debridement (UPD) and compare it to UD only for the treatment of chronic periodontitis in type 2 diabetic patients. Twenty type 2 diabetic patients with moderate to severe generalized chronic periodontitis were selected. Two periodontal pockets with probing depth (PD) and clinical attachment level (CAL) ≥5 mm received UPD only (UPD group) or UPD plus adjunct aPDT (UPD + aPDT group). Periodontal clinical measures were collected and compared at baseline and 30, 90, and 180 days. After 180 days of follow-up, there were statistically significant reductions in PD from 5.75 ± 0.91 to 3.47 ± 0.97 mm in the UPD group and from 6.15 ± 1.27 to 3.71 ± 1.63 mm in the UPD + aPDT group. However, intergroup analysis did not reveal statistically significant differences in any of the evaluated clinical parameters (p > 0.05). The adjunct application of aPDT to UPD did not present additional benefits for the treatment of chronic periodontitis in type 2 diabetic patients. The ClinicalTrials.gov identifier of the present study is NCT02627534.

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

Smith, M.J.; Upadhyaya, M.; Clarke, A.

Uniparental disomy (UPD) is the inheritance of a pair of homologous chromosomes from one parent with no corresponding homologue from the other, in an individual with an apparently normal karyotype. Polymorphic DNA markers for the appropriate chromosome will therefore lack alleles from the non-contributing parent. There may be pathological consequences of UPD if an imprinted gene(s) resides on the affected chromosome. A number of human developmental disorders of unknown etiology, including Cornelia de Lange syndrome (CdLS) and spontaneous abortion, may be caused by imprinted genes yet to be discovered. There are a number of reports of chromosome 3q rearrangements associatedmore » with CdLS, therefore excluding whole-chromosome 3 UPD as a cause in these patients. We are also examining DNA markers for all autosomes in a series of 42 karyotypically normal spontaneous abortions and their parents. To date, no UPD has been observed for chromosomes 3, 17, 20, 21 and 22. Further work is in progress, both here and using the DNA typing facilities at Geneathon, France.« less

Prader-Willi syndrome: genetic tests and clinical findings.

PubMed

Fridman, C; Varela, M C; Kok, F; Setian, N; Koiffmann, C P

2000-01-01

Here we describe the genetic studies performed in 53 patients with the suspected diagnosis of Prader-Willi syndrome (PWS). PWS is characterized by neonatal hypotonia, hypogonadism, delayed psychomotor development, hyperphagia, obesity, short stature, small hands and feet, learning disabilities, and obsessive-compulsive behavior. Through the methylation analysis of the SNRPN gene, microsatellite studies of loci mapped within and outside the PWS/AS region, and fluorescence in situ hybridization (FISH) study, we confirmed the diagnosis in 35 patients: 27 with a paternal deletion, and 8 with maternal uniparental disomy (UPD). The clinical comparisons between deleted and UPD patients indicated that there were no major phenotype differences, except for a lower birth length observed in the UPD children. Our sample was composed of more girls than boys; UPD patients were diagnosed earlier than the deleted cohort (2(10/12) s. 7(9/12) years); and, in the deleted group, the boys were diagnosed earlier than the girls (5(2/12) vs. 7(8/12) years, respectively).

Effects of Additives on Electrochemical Growth of Cu Film on Co/SiO2/Si Substrate by Alternating Underpotential Deposition of Pb and Surface-Limited Redox Replacement by Cu

NASA Astrophysics Data System (ADS)

Fang, J. S.; Lin, L. Y.; Wu, C. L.; Cheng, Y. L.; Chen, G. S.

2017-11-01

The effects of additives to an acidic electrolyte for electrochemical deposition of copper film to prevent corrosion of the Co/SiO2/Si substrate have been investigated. A sacrificial Pb layer was formed by underpotential deposition (UPD), then a Cu layer was prepared using surface-limited redox replacement (SLRR) to exchange the UPD-Pb layer in an acidic copper electrolyte with trisodium citrate, sodium perchlorate, and ethylenediamine as additives. The additives significantly affected the replacement of UPD-Pb by Cu and prevented galvanic corrosion of the Co/SiO2/Si substrate in the acidic Cu electrolyte. The results showed that both sodium perchlorate and ethylenediamine reduced the corrosion of the Co substrate and resulted in Cu film with low electrical resistivity. However, residual Pb was present in the Cu film when using trisodium citrate, as the citrate ions slowed copper displacement. The proposed sequential UPD-Pb and SLRR-Cu growth method may enable electrochemical deposition for fabrication of Cu interconnects on Co substrate from acidic Cu electrolyte.

Gender Differences in the Behavioral Symptom Severity of Prader-Willi Syndrome.

PubMed

Gito, Masao; Ihara, Hiroshi; Ogata, Hiroyuki; Sayama, Masayuki; Murakami, Nobuyuki; Nagai, Toshiro; Ayabe, Tadayuki; Oto, Yuji; Shimoda, Kazutaka

2015-01-01

This study measured gender differences in Prader-Willi syndrome (PWS) in regard to the severity of behavioral symptoms. The Food Related Problem Questionnaire (FRPQ), the Aberrant Behavior Checklist Japanese Version, the Childhood Routines Inventory, the Pervasive Developmental Disorders Autism Society Japan Rating Scale, and Japanese ADHD-RS were administered to PWS patients (45 males aged 6 to 58 and 37 females aged 6 to 45). To examine the effects that gender and genotype have on the severity of each symptom, two-way ANOVAs were conducted. Significant interactions were found only in regard to FRPQ scores, such as FRPQ total score (F(1, 78) = 8.43, p < 0.01). The FRPQ of male deletion (DEL) individuals was higher than that of female DEL and male mUPD. The FRPQ of male maternal uniparental disomy (mUPD) was lower than that of female mUPD. In terms of problem behaviors, routines, autistic behaviors, and hyperactivity, no significant differences were found. Food-related behaviors in DEL were more severe in males, although those in mUPD were less severe in males.

Superconducting symmetries and magnetic responses of uranium heavy-fermion systems UBe13 and UPd2Al3

NASA Astrophysics Data System (ADS)

Shimizu, Yusei; Kittaka, Shunichiro; Sakakibara, Toshiro; Aoki, Dai

2018-05-01

Low-temperature thermodynamic investigation for UBe13 and UPd2Al3 were performed in order to gain insight into their unusual ground states of 5 f electrons. Our heat-capacity data for the cubic UBe13 strongly suggest that nodal quasiparticles are absent and its superconducting (SC) gap is fully open over the Fermi surface. Moreover, two unusual thermodynamic anomalies are also observed in UBe13 at ∼ 3 T and ∼ 9 T; the lower-field anomaly is seen only in the SC mixed state by dc magnetization M (H) as well as heat-capacity C (H) , while the higher-field anomaly appears for C (H) in the normal phase above the upper critical field. On the other hand, field-orientation dependence of the heat capacity in the hexagonal UPd2Al3 shows a significantly anisotropic behavior of C (H) ∝H 1 / 2 , reflecting the nodal gap structure of this system. Our result strongly suggests the presence of a horizontal line node on the Fermi surface with heavy effective mass in UPd2Al3.

A prospective study validating a clinical scoring system and demonstrating phenotypical-genotypical correlations in Silver-Russell syndrome

PubMed Central

Azzi, Salah; Salem, Jennifer; Thibaud, Nathalie; Chantot-Bastaraud, Sandra; Lieber, Eli; Netchine, Irène; Harbison, Madeleine D

2015-01-01

Background Multiple clinical scoring systems have been proposed for Silver-Russell syndrome (SRS). Here we aimed to test a clinical scoring system for SRS and to analyse the correlation between (epi)genotype and phenotype. Subjects and methods Sixty-nine patients were examined by two physicians. Clinical scores were generated for all patients, with a new, six-item scoring system: (1) small for gestational age, birth length and/or weight ≤−2SDS, (2) postnatal growth retardation (height ≤−2SDS), (3) relative macrocephaly at birth, (4) body asymmetry, (5) feeding difficulties and/or body mass index (BMI) ≤−2SDS in toddlers; (6) protruding forehead at the age of 1–3 years. Subjects were considered to have likely SRS if they met at least four of these six criteria. Molecular investigations were performed blind to the clinical data. Results The 69 patients were classified into two groups (Likely-SRS (n=60), Unlikely-SRS (n=9)). Forty-six Likely-SRS patients (76.7%) displayed either 11p15 ICR1 hypomethylation (n=35; 58.3%) or maternal UPD of chromosome 7 (mUPD7) (n=11; 18.3%). Eight Unlikely-SRS patients had neither ICR1 hypomethylation nor mUPD7, whereas one patient had mUPD7. The clinical score and molecular results yielded four groups that differed significantly overall and for individual scoring system factors. Further molecular screening led identifying chromosomal abnormalities in Likely-SRS-double-negative and Unlikely-SRS groups. Four Likely-SRS-double negative patients carried a DLK1/GTL2 IG-DMR hypomethylation, a mUPD16; a mUPD20 and a de novo 1q21 microdeletion. Conclusions This new scoring system is very sensitive (98%) for the detection of patients with SRS with demonstrated molecular abnormalities. Given its clinical and molecular heterogeneity, SRS could be considered as a spectrum. PMID:25951829

Increased body mass in infancy and early toddlerhood in Angelman syndrome patients with uniparental disomy and imprinting center defects.

PubMed

Brennan, Marie-Luise; Adam, Margaret P; Seaver, Laurie H; Myers, Angela; Schelley, Susan; Zadeh, Neda; Hudgins, Louanne; Bernstein, Jonathan A

2015-01-01

The diagnosis of Angelman syndrome (AS) is based on clinical features and genetic testing. Developmental delay, severe speech impairment, ataxia, atypical behavior and microcephaly by two years of age are typical. Feeding difficulties in young infants and obesity in late childhood can also be seen. The NIH Angelman-Rett-Prader-Willi Consortium and others have documented genotype-phenotype associations including an increased body mass index in children with uniparental disomy (UPD) or imprinting center (IC) defects. We recently encountered four cases of infantile obesity in non-deletion AS cases, and therefore examined body mass measures in a cohort of non-deletion AS cases. We report on 16 infants and toddlers (ages 6 to 44 months; 6 female, and 10 male) with severe developmental delay. Birth weights were appropriate for gestational age in most cases, >97th% in one case and not available in four cases. The molecular subclass case distribution consisted of: UPD (n = 2), IC defect (n = 3), UPD or IC defect (n = 3), and UBE3A mutation (n = 8). Almost all (7 out of 8) UPD, IC and UPD/IC cases went on to exhibit >90th% age- and gender-appropriate weight for height or BMI within the first 44 months. In contrast, no UBE3A mutation cases exhibited obesity or pre-obesity measures (percentiles ranged from <3% to 55%). These findings demonstrate that increased body mass may be evident as early as the first year of life and highlight the utility of considering the diagnosis of AS in the obese infant or toddler with developmental delay, especially when severe. Although a mechanism explaining the association of UPD, and IC defects with obesity has not been identified, recognition of this correlation may inform investigation of imprinting at the PWS/AS locus and obesity. © 2014 Wiley Periodicals, Inc.

Examining the University-Profession Divide: An Inquiry into a Teacher Education Program's Practices

ERIC Educational Resources Information Center

Sivia, Awneet; MacMath, Sheryl

2016-01-01

This paper focuses on the divide between the university as a site of teacher education and the profession of practicing teachers. We employed a theoretical inquiry methodology on a singular case study which included formulating questions about the phenomena of the university-profession divide (UPD), analysing constituents of the UPD, and…

Risk assessment of medically assisted reproduction and advanced maternal ages in the development of Prader-Willi syndrome due to UPD(15)mat.

PubMed

Matsubara, K; Murakami, N; Fukami, M; Kagami, M; Nagai, T; Ogata, T

2016-05-01

Recent studies have suggested that disomic oocyte-mediated uniparental disomy 15 (UPD(15)mat) is increased in patients with Prader-Willi syndrome (PWS) born after medically assisted reproduction (MAR). However, it remains unknown whether the increase is primarily due to MAR procedure itself or advanced maternal childbearing ages as a predisposing factor for the disomic oocyte production. To examine this matter, we studied 122 naturally conceived PWS patients (PWS-NC group) and 13 MAR-conceived patients (PWS-MAR group). The relative frequency of disomic oocyte-mediated UPD(15)mat was significantly higher in PWS-MAR group than in PWS-NC group (7/13 vs 20/122, p = 0.0045), and the maternal childbearing ages were significantly higher in PWS-MAR group than in PWS-NC group [median (range), 38 (26-45) vs 30 (19-42), p = 0.0015]. However, the logistic regression analysis revealed no significant association between the occurrence of disomic oocyte-mediated UPD(15)mat and MAR, after adjusting for childbearing age (p = 0.25). Consistent with this, while the frequency of assisted reproductive technology (ART)-conceived livebirths was higher in the PWS patients than in the Japanese general population (6.4% vs 1.1%, p = 0.00018), the distribution of childbearing ages was significantly skewed to the increased ages in the PWS patients (p < 2.2 × 10(-16) ). These results argue against a positive association of MAR procedure itself with the development of UPD(15)mat. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Doping effects on UPd 2Al 3

NASA Astrophysics Data System (ADS)

Geibel, C.; Schank, C.; Jährling, F.; Buschinger, B.; Grauel, A.; Lühmann, T.; Gegenwart, P.; Helfrich, R.; Reinders, P. H. P.; Steglich, F.

1994-04-01

We present first results of a doping study on the U site on UPd 2Al 3. These results give further support for a tetravalent uranium configuration and an induced type of antiferromagnetic ordering. They confirm the importance of an unperturbed electronic configuration for both antiferromagnetic long-range ordering and heavy-fermion superconductivity. Implications for the interaction between both phenomena are discussed.

Nanoscale patterning of a self-assembled monolayer by modification of the molecule-substrate bond.

PubMed

Shen, Cai; Buck, Manfred

2014-01-01

The intercalation of Cu at the interface of a self-assembled monolayer (SAM) and a Au(111)/mica substrate by underpotential deposition (UPD) is studied as a means of high resolution patterning. A SAM of 2-(4'-methylbiphenyl-4-yl)ethanethiol (BP2) prepared in a structural phase that renders the Au substrate completely passive against Cu-UPD, is patterned by modification with the tip of a scanning tunneling microscope. The tip-induced defects act as nucleation sites for Cu-UPD. The lateral diffusion of the metal at the SAM-substrate interface and, thus, the pattern dimensions are controlled by the deposition time. Patterning down to the sub-20 nm range is demonstrated. The difference in strength between the S-Au and S-Cu bond is harnessed to develop the latent Cu-UPD image into a patterned binary SAM. Demonstrated by the exchange of BP2 by adamantanethiol (AdSH) this is accomplished by a sequence of reductive desorption of BP2 in Cu free areas followed by adsorption of AdSH. The appearance of Au adatom islands upon the thiol exchange suggests that the interfacial structures of BP2 and AdSH SAMs are different.

[Strengthening health literacy of people with migration background: results of a qualitative evaluation].

PubMed

Horn, Annett; Vogt, Dominique; Messer, Melanie; Schaeffer, Doris

2015-06-01

The concept of "health literacy", which has gained attention in English-speaking countries during the last decade, is becoming increasingly popular in Germany. While studies on an international level indicate that people with migration background are often limited in their health literacy, there is a lack of empirical data on that topic in Germany. However, it is well known that they are exposed to health-related risks and problems comparatively often whereas they use health care services less frequently. This article focuses on the native speaking counseling services of the Independent Patient Counseling Germany (UPD gGmbH) as an example of good practice and introduces the results of the evaluation of this counseling service. Qualitative interviews were conducted with UPD-consultants as well as with users of the services. It became apparent that Turkish and Russian-speaking immigrants often have limited health-related literacy. Therefore, support and counseling services should focus not only on issues concerning language and cultural aspects. Furthermore, strategies strengthening the health literacy of persons with migration background are required. Therefore, instruments and strategies will be developed in cooperation with the UPD which aim to improve such skills of the UPD-consultants.

Uranium 5f shell in UPd2Al3 and URu2Si2 studied by x-ray magnetic circular dichroism

NASA Astrophysics Data System (ADS)

Yaouanc, A.; Dalmas de Réotier, P.; van der Laan, G.; Hiess, A.; Goulon, J.; Neumann, C.; Lejay, P.; Sato, N.

1998-10-01

We report x-ray magnetic circular dichroism (XMCD) measurements performed at the uranium M4,5 edges in the paramagnetic phase of the heavy fermion superconductors UPd2Al3 and URu2Si2. The analysis of the spectra with the first sum rule yields the orbital moment of the 5f shell for both compounds. The shape of the dichroic spectrum at the M5 edge for the two compounds is qualitatively different: a single lobe is observed for URu2Si2 and two lobes are detected for UPd2Al3. This two lobe structure reflects the strong effect of the interaction of the uranium 5f electrons with their environment in the latter compound.

A prospective study validating a clinical scoring system and demonstrating phenotypical-genotypical correlations in Silver-Russell syndrome.

PubMed

Azzi, Salah; Salem, Jennifer; Thibaud, Nathalie; Chantot-Bastaraud, Sandra; Lieber, Eli; Netchine, Irène; Harbison, Madeleine D

2015-07-01

Multiple clinical scoring systems have been proposed for Silver-Russell syndrome (SRS). Here we aimed to test a clinical scoring system for SRS and to analyse the correlation between (epi)genotype and phenotype. Sixty-nine patients were examined by two physicians. Clinical scores were generated for all patients, with a new, six-item scoring system: (1) small for gestational age, birth length and/or weight ≤-2SDS, (2) postnatal growth retardation (height ≤-2SDS), (3) relative macrocephaly at birth, (4) body asymmetry, (5) feeding difficulties and/or body mass index (BMI) ≤-2SDS in toddlers; (6) protruding forehead at the age of 1-3 years. Subjects were considered to have likely SRS if they met at least four of these six criteria. Molecular investigations were performed blind to the clinical data. The 69 patients were classified into two groups (Likely-SRS (n=60), Unlikely-SRS (n=9)). Forty-six Likely-SRS patients (76.7%) displayed either 11p15 ICR1 hypomethylation (n=35; 58.3%) or maternal UPD of chromosome 7 (mUPD7) (n=11; 18.3%). Eight Unlikely-SRS patients had neither ICR1 hypomethylation nor mUPD7, whereas one patient had mUPD7. The clinical score and molecular results yielded four groups that differed significantly overall and for individual scoring system factors. Further molecular screening led identifying chromosomal abnormalities in Likely-SRS-double-negative and Unlikely-SRS groups. Four Likely-SRS-double negative patients carried a DLK1/GTL2 IG-DMR hypomethylation, a mUPD16; a mUPD20 and a de novo 1q21 microdeletion. This new scoring system is very sensitive (98%) for the detection of patients with SRS with demonstrated molecular abnormalities. Given its clinical and molecular heterogeneity, SRS could be considered as a spectrum. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

A case with concurrent duplication, triplication, and uniparental isodisomy at 1q42.12-qter supporting microhomology-mediated break-induced replication model for replicative rearrangements.

PubMed

Kohmoto, Tomohiro; Okamoto, Nana; Naruto, Takuya; Murata, Chie; Ouchi, Yuya; Fujita, Naoko; Inagaki, Hidehito; Satomura, Shigeko; Okamoto, Nobuhiko; Saito, Masako; Masuda, Kiyoshi; Kurahashi, Hiroki; Imoto, Issei

2017-01-01

Complex genomic rearrangements (CGRs) consisting of interstitial triplications in conjunction with uniparental isodisomy (isoUPD) have rarely been reported in patients with multiple congenital anomalies (MCA)/intellectual disability (ID). One-ended DNA break repair coupled with microhomology-mediated break-induced replication (MMBIR) has been recently proposed as a possible mechanism giving rise to interstitial copy number gains and distal isoUPD, although only a few cases providing supportive evidence in human congenital diseases with MCA have been documented. Here, we report on the chromosomal microarray (CMA)-based identification of the first known case with concurrent interstitial duplication at 1q42.12-q42.2 and triplication at 1q42.2-q43 followed by isoUPD for the remainder of chromosome 1q (at 1q43-qter). In distal 1q duplication/triplication overlapping with 1q42.12-q43, variable clinical features have been reported, and our 25-year-old patient with MCA/ID presented with some of these frequently described features. Further analyses including the precise mapping of breakpoint junctions within the CGR in a sequence level suggested that the CGR found in association with isoUPD in our case is a triplication with flanking duplications, characterized as a triplication with a particularly long duplication-inverted triplication-duplication (DUP-TRP/INV-DUP) structure. Because microhomology was observed in both junctions between the triplicated region and the flanking duplicated regions, our case provides supportive evidence for recently proposed replication-based mechanisms, such as MMBIR, underlying the formation of CGRs + isoUPD implicated in chromosomal disorders. To the best of our knowledge, this is the first case of CGRs + isoUPD observed in 1q and having DUP-TRP/INV-DUP structure with a long proximal duplication, which supports MMBIR-based model for genomic rearrangements. Molecular cytogenetic analyses using CMA containing single-nucleotide polymorphism probes with further analyses of the breakpoint junctions are recommended in cases suspected of having complex chromosomal abnormalities based on discrepancies between clinical and conventional cytogenetic findings.

Ultraviolet photodetector based on Mg{sub x}Zn{sub 1-x}O films using plasma-enhanced atomic layer deposition

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

Lin, Yu-Chang; Lee, Hsin-Ying, E-mail: hylee@ee.ncku.edu.tw; Lee, Ching-Ting

2016-01-15

A plasma-enhanced atomic layer deposition (PE-ALD) system was used to deposit magnesium zinc oxide (Mg{sub x}Zn{sub 1−x}O) films with various Mg content (x). The Mg{sub x}Zn{sub 1-x}O films were applied to metal–semiconductor–metal ultraviolet (UV) photodetectors (MSM-UPDs) as an active layer. The Mg content in the Mg{sub x}Zn{sub 1-x}O films was modulated by adjusting the ZnO–MgO cycle ratios to 15:1, 12:1, and 9:1. Correspondingly, the Mg content in the Mg{sub x}Zn{sub 1-x}O films characterized using an energy dispersive spectrometer was 0.10, 0.13, and 0.16, respectively. The optical bandgap of the Mg{sub x}Zn{sub 1-x}O films increased from 3.56 to 3.66 eV withmore » an increase in Mg content from 0.10 to 0.16. The peak position of photoresponsivity for the Mg{sub x}Zn{sub 1-x}O MSM-UPDs was also shifted from 350 to 340 nm. The UV-visible rejection ratios of the Mg{sub x}Zn{sub 1-x}O MSM-UPDs were higher than 3 orders of magnitude. In addition, excellent detectivity and noise equivalent power for the Mg{sub x}Zn{sub 1-x}O MSM-UPDs were observed at a bias voltage of 5 V. The high performance of the Mg{sub x}Zn{sub 1-x}O MSM-UPDs was achieved by PE-ALD at a low temperature.« less

QOL in caregivers of Japanese patients with Prader-Willi syndrome with reference to age and genotype.

PubMed

Ihara, Hiroshi; Ogata, Hiroyuki; Sayama, Masayuki; Kato, Aya; Gito, Masao; Murakami, Nobuyuki; Kido, Yasuhiro; Nagai, Toshiro

2014-09-01

This study aimed to measure quality of life (QOL) of the primary family caregivers for patients with Prader-Willi syndrome (PWS). Comparisons were made between caregivers' QOL in regard to their dependents' genotype and age group. The participants with PWS consisted of 22 children (aged from 6 to 12 years) and 23 adolescents (aged from 13 to 19 years), including 6 children and 7 adolescents with maternal uniparental disomy (mUPD) and 16 children and 16 adolescents with deletion (DEL). The QOL of the primary family caregiver for each patient was assessed using the Japanese version of the WHOQOL-BREF. To examine the effect that age (children vs. adolescents) and genotype (DEL vs. mUPD) have on the QOL of caregivers, a two-way ANOVA was conducted, followed by the Bonferroni procedure to test the simple main effects. The two age groups and the two genotypes of PWS were used as independent variables and the total QOL of caregivers as a dependent variable. The two-way ANOVA (F(1, 41) = 6.98, P < 0.05), followed by the Bonferroni procedure, showed the following: the total QOL of caregivers of DEL adolescents showed little difference from that with DEL children, but the QOL of caregivers for mUPD adolescents was shown to be lower than that with mUPD children along with that of caregivers with DEL adolescents. There is hence a growing tendency for the deterioration in the QOL of caregivers to manifest itself later in the patients' adolescence, found mainly with mUPD patients. © 2014 The Authors. American Journal of Medical Genetics Part A Published by Wiley Periodicals, Inc.

TPH2 polymorphisms and expression in Prader-Willi syndrome subjects with differing genetic subtypes.

PubMed

Henkhaus, Rebecca S; Bittel, Douglas C; Butler, Merlin G

2010-09-01

Prader-Willi syndrome (PWS) is a genetic imprinting disease that causes developmental and behavioral disturbances resulting from loss of expression of genes from the paternal chromosome 15q11-q13 region. In about 70% of subjects, this portion of the paternal chromosome is deleted, while 25% have two copies of the maternal chromosome 15, or uniparental maternal disomy (UPD; the remaining subjects have imprinting center defects. There are several documented physical and behavioral differences between the two major PWS genetic subtypes (deletion and UPD) indicating the genetic subtype plays a role in clinical presentation. Serotonin is known to be disturbed in PWS and affects both eating behavior and compulsion, which are reported to be abnormal in PWS. We investigated the tryptophan hydroxylase gene (TPH2), the rate-limiting enzyme in the production of brain serotonin, by analyzing three different TPH2 gene polymorphisms, transcript expression, and correlation with PWS genetic subtype. DNA and RNA from lymphoblastoid cell lines derived from 12 PWS and 12 comparison subjects were used for the determination of genetic subtype, TPH2 polymorphisms and quantitative RT-PCR analysis. A similar frequency of TPH2 polymorphisms was seen in the PWS and comparison subjects with PWS deletion subjects showing increased expression with one or more TPH2 polymorphism. Both PWS deletion and PWS UPD subjects had significantly lower TPH2 expression than control subjects and PWS deletion subjects had significantly lower TPH2 expression compared with PWS UPD subjects. PWS subjects with 15q11-q13 deletions had lower TPH2 expression compared with PWS UPD or control subjects, requiring replication and further studies to identify the cause including identification of disturbed gene interactions resulting from the deletion process.

Comprehensive clinical studies in 34 patients with molecularly defined UPD(14)pat and related conditions (Kagami–Ogata syndrome)

PubMed Central

Kagami, Masayo; Kurosawa, Kenji; Miyazaki, Osamu; Ishino, Fumitoshi; Matsuoka, Kentaro; Ogata, Tsutomu

2015-01-01

Paternal uniparental disomy 14 (UPD(14)pat) and epimutations and microdeletions affecting the maternally derived 14q32.2 imprinted region lead to a unique constellation of clinical features such as facial abnormalities, small bell-shaped thorax with a coat-hanger appearance of the ribs, abdominal wall defects, placentomegaly, and polyhydramnios. In this study, we performed comprehensive clinical studies in patients with UPD(14)pat (n=23), epimutations (n=5), and microdeletions (n=6), and revealed several notable findings. First, a unique facial appearance with full cheeks and a protruding philtrum and distinctive chest roentgenograms with increased coat-hanger angles to the ribs constituted the pathognomonic features from infancy through childhood. Second, birth size was well preserved, with a median birth length of ±0 SD (range, −1.7 to +3.0 SD) and a median birth weight of +2.3 SD (range, +0.1 to +8.8 SD). Third, developmental delay and/or intellectual disability was invariably present, with a median developmental/intellectual quotient of 55 (range, 29–70). Fourth, hepatoblastoma was identified in three infantile patients (8.8%), and histological examination in two patients showed a poorly differentiated embryonal hepatoblastoma with focal macrotrabecular lesions and well-differentiated hepatoblastoma, respectively. These findings suggest the necessity of an adequate support for developmental delay and periodical screening for hepatoblastoma in the affected patients, and some phenotypic overlap between UPD(14)pat and related conditions and Beckwith–Wiedemann syndrome. On the basis of our previous and present studies that have made a significant contribution to the clarification of underlying (epi)genetic factors and the definition of clinical findings, we propose the name ‘Kagami–Ogata syndrome' for UPD(14)pat and related conditions. PMID:25689926

Reciprocal uniparental disomy in yeast.

PubMed

Andersen, Sabrina L; Petes, Thomas D

2012-06-19

In the diploid cells of most organisms, including humans, each chromosome is usually distinguishable from its partner homolog by multiple single-nucleotide polymorphisms. One common type of genetic alteration observed in tumor cells is uniparental disomy (UPD), in which a pair of homologous chromosomes are derived from a single parent, resulting in loss of heterozygosity for all single-nucleotide polymorphisms while maintaining diploidy. Somatic UPD events are usually explained as reflecting two consecutive nondisjunction events. Here we report a previously undescribed mode of chromosome segregation in Saccharomyces cerevisiae in which one cell division produces daughter cells with reciprocal UPD for the same pair of chromosomes without an aneuploid intermediate. One pair of sister chromatids is segregated into one daughter cell and the other pair is segregated into the other daughter cell, mimicking a meiotic chromosome segregation pattern. We term this process "reciprocal uniparental disomy."

Epimutation (hypomethylation) affecting the chromosome 14q32.2 imprinted region in a girl with upd(14)mat-like phenotype.

PubMed

Hosoki, Kana; Ogata, Tsutomu; Kagami, Masayo; Tanaka, Touju; Saitoh, Shinji

2008-08-01

Maternal uniparental disomy for chromosome 14 (upd(14)mat) causes clinically discernible features such as pre- and/or postnatal growth failure, hypotonia, obesity, small hands, and early onset of puberty. The monoallelic expression patterns at the 14q32.2 imprinted region are tightly related to methylation status of the DLK1-MEG3 intergenic differential methylation region (DMR) and the MEG3-DMR that are severely hypermethylated after paternal transmission and grossly hypomethylated after maternal transmission. We examined this imprinted region in a 2 2/12-year-old Japanese patient who was born with a normal birth size (length, +0.2 SD; weight, -0.5 SD) and showed postnatal growth failure (height, -3.1 SD; weight, -3.4 SD), hypotonia, frontal bossing, micrognathia, and small hands. Methylation analysis, genotyping analysis, and deletion analysis were performed with blood samples of the patient and the parents, showing that the DMRs of this patient were grossly hypomethylated in the absence of upd(14)mat and deletion of the DMRs. The results indicate the occurrence of an epimutation (hypomethylation) affecting the normally methylated DMRs of paternal origin, and imply that epimutations should be examined in patients with upd(14)mat-like phenotype.

Understanding the quadrupolar structures of UPd3

NASA Astrophysics Data System (ADS)

McEwen, K. A.; Walker, H. C.; Le, M. D.; McMorrow, D. F.; Colineau, E.; Wastin, F.; Wilkins, S. B.; Park, J.-G.; Bewley, R. I.; Fort, D.

2007-03-01

UPd3 exhibits four phase transitions below T0=7.8 K, attributed to a succession of antiferroquadrupolar (AFQ) orderings of the 5f2 uranium ions localised on the quasi-cubic sites of the dhcp crystal structure. From earlier polarised neutron diffraction measurements in a magnetic field, we proposed that the order parameter of the phase below T0 is Q and a model for the order parameters of the four phases was subsequently developed. This model has now been tested experimentally with measurements of the azimuthal dependence of the intensities of the quadrupolar reflections in the different phases, by means of X-ray resonant scattering (XRS) studies at ESRF. The results indicate that the order parameter, in zero field, of the phase below T0 is Qzx. Our model provides an explanation for these apparently contradictory results. New measurements of the heat capacity of UPd3 at low temperatures have revealed the entropy changes at each of the four transitions. We find that the entropy changes ( ΔS) at T0 and T+1=6.9 K are minimal, whereas ΔS is large at T-1=6.7 K. From this information together with the new XRS results, we have extended our model to provide an explanation of the AFQ structures of UPd3.

Brazil’s Technology Sector

DTIC Science & Technology

2006-10-01

and Innovation in Brazil" (Rio de Janeiro: Agencia da Ciencia e Tecnologia , Ministerio da Cienca e Tecnologia , 2006) <agenciact.mct.gov.br/upd_blob...laboratories, and 27 Ministério da Ciência e Tecnologia , “Relatório Nanotecnologia Investimentos, Resultados e Demandas” (Brasília: 2006), 12. <http...www.mct.gov.br/upd_blob/8075.pdf> (accessed on October 20, 2006). 28 Ministério da Ciência e Tecnologia , “Relatório Nanotecnologia Investimentos

The Neuroanatomy of Genetic Subtype Differences in Prader-Willi Syndrome

PubMed Central

Honea, Robyn A.; Holsen, Laura M.; Lepping, Rebecca J.; Perea, Rodrigo; Butler, Merlin G.; Brooks, William M.; Savage, Cary R.

2012-01-01

Objective Despite behavioral differences between genetic subtypes of Prader-Willi syndrome, no studies have been published characterizing brain structure in these subgroups. Our goal was to examine differences in the brain structure phenotype of common subtypes of Prader-Willi syndrome (PWS) [chromosome 15q deletions and maternal uniparental disomy 15 (UPD)]. Methods Fifteen individuals with PWS due to a typical deletion ((DEL) Type I; n=5, Type II; n=10), 8 with PWS due to UPD, and 25 age-matched healthy-weight individuals (HWC) participated in structural magnetic resonance imaging (MRI) scans. A custom voxel-based morphometry processing stream was used to examine regional differences in gray and white matter volume between groups, covarying for age, sex, and body mass index (BMI). Results Overall, compared to HWC, PWS individuals had lower gray matter volumes that encompassed the prefrontal, orbitofrontal and temporal cortices, hippocampus and parahippocampal gyrus, and lower white matter volumes in the brain stem, cerebellum, medial temporal and frontal cortex. Compared to UPD, the DEL subtypes had lower gray matter volume primarily in the prefrontal and temporal cortices, and lower white matter in the parietal cortex. The UPD subtype had more extensive lower gray and white matter volumes in the orbitofrontal and limbic cortices compared to HWC. Conclusions These preliminary findings are the first structural neuroimaging findings to support potentially separate neural mechanisms mediating the behavioral differences seen in these genetic subtypes. PMID:22241551

The neuroanatomy of genetic subtype differences in Prader-Willi syndrome.

PubMed

Honea, Robyn A; Holsen, Laura M; Lepping, Rebecca J; Perea, Rodrigo; Butler, Merlin G; Brooks, William M; Savage, Cary R

2012-03-01

Despite behavioral differences between genetic subtypes of Prader-Willi syndrome (PWS), no studies have been published characterizing brain structure in these subgroups. Our goal was to examine differences in the brain structure phenotype of common subtypes of PWS [chromosome 15q deletions and maternal uniparental disomy 15 (UPD)]. Fifteen individuals with PWS due to a typical deletion [(DEL) type I; n = 5, type II; n = 10], eight with PWS due to UPD, and 25 age-matched healthy-weight individuals (HWC) participated in structural magnetic resonance imaging (MRI) scans. A custom voxel-based morphometry processing stream was used to examine regional differences in gray and white matter volume (WMV) between groups, covarying for age, sex, and body mass index (BMI). Overall, compared to HWC, PWS individuals had lower gray matter volumes (GMV) that encompassed the prefrontal, orbitofrontal and temporal cortices, hippocampus and parahippocampal gyrus, and lower WMVs in the brain stem, cerebellum, medial temporal, and frontal cortex. Compared to UPD, the DEL subtypes had lower GMV primarily in the prefrontal and temporal cortices, and lower white matter in the parietal cortex. The UPD subtype had more extensive lower gray and WMVs in the orbitofrontal and limbic cortices compared to HWC. These preliminary findings are the first structural neuroimaging findings to support potentially separate neural mechanisms mediating the behavioral differences seen in these genetic subtypes. Copyright © 2012 Wiley Periodicals, Inc.

Maternal uniparental disomy for human chromosome 14, due to loss of a chromosome 14 from somatic cells with t(13; 14) trisomy 14

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

Antonarakis, S.E.; Blouin, J.L.; Maher, J.

1993-06-01

Uniparental disomy (UPD) for particular chromosomes is increasingly recognized as a cause of abnormal phenotypes in humans. The authors recently studied a 9-year-old female with a de novo Robertsonian translocation t(13;14), short stature, mild developmental delay, scoliosis, hyperextensible joints, hydrocephalus that resolved spontaneously during the first year of life, and hyperchloesterolemia. To determine the parental origin of chromosomes 13 and 14 in the proband, they have studied the genotypes of DNA polymorphic markers due to (GT)n repeats in the patient and her parents' blood DNA. The genotypes of markers D14S43, D14S45, D14S49, and D14S54 indicated maternal UPD for chromosome 14.more » There was isodisomy for proximal markers and heterodisomy for distal markers, suggesting a recombination event on maternal chromosomes 14. In addition, DNA analysis first revealed -- and subsequent cytogenetic analysis confirmed -- that there was mosaic trisomy 14 in 5% of blood lymphocytes. There was normal (biparental) inheritance for chromosome 13, and there was no evidence of false paternity in genotypes of 11 highly polymorphic markers on human chromosome 21. Two cases of maternal UPD for chromosome 14 have previously been reported, one with a familial rob t(13;14) and the other with a t(14;14). There are several similarities among these patients, and a [open quotes]maternal UPD chromosome 14 syndrome[close quotes] is emerging; however, the contribution of the mosaic trisomy 14 to the phenotype cannot be evaluated. The study of de novo Robertsonian translocations of the type reported here should reveal both the extent of UPD in these events and the contribution of particular chromosomes involved in certain phenotypes. 33 refs., 3 figs., 1 tab.« less

Resonant magnetic X-ray scattering studies of heavy fermion superconductors

NASA Astrophysics Data System (ADS)

Gaulin, B. D.; Isaacs, E. D.; Lussier, J. G.; Reimers, J. N.; Gibbs, D.; Zschack, P.; Schröder, A.; Taillefer, L.; Garrett, J. D.

1994-04-01

The uranium-based heavy fermion superconductors which are known to display weak antiferromagnetism at low temperatures are well suited to study by the newly developed resonant magnetic X-ray scattering technique. We review recent synchrotron X-ray scattering studies of the magnetic behavior of UPd 2Al 3 and URu 2Si 2 and the interaction between magnetism and superconductivity in these materials. These measurements show resolution-limited magnetic Bragg peaks in UPd 2Al 3 in contrast to those in URu 2Si 2. The order parameter as measured at the (0 0 {1}/{2}) magnetic reciprocal lattice position in UPd 2Al 3 is different from that at (0, 0, {3}/{2}), the latter of which indicates a strong anomaly at TNI ∼ 11.8 K below the sharp onset of the antiferromagnetic phase at TN ∼ 14.5 K. Finally, the behavior of the (0 0 {1}/{2}) order parameter is smooth for T ≤ Tc = 2.00 ± 0.04 K.

The length of an internal poly(A) tract of hibiscus latent Singapore virus is crucial for its replication.

PubMed

Niu, Shengniao; Cao, Shishu; Huang, Li-Jing; Tan, Kelvin Chee-Leong; Wong, Sek-Man

2015-01-01

Hibiscus latent Singapore virus (HLSV) mutants were constructed to study roles of its internal poly(A) tract (IPAT) in viral replication and coat protein (CP) expression. Shortening of the IPAT resulted in reduced HLSV RNA accumulation and its minimal length required for HLSV CP expression in plants was 24 nt. Disruption of a putative long range RNA-RNA interacting structure between 5' and 3' untranslated regions of HLSV-22A and -24A resulted in reduced viral RNA and undetectable CP accumulation in inoculated leaves. Replacement of the IPAT in HLSV with an upstream pseudoknot domain (UPD) of Tobacco mosaic virus (TMV) or insertion of the UPD to the immediate downstream of a 24 nt IPAT in HLSV resulted in drastically reduced viral RNA replication. Plants infected with a TMV mutant by replacement of the UPD with 43 nt IPAT exhibited milder mosaic symptoms without necrosis. We have proposed a model for HLSV replication. Copyright © 2014 Elsevier Inc. All rights reserved.

Temperature effects on the atomic structure and kinetics in single crystal electrochemistry

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

Gründer, Yvonne; Markovic, Nenad M.; Thompson, Paul

2015-01-01

The influence of temperature on the atomic structure at the electrochemical interface has been studied using in-situ surface x-ray scattering (SXS) during the formation of metal monolayers on a Au(111) electrode. For the surface reconstruction of Au(111), higher temperatures increase the mobility of surface atoms in the unreconstructed phase which then determines the surface ordering during the formation of the reconstruction. For the underpotential deposition (UPD) systems, the surface diffusion of the depositing metal adatoms is significantly reduced at low temperatures which results in the frustration of ordered structures in the case of Cu UPD, occurring on a Br-modified surface,more » and in the formation of a disordered Ag monolayer during Ag UPD. The results indicate that temperature changes affect the mass transport and diffusion of metal adatoms on the electrode surface. This demonstrates the importance of including temperature as a variable in studying surface structure and reactions at the electrochemical interface.« less

Modelling the nonlinear behaviour of an underplatform damper test rig for turbine applications

NASA Astrophysics Data System (ADS)

Pesaresi, L.; Salles, L.; Jones, A.; Green, J. S.; Schwingshackl, C. W.

2017-02-01

Underplatform dampers (UPD) are commonly used in aircraft engines to mitigate the risk of high-cycle fatigue failure of turbine blades. The energy dissipated at the friction contact interface of the damper reduces the vibration amplitude significantly, and the couplings of the blades can also lead to significant shifts of the resonance frequencies of the bladed disk. The highly nonlinear behaviour of bladed discs constrained by UPDs requires an advanced modelling approach to ensure that the correct damper geometry is selected during the design of the turbine, and that no unexpected resonance frequencies and amplitudes will occur in operation. Approaches based on an explicit model of the damper in combination with multi-harmonic balance solvers have emerged as a promising way to predict the nonlinear behaviour of UPDs correctly, however rigorous experimental validations are required before approaches of this type can be used with confidence. In this study, a nonlinear analysis based on an updated explicit damper model having different levels of detail is performed, and the results are evaluated against a newly-developed UPD test rig. Detailed linear finite element models are used as input for the nonlinear analysis, allowing the inclusion of damper flexibility and inertia effects. The nonlinear friction interface between the blades and the damper is described with a dense grid of 3D friction contact elements which allow accurate capturing of the underlying nonlinear mechanism that drives the global nonlinear behaviour. The introduced explicit damper model showed a great dependence on the correct contact pressure distribution. The use of an accurate, measurement based, distribution, better matched the nonlinear dynamic behaviour of the test rig. Good agreement with the measured frequency response data could only be reached when the zero harmonic term (constant term) was included in the multi-harmonic expansion of the nonlinear problem, highlighting its importance when the contact interface experiences large normal load variation. The resulting numerical damper kinematics with strong translational and rotational motion, and the global blades frequency response were fully validated experimentally, showing the accuracy of the suggested high detailed explicit UPD modelling approach.

Competence in pediatric urology upon graduation from residency: perceptions of residents, program directors and pediatric urologists.

PubMed

Mickelson, Jennifer J; Macneily, Andrew E; Samarasekera, Dinesh; Beiko, Darren; Afshar, Kourosh

2008-06-01

We aimed to clarify the scope of pediatric urological procedures that Canadian urology residents are perceived to be competent to perform upon graduation. We conducted a survey from April 2005 to June 2006 of urology residency program directors (UPDs), senior urology residents (SURs) and Pediatric Urologists of Canada (PUC) members from all 12 Canadian training programs. Questions focused on which of 23 pediatric urological procedures the 3 study groups perceived urology residents would be competent to perform upon completion of residency without further fellowship training. Procedures were based on the "A," "B" and "C" lists of procedures (least complex to most complex) as outlined in the Royal College of Physicians and Surgeons of Canada Objectives of Training in Urology. Response rates were 12/12 (100%), 41/53 (77%) and 17/23 (74%) for UPDs, SURs and PUC members, respectively. Average exposure to pediatric urology during residency was 5.4 (range 3-9) months and considered sufficient by 75% of UPDs and 69% of SURs, but only 41% of PUC members (p = 0.05). Overall, the 3 groups disagreed on the level of competence for performing level "A" and "B" procedures, with significant disagreement between PUC members and UPDs as well as SURs (p < 0.005). PUC members perceive Canadian urology residents' exposure to pediatric urology as insufficient and their competence for procedures of low to moderate complexity as inadequate. Further investigation regarding exposure to and competence in other emerging subspecialty spheres of urology may be warranted. Ongoing assessment of the objectives for training in pediatric urology is required.

Incidental memory for faces in children with different genetic subtypes of Prader-Willi syndrome.

PubMed

Key, Alexandra P; Dykens, Elisabeth M

2017-06-01

The present study examined the effects of genetic subtype on social memory in children (7-16 years) with Prader-Willi syndrome (PWS). Visual event-related potentials (ERPs) during a passive viewing task were used to compare incidental memory traces for repeated vs single presentations of previously unfamiliar social (faces) and nonsocial (houses) images in 15 children with the deletion subtype and 13 children with maternal uniparental disomy (mUPD). While all participants perceived faces as different from houses (N170 responses), repeated faces elicited more positive ERP amplitudes ('old/new' effect, 250-500ms) only in children with the deletion subtype. Conversely, the mUPD group demonstrated reduced amplitudes suggestive of habituation to the repeated faces. ERP responses to repeated vs single house images did not differ in either group. The results suggest that faces hold different motivational value for individuals with the deletion vs mUPD subtype of PWS and could contribute to the explanation of subtype differences in the psychiatric symptoms, including autism symptomatology. © The Author (2017). Published by Oxford University Press.

Macrophage-derived upd3 cytokine causes impaired glucose homeostasis and reduced lifespan in Drosophila fed a lipid-rich diet.

PubMed

Woodcock, Katie J; Kierdorf, Katrin; Pouchelon, Clara A; Vivancos, Valérie; Dionne, Marc S; Geissmann, Frédéric

2015-01-20

Long-term consumption of fatty foods is associated with obesity, macrophage activation and inflammation, metabolic imbalance, and a reduced lifespan. We took advantage of Drosophila genetics to investigate the role of macrophages and the pathway(s) that govern their response to dietary stress. Flies fed a lipid-rich diet presented with increased fat storage, systemic activation of JAK-STAT signaling, reduced insulin sensitivity, hyperglycemia, and a shorter lifespan. Drosophila macrophages produced the JAK-STAT-activating cytokine upd3, in a scavenger-receptor (crq) and JNK-dependent manner. Genetic depletion of macrophages or macrophage-specific silencing of upd3 decreased JAK-STAT activation and rescued insulin sensitivity and the lifespan of Drosophila, but did not decrease fat storage. NF-κB signaling made no contribution to the phenotype observed. These results identify an evolutionarily conserved "scavenger receptor-JNK-type 1 cytokine" cassette in macrophages, which controls glucose metabolism and reduces lifespan in Drosophila maintained on a lipid-rich diet via activation of the JAK-STAT pathway.

Macrophage-Derived upd3 Cytokine Causes Impaired Glucose Homeostasis and Reduced Lifespan in Drosophila Fed a Lipid-Rich Diet

PubMed Central

Woodcock, Katie J.; Kierdorf, Katrin; Pouchelon, Clara A.; Vivancos, Valérie; Dionne, Marc S.; Geissmann, Frédéric

2015-01-01

Summary Long-term consumption of fatty foods is associated with obesity, macrophage activation and inflammation, metabolic imbalance, and a reduced lifespan. We took advantage of Drosophila genetics to investigate the role of macrophages and the pathway(s) that govern their response to dietary stress. Flies fed a lipid-rich diet presented with increased fat storage, systemic activation of JAK-STAT signaling, reduced insulin sensitivity, hyperglycemia, and a shorter lifespan. Drosophila macrophages produced the JAK-STAT-activating cytokine upd3, in a scavenger-receptor (crq) and JNK-dependent manner. Genetic depletion of macrophages or macrophage-specific silencing of upd3 decreased JAK-STAT activation and rescued insulin sensitivity and the lifespan of Drosophila, but did not decrease fat storage. NF-κB signaling made no contribution to the phenotype observed. These results identify an evolutionarily conserved “scavenger receptor-JNK-type 1 cytokine” cassette in macrophages, which controls glucose metabolism and reduces lifespan in Drosophila maintained on a lipid-rich diet via activation of the JAK-STAT pathway. PMID:25601202

Eukaryotic Elongation Factor 1A Interacts with the Upstream Pseudoknot Domain in the 3′ Untranslated Region of Tobacco Mosaic Virus RNA

PubMed Central

Zeenko, Vladimir V.; Ryabova, Lyubov A.; Spirin, Alexander S.; Rothnie, Helen M.; Hess, Daniel; Browning, Karen S.; Hohn, Thomas

2002-01-01

The genomic RNA of tobacco mosaic virus (TMV), like that of other positive-strand RNA viruses, acts as a template for both translation and replication. The highly structured 3′ untranslated region (UTR) of TMV RNAs plays an important role in both processes; it is not polyadenylated but ends with a tRNA-like structure (TLS) preceded by a conserved upstream pseudoknot domain (UPD). The TLS of tobamoviral RNAs can be specifically aminoacylated and, in this state, can interact with eukaryotic elongation factor 1A (eEF1A)/GTP with high affinity. Using a UV cross-linking assay, we detected another specific binding site for eEF1A/GTP, within the UPDs of TMV and crucifer-infecting tobamovirus (crTMV), that does not require aminoacylation. A mutational analysis revealed that UPD pseudoknot conformation and some conserved primary sequence elements are required for this interaction. Its possible role in the regulation of tobamovirus gene expression and replication is discussed. PMID:11991996

Psychiatric illness and intellectual disability in the Prader-Willi syndrome with different molecular defects--a meta analysis.

PubMed

Yang, Lin; Zhan, Guo-dong; Ding, Jun-jie; Wang, Hui-jun; Ma, Duan; Huang, Guo-ying; Zhou, Wen-hao

2013-01-01

Several studies have suggested a difference in clinical features of intellectual ability and psychiatric illness in the Prader-Willi syndrome (PWS) with the 15q11-q13 paternal deletion and maternal uniparental disomy (mUPD). Our objective was to appraise evidence on this association through a meta-analysis. The electronic records PubMed and EMBASE from 1956 to 2012 were extracted for meta-analysis. Meta-analyses were performed by using fixed effect model. Mean difference, odds ratio, and 95% confidence interval were calculated. We retrieved a total of 744 PWS cases from 13 studies. These include 423 cases with paternal 15q11-q13 deletions and 318 cases of mUPD. Compare to the PWS cases with mUPD, PWS patients with the paternal 15q11-q13 deletion associated with significantly lower full scale IQ (FSIQ) [mean difference (MD), -2.69; 95%CI, -4.86 to -0.52; p=0.02] and verbal IQ (VIQ) (MD, -7.5; 95%CI, -9.75 to -5.26; p<0.00001) but higher performance IQ (PIQ) (MD, 4.02; 95%CI, 1.13 to 6.91; p=0.006). In contrast, PWS patients with mUPD are associated with significantly higher risk of psychiatric illness [odds rate (OR), 0.14; 95%CI, 0.08 to 0.23; p<0.00001] and higher risk of bipolar disorder (OR, 0.04; 95%CI, 0.01 to 0.23; p=0.0002). Significant different clinical features of cognitive development and psychiatric illness are associated with PWS with different molecular defects. These findings provide support for evidence based practice to evaluate and manage the PWS syndrome with different molecular defects.

Multicentre study of maternal and neonatal outcomes in individuals with Prader-Willi syndrome.

PubMed

Singh, Preeti; Mahmoud, Ranim; Gold, June-Anne; Miller, Jennifer L; Roof, Elizabeth; Tamura, Roy; Dykens, Elisabeth; Butler, Merlin G; Driscoll, Dan J; Kimonis, Virginia

2018-05-18

Prader-Willi syndrome (PWS) is a complex genetic disorder associated with three different genetic subtypes: deletion of the paternal copy of 15q11-q13, maternal UPD for chromosome 15 and imprinting defect. Patients are typically diagnosed because of neonatal hypotonia, dysmorphism and feeding difficulties; however, data on the prenatal features of PWS are limited. The aim of the study was to identify and compare frequencies of prenatal and neonatal clinical features of PWS among the three genetic subtypes. Data from 355 patients with PWS from the Rare Diseases Clinical Research Network PWS registry were used to analyse multiple maternal and neonatal factors collected during an 8-year multisite study. Among our cohort of 355 patients with PWS (61% deletion, 36% UPD and 3% imprinting defect) 54% were born by caesarean section, 26% were born prematurely and 34% with a low birth weight (frequencies 32%, 9.6% and 8.1%, respectively, in the general population). Fetal movements were reported as decreased in 72%. All babies were hypotonic, and 99% had feeding difficulties. Low Apgar scores (<7) were noted in 17.7% and 5.6% of patients, respectively, compared with 1% and 1.4%, respectively, in the general population. Maternal age and pre-pregnancy weight were significantly higher in the UPD group (p=0.01 and <0.001, respectively). We found a higher rate of perinatal complications in PWS syndrome compared with the general population. No significant differences in the genetic subtypes were noted except for a higher maternal age and pre-pregnancy weight in the UPD subgroup. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Mosaicism for maternal uniparental disomy 15 in a boy with some clinical features of Prader-Willi syndrome.

PubMed

Zilina, Olga; Kahre, Tiina; Talvik, Inga; Oiglane-Shlik, Eve; Tillmann, Vallo; Ounap, Katrin

2014-01-01

Prader-Willi syndrome (PWS) is caused by the lack of paternal expression of imprinted genes in the human chromosomal region 15q11.2-q13.2, which can be due to an interstitial deletion at 15q11.2-q13 of paternal origin (65-75%), maternal uniparental disomy (matUPD) of chromosome 15 (20-30%), or an imprinting defect (1-3%). The majority of PWS-associated matUPD15 cases represent a complete heterodisomy of chromosome 15 or a mixture of hetero- and isodisomic regions across the chromosome 15. Pure maternal isodisomy is observed in only a few matUPD15 patients. Here we report a case of an 18-year-old boy with some clinical features of Prader-Willi syndrome, such as overweight, muscular hypotonia, facial dysmorphism and psychiatric problems, but there was no reason to suspect PWS in the patient based solely on the phenotype estimation. However, chromosomal microarray analysis (CMA) revealed mosaic loss of heterozygosity of the entire chromosome 15. Methylation-specific multiplex ligation-dependant probe amplification (MS-MLPA) analysis showed hypermethylation of the SNRPN and NDN genes in the PWS/AS critical region of chromosome 15 in this patient. Taking into consideration the MS-MLPA results and the presence of PWS features in the patient, we concluded that it was matUPD15, although the patient's parents were not enrolled in the study. According to CMA and karyotyping, no trisomic or monosomic cells were present. To the best of our knowledge, only two PWS cases with mosaic maternal isodisomy 15 and without trisomic/monosomic cell lines have been reported so far. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Non-pathological complete paternal uniparental isodisomy of chromosome 2 revealed in a maternity testing case.

PubMed

Chen, Man; Jiang, Jian; Li, Chen; Ren, He; Chen, Wei; Liu, Zhiyong; Cheng, Feng; Zhao, Jing; Chen, Tong; Chen, Chuguang; Yan, Jiangwei

2018-05-25

We present a duo paternity test case to assess the biological relationship between a woman and her female child. After analyzing 57 autosomal and 19 X-chromosomal short tandem repeat loci, mother-daughter exclusions were discovered at four loci, which were all located on chromosome 2. Further testing of whole-genome single nucleotide polymorphisms confirmed that the daughter had complete uniparental disomy (UPD) of chromosome 2. This study presents a cautionary case demonstrating that hasty decisions of parentage exclusion should not be made when genetic markers on the same chromosome do not conform to Mendel's laws due to UPD.

Pathogenesis and Consequences of Uniparental Disomy in Cancer

PubMed Central

Makishima, Hideki; Maciejewski, Jaroslaw P.

2012-01-01

Systematic application of new genome-wide single nucleotide polymorphism arrays has demonstrated that somatically acquired regions of loss of heterozygosity (LOH) without changes in copy number frequently occur in many types of cancer. Until recently, the ubiquity of this type of chromosomal defect had remained unrecognized as it cannot be detected using routine cytogenetic technologies. Random and recurrent patterns of copy-neutral LOH, also referred to as uniparental disomy (UPD), can be found in specific cancer types and probably contribute to clonal outgrowth owing to various mechanisms. In this review we explore the types, topography, genesis, pathophysiological consequences and clinical implications of UPD. PMID:21518781

Double layer, diluent and anode effects upon the electrodeposition of aluminium from chloroaluminate based ionic liquids.

PubMed

Abbott, Andrew P; Qiu, Fulian; Abood, Hadi M A; Ali, M Rostom; Ryder, Karl S

2010-02-28

The deposition of aluminium from a chloroaluminate based ionic liquid was studied to elucidate the effect of a diluent (toluene) and electrolyte (LiCl) on the deposit morphology. A wide variety of analytical techniques was applied to this system to determine the speciation and mechanism of material growth. These included: (27)Al NMR, FAB-MS, cyclic voltammetry, chronocoulometry, chronopotentiometry, scanning electron microscopy and atomic force microscopy. It was found that under-potential deposition (upd) causes a change in the way in which metal grows on the electrode surface. Metal grows in two regimes which are believed to be nano-material and bulk material. The addition of toluene causes a change in speciation and a decrease in upd which in turn changes the morphology of the deposit obtained and can lead to mirror finish aluminium. The addition of LiCl has the opposite effect encouraging upd and leading to larger crystallites and a dark grey deposit. It is also shown for the first time that under many conditions the rate of the anodic dissolution process is overall rate controlling and one effect of the addition of toluene is to increase the rate of anodic dissolution.

[Phenotype-genotype correlation analysis of 12 cases with Angelman/Prader-Willi syndrome].

PubMed

Chen, Chen; Peng, Ying; Xia, Yan; Li, Haoxian; Zhu, Huimin; Pan, Qian; Yin, Fei; Wu, Lingqian

2014-12-01

To investigate the genotype-phenotype correlation in patients with Angelman syndrome/Prader-Willi syndrome (AS/PWS) and assess the application value of high-resolution single nucleotide polymorphism microarrays (SNP array) for such diseases. Twelve AS/PWS patients were diagnosed through SNP array, fluorescence in situ hybridization (FISH) and karyotype analysis. Clinical characteristics were analyzed. Deletions ranging from 4.8 Mb to 7.0 Mb on chromosome 15q11.2-13 were detected in 11 patients. Uniparental disomy (UPD) was detected in only 1 patient. Patients with deletions could be divided into 2 groups, including 7 cases with class I and 4 with class II. The two groups however had no significant phenotypic difference. The UPD patient had relatively better development and language ability. Deletions of 6 patients were confirmed by FISH to be of de novo in origin. The risk to their sibs was determined to be less than 1%. The phenotypic differences between AS/PWS patients with class I and class II deletion need to be further studied. SNP array is useful in detecting and distinguishing of patients with deletion or UPD. This method may be applied for studying the genotype-phenotype association and the mechanism underlying AS/PWS.

Klinefelter's syndrome and Prader-Willi syndrome: a rare combination.

PubMed

Verhoeven, W M A; de Vries, B B A; Duffels, S J H; Egger, J I M; Noordam, C; Tuinier, S

2007-01-01

In this paper a review is presented of the rare combination of Klinefelter's syndrome and Prader-Willi syndrome (PWS) and a second case of this combination with a uniparental disomy (UPD) etiology of PWS is described. Patients outlined in all other 8 reports and the present case have a PWS phenotype. Virtually no information is available on the behavioral and psychopathological phenotype in this combination. The latter may be explained by the observation that psychiatric syndromes are especially prevalent in PWS patients with a UPD. It is concluded that instability in mood and behavior in this and other syndromes should be preferentially treated with mood stabilizing agents. Copyright (c) 2007 S. Karger AG, Basel.

Prader-Willi syndrome: intellectual abilities and behavioural features by genetic subtype.

PubMed

Milner, Katja M; Craig, Ellen E; Thompson, Russell J; Veltman, Marijcke W M; Thomas, N Simon; Roberts, Sian; Bellamy, Margaret; Curran, Sarah R; Sporikou, Caroline M J; Bolton, Patrick F

2005-10-01

Studies of chromosome 15 abnormality have implicated over-expression of paternally imprinted genes in the 15q11-13 region in the aetiology of autism. To test this hypothesis we compared individuals with Prader-Willi syndrome (PWS) due to uniparental disomy (UPD--where paternally imprinted genes are over-expressed) to individuals with the 15q11-13 deletion form of the syndrome (where paternally imprinted genes are not over-expressed). We also tested reports that PWS cases due to the larger type I (TI) form of deletion show differences to cases with the smaller type II (TII) deletion. Ninety-six individuals with PWS were recruited from genetic centres and the PWS association. Forty-nine individuals were confirmed as having maternal UPD of chromosome 15 and were age and sex matched to 47 individuals with a deletion involving 15q11-13 (32 had the shorter (T II) deletion, and 14 had the longer (TI) deletion). Behavioural assessments were carried out blind to genetic status, using the Autism Diagnostic Observation Schedule (ADOS), the Autism Diagnostic Interview (ADI), the Autism Screening Questionnaire (ASQ), the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), the Vineland Adaptive Behaviour Scales (VABS), and measurements of intellectual ability, including the Wechsler and Mullen Scales and Raven's Matrices. UPD cases exhibited significantly more autistic-like impairments in reciprocal social interaction on questionnaire, interview and standardised observational measures. Comparison of TI and TII deletion cases revealed few differences, but ability levels tended to be lower in the TI deletion cases. Findings from a large study comparing deletion and UPD forms of Prader-Willi syndrome were consistent with other evidence in indicating that paternally imprinted genes in the 15q11-13 region constitute a genetic risk factor for aspects of autistic symptomatology. These genes may therefore play a role in the aetiology of autism. By contrast with another report, there was no clear-cut relationship between the size of the deletion and the form of cognitive and behavioural phenotype.

5f delocalization-induced suppression of quadrupolar order in U(Pd 1-xPt x)₃

DOE PAGES

Walker, H. C.; Le, M. D.; McEwen, K. A.; ...

2011-12-27

We present bulk magnetic and transport measurements and x-ray resonant scattering measurements on U(Pd 1-xPt x)₃ for x=0.005 and 0.01, which demonstrate the high sensitivity of the quadrupolar order in the canonical antiferroquadrupolar ordered system UPd₃ to doping with platinum. Bulk measurements for x=0.005 reveal behavior similar to that seen in UPd₃, albeit at a lower temperature, and x-ray resonant scattering provides evidence of quadrupolar order described by the Q xy order parameter. In contrast, bulk measurements reveal only an indistinct transition in x=0.01, consistent with the observation of short-range quadrupolar order in our x-ray resonant scattering results.

Neurocognitive function in an extended Afrikaner-ancestry family with affective illness.

PubMed

Savitz, Jonathan; van der Merwe, Lize; Solms, Mark; Ramesar, Rajkumar

2007-03-01

To characterize the neuropsychological profile of an extended family with unipolar depression (UPD) and other forms of affective illness. We administered a battery of neuropsychological tasks measuring various aspects of executive function and visual and verbal memory to 49 individuals in 1 extended family. Six participants had 1 lifetime episode of major depression (MDE-S), 15 were diagnosed with recurrent major depression (MDE-R), 11 had another DSM-IV diagnosis and 17 subjects were unaffected. After controlling for multiple confounding factors, including mood and medication, the MDE-R sample made significantly more errors than unaffected relatives on the Stroop Task, a measure of cognitive control. There may be at least 1 subtype of UPD characterized by a state-independent deficit in cognitive control.

Die nuklearen Anlagen von Hanford (1943-1987) Eine Fallstudie über die Schnittstellen von Physik, Biologie und die US-amerikanische Gesellschaft zur Zeit des Kalten Krieges

NASA Astrophysics Data System (ADS)

Macuglia, Daniele

Die Geschichte des Kalten Krieges eröffnet viele Möglichkeiten, sich näher mit den Schnittstellen von Physik und Biologie während des 20. Jahrhunderts zu befassen. Nicht nur das Unglück in Tschernobyl aus dem Jahr 1986, auch das Beispiel der nuklearen Anlagen in Hanford in den Vereinigten Staaten zeigt die biologischen Folgen von nuklearer Physik.

Adrenal Insufficiency, Sex Reversal, and Angelman Syndrome due to Uniparental Disomy Unmasking a Mutation in CYP11A1.

PubMed

Kim, Ahlee; Fujimoto, Masanobu; Hwa, Vivian; Backeljauw, Philippe; Dauber, Andrew

2018-01-01

Cholesterol side-chain cleavage enzyme (P450scc) deficiency is a rare genetic disorder causing primary adrenal insufficiency with or without a 46,XY disorder of sexual development (DSD). Herein, we report a case of the combination of primary adrenal insufficiency, a DSD (testes with female external genitalia in a setting of a 47,XXY karyotype), and Angelman syndrome. Comprehensive genetic analyses were performed, including a single nucleotide polymorphism microarray and whole-exome sequencing. In vitro studies were performed to evaluate the pathogenicity of the novel mutation that was identified by whole-exome sequencing. The patient was found to have segmental uniparental disomy (UPD) of chromosome 15 explaining her diagnosis of Angelman syndrome. Whole-exome sequencing further revealed a novel homozygous intronic variant in CYP11A1, the gene encoding P450scc, found within the region of UPD. In vitro studies confirmed that this variant led to decreased efficiency of CYP11A1 splicing. We report the first case of the combination of 2 rare genetic disorders, Angelman syndrome, and P450scc deficiency. After 20 years of diagnostic efforts, significant advances in genetic diagnostic technology allowed us to determine that these 2 disorders originate from a unified genetic etiology, segmental UPD unmasking a novel recessive mutation in CYP11A1. © 2018 S. Karger AG, Basel.

Mosaic isochromosome 15q and maternal uniparental isodisomy for chromosome 15 in a patient with morbid obesity and variant PWS-like phenotype.

PubMed

Wang, Jia-Chi; Vaccarello-Cruz, Mary; Ross, Leslie; Owen, Renius; Pratt, Victoria M; Lightman, Katherine; Liu, Yan; Hafezi, Katayoun; Cherif, Dhia; Sahoo, Trilochan

2013-07-01

Angelman and Prader-Willi syndromes are reciprocal imprinting disorders caused by loss of maternally or paternally expressed genes, respectively, within 15q11.2-q13. Angelman syndrome (AS; OMIM 105830) is a neurodevelopmental disorder and is due to the loss of maternally expressed UBE3A gene. Prader-Willi syndrome (PWS; OMIM 176270) is a clinically distinct disorder caused by the loss of paternally expressed genes in the human chromosome region 15q11.2-q13. Recently published data strongly suggest a role for the paternally expressed small nucleolar RNA (snoRNA) cluster, SNORD116, in PWS etiology. Uniparental disomy (UPD) 15 is one of the important causes of PWS and AS. Interestingly, balanced and unbalanced chromosomal aberrations in the form of Robertsonian translocation, isochromosomes, supernumerary marker chromosomes and copy number variations have been strongly linked with the occurrence of UPD. Here we report on a very unique case with a mosaic isochromosome for the entire long arm of 15, that is, i(15)(q10), resulting in mosaic uniparental isodisomy for 15q and with no copy number alterations. This is the first report of UPD15 constituted by a mosaic, but copy number neutral chromosomal rearrangement in a patient with a variant PWS-like phenotype. Copyright © 2013 Wiley Periodicals, Inc.

Dealloying, Microstructure and the Corrosion/Protection of Cast Magnesium Alloys

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

Sieradzki, Karl; Aiello, Ashlee; McCue, Ian

The purpose of this project was to develop a greater understanding of micro-galvanic corrosion effects in cast magnesium alloys using both experimental and computational methods. Experimental accomplishments have been made in the following areas of interest: characterization, aqueous free-corrosion, atmospheric corrosion, ionic liquid dissolution, rate kinetics of oxide dissolution, and coating investigation. Commercial alloys (AZ91D, AM60, and AZ31B), binary-phase alloys (αMg-2at.%Al, αMg-5at.%Al, and Mg-8at.%Al), and component phases (Mg, Al, β-Mg, β-1%Zn, MnAl3) were obtained and characterized using energy dispersive spectroscopy (EDS), X-ray diffraction (XRD), and scanning electron microscopy (SEM). Full immersion in aqueous chloride was used to characterize the corrosionmore » behavior of alloys. Rotating disc electrodes (RDEs) were used to observe accelerated long-term corrosion behavior. Al surface redistribution for freely corroded samples was analyzed using SEM, EDS, and lithium underpotential deposition (Li UPD). Atmospheric corrosion was observed using contact angle evolution, overnight pH monitoring, and surface pH evolution studies. Ionic liquid corrosion characterization was performed using linear sweep voltammetry and potentiostatic dissolution in 150° choline chloride-urea (cc-urea). Two surface coatings were investigated: (1) Li-carbonate and (2) cc-urea. Li-carbonate coatings were characterized using X-ray photoelectron spectroscopy (XPS), SEM, and aqueous free corrosion potential monitoring. Hydrophobic cc-urea coatings were characterized using contact angle measurements and electrochemical impedance spectroscopy. Oxide dissolution rate kinetics were studied using inductively coupled plasma mass spectroscopy (ICP-MS). Computational accomplishments have been made through the development of Kinetic Monte Carlo (KMC) simulations which model time- and composition-dependent effects on the microstructure due to spatial redistribution of alloying elements during corrosion.« less

Multiplet Splitting Effects on Core-Level Photoemission and Inverse-Photoemission Spectra of Uranium Intermetallic Compounds

NASA Astrophysics Data System (ADS)

Okada, Kozo

1999-03-01

The present paper discusses the role of U 5f-5f exchange interaction (J) in the inverse photoemission spectrum (IPES) and the U 4f x-ray photoemission spectrum (XPS) of uranium intermetallic compounds. The origin of the broad main peak in the IPES of UPd3 and UPd2Al3, for instance, is ascribed to the exchange coupling effects of 5f electrons. In other words, whether the ground state is of high-spin or of low-spin is directly reflected in the width of the IPES. On the other hand, the interpretation for the U 4f photoemission spectrum is not so greatly influenced by J. The full-multiplet calculations are also performed for an U4+ ion for comparison.

Neurocognitive function in an extended Afrikaner-ancestry family with affective illness

PubMed Central

Savitz, Jonathan; van der Merwe, Lize; Solms, Mark; Ramesar, Rajkumar

2007-01-01

Objective To characterize the neuropsychological profile of an extended family with unipolar depression (UPD) and other forms of affective illness. Method We administered a battery of neuropsychological tasks measuring various aspects of executive function and visual and verbal memory to 49 individuals in 1 extended family. Six participants had 1 lifetime episode of major depression (MDE-S), 15 were diagnosed with recurrent major depression (MDE-R), 11 had another DSM-IV diagnosis and 17 subjects were unaffected. Results After controlling for multiple confounding factors, including mood and medication, the MDE-R sample made significantly more errors than unaffected relatives on the Stroop Task, a measure of cognitive control. Conclusion There may be at least 1 subtype of UPD characterized by a state-independent deficit in cognitive control. PMID:17353940

Behavioral differences among subjects with Prader-Willi syndrome and type I or type II deletion and maternal disomy.

PubMed

Butler, Merlin G; Bittel, Douglas C; Kibiryeva, Nataliya; Talebizadeh, Zohreh; Thompson, Travis

2004-03-01

To determine whether phenotypic differences exist among individuals with Prader-Willi syndrome with either type I or type II deletions of chromosome 15 or maternal disomy 15 leading to a better understanding of cause and pathophysiology of this classical genetic syndrome. We analyzed clinical, anthropometric, and behavioral data in 12 individuals (5 men, 7 women; mean age: 25.9 +/- 8.8 years) with PWS and a type I (TI) deletion, 14 individuals (6 men, 8 women; mean age: 19.6 +/- 6.5 years) with PWS and a type II (TII) deletion, and 21 individuals (10 men, 11 women; mean age: 23.6 +/- 9.2 years) with PWS and maternal disomy 15 (UPD). The deletion type was determined by genotyping of DNA markers between proximal chromosome 15 breakpoints BP1 and BP2. TI deletions are approximately 500 kb larger than TII deletions. Several validated psychological and behavioral tests were used to assess phenotypic characteristics of individuals with PWS representing the 3 genetic subtypes. Significant differences were found between the 2 deletion groups and those with UPD in multiple psychological and behavioral tests, but no differences were observed in other clinical or anthropometric data studied. Adaptive behavior scores were generally worse in individuals with PWS and the TI deletion, and specific obsessive-compulsive behaviors were more evident in the TI individuals compared with those with UPD. Individuals with PWS with TI deletions also had poorer reading and math skills as well as visual-motor integration. Our study indicates that individuals with TI deletion generally have more behavioral and psychological problems than individuals with the TII deletion or UPD. Four recently identified genes have been identified in the chromosome region between BP1 and BP2 with 1 of the genes (NIPA-1) expressed in mouse brain tissue but not thought to be imprinted. It may be important for brain development or function. These genes are deleted in individuals with TI deletion and are implicated in compulsive behavior and lower intellectual ability in individuals with TI versus TII.

Effect of Genotype and Previous GH Treatment on Adiposity in Adults With Prader-Willi Syndrome.

PubMed

Coupaye, Muriel; Tauber, Maithé; Cuisset, Laurence; Laurier, Virginie; Bieth, Eric; Lacorte, Jean-Marc; Oppert, Jean-Michel; Clément, Karine; Poitou, Christine

2016-12-01

Adults with Prader-Willi syndrome (PWS) have an increased proportion of sc fat mass compared with body mass index (BMI)-matched controls, but whether the genotype influences body composition and metabolic profile remains controversial. To assess body composition and metabolic features in adults with PWS, according to genetic subtype. In addition, the effect of previous GH treatment was assessed. Main Outcomes and Measures: Body composition (Dual Energy X-ray Absorptiometry) and metabolic parameters were compared in PWS adults (mean age, 25.5 ± 8.9 y) with deletion (n = 47) or uniparental disomy (UPD) (n = 26), taking into account GH treatment in childhood and/or adolescence. In subgroups, adipocyte size, fasting total ghrelin levels, and resting energy expenditure were measured, and hyperphagia was assessed by the Dykens Hyperphagia Questionnaire. Body composition (Dual Energy X-ray Absorptiometry) and metabolic parameters were compared in PWS adults (mean age, 25.5 ± 8.9 y) with deletion (n = 47) or uniparental disomy (UPD) (n = 26), taking into account GH treatment in childhood and/or adolescence. In subgroups, adipocyte size, fasting total ghrelin levels, and resting energy expenditure were measured, and hyperphagia was assessed by the Dykens Hyperphagia Questionnaire. In the whole sample, the deletion group had a higher BMI compared with UPD (40.9 ± 11.5 vs 34.6 ± 9.6 kg/m 2 , P = .02), but there was no difference between groups in percent body fat, metabolic profile, adipocyte size, resting energy expenditure, hyperphagia score, or ghrelin levels. In subjects previously treated with GH, BMI was not different between UPD and deletion groups (33.0 ± 9.7 vs 33.5 ± 11.1 kg/m 2 ). In addition, previous GH treatment was associated with decreased percent body fat and adipocyte volume only in the deletion group. A deletion genotype in adults with PWS is associated with increased BMI. GH treatment in childhood and/or adolescence limits this deleterious phenotypic effect with improved adiposity markers. This study suggests relationships between the molecular phenotype of PWS and adipose tissue development as well as sensitivity to GH.

mom identifies a receptor for the Drosophila JAK/STAT signal transduction pathway and encodes a protein distantly related to the mammalian cytokine receptor family

PubMed Central

Chen, Hua-Wei; Chen, Xiu; Oh, Su-Wan; Marinissen, Maria J.; Gutkind, J. Silvio; Hou, Steven X.

2002-01-01

The JAK/STAT signal transduction pathway controls numerous events in Drosophila melanogaster development. Receptors for the pathway have yet to be identified. Here we have identified a Drosophila gene that shows embryonic mutant phenotypes identical to those in the hopscotch (hop)/JAK kinase and marelle (mrl)/Stat92e mutations. We named this gene master of marelle (mom). Genetic analyses place mom's function between upd (the ligand) and hop. We further show that cultured cells transfected with the mom gene bind UPD and activate the HOP/STAT92E signal transduction pathway. mom encodes a protein distantly related to the mammalian cytokine receptor family. These data show that mom functions as a receptor of the Drosophila JAK/STAT signal transduction pathway. PMID:11825879

Angelman syndrome with uniparental disomy due to paternal meiosis II nondisjunction.

PubMed

Gyftodimou, J; Karadima, G; Pandelia, E; Vassilopoulos, D; Petersen, M B

1999-06-01

We report a case of Angelman syndrome (AS) with paternal uniparental disomy (pUPD) of chromosome 15. This 6-year-old girl with overgrowth had frequent, but only provoked laughter, was mildly ataxic with limb hypertonia, and had no intelligible speech. She had deep-set eyes, protruding tongue, and prominent chin. The karyotype was normal. DNA analysis with microsatellites from chromosome 15 showed no inheritance of maternal alleles both within and outside the AS critical region. Proximal markers showed reduction to homozygosity of paternal alleles, intermediate markers showed nonreduction, and distal markers reduction, thus suggesting a meiosis II nondisjunction event in the father with two crossovers. This is, to our knowledge, the first reported case of AS due to meiosis II nondisjunction. We present detailed physical measurements in this patient, adding to the clinical description of the milder phenotype in AS due to pUPD.

Hybridization gap and dual nature of the heavy-fermion compound UPd 2Al 3 via quasiparticle scattering spectroscopy

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

Jaggi, N. K.; Mehio, O.; Dwyer, M.

We present results from point-contact spectroscopy of the antiferromagnetic heavy-fermion superconductor UPd 2Al 3 : Conductance spectra are taken from single crystals with two major surface orientations as a function of temperature and magnetic field and analyzed using a theory of cotunneling into an Anderson lattice. Spectroscopic signatures are clearly identified, including the distinct asymmetric double-peak structure arising from the opening of a hybridization gap when a coherent heavy-Fermi liquid is formed. Both the hybridization gap, found to be 7.2 ± 0.3 meV at 4 K, and the conductance enhancement above a flat background decrease upon increasing temperature. While themore » hybridization gap is extrapolated to remain finite up to ~28 K, close to the temperature around which the magnetic susceptibility displays a broad peak, the conductance enhancement vanishes at ~18 K, slightly above the antiferromagnetic transition temperature (T N ≈ 14 K) . This rapid decrease of the conductance enhancement is understood as a consequence of the junction drifting away from the ballistic regime due to increased scattering off magnons associated with the localized U 5 f electrons. This shows that while the hybridization gap opening is not directly associated with the antiferromagnetic ordering, its visibility in the conductance is greatly affected by the temperature-dependent magnetic excitations. Our findings are not only consistent with the 5 f dual-nature picture in the literature but also shed new light on the interplay between the itinerant and localized electrons in UPd 2Al 3 .« less

Hybridization gap and dual nature of the heavy-fermion compound UPd 2Al 3 via quasiparticle scattering spectroscopy

DOE PAGES

Jaggi, N. K.; Mehio, O.; Dwyer, M.; ...

2017-04-17

We present results from point-contact spectroscopy of the antiferromagnetic heavy-fermion superconductor UPd 2Al 3 : Conductance spectra are taken from single crystals with two major surface orientations as a function of temperature and magnetic field and analyzed using a theory of cotunneling into an Anderson lattice. Spectroscopic signatures are clearly identified, including the distinct asymmetric double-peak structure arising from the opening of a hybridization gap when a coherent heavy-Fermi liquid is formed. Both the hybridization gap, found to be 7.2 ± 0.3 meV at 4 K, and the conductance enhancement above a flat background decrease upon increasing temperature. While themore » hybridization gap is extrapolated to remain finite up to ~28 K, close to the temperature around which the magnetic susceptibility displays a broad peak, the conductance enhancement vanishes at ~18 K, slightly above the antiferromagnetic transition temperature (T N ≈ 14 K) . This rapid decrease of the conductance enhancement is understood as a consequence of the junction drifting away from the ballistic regime due to increased scattering off magnons associated with the localized U 5 f electrons. This shows that while the hybridization gap opening is not directly associated with the antiferromagnetic ordering, its visibility in the conductance is greatly affected by the temperature-dependent magnetic excitations. Our findings are not only consistent with the 5 f dual-nature picture in the literature but also shed new light on the interplay between the itinerant and localized electrons in UPd 2Al 3 .« less

Collagen degradation products and proinflammatory cytokines in systemic and localized scleroderma.

PubMed

Becvár, R; Hulejová, H; Braun, M; Stork, J

2007-01-01

The aim of this study was to assess the degradation of collagen type I and proinflammatory cytokines in systemic and localized scleroderma compared with psoriasis and healthy controls. Total 99 individuals were examined - 24 with SSc, 22 with LSc, 39 patients with PsV and 14 healthy controls. U-PD and U-DPD were measured using a sensitive isocratic HPLC method. Serum levels of IL-6 and soluble IL-2R were assayed using commercial ELISA kits. In the SSc group U-PD and U-DPD levels (nmol/mmol creatinine) were increased compared with controls (P = 0.001) and with PsV (P = 0.006). IL-6 levels were increased compared with controls (P = 0.004) and with PsV (P = 0.002). IL-2R concentrations were insignificantly increased in comparison with controls and were lower than in PsV, but the difference was not significant. In the LSc group excretion of U-PD and U-DPD did not differ from controls, but was insignificantly decreased compared with PsV. IL-6 levels were increased compared with controls (P = 0.001) and also with PsV (P = 0.03). IL-2R concentrations were significantly increased in comparison with controls only (P = 0.03). In patients with SSc our data have shown the most intensive collagen degradation and simultaneously an active inflammation, as documented by IL-6, which reflects the pathological processes in the skin and visceral organs compared with PsV patients and healthy individuals. In the LSc group collagen degradation was similar to that in control groups, but a certain inflammatory activity was observed.

Autism spectrum disorder in Prader-Willi syndrome: A systematic review.

PubMed

Bennett, Jeffrey A; Germani, Tamara; Haqq, Andrea M; Zwaigenbaum, Lonnie

2015-12-01

Prader-Willi syndrome (PWS) is a rare genetic disorder that results from lack of expression of paternally-derived genes on chromosome 15q11-13; caused by a deletion (DEL), uniparental disomy (UPD), or a rare imprinting center defect. PWS is associated with a distinct behavioral phenotype that in some respects overlaps with autism spectrum disorder (ASD), a neurodevelopmental disorder characterized by restricted or repetitive behaviors (RRBs) and social-communication impairment. The goal of this review was to (i) review published literature investigating core ASD symptoms in PWS and (ii) provide a prevalence estimate of ASD in PWS. Two independent reviewers searched Medline, CINAHL, PsychINFO, Embase, and Web of Science to find studies that answered the research questions. Individuals with PWS demonstrate significant levels of RRBs and social-communication impairment, in some reports reaching similar levels to those of non-PWS ASD comparison groups. Individuals with UPD had more social-communication impairment than those with DEL. Of 786 PWS participants, 210 (26.7%) were reported as meeting criteria for ASD, either based on clinical diagnosis or by exceeding clinical cut-points on relevant ASD symptom measures. In studies that distinguished genetic subtypes, rates of ASD were higher in individuals with PWS with UPD (67 of 190; 35.3%) than those with DEL (47 of 254; 18.5%). Published data on the association of PWS and ASD to date are limited to sample means of 8 years of age and older. Further research is needed to identify early markers of ASD in PWS children, to support earlier diagnosis and intervention for this important comorbidity. © 2015 Wiley Periodicals, Inc.

Behavior in Prader-Willi syndrome: relationship to genetic subtypes and age.

PubMed

Dykens, Elisabeth M; Roof, Elizabeth

2008-09-01

Some behavioral features of Prader-Willi syndrome (PWS) are associated with the major genetic subtypes of this disorder. While most agree that those with maternal uniparental disomy (UPD) have a distinctive cognitive and psychiatric profile, findings are more controversial regarding possible differences among persons who vary in paternal deletion size. Caregivers of 88 persons with PWS aged 5 to 51 years (M = 22 years) were administered measures of problem behavior, compulsivity, hyperphagia, and adaptive skills. The sample was well characterized as having relatively large, Type I (n = 26) or smaller, Type II (n = 29) deletions, or UPD (n = 33). No significant behavioral differences were found between the Type I versus Type II deletion groups. Within each genetic subtype, however, differences emerged in how advancing age related to behavior. Although age did not emerge as a significant correlate of behavior in the Type II or UPD groups, in the Type I group age was consistently associated with lower problem behaviors, adaptive skills, and externalizing symptoms. Although differences between deletion subtypes were not found, significant within-subtype differences emerged in relationships between age and behavior. Negative associations between age and behavior in the Type I group only may relate to non-imprinted genes that are deleted in Type I but not Type II cases, including CYFIP1. Altered expression of CYFIP1 is seen in other developmental disabilities, including 15q disorders, and haploinsufficiency of CYFIP1 in Type I PWS cases may be associated with age-related phenotypic effects. Findings underscore the importance of a life-span perspective in phenotypic research.

Tennessee long-range transportation plan : aviation system plan update

DOT National Transportation Integrated Search

2005-01-01

This plan update is streamlined in nature and will only consider the ttates six commercial service airports and 14 regional airports. The tasks completed for this update included an inventory of facilities, aviation industry review, review and upd...

Materials Data on U(PdS2)2 (SG:88) by Materials Project

DOE Data Explorer

Kristin Persson

2016-02-10

Computed materials data using density functional theory calculations. These calculations determine the electronic structure of bulk materials by solving approximations to the Schrodinger equation. For more information, see https://materialsproject.org/docs/calculations

Clonal hematopoiesis in acquired aplastic anemia.

PubMed

Ogawa, Seishi

2016-07-21

Clonal hematopoiesis (CH) in aplastic anemia (AA) has been closely linked to the evolution of late clonal disorders, including paroxysmal nocturnal hemoglobinuria and myelodysplastic syndromes (MDS)/acute myeloid leukemia (AML), which are common complications after successful immunosuppressive therapy (IST). With the advent of high-throughput sequencing of recent years, the molecular aspect of CH in AA has been clarified by comprehensive detection of somatic mutations that drive clonal evolution. Genetic abnormalities are found in ∼50% of patients with AA and, except for PIGA mutations and copy-neutral loss-of-heterozygosity, or uniparental disomy (UPD) in 6p (6pUPD), are most frequently represented by mutations involving genes commonly mutated in myeloid malignancies, including DNMT3A, ASXL1, and BCOR/BCORL1 Mutations exhibit distinct chronological profiles and clinical impacts. BCOR/BCORL1 and PIGA mutations tend to disappear or show stable clone size and predict a better response to IST and a significantly better clinical outcome compared with mutations in DNMT3A, ASXL1, and other genes, which are likely to increase their clone size, are associated with a faster progression to MDS/AML, and predict an unfavorable survival. High frequency of 6pUPD and overrepresentation of PIGA and BCOR/BCORL1 mutations are unique to AA, suggesting the role of autoimmunity in clonal selection. By contrast, DNMT3A and ASXL1 mutations, also commonly seen in CH in the general population, indicate a close link to CH in the aged bone marrow, in terms of the mechanism for selection. Detection and close monitoring of somatic mutations/evolution may help with prediction and diagnosis of clonal evolution of MDS/AML and better management of patients with AA. © 2016 by The American Society of Hematology.

Clonal hematopoiesis in acquired aplastic anemia

PubMed Central

2016-01-01

Clonal hematopoiesis (CH) in aplastic anemia (AA) has been closely linked to the evolution of late clonal disorders, including paroxysmal nocturnal hemoglobinuria and myelodysplastic syndromes (MDS)/acute myeloid leukemia (AML), which are common complications after successful immunosuppressive therapy (IST). With the advent of high-throughput sequencing of recent years, the molecular aspect of CH in AA has been clarified by comprehensive detection of somatic mutations that drive clonal evolution. Genetic abnormalities are found in ∼50% of patients with AA and, except for PIGA mutations and copy-neutral loss-of-heterozygosity, or uniparental disomy (UPD) in 6p (6pUPD), are most frequently represented by mutations involving genes commonly mutated in myeloid malignancies, including DNMT3A, ASXL1, and BCOR/BCORL1. Mutations exhibit distinct chronological profiles and clinical impacts. BCOR/BCORL1 and PIGA mutations tend to disappear or show stable clone size and predict a better response to IST and a significantly better clinical outcome compared with mutations in DNMT3A, ASXL1, and other genes, which are likely to increase their clone size, are associated with a faster progression to MDS/AML, and predict an unfavorable survival. High frequency of 6pUPD and overrepresentation of PIGA and BCOR/BCORL1 mutations are unique to AA, suggesting the role of autoimmunity in clonal selection. By contrast, DNMT3A and ASXL1 mutations, also commonly seen in CH in the general population, indicate a close link to CH in the aged bone marrow, in terms of the mechanism for selection. Detection and close monitoring of somatic mutations/evolution may help with prediction and diagnosis of clonal evolution of MDS/AML and better management of patients with AA. PMID:27121470

Three-frequency BDS precise point positioning ambiguity resolution based on raw observables

NASA Astrophysics Data System (ADS)

Li, Pan; Zhang, Xiaohong; Ge, Maorong; Schuh, Harald

2018-02-01

All BeiDou navigation satellite system (BDS) satellites are transmitting signals on three frequencies, which brings new opportunity and challenges for high-accuracy precise point positioning (PPP) with ambiguity resolution (AR). This paper proposes an effective uncalibrated phase delay (UPD) estimation and AR strategy which is based on a raw PPP model. First, triple-frequency raw PPP models are developed. The observation model and stochastic model are designed and extended to accommodate the third frequency. Then, the UPD is parameterized in raw frequency form while estimating with the high-precision and low-noise integer linear combination of float ambiguity which are derived by ambiguity decorrelation. Third, with UPD corrected, the LAMBDA method is used for resolving full or partial ambiguities which can be fixed. This method can be easily and flexibly extended for dual-, triple- or even more frequency. To verify the effectiveness and performance of triple-frequency PPP AR, tests with real BDS data from 90 stations lasting for 21 days were performed in static mode. Data were processed with three strategies: BDS triple-frequency ambiguity-float PPP, BDS triple-frequency PPP with dual-frequency (B1/B2) and three-frequency AR, respectively. Numerous experiment results showed that compared with the ambiguity-float solution, the performance in terms of convergence time and positioning biases can be significantly improved by AR. Among three groups of solutions, the triple-frequency PPP AR achieved the best performance. Compared with dual-frequency AR, additional the third frequency could apparently improve the position estimations during the initialization phase and under constraint environments when the dual-frequency PPP AR is limited by few satellite numbers.

Mutations of E3 Ubiquitin Ligase Cbl Family Members Constitute a Novel Common Pathogenic Lesion in Myeloid Malignancies

PubMed Central

Makishima, Hideki; Cazzolli, Heather; Szpurka, Hadrian; Dunbar, Andrew; Tiu, Ramon; Huh, Jungwon; Muramatsu, Hideki; O'Keefe, Christine; Hsi, Eric; Paquette, Ronald L.; Kojima, Seiji; List, Alan F.; Sekeres, Mikkael A.; McDevitt, Michael A.; Maciejewski, Jaroslaw P.

2009-01-01

Purpose Acquired somatic uniparental disomy (UPD) is commonly observed in myelodysplastic syndromes (MDS), myelodysplastic/myeloproliferative neoplasms (MDS/MPN), or secondary acute myelogenous leukemia (sAML) and may point toward genes harboring mutations. Recurrent UPD11q led to identification of homozygous mutations in c-Cbl, an E3 ubiquitin ligase involved in attenuation of proliferative signals transduced by activated receptor tyrosine kinases. We examined the role and frequency of Cbl gene family mutations in MPN and related conditions. Methods We applied high-density SNP-A karyotyping to identify loss of heterozygosity of 11q in 442 patients with MDS, MDS/MPN, MPN, sAML evolved from these conditions, and primary AML. We sequenced c-Cbl, Cbl-b, and Cbl-c in patients with or without corresponding UPD or deletions and correlated mutational status with clinical features and outcomes. Results We identified c-Cbl mutations in 5% and 9% of patients with chronic myelomonocytic leukemia (CMML) and sAML, and also in CML blast crisis and juvenile myelomonocytic leukemia (JMML). Most mutations were homozygous and affected c-Cbl; mutations in Cbl-b were also found in patients with similar clinical features. Patients with Cbl family mutations showed poor prognosis, with a median survival of 5 months. Pathomorphologic features included monocytosis, monocytoid blasts, aberrant expression of phosphoSTAT5, and c-kit overexpression. Serial studies showed acquisition of c-Cbl mutations during malignant evolution. Conclusion Mutations in the Cbl family RING finger domain or linker sequence constitute important pathogenic lesions associated with not only preleukemic CMML, JMML, and other MPN, but also progression to AML, suggesting that impairment of degradation of activated tyrosine kinases constitutes an important cancer mechanism. PMID:19901108

Clinical-etiologic correlation in children with Prader-Willi syndrome (PWS): an interdisciplinary study.

PubMed

Torrado, Maria; Araoz, Veronica; Baialardo, Edgardo; Abraldes, Karina; Mazza, Carmen; Krochik, Gabriela; Ozuna, Blanca; Leske, Vivian; Caino, Silvia; Fano, Virginia; Chertkoff, Lilien

2007-03-01

Prader-Willi syndrome (PWS) is a multisystemic disorder caused by the loss of expression of paternally transcribed genes within chromosome 15q11-q13. Most cases are due to paternal deletion of this region; the remaining cases result from maternal uniparental disomy (UPD) and imprinting defects. To better understand the phenotypic variability of PWS, a genotype-phenotype correlation study was performed in 91 children with PWS. Patients were diagnosed by Southern Blot Methylation assay and genetic subtypes were established using FISH and microsatellite analyses. Fifty-nine subjects with deletion (31/28 males/females; mean age 3.86 years), 30 with UPD (14/16 males/females; mean age 3.89 years) and 2 girls with a presumed imprinting defect (mean age 0.43 yrs) were identified. For correlation purposes patients were grouped as "deleted" and "non-deleted." An increased maternal age was found in the UPD group. Four of Holm's criteria were more frequently present in the deleted group: need for special feeding techniques, sleep disturbance, hypopigmentation, and speech articulation defects. Concerning cognitive assessments, only 9.52% of subjects with deletion had Full-Scale IQ (FSIQ) > or =70, while 61.53% of subjects without deletion had FSIQ > or =70. Similar results were found in behavioral measures. Sleep disorders and carbohydrate metabolism were systematically assessed. Polysomnoghaphic studies revealed a higher frequency of central events with desaturations > or =10% in the deleted group (P = 0.020). In summary, the phenotype was significantly different between both groups in certain parameters related to the CNS. These results might be related to the differences in brain gene expression of the genetic subtypes. (c) 2006 Wiley-Liss, Inc.

Quantitative DNA methylation analysis improves epigenotype-phenotype correlations in Beckwith-Wiedemann syndrome

PubMed Central

Calvello, Mariarosaria; Tabano, Silvia; Colapietro, Patrizia; Maitz, Silvia; Pansa, Alessandra; Augello, Claudia; Lalatta, Faustina; Gentilin, Barbara; Spreafico, Filippo; Calzari, Luciano; Perotti, Daniela; Larizza, Lidia; Russo, Silvia; Selicorni, Angelo; Sirchia, Silvia M; Miozzo, Monica

2013-01-01

Beckwith-Wiedemann syndrome (BWS) is a rare disorder characterized by overgrowth and predisposition to embryonal tumors. BWS is caused by various epigenetic and/or genetic alterations that dysregulate the imprinted genes on chromosome region 11p15.5. Molecular analysis is required to reinforce the clinical diagnosis of BWS and to identify BWS patients with cancer susceptibility. This is particularly crucial prenatally because most signs of BWS cannot be recognized in utero. We established a reliable molecular assay by pyrosequencing to quantitatively evaluate the methylation profiles of ICR1 and ICR2. We explored epigenotype-phenotype correlations in 19 patients that fulfilled the clinical diagnostic criteria for BWS, 22 patients with suspected BWS, and three fetuses with omphalocele. Abnormal methylation was observed in one prenatal case and 19 postnatal cases, including seven suspected BWS. Seven cases showed ICR1 hypermethylation, five cases showed ICR2 hypomethylation, and eight cases showed abnormal methylation of ICR1 and ICR2 indicating paternal uniparental disomy (UPD). More cases of ICR1 alterations and UPD were found than expected. This is likely due to the sensitivity of this approach, which can detect slight deviations in methylation from normal levels. There was a significant correlation (p < 0.001) between the percentage of ICR1 methylation and BWS features: severe hypermethylation (range: 75–86%) was associated with macroglossia, macrosomia, and visceromegaly, whereas mild hypermethylation (range: 55–59%) was associated with umbilical hernia and diastasis recti. Evaluation of ICR1 and ICR2 methylation by pyrosequencing in BWS can improve epigenotype-phenotype correlations, detection of methylation alterations in suspected cases, and identification of UPD. PMID:23917791

77 FR 50112 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-20

... the UPD helps to protect the integrity of ACF's award selection process. All ACF discretionary grant... instructions; the Standard Form 424 series, which requests basic information, budget information, and... Planning, Research and Evaluation, 370 L'Enfant Promenade SW., Washington, DC 20447, Attn: ACF Reports...

Donnai–Barrow Syndrome (DBS/FOAR) in a Child With a Homozygous LRP2 Mutation Due to Complete Chromosome 2 Paternal Isodisomy

PubMed Central

Kantarci, Sibel; Ragge, Nicola K.; Thomas, N. Simon; Robinson, David O.; Noonan, Kristin M.; Russell, Meaghan K.; Donnai, Dian; Raymond, F. Lucy; Walsh, Christopher A.; Donahoe, Patricia K.; Pober, Barbara R.

2010-01-01

Donnai–Barrow syndrome [Faciooculoacousticorenal (FOAR) syndrome; DBS/FOAR] is a rare autosomal recessive disorder resulting from mutations in the LRP2 gene located on chromosome 2q31.1. We report a unique DBS/FOAR patient homozygous for a 4-bp LRP2 deletion secondary to paternal uniparental isodisomy for chromosome 2. The propositus inherited the mutation from his heterozygous carrier father, whereas the mother carried only wild-type LRP2 alleles. This is the first case of DBS/FOAR resulting from uniparental disomy (UPD) and the fourth published case of any paternal UPD 2 ascertained through unmasking of an autosomal recessive disorder. The absence of clinical symptoms above and beyond the classical phenotype in this and the other disorders suggests that paternal chromosome 2 is unlikely to contain imprinted genes notably affecting either growth or development. This report highlights the importance of parental genotyping in order to give accurate genetic counseling for autosomal recessive disorders. PMID:18553518

Third Prader-Willi syndrome phenotype due to maternal uniparental disomy 15 with mosaic trisomy 15.

PubMed

Olander, E; Stamberg, J; Steinberg, L; Wulfsberg, E A

2000-07-31

We report on a boy with mosaicism for trisomy 15 and Prader-Willi syndrome (PWS) due to maternal isodisomy for chromosome 15. His phenotype is consistent with PWS and trisomy 15 mosaicism. Although our patient is unusual in having maternal isodisomy rather than the more common maternal heterodisomy, we think that his more severe PWS phenotype is due to his trisomy 15 mosaicism rather than to homozygosity for deleterious chromosome 15 genes. We propose that individuals with PWS have one of three similar but distinctive phenotypes depending on the cause of their condition. Patients with paternal deletions have the typical PWS phenotype, patients with maternal UPD have a slightly milder phenotype with better cognitive function, and those with maternal UPD and mosaic trisomy 15 have the most severe phenotype with a high incidence of congenital heart disease. These phenotype-genotype differences are useful to guide the work-up of patients with suspected PWS and to provide prognostic counseling for families.

Comparative analysis of isodisomic and heterodisomic segments in cases with maternal uniparental disomy 14 suggests more than one imprinted region.

PubMed

Kotzot, D

2001-09-01

The results of molecular investigations of 21 cases with complete or segmental maternal uniparental disomy (UPD) 14 published in the literature were compared with respect to isodisomic and heterodisomic segments. The aim of the study was to find hints toward imprinted regions other than the recently defined imprinted segment 14q32. Three regions with no isodisomic molecular marker were found. The most distal of these regions located on 14q32.12 and 14q32.13 supports the hypothesis of genomic imprinting as the cause of the maternal UPD 14 phenotype by synteny to the maternally imprinted region on mouse distal chromosome 12 and correlation with the recently defined imprinting cluster on human chromosome 14q32. The other two heterodisomic areas located on 14q11.2-->14q12 and 14q21.1-->14q31.2 are hints toward one or more additional regions of genomic imprinting on human chromosome 14.

Using VIIRS/NPP and MODIS/Aqua data to provide a continuous record of suspended particulate matter in a highly turbid inland lake

NASA Astrophysics Data System (ADS)

Cao, Zhigang; Duan, Hongtao; Shen, Ming; Ma, Ronghua; Xue, Kun; Liu, Dong; Xiao, Qitao

2018-02-01

Inland lakes are generally an important source of drinking water, and information on their water quality needs to be obtained in real time. To date, Moderate-resolution imaging spectroradiometer (MODIS) data have played a critical, effective and long-term role in fulfilling this function. However, the MODIS instruments on board both the Terra and Aqua satellites have operated beyond their designed five-year mission lifespans (Terra was launched in 1999, whereas Aqua was launched in 2002), and these instruments may stop running at any time in the near future. The Visible Infrared Imager Radiometer Suite (VIIRS) on board the Suomi National Polar-Orbiting Partnership (Suomi NPP, which was launched in Oct 2011) is expected to provide a consistent, long-term data record and continue the series of observations initiated by MODIS. To date, few evaluations of the consistency between VIIRS and MODIS have been conducted for turbid inland waters. In this study, we first used synchronous MODIS/Aqua and VIIRS/NPP data (±1 h) collected during 2012-2015 to evaluate the consistency of Rayleigh-corrected reflectance (Rrc) observations over Lake Hongze (the fourth-largest freshwater lake in China), since accurate remote sensing reflectance (Rrs) values cannot be acquired over turbid inland waters. Second, we used recently developed algorithms based on Rrc in the red band to estimate the concentrations of suspended particulate matter (SPM) from MODIS/Aqua and VIIRS/NPP data. Finally, we assessed the consistency of the SPM products derived from MODIS/Aqua and VIIRS/NPP. The results show the following. (1) The differences in Rrc among the green (VIIRS 551 nm and MODIS 555 nm) and red bands (VIIRS 671 nm and MODIS 645 nm) indicate a satisfactory consistency, and the unbiased percentage difference (UPD) is <12%. Meanwhile, the results for the near infrared (NIR) band (MODIS 859 nm and VIIRS 862 nm) indicate relatively large differences (UPD = 21.84%). (2) The satellite-derived SPM products obtained using MODIS/Aqua and VIIRS/NPP have a satisfactory degree of consistency (0-150 mg/L SPM: R2 = 0.81, UPD < 16% and 0-80 mg/L SPM: R2 = 0.85, UPD < 12%, respectively). These results demonstrate that VIIRS/NPP can continue to record the SPM observations initiated by MODIS/Aqua for turbid inland waters and establish environmental datasets over long time periods to support water quality management endeavors.

The 2017 Plasma Roadmap: Low temperature plasma science and technology

USDA-ARS?s Scientific Manuscript database

Journal of Physics D: Applied Physics published the first Plasma Roadmap in 2012 consisting of the individual perspectives of 16 leading experts in the various sub-fields of low temperature plasma science and technology. The 2017 Plasma Roadmap is the first update of a planned series of periodic upd...

Behavior in Prader-Willi Syndrome: Relationship to Genetic Subtypes and Age

ERIC Educational Resources Information Center

Dykens, Elisabeth M.; Roof, Elizabeth

2008-01-01

Background: Some behavioral features of Prader-Willi syndrome (PWS) are associated with the major genetic subtypes of this disorder. While most agree that those with maternal uniparental disomy (UPD) have a distinctive cognitive and psychiatric profile, findings are more controversial regarding possible differences among persons who vary in…

Face Discrimination Skills in Prader-Willi Syndrome and Autism Spectrum Disorder

ERIC Educational Resources Information Center

Feldman, Benjamin H.; Dimitropoulos, Anastasia

2014-01-01

Individuals with Prader-Willi Syndrome (PWS) are at risk for autism spectrum disorder (ASD), including socialization problems. The PWS chromosome 15q11-13 maternal uniparental disomy (mUPD) subtype displays greater ASD symptoms than the paternal deletion (DEL) subtype. Since interpreting faces leads to successful socialization, we compared face…

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

Benson, David M.; Tsang, Chu F.; Sugar, Joshua Daniel

One method for the formation of nanofilms of materials, is Electrochemical atomic layer deposition (E-ALD), one atomic layer at a time. It uses the galvanic exchange of a less noble metal, deposited using underpotential deposition (UPD), to produce an atomic layer of a more noble element by reduction of its ions. This process is referred to as surface limited redox replacement and can be repeated in a cycle to grow thicker deposits. Previously, we performed it on nanoparticles and planar substrates. In the present report, E-ALD is applied for coating a submicron-sized powder substrate, making use of a new flowmore » cell design. E-ALD is used to coat a Pd powder substrate with different thicknesses of Rh by exchanging it for Cu UPD. Furthermore, cyclic voltammetry and X-ray photoelectron spectroscopy indicate an increasing Rh coverage with increasing numbers of deposition cycles performed, in a manner consistent with the atomic layer deposition (ALD) mechanism. Cyclic voltammetry also indicated increased kinetics of H sorption and desorption in and out of the Pd powder with Rh present, relative to unmodified Pd.« less

Genomewide scan in families with schizophrenia from the founder population of Afrikaners reveals evidence for linkage and uniparental disomy on chromosome 1.

PubMed

Abecasis, Gonçalo R; Burt, Rachel A; Hall, Diana; Bochum, Sylvia; Doheny, Kimberly F; Lundy, S Laura; Torrington, Marie; Roos, J Louw; Gogos, Joseph A; Karayiorgou, Maria

2004-03-01

We report on our initial genetic linkage studies of schizophrenia in the genetically isolated population of the Afrikaners from South Africa. A 10-cM genomewide scan was performed on 143 small families, 34 of which were informative for linkage. Using both nonparametric and parametric linkage analyses, we obtained evidence for a small number of disease loci on chromosomes 1, 9, and 13. These results suggest that few genes of substantial effect exist for schizophrenia in the Afrikaner population, consistent with our previous genealogical tracing studies. The locus on chromosome 1 reached genomewide significance levels (nonparametric LOD score of 3.30 at marker D1S1612, corresponding to an empirical P value of.012) and represents a novel susceptibility locus for schizophrenia. In addition to providing evidence for linkage for chromosome 1, we also identified a proband with a uniparental disomy (UPD) of the entire chromosome 1. This is the first time a UPD has been described in a patient with schizophrenia, lending further support to involvement of chromosome 1 in schizophrenia susceptibility in the Afrikaners.

Autistic-like symptomatology in Prader-Willi syndrome: a review of recent findings.

PubMed

Dimitropoulos, Anastasia; Schultz, Robert T

2007-04-01

Prader-Willi syndrome (PWS) is caused by either the structural loss of material or the absence of gene expression from the paternally inherited copy of chromosome 15 in the q11-q13 region. In addition to a well-described behavioral phenotype that includes hyperphagia, obsessive-compulsive symptoms, disruptive behavior, and an increased risk for mood disorders, recent evidence also suggests that some individuals with PWS have repetitive behavior and social deficits reminiscent of autism spectrum disorders. In particular, it appears as if those with maternal uniparental disomy (UPD) as the cause of PWS are at greater risk for autistic symptomatology than those with paternal deletions of 15q11-q13. These findings are particularly intriguing in light of data implicating maternal duplications and triplications of the same chromosomal interval in idiopathic autism, as well as evidence that functional alterations of genes in this region are associated with social deficits found in a variety of neurodevelopmental disorders. This paper will review the recent evidence for phenotypic similarities between autism and PWS and the risk of symptomatology for the UPD subtype.

Cognitive and behavioural aspects of Prader-Willi syndrome.

PubMed

Rice, Lauren J; Einfeld, Stewart L

2015-03-01

To provide a review of the recent advances in the diagnosis and treatment of psychiatric disorders in Prader-Willi syndrome (PWS). Research in the last 12 months has provided a descriptive prognosis of psychosis in PWS and highlighted the possible genes associated with the increased risk of psychosis for those with maternal uniparental disomy (mUPD). Several studies investigating social and communication skills have shown people with PWS to have difficulty with core, receptive and expressive language skills, interpreting emotional valence in faces, playing with children of their own age, understanding personal space and a developmental delay in the theory of mind. These social and communication deficits are often more pronounced in those with mUPD. Two recent clinical trials of oxytocin provide mixed results and highlight the need for an improved understanding of the neurobiological characteristics of the PWS brain. A recent pilot study suggests N-acetylcysteine may be a viable treatment for skin picking. Recent advances have contributed to our understanding of the emotional and behavioural problems associated with PWS, and provided directions for further research.

Establishment of a Conditionally Immortalized Wilms Tumor Cell Line with a Homozygous WT1 Deletion within a Heterozygous 11p13 Deletion and UPD Limited to 11p15.

PubMed

Brandt, Artur; Löhers, Katharina; Beier, Manfred; Leube, Barbara; de Torres, Carmen; Mora, Jaume; Arora, Parineeta; Jat, Parmjit S; Royer-Pokora, Brigitte

2016-01-01

We describe a stromal predominant Wilms tumor with focal anaplasia and a complex, tumor specific chromosome 11 aberration: a homozygous deletion of the entire WT1 gene within a heterozygous 11p13 deletion and an additional region of uniparental disomy (UPD) limited to 11p15.5-p15.2 including the IGF2 gene. The tumor carried a heterozygous p.T41A mutation in CTNNB1. Cells established from the tumor carried the same chromosome 11 aberration, but a different, homozygous p.S45Δ CTNNB1 mutation. Uniparental disomy (UPD) 3p21.3pter lead to the homozygous CTNNB1 mutation. The tumor cell line was immortalized using the catalytic subunit of human telomerase (hTERT) in conjunction with a novel thermolabile mutant (U19dl89-97tsA58) of SV40 large T antigen (LT). This cell line is cytogenetically stable and can be grown indefinitely representing a valuable tool to study the effect of a complete lack of WT1 in tumor cells. The origin/fate of Wilms tumors with WT1 mutations is currently poorly defined. Here we studied the expression of several genes expressed in early kidney development, e.g. FOXD1, PAX3, SIX1, OSR1, OSR2 and MEIS1 and show that these are expressed at similar levels in the parental and the immortalized Wilms10 cells. In addition the limited potential for muscle/ osteogenic/ adipogenic differentiation similar to all other WT1 mutant cell lines is also observed in the Wilms10 tumor cell line and this is retained in the immortalized cells. In summary these Wilms10 cells are a valuable model system for functional studies of WT1 mutant cells.

Establishment of a Conditionally Immortalized Wilms Tumor Cell Line with a Homozygous WT1 Deletion within a Heterozygous 11p13 Deletion and UPD Limited to 11p15

PubMed Central

Brandt, Artur; Löhers, Katharina; Beier, Manfred; Leube, Barbara; de Torres, Carmen; Mora, Jaume; Arora, Parineeta; Jat, Parmjit S.; Royer-Pokora, Brigitte

2016-01-01

We describe a stromal predominant Wilms tumor with focal anaplasia and a complex, tumor specific chromosome 11 aberration: a homozygous deletion of the entire WT1 gene within a heterozygous 11p13 deletion and an additional region of uniparental disomy (UPD) limited to 11p15.5-p15.2 including the IGF2 gene. The tumor carried a heterozygous p.T41A mutation in CTNNB1. Cells established from the tumor carried the same chromosome 11 aberration, but a different, homozygous p.S45Δ CTNNB1 mutation. Uniparental disomy (UPD) 3p21.3pter lead to the homozygous CTNNB1 mutation. The tumor cell line was immortalized using the catalytic subunit of human telomerase (hTERT) in conjunction with a novel thermolabile mutant (U19dl89-97tsA58) of SV40 large T antigen (LT). This cell line is cytogenetically stable and can be grown indefinitely representing a valuable tool to study the effect of a complete lack of WT1 in tumor cells. The origin/fate of Wilms tumors with WT1 mutations is currently poorly defined. Here we studied the expression of several genes expressed in early kidney development, e.g. FOXD1, PAX3, SIX1, OSR1, OSR2 and MEIS1 and show that these are expressed at similar levels in the parental and the immortalized Wilms10 cells. In addition the limited potential for muscle/ osteogenic/ adipogenic differentiation similar to all other WT1 mutant cell lines is also observed in the Wilms10 tumor cell line and this is retained in the immortalized cells. In summary these Wilms10 cells are a valuable model system for functional studies of WT1 mutant cells. PMID:27213811

Parent stress across molecular subtypes of children with Angelman syndrome.

PubMed

Miodrag, N; Peters, S

2015-09-01

Parenting stress has been consistently reported among parents of children with developmental disabilities. However, to date, no studies have investigated the impact of a molecular subtype of Angelman syndrome (AS) on parent stress, despite distinct phenotypic differences among subtypes. Data for 124 families of children with three subtypes of AS: class I and II deletions (n = 99), imprinting centre defects (IC defects; n = 11) and paternal uniparental disomy (UPD; n = 14) were drawn from the AS Rare Diseases Clinical Research Network (RDCRN) database and collected from five research sites across the Unites States. The AS study at the RDCRN gathered health information to understand how the syndrome develops and how to treat it. Parents completed questionnaires on their perceived psychological stress, the severity of children's aberrant behaviour and children's sleep patterns. Children's adaptive functioning and developmental levels were clinically evaluated. Child-related stress reached clinical levels for 40% of parents of children with deletions, 100% for IC defects and 64.3% for UPD. Sleep difficulties were similar and elevated across subtypes. There were no differences between molecular subtypes for overall child and parent-related stress. However, results showed greater isolation and lack of perceived parenting skills for parents of children with UPD compared with deletions. Better overall cognition for children with deletions was significantly related to more child-related stress while their poorer adaptive functioning was associated with more child-related stress. For all three groups, the severity of children's inappropriate behaviour was positively related to different aspects of stress. How parents react to stress depends, in part, on children's AS molecular subtype. Despite falling under the larger umbrella term of AS, it is important to acknowledge the unique aspects associated with children's molecular subtype. Identifying these factors can lead to tailored interventions that fit the particular needs of families of children with different AS subtypes. © 2015 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Database Migration for Command and Control

DTIC Science & Technology

2002-11-01

Sql - proprietary JDP Private Area Air defense data Defended asset list Oracle 7.3.2 - Automated process (OLTP...TADIL warnings Oracle 7.3.2 Flat File - Discrete transaction with data upds - NRT response required Pull mission data Std SQL ...level execution data Oracle 7.3 User update External interfaces Auto/manual backup Messaging Proprietary replication (internally) SQL Web server

British Bluebells: Primary Upd8 Activity

ERIC Educational Resources Information Center

Moon, Miranda; Oldershaw, Cally

2010-01-01

Bluebells in the woods and by the roadside in May are a colourful reminder that spring has arrived and summer is on the way. This is an ideal time to make the most of the outdoor classroom and enthuse children, with the opportunities for new learning experiences and observing the outdoors, finding answers to questions such as "Are all…

Prader-Willi Syndrome: Intellectual Abilities and Behavioural Features by Genetic Subtype

ERIC Educational Resources Information Center

Milner, Katja M.; Craig, Ellen E.; Thompson, Russell J.; Veltman, Marijcke W. M.; Simon Thomas, N.; Roberts, Sian; Bellamy, Margaret; Curran, Sarah R.; Sporikou, Caroline M. J.; Bolton, Patrick F.

2005-01-01

Background: Studies of chromosome 15 abnormality have implicated over-expression of paternally imprinted genes in the 15q11-13 region in the aetiology of autism. To test this hypothesis we compared individuals with Prader-Willi syndrome (PWS) due to uniparental disomy (UPD--where paternally imprinted genes are over-expressed) to individuals with…

Clinical Management of a Child with Prader-Willi Syndrome from Maternal Uniparental Disomy (UPD) Genetic Inheritance

ERIC Educational Resources Information Center

Bellon-Harn, Monica L.

2005-01-01

Prader-Willi Syndrome (PWS) is reported in 1 in 10,000-15,000 individuals. Unfortunately, many cases are missed due to clinicians' lack of familiarity with the syndrome as well as clinical and laboratory diagnostic criteria. Although common clinical characteristics are reported, variety exists in the nature and severity of dysfunction associated…

An Investigation of Executive Function Abilities in Adults with Praderwilli Syndrome

ERIC Educational Resources Information Center

Walley, R. M.; Donaldson, M. D. C.

2005-01-01

Background: PraderWilli syndrome (PWS) is a genetic disorder caused by the absence of expression of maternally imprinted genes on the long arm of chromosome 15 (15q 11-13). There are two main genetic sub-types: (1) deletion, caused by the absence of paternally derived genetic material; and (2) uniparental disomy (UPD), where two copies of…

An Atypical Human Induced Pluripotent Stem Cell Line With a Complex, Stable, and Balanced Genomic Rearrangement Including a Large De Novo 1q Uniparental Disomy

PubMed Central

Steichen, Clara; Maluenda, Jérôme; Tosca, Lucie; Luce, Eléanor; Pineau, Dominique; Dianat, Noushin; Hannoun, Zara; Tachdjian, Gérard; Melki, Judith

2015-01-01

Human induced pluripotent stem cells (hiPSCs) hold great promise for cell therapy through their use as vital tools for regenerative and personalized medicine. However, the genomic integrity of hiPSCs still raises some concern and is one of the barriers limiting their use in clinical applications. Numerous articles have reported the occurrence of aneuploidies, copy number variations, or single point mutations in hiPSCs, and nonintegrative reprogramming strategies have been developed to minimize the impact of the reprogramming process on the hiPSC genome. Here, we report the characterization of an hiPSC line generated by daily transfections of modified messenger RNAs, displaying several genomic abnormalities. Karyotype analysis showed a complex genomic rearrangement, which remained stable during long-term culture. Fluorescent in situ hybridization analyses were performed on the hiPSC line showing that this karyotype is balanced. Interestingly, single-nucleotide polymorphism analysis revealed the presence of a large 1q region of uniparental disomy (UPD), demonstrating for the first time that UPD can occur in a noncompensatory context during nonintegrative reprogramming of normal fibroblasts. PMID:25650439

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

Jagannathan, Kaushik; Benson, David M.; Robinson, David B.

Nanofilms of Pd were grown using an electrochemical form of atomic layer deposition (E-ALD) on 100 nm evaporated Au films on glass. Multiple cycles of surface-limited redox replacement (SLRR) were used to grow deposits. Each SLRR involved the underpotential deposition (UPD) of a Cu atomic layer, followed by open circuit replacement via redox exchange with tetrachloropalladate, forming a Pd atomic layer: one E-ALD deposition cycle. That cycle was repeated in order to grow deposits of a desired thickness. 5 cycles of Pd deposition were performed on the Au on glass substrates, resulting in the formation of 2.5 monolayers of Pd.more » Those Pd films were then modified with varying coverages of Pt, also formed using SLRR. The amount of Pt was controlled by changing the potential for Cu UPD, and by increasing the number of Pt deposition cycles. Hydrogen absorption was studied using coulometry and cyclic voltammetry in 0.1 M H 2SO 4 as a function of Pt coverage. The presence of even a small fraction of a Pt monolayer dramatically increased the rate of hydrogen desorption. However, this did not reduce the films’ hydrogen storage capacity. The increase in desorption rate in the presence of Pt was over an order of magnitude.« less

Hydrogen peroxide sensing using ultrathin platinum-coated gold nanoparticles with core@shell structure.

PubMed

Li, Yongxin; Lu, Qiufang; Wu, Shengnan; Wang, Lun; Shi, Xianming

2013-03-15

Ultrathin platinum-coated gold (Pt@Au) nanoparticles with core@shell structure have been developed by under-potential deposition (UPD) redox replacement technique. A single UPD Cu replacement with Pt(2+) produced a uniform Pt monolayer on the surface of gold nanoparticles, which are immobilized on glassy carbon electrode (GCE) surface based on electrostatic interaction. The ultrathin Pt@Au nanoparticles were confirmed by cyclic voltammetry and X-ray photoelectron spectroscopy (XPS). Voltammetry and amperometric methodologies were used to evaluate the electrocatalytic activity of the Pt@Au nanoparticles modified electrode towards the reduction of hydrogen peroxide under the physiological condition. The present results show that ultrathin Pt coating greatly enhances the electrocatalytic activity towards the reduction of hydrogen peroxide, which can be utilized to fabricate the hydrogen peroxide sensor. Chronoamperometric experiments showed that at an applied potential of 0.08 V (vs. Ag/AgCl), the current reduction of hydrogen peroxide was linear to its concentration in the range of 1-450 μΜ, and the detection limit was found to be 0.18 μM (signal-to-noise ratio, S/N=3). Copyright © 2012 Elsevier B.V. All rights reserved.

Genomewide Scan in Families with Schizophrenia from the Founder Population of Afrikaners Reveals Evidence for Linkage and Uniparental Disomy on Chromosome 1

PubMed Central

Abecasis, Gonçalo R.; Burt, Rachel A.; Hall, Diana; Bochum, Sylvia; Doheny, Kimberly F.; Lundy, S. Laura; Torrington, Marie; Roos, J. Louw; Gogos, Joseph A.; Karayiorgou, Maria

2004-01-01

We report on our initial genetic linkage studies of schizophrenia in the genetically isolated population of the Afrikaners from South Africa. A 10-cM genomewide scan was performed on 143 small families, 34 of which were informative for linkage. Using both nonparametric and parametric linkage analyses, we obtained evidence for a small number of disease loci on chromosomes 1, 9, and 13. These results suggest that few genes of substantial effect exist for schizophrenia in the Afrikaner population, consistent with our previous genealogical tracing studies. The locus on chromosome 1 reached genomewide significance levels (nonparametric LOD score of 3.30 at marker D1S1612, corresponding to an empirical P value of .012) and represents a novel susceptibility locus for schizophrenia. In addition to providing evidence for linkage for chromosome 1, we also identified a proband with a uniparental disomy (UPD) of the entire chromosome 1. This is the first time a UPD has been described in a patient with schizophrenia, lending further support to involvement of chromosome 1 in schizophrenia susceptibility in the Afrikaners. PMID:14750073

Enhanced Kinetics of Electrochemical Hydrogen Uptake and Release by Palladium Powders Modified by Electrochemical Atomic Layer Deposition

DOE PAGES

Benson, David M.; Tsang, Chu F.; Sugar, Joshua Daniel; ...

2017-04-28

One method for the formation of nanofilms of materials, is Electrochemical atomic layer deposition (E-ALD), one atomic layer at a time. It uses the galvanic exchange of a less noble metal, deposited using underpotential deposition (UPD), to produce an atomic layer of a more noble element by reduction of its ions. This process is referred to as surface limited redox replacement and can be repeated in a cycle to grow thicker deposits. Previously, we performed it on nanoparticles and planar substrates. In the present report, E-ALD is applied for coating a submicron-sized powder substrate, making use of a new flowmore » cell design. E-ALD is used to coat a Pd powder substrate with different thicknesses of Rh by exchanging it for Cu UPD. Furthermore, cyclic voltammetry and X-ray photoelectron spectroscopy indicate an increasing Rh coverage with increasing numbers of deposition cycles performed, in a manner consistent with the atomic layer deposition (ALD) mechanism. Cyclic voltammetry also indicated increased kinetics of H sorption and desorption in and out of the Pd powder with Rh present, relative to unmodified Pd.« less

Ionospheric effects in uncalibrated phase delay estimation and ambiguity-fixed PPP based on raw observable model

NASA Astrophysics Data System (ADS)

Gu, Shengfeng; Shi, Chuang; Lou, Yidong; Liu, Jingnan

2015-05-01

Zero-difference (ZD) ambiguity resolution (AR) reveals the potential to further improve the performance of precise point positioning (PPP). Traditionally, PPP AR is achieved by Melbourne-Wübbena and ionosphere-free combinations in which the ionosphere effect are removed. To exploit the ionosphere characteristics, PPP AR with L1 and L2 raw observable has also been developed recently. In this study, we apply this new approach in uncalibrated phase delay (UPD) generation and ZD AR and compare it with the traditional model. The raw observable processing strategy treats each ionosphere delay as an unknown parameter. In this manner, both a priori ionosphere correction model and its spatio-temporal correlation can be employed as constraints to improve the ambiguity resolution. However, theoretical analysis indicates that for the wide-lane (WL) UPD retrieved from L1/L2 ambiguities to benefit from this raw observable approach, high precision ionosphere correction of better than 0.7 total electron content unit (TECU) is essential. This conclusion is then confirmed with over 1 year data collected at about 360 stations. Firstly, both global and regional ionosphere model were generated and evaluated, the results of which demonstrated that, for large-scale ionosphere modeling, only an accuracy of 3.9 TECU can be achieved on average for the vertical delays, and this accuracy can be improved to about 0.64 TECU when dense network is involved. Based on these ionosphere products, WL/narrow-lane (NL) UPDs are then extracted with the raw observable model. The NL ambiguity reveals a better stability and consistency compared to traditional approach. Nonetheless, the WL ambiguity can be hardly improved even constrained with the high spatio-temporal resolution ionospheric corrections. By applying both these approaches in PPP-RTK, it is interesting to find that the traditional model is more efficient in AR as evidenced by the shorter time to first fix, while the three-dimensional positioning accuracy of the RAW model outperforms the combination model by about . This reveals that, with the current ionosphere models, there is actually no optimal strategy for the dual-frequency ZD ambiguity resolution, and the combination approach and raw approach each has merits and demerits.

Electrodeposition of Highly Porous Pt Nanoparticles Studied by Quantitative 3D Electron Tomography: Influence of Growth Mechanisms and Potential Cycling on the Active Surface Area.

PubMed

Ustarroz, Jon; Geboes, Bart; Vanrompay, Hans; Sentosun, Kadir; Bals, Sara; Breugelmans, Tom; Hubin, Annick

2017-05-17

Nanoporous Pt nanoparticles (NPs) are promising fuel cell catalysts due to their large surface area and increased electrocatalytic activity toward the oxygen reduction reaction (ORR). Herein, we report on the influence of the growth mechanisms on the surface properties of electrodeposited Pt dendritic NPs with large surface areas. The electrochemically active surface was studied by hydrogen underpotential deposition (H UPD) and compared for the first time to high-angle annular dark field scanning transmission electron microscopy (HAADF-STEM) quantitative 3D electron tomography of individual nanoparticles. Large nucleation overpotential leads to a large surface coverage of roughened spheroids, which provide a large roughness factor (R f ) but low mass-specific electrochemically active surface area (EASA). Lowering the nucleation overpotential leads to highly porous Pt NPs with pores stretching to the center of the structure. At the expense of smaller R f , the obtained EASA values of these structures are in the range of those of large surface area supported fuel cell catalysts. The active surface area of the Pt dendritic NPs was measured by electron tomography, and it was found that the potential cycling in the H adsorption/desorption and Pt oxidation/reduction region, which is generally performed to determine the EASA, leads to a significant reduction of that surface area due to a partial collapse of their dendritic and porous morphology. Interestingly, the extrapolation of the microscopic tomography results in macroscopic electrochemical parameters indicates that the surface properties measured by H UPD are comparable to the values measured on individual NPs by electron tomography after the degradation caused by the H UPD measurement. These results highlight that the combination of electrochemical and quantitative 3D surface analysis techniques is essential to provide insights into the surface properties, the electrochemical stability, and, hence, the applicability of these materials. Moreover, it indicates that care must be taken with widely used electrochemical methods of surface area determination, especially in the case of large surface area and possibly unstable nanostructures, since the measured surface can be strongly affected by the measurement itself.

Spatiotemporal regulation of cell fusion by JNK and JAK/STAT signaling during Drosophila wound healing.

PubMed

Lee, Ji-Hyun; Lee, Chan-Wool; Park, Si-Hyoung; Choe, Kwang-Min

2017-06-01

Cell-cell fusion is widely observed during development and disease, and imposes a dramatic change on participating cells. Cell fusion should be tightly controlled, but the underlying mechanism is poorly understood. Here, we found that the JAK/STAT pathway suppressed cell fusion during wound healing in the Drosophila larval epidermis, restricting cell fusion to the vicinity of the wound. In the absence of JAK/STAT signaling, a large syncytium containing a 3-fold higher number of nuclei than observed in wild-type tissue formed in wounded epidermis. The JAK/STAT ligand-encoding genes upd2 and upd3 were transcriptionally induced by wounding, and were required for suppressing excess cell fusion. JNK (also known as Basket in flies) was activated in the wound vicinity and activity peaked at ∼8 h after injury, whereas JAK/STAT signaling was activated in an adjoining concentric ring and activity peaked at a later stage. Cell fusion occurred primarily in the wound vicinity, where JAK/STAT activation was suppressed by fusion-inducing JNK signaling. JAK/STAT signaling was both necessary and sufficient for the induction of βPS integrin (also known as Myospheroid) expression, suggesting that the suppression of cell fusion was mediated at least in part by integrin protein. © 2017. Published by The Company of Biologists Ltd.

Energy-based culture medium design for biomanufacturing optimization: A case study in monoclonal antibody production by GS-NS0 cells.

PubMed

Quiroga-Campano, Ana L; Panoskaltsis, Nicki; Mantalaris, Athanasios

2018-03-02

Demand for high-value biologics, a rapidly growing pipeline, and pressure from competition, time-to-market and regulators, necessitate novel biomanufacturing approaches, including Quality by Design (QbD) principles and Process Analytical Technologies (PAT), to facilitate accelerated, efficient and effective process development platforms that ensure consistent product quality and reduced lot-to-lot variability. Herein, QbD and PAT principles were incorporated within an innovative in vitro-in silico integrated framework for upstream process development (UPD). The central component of the UPD framework is a mathematical model that predicts dynamic nutrient uptake and average intracellular ATP content, based on biochemical reaction networks, to quantify and characterize energy metabolism and its adaptive response, metabolic shifts, to maintain ATP homeostasis. The accuracy and flexibility of the model depends on critical cell type/product/clone-specific parameters, which are experimentally estimated. The integrated in vitro-in silico platform and the model's predictive capacity reduced burden, time and expense of experimentation resulting in optimal medium design compared to commercially available culture media (80% amino acid reduction) and a fed-batch feeding strategy that increased productivity by 129%. The framework represents a flexible and efficient tool that transforms, improves and accelerates conventional process development in biomanufacturing with wide applications, including stem cell-based therapies. Copyright © 2018. Published by Elsevier Inc.

Effect of hydrogen peroxide pretreatment on ZnO-based metal–semiconductor–metal ultraviolet photodetectors deposited using plasma-enhanced atomic layer deposition

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

Lin, Yu-Chang; Lee, Hsin-Ying, E-mail: hylee@ee.ncku.edu.tw; Lee, Tsung-Hsin

2016-01-15

In this study, zinc oxide (ZnO) films were deposited on sapphire substrates using a plasma-enhanced atomic layer deposition system. Prior to deposition, the substrates were treated with hydrogen peroxide (H{sub 2}O{sub 2}) in order to increase nucleation on the initial sapphire surface and, thus, enhance the quality of deposited ZnO films. Furthermore, x-ray diffraction spectroscopy measurements indicated that the crystallinity of ZnO films was considerably enhanced by H{sub 2}O{sub 2} pretreatment, with the strongest (002) diffraction peak occurring for the film pretreated with H{sub 2}O{sub 2} for 60 min. X-ray photoelectron spectroscopy also was used, and the results indicated that amore » high number of Zn–O bonds was generated in ZnO films pretreated appropriately with H{sub 2}O{sub 2}. The ZnO film deposited on a sapphire substrate with H{sub 2}O{sub 2} pretreatment for 60 min was applied to metal–semiconductor–metal ultraviolet photodetectors (MSM-UPDs) as an active layer. The fabricated ZnO MSM-UPDs showed improvements in dark current and ultraviolet–visible rejection ratios (0.27 μA and 1.06 × 10{sup 3}, respectively) compared to traditional devices.« less

The electrooxidation mechanism of formic acid on platinum and on lead ad-atoms modified platinum studied with the kinetic isotope effect

NASA Astrophysics Data System (ADS)

Bełtowska-Brzezinska, M.; Łuczak, T.; Stelmach, J.; Holze, R.

2014-04-01

Kinetics and mechanism of formic acid (FA) oxidation on platinum and upd-lead ad-atoms modified platinum electrodes have been studied using unlabelled and deuterated compounds. Poisoning of the electrode surface by CO-like species was prevented by suppression of dissociative chemisorption of FA due to a fast competitive underpotential deposition of lead ad-atoms on the Pt surface from an acidic solution containing Pb2+ cations. Modification of the Pt electrode with upd lead induced a catalytic effect in the direct electrooxidation of physisorbed FA to CO2. With increasing degree of H/D substitution, the rate of this reaction decreased in the order: HCOOH > DCOOH ≥ HCOOD > DCOOD. HCOOH was oxidized 8.5-times faster on a Pt/Pb electrode than DCOOD. This primary kinetic isotope effect proves that the C-H- and O-H-bonds are simultaneously cleaved in the rate determining step. A secondary kinetic isotope effect was found in the dissociative chemisorption of FA in the hydrogen adsorption-desorption range on a bare Pt electrode after H/D exchange in the C-H bond, wherein the influence of deuterium substitution in the O-H group was negligibly small. Thus the C-H bond cleavage is accompanied by the C-OH and not the O-H bond split in the FA decomposition, producing CO-like species on the Pt surface sites.

Social responsiveness and competence in Prader-Willi syndrome: direct comparison to autism spectrum disorder.

PubMed

Dimitropoulos, Anastasia; Ho, Alan; Feldman, Benjamin

2013-01-01

Prader-Willi syndrome (PWS), a neurodevelopmental disorder primarily characterized by hyperphagia and food preoccupations, is caused by the absence of expression of the paternally active genes in the proximal arm of chromosome 15. Although maladaptive behavior and the cognitive profile in PWS have been well characterized, social functioning has only more recently been systematically examined. Findings to date indicate the social impairment exhibited may reflect specific difficulty interpreting and using social information effectively. In addition, evidence suggests that there is an increased risk of social deficits in people with the maternally-derived uniparental disomy (mUPD) subtype of PWS in comparison to those with 15q11-13 paternal deletion (DEL). Using the Social Responsiveness Scale (SRS) and the Social Competence Inventory, our goal was to compare social functioning in PWS to individuals with autism spectrum disorder (ASD). Participants with mUPD scored similarly to the ASD group across most SRS domains. All groups had difficulty with social competence, although the DEL group scored highest on prosocial behavior. Findings suggest further characterization of social behavior in PWS is necessary to aid in advancing the understanding of the contributions of genes in the 15q11-13 critical region to ASD susceptibility, particularly with respect to the overexpression of maternally expressed genes in this region, as well as aiding in awareness and development/implementation of interventions.

Hydrogen Sorption Kinetics on Bare and Platinum-Modified Palladium Nanofilms, Grown by Electrochemical Atomic Layer Deposition (E-ALD)

DOE PAGES

Jagannathan, Kaushik; Benson, David M.; Robinson, David B.; ...

2016-01-01

Nanofilms of Pd were grown using an electrochemical form of atomic layer deposition (E-ALD) on 100 nm evaporated Au films on glass. Multiple cycles of surface-limited redox replacement (SLRR) were used to grow deposits. Each SLRR involved the underpotential deposition (UPD) of a Cu atomic layer, followed by open circuit replacement via redox exchange with tetrachloropalladate, forming a Pd atomic layer: one E-ALD deposition cycle. That cycle was repeated in order to grow deposits of a desired thickness. 5 cycles of Pd deposition were performed on the Au on glass substrates, resulting in the formation of 2.5 monolayers of Pd.more » Those Pd films were then modified with varying coverages of Pt, also formed using SLRR. The amount of Pt was controlled by changing the potential for Cu UPD, and by increasing the number of Pt deposition cycles. Hydrogen absorption was studied using coulometry and cyclic voltammetry in 0.1 M H 2SO 4 as a function of Pt coverage. The presence of even a small fraction of a Pt monolayer dramatically increased the rate of hydrogen desorption. However, this did not reduce the films’ hydrogen storage capacity. The increase in desorption rate in the presence of Pt was over an order of magnitude.« less

238U Mössbauer study on the magnetic properties of uranium-based heavy fermion superconductors

NASA Astrophysics Data System (ADS)

Tsutsui, Satoshi; Nakada, Masami; Nasu, Saburo; Haga, Yoshinori; Honma, Tetsuo; Yamamoto, Etsuji; Ohkuni, Hitoshi; Ōnuki, Yoshichika

2000-07-01

We have performed 238U Mössbauer spectroscopy of uranium-based heavy fermion superconductors, UPd2Al3 and URu2Si2, in order to investigate their physical properties, mainly their magnetic properties. The slow relaxation of magnetic hyperfine interaction in a paramagnetic state and the static hyperfine field has been observed in an antiferromagnetic ordered state for each compound. The line-widths have maximum at their characteristic temperatures where their magnetic susceptibilities have maximum values.

Insights on the SO2 Poisoning of Pt3Co/VC and Pt/VC Fuel Cell Catalysts

DTIC Science & Technology

2010-01-01

catalyst is performed at the cathode of proton exchange membrane fuel cells ( PEMFCs ) in order to link previously reported results at the elec- trode...stripping voltammetry and underpotential deposition (upd) of copper adatoms. Then the performance of PEMFC cathodes employing 30wt.% Pt3Co/VC and 50wt.% Pt/VC...proton exchange membrane fuel cells( PEMFCs )in order to link previously reported results at the elec- trode/solution interface to the FC environment. First

The Preliminary Pollutant Limit Value Approach: Manual for Users

DTIC Science & Technology

1988-07-01

48 5.2.3 Plant Consumption by Dairy Cows (Upd) ............. 48 5.2.4 Water Consumption by Dairy Cows (Uwd) ............. 48 5.2.5 Soil...other equations include the effect of concurrent consumption of soil by grazing cows (equation 19), and for contaminated water intake, such as from a...ingestion of soil by dairy cow , kg/day. A default value of 0.87 kg/day is suggested (see Section 5.2.5) 4.2.6 Direct Soil Intake Two pathway equations are

Behavioral phenotype in a child with Prader-Willi syndrome and comorbid 47, XYY.

PubMed

Palkar, Pooja; Kabasakalian, Anahid; Taylor, Bonnie; Doernberg, Ellen; Ferretti, Casara Jean; Uzunova, Genoveva; Hollander, Eric

2016-08-01

We report a 12-year-old male with Prader-Willi syndrome (PWS) and 47, XYY syndrome. Genetic work up revealed 47, XYY karyotype. PWS diagnosis was made by polymerase chain reaction methylation and maternal uniparental disomy (mUPD) was determined to be the etiology. Review of distinct behavioral features, possible interplay between the two syndromes and considerations for diagnoses are presented. To our knowledge, this is the first report of behavioral features in PWS with comorbid 47, XYY.

Development of an Inflatable Head/Neck Restraint System for Ejection Seats (Update)

DTIC Science & Technology

1978-12-19

REPORT NO. NADC-78213-60 DEVELOPMENT OF AN INFLATABLE HEAD /NECK RESTRAINT SYSTEM FOR EJECTION SEATS (UPD ATE) Thomas J. Zenobi Aircraft and Crew...olde if necsesey anid dentlif hr bl0ck ma11,0s.) t Inflatable neck collar Inflatable neck ring Neck injury Head rotation ý2 .AeSSRACT (Continus on...toenes side It nec~essary mod identl)_* by block naob..) F1 A ring-shaped inflatable head /neck restraint system for ejection seats is be- ing developed at

Pretreatment of Cellulose By Electron Beam Irradiation Method

NASA Astrophysics Data System (ADS)

Jusri, N. A. A.; Azizan, A.; Ibrahim, N.; Salleh, R. Mohd; Rahman, M. F. Abd

2018-05-01

Pretreatment process of lignocellulosic biomass (LCB) to produce biofuel has been conducted by using various methods including physical, chemical, physicochemical as well as biological. The conversion of bioethanol process typically involves several steps which consist of pretreatment, hydrolysis, fermentation and separation. In this project, microcrystalline cellulose (MCC) was used in replacement of LCB since cellulose has the highest content of LCB for the purpose of investigating the effectiveness of new pretreatment method using radiation technology. Irradiation with different doses (100 kGy to 1000 kGy) was conducted by using electron beam accelerator equipment at Agensi Nuklear Malaysia. Fourier Transform Infrared Spectroscopy (FTIR) and X-Ray Diffraction (XRD) analyses were studied to further understand the effect of the suggested pretreatment step to the content of MCC. Through this method namely IRR-LCB, an ideal and optimal condition for pretreatment prior to the production of biofuel by using LCB may be introduced.

Drosophila's contribution to stem cell research.

PubMed

Singh, Gyanesh

2015-01-01

The discovery of Drosophila stem cells with striking similarities to mammalian stem cells has brought new hope for stem cell research. Recent developments in Drosophila stem cell research is bringing wider opportunities for contemporary stem cell biologists. In this regard, Drosophila germ cells are becoming a popular model of stem cell research. In several cases, genes that controlled Drosophila stem cells were later discovered to have functional homologs in mammalian stem cells. Like mammals, Drosophila germline stem cells (GSCs) are controlled by both intrinsic as well as external signals. Inside the Drosophila testes, germline and somatic stem cells form a cluster of cells (the hub). Hub cells depend on JAK-STAT signaling, and, in absence of this signal, they do not self-renew. In Drosophila, significant changes occur within the stem cell niche that contributes to a decline in stem cell number over time. In case of aging Drosophila, somatic niche cells show reduced DE-cadherin and unpaired (Upd) proteins. Unpaired proteins are known to directly decrease stem cell number within the niches, and, overexpression of upd within niche cells restored GSCs in older males also . Stem cells in the midgut of Drosophila are also very promising. Reduced Notch signaling was found to increase the number of midgut progenitor cells. On the other hand, activation of the Notch pathway decreased proliferation of these cells. Further research in this area should lead to the discovery of additional factors that regulate stem and progenitor cells in Drosophila.

Drosophila's contribution to stem cell research

PubMed Central

Singh, Gyanesh

2016-01-01

The discovery of Drosophila stem cells with striking similarities to mammalian stem cells has brought new hope for stem cell research. Recent developments in Drosophila stem cell research is bringing wider opportunities for contemporary stem cell biologists. In this regard, Drosophila germ cells are becoming a popular model of stem cell research. In several cases, genes that controlled Drosophila stem cells were later discovered to have functional homologs in mammalian stem cells. Like mammals, Drosophila germline stem cells (GSCs) are controlled by both intrinsic as well as external signals. Inside the Drosophila testes, germline and somatic stem cells form a cluster of cells (the hub). Hub cells depend on JAK-STAT signaling, and, in absence of this signal, they do not self-renew. In Drosophila, significant changes occur within the stem cell niche that contributes to a decline in stem cell number over time. In case of aging Drosophila, somatic niche cells show reduced DE-cadherin and unpaired (Upd) proteins. Unpaired proteins are known to directly decrease stem cell number within the niches, and, overexpression of upd within niche cells restored GSCs in older males also . Stem cells in the midgut of Drosophila are also very promising. Reduced Notch signaling was found to increase the number of midgut progenitor cells. On the other hand, activation of the Notch pathway decreased proliferation of these cells. Further research in this area should lead to the discovery of additional factors that regulate stem and progenitor cells in Drosophila. PMID:26180635

Formal Uncertainty and Dispersion of Single and Double Difference Models for GNSS-Based Attitude Determination.

PubMed

Chen, Wen; Yu, Chao; Dong, Danan; Cai, Miaomiao; Zhou, Feng; Wang, Zhiren; Zhang, Lei; Zheng, Zhengqi

2017-02-20

With multi-antenna synchronized global navigation satellite system (GNSS) receivers, the single difference (SD) between two antennas is able to eliminate both satellite and receiver clock error, thus it becomes necessary to reconsider the equivalency problem between the SD and double difference (DD) models. In this paper, we quantitatively compared the formal uncertainties and dispersions between multiple SD models and the DD model, and also carried out static and kinematic short baseline experiments. The theoretical and experimental results show that under a non-common clock scheme the SD and DD model are equivalent. Under a common clock scheme, if we estimate stochastic uncalibrated phase delay (UPD) parameters every epoch, this SD model is still equivalent to the DD model, but if we estimate only one UPD parameter for all epochs or take it as a known constant, the SD (here called SD2) and DD models are no longer equivalent. For the vertical component of baseline solutions, the formal uncertainties of the SD2 model are two times smaller than those of the DD model, and the dispersions of the SD2 model are even more than twice smaller than those of the DD model. In addition, to obtain baseline solutions, the SD2 model requires a minimum of three satellites, while the DD model requires a minimum of four satellites, which makes the SD2 more advantageous in attitude determination under sheltered environments.

Formal Uncertainty and Dispersion of Single and Double Difference Models for GNSS-Based Attitude Determination

PubMed Central

Chen, Wen; Yu, Chao; Dong, Danan; Cai, Miaomiao; Zhou, Feng; Wang, Zhiren; Zhang, Lei; Zheng, Zhengqi

2017-01-01

With multi-antenna synchronized global navigation satellite system (GNSS) receivers, the single difference (SD) between two antennas is able to eliminate both satellite and receiver clock error, thus it becomes necessary to reconsider the equivalency problem between the SD and double difference (DD) models. In this paper, we quantitatively compared the formal uncertainties and dispersions between multiple SD models and the DD model, and also carried out static and kinematic short baseline experiments. The theoretical and experimental results show that under a non-common clock scheme the SD and DD model are equivalent. Under a common clock scheme, if we estimate stochastic uncalibrated phase delay (UPD) parameters every epoch, this SD model is still equivalent to the DD model, but if we estimate only one UPD parameter for all epochs or take it as a known constant, the SD (here called SD2) and DD models are no longer equivalent. For the vertical component of baseline solutions, the formal uncertainties of the SD2 model are two times smaller than those of the DD model, and the dispersions of the SD2 model are even more than twice smaller than those of the DD model. In addition, to obtain baseline solutions, the SD2 model requires a minimum of three satellites, while the DD model requires a minimum of four satellites, which makes the SD2 more advantageous in attitude determination under sheltered environments. PMID:28230753

Detection of novel genomic aberrations in anaplastic astrocytomas by GTG-banding, SKY, locus-specific FISH, and high density SNP-array.

PubMed

Holland, Heidrun; Ahnert, Peter; Koschny, Ronald; Kirsten, Holger; Bauer, Manfred; Schober, Ralf; Meixensberger, Jürgen; Fritzsch, Dominik; Krupp, Wolfgang

2012-06-15

Astrocytomas represent the largest and most common subgroup of brain tumors. Anaplastic astrocytoma (WHO grade III) may arise from low-grade diffuse astrocytoma (WHO grade II) or as primary tumors without any precursor lesion. Comprehensive analyses of anaplastic astrocytomas combining both cytogenetic and molecular cytogenetic techniques are rare. Therefore, we analyzed genomic alterations of five anaplastic astrocytomas using high-density single nucleotide polymorphism arrays combined with GTG-banding and FISH-techniques. By cytogenetics, we found 169 structural chromosomal aberrations most frequently involving chromosomes 1, 2, 3, 4, 10, and 12, including two not previously described alterations, a nonreciprocal translocation t(3;11)(p12;q13), and one interstitial chromosomal deletion del(2)(q21q31). Additionally, we detected previously not documented loss of heterozygosity (LOH) without copy number changes in 4/5 anaplastic astrocytomas on chromosome regions 5q11.2, 5q22.1, 6q21, 7q21.11, 7q31.33, 8q11.22, 14q21.1, 17q21.31, and 17q22, suggesting segmental uniparental disomy (UPD), applying high-density single nucleotide polymorphism arrays. UPDs are currently considered to play an important role in the initiation and progression of different malignancies. The significance of previously not described genetic alterations in anaplastic astrocytomas presented here needs to be confirmed in a larger series. Copyright © 2012 Elsevier GmbH. All rights reserved.

Aging in Prader-Willi syndrome: twelve persons over the age of 50 years.

PubMed

Sinnema, Margje; Schrander-Stumpel, Constance T R M; Maaskant, Marian A; Boer, Harm; Curfs, Leopold M G

2012-06-01

The life expectancy of persons with Prader-Willi syndrome (PWS) has increased in recent years. Because of the paucity of reports on older persons with PWS, the natural history, the onset, and type of age-related problems are poorly understood. Twelve persons with a genetically confirmed diagnosis of PWS aged over 50 years are described (4 deletion; 8 mUPD). Data on physical, behavioral, psychiatric, and aging characteristics were collected through semi-structured interviews with the individuals with PWS and their main carers. Cardiovascular diseases, diabetes, dermatological, and orthopedic problems were common physical complaints in older people with PWS. Functioning in activities of daily living, psychological functioning, physical functions, and care dependence were substantially worse in the older age group (50+) compared to the control group (18-49 years). Seven out of eight persons with mUPD had a history of psychiatric illness. Behavioral problems were observed in the older age group. Given the combination of age-related physical morbidity, physical appearance, behavioral and psychiatric problems, and functional decline in our cohort, we hypothesize that premature aging occurs in PWS. The care for older people with PWS requires a lifespan approach that recognizes the presence, progression, and consequences of specific morbidity. Special medical surveillance of people with PWS from 40 years onwards would ensure that intervention and support is offered with respect to specific areas of decline at the earliest possible time. Copyright © 2012 Wiley Periodicals, Inc.

Proposal for a Universal Particle Detector Experiment

NASA Technical Reports Server (NTRS)

Lesho, J. C.; Cain, R. P; Uy, O. M.

1993-01-01

The Universal Particle Detector Experiment (UPDE), which consists of parallel planes of two diode laser beams of different wavelengths and a large surface metal oxide semiconductor (MOS) impact detector, is proposed. It will be used to perform real-time monitoring of contamination particles and meteoroids impacting the spacecraft surface with high resolution of time, position, direction, and velocity. The UPDE will discriminate between contaminants and meteoroids, and will determine their velocity and size distribution around the spacecraft environment. With two different color diode lasers, the contaminant and meteroid composition will also be determined based on laboratory calibration with different materials. Secondary particles dislodged from the top aluminum surface of the MOS detector will also be measured to determine the kinetic energy losses during energetic meteoroid impacts. The velocity range of this instrument is 0.1 m/s to more than 14 km/s, while its size sensitivity is from 0.2 microns to millimeter-sized particles. The particulate measurements in space of the kind proposed will be the first simultaneous multipurpose particulate experiment that includes velocities from very slow to hypervelocities, sizes from submicrometer- to pellet-sized diameters, chemical analysis of the particulate composition, and measurements of the kinetic energy losses after energetic impacts of meteroids. The experiment will provide contamination particles and orbital debris data that are critically needed for our present understanding of the space environment. The data will also be used to validate contamination and orbital debris models for predicting optimal configuration of future space sensors and for understanding their effects on sensitive surfaces such as mirrors, lenses, paints, and thermal blankets.

Comparison of Measurements from Pressure-recording Inverted Echo Sounders and Satellite Altimetry in the North Equatorial Current Region of the Western Pacific

NASA Astrophysics Data System (ADS)

Jeon, Chanhyung; Park, Jae-Hun; Kim, Dong Guk; Kim, Eung; Jeon, Dongchull

2018-04-01

An array of 5 pressure-recording inverted echo sounders (PIESs) was deployed along the Jason-2 214 ground track in the North Equatorial Current (NEC) region of the western Pacific Ocean for about 2 years from June 2012. Round-trip acoustic travel time from the bottom to the sea surface and bottom pressure measurements from PIES were converted to sea level anomaly (SLA). AVISO along-track mono-mission SLA (Mono-SLA), reference mapped SLA (Ref-MSLA), and up-to-date mapped SLA (Upd-MSLA) products were used for comparison with PIESderived SLA (η tot). Comparisons of η tot with Mono-SLA revealed that hump artifact errors significantly contaminate the Mono-SLA. Differences of η tot from both Ref-MSLA and Upd-MSLA decreased as the hump errors were reduced in mapped SLA products. Comparisons of Mono-SLA measurements at crossover points of ground tracks near the observation sites revealed large differences though the time differences of their measurements were only 1.53 and 4.58 days. Comparisons between Mono-SLA and mapped SLA suggested that mapped SLA smooths out the hump artifact errors by taking values between the two discrepant Mono-SLA measurements at the crossover points. Consequently, mapped SLA showed better agreement with η tot at our observation sites. AVISO mapped sea surface height (SSH) products are the preferable dataset for studying SSH variability in the NEC region of the western Pacific, though some portions of hump artifact errors seem to still remain in them.

Clinical spectrum and molecular diagnosis of Angelman and Prader-Willi syndrome patients with an imprinting mutation

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

Saitoh, S.; Cassidy, S.B.; Conroy, J.M.

Recent studies have identified a new class of Prader-Willi syndrome (PWS) and Angelman syndrome (AS) patients who have biparental inheritance, but neither the typical deletion nor uniparental disomy (UPD) or translocation. However, these patients have uniparental DNA methylation throughout 15q11-q13, and thus appear to have a mutation in the imprinting process for this region. Here we describe detailed clinical findings of five AS imprinting mutation patients (three families) and two PWS imprinting mutation patients (one new family). All these patients have essentially the classical clinical phenotype for the respective syndrome, except that the incidence of microcephaly is lower in imprintingmore » mutation AS patients than in deletion AS patients. Furthermore, imprinting mutation AS and PWS patients do not typically have hypopigmentation, which is commonly found in patients with the usual large deletion. Molecular diagnosis of these cases is initially achieved by DNA methylation analyses of the DN34/ZNF127, PW71 (D15S63), and SNRPN loci. The latter two probes have clear advantages in the simple molecular diagnostic analysis of PWS and AS patients with an imprinting mutation, as has been found for typical deletion or UPD PWS and AS cases. With the recent finding of inherited microdeletions in PWS and AS imprinting mutation families, our studies define a new class of these two syndromes. The clinical and molecular identification of these PWS and AS patients has important genetic counseling consequences. 49 refs., 4 figs., 3 tabs.« less

Constitutional SAMD9L mutations cause familial myelodysplastic syndrome and transient monosomy 7

PubMed Central

Pastor, Victor B.; Sahoo, Sushree S.; Boklan, Jessica; Schwabe, Georg C.; Saribeyoglu, Ebru; Strahm, Brigitte; Lebrecht, Dirk; Voss, Matthias; Bryceson, Yenan T.; Erlacher, Miriam; Ehninger, Gerhard; Niewisch, Marena; Schlegelberger, Brigitte; Baumann, Irith; Achermann, John C.; Shimamura, Akiko; Hochrein, Jochen; Tedgård, Ulf; Nilsson, Lars; Hasle, Henrik; Boerries, Melanie; Busch, Hauke; Niemeyer, Charlotte M.; Wlodarski, Marcin W.

2018-01-01

Familial myelodysplastic syndromes arise from haploinsufficiency of genes involved in hematopoiesis and are primarily associated with early-onset disease. Here we describe a familial syndrome in seven patients from four unrelated pedigrees presenting with myelodysplastic syndrome and loss of chromosome 7/7q. Their median age at diagnosis was 2.1 years (range, 1–42). All patients presented with thrombocytopenia with or without additional cytopenias and a hypocellular marrow without an increase of blasts. Genomic studies identified constitutional mutations (p.H880Q, p.R986H, p.R986C and p.V1512M) in the SAMD9L gene on 7q21, with decreased allele frequency in hematopoiesis. The non-random loss of mutated SAMD9L alleles was attained via monosomy 7, deletion 7q, UPD7q, or acquired truncating SAMD9L variants p.R1188X and p.S1317RfsX21. Incomplete penetrance was noted in 30% (3/10) of mutation carriers. Long-term observation revealed divergent outcomes with either progression to leukemia and/or accumulation of driver mutations (n=2), persistent monosomy 7 (n=4), and transient monosomy 7 followed by spontaneous recovery with SAMD9L-wildtype UPD7q (n=2). Dysmorphic features or neurological symptoms were absent in our patients, pointing to the notion that myelodysplasia with monosomy 7 can be a sole manifestation of SAMD9L disease. Collectively, our results define a new subtype of familial myelodysplastic syndrome and provide an explanation for the phenomenon of transient monosomy 7. Registered at: www.clinicaltrials.gov; #NCT00047268. PMID:29217778

Proposal for a universal particle detector experiment

NASA Astrophysics Data System (ADS)

Lesho, J. C.; Cain, R. P.; Uy, O. M.

The Universal Particle Detector Experiment (UPDE), which consists of parallel planes of two diode laser beams of different wavelengths and a large surface metal oxide semiconductor (MOS) impact detector, is proposed. It will be used to perform real-time monitoring of contamination particles and meteoroids impacting the spacecraft surface with high resolution of time, position, direction, and velocity. The UPDE will discriminate between contaminants and meteoroids, and will determine their velocity and size distribution around the spacecraft environment. With two different color diode lasers, the contaminant and meteroid composition will also be determined based on laboratory calibration with different materials. Secondary particles dislodged from the top aluminum surface of the MOS detector will also be measured to determine the kinetic energy losses during energetic meteoroid impacts. The velocity range of this instrument is 0.1 m/s to more than 14 km/s, while its size sensitivity is from 0.2 microns to millimeter-sized particles. The particulate measurements in space of the kind proposed will be the first simultaneous multipurpose particulate experiment that includes velocities from very slow to hypervelocities, sizes from submicrometer- to pellet-sized diameters, chemical analysis of the particulate composition, and measurements of the kinetic energy losses after energetic impacts of meteroids. The experiment will provide contamination particles and orbital debris data that are critically needed for our present understanding of the space environment. The data will also be used to validate contamination and orbital debris models for predicting optimal configuration of future space sensors and for understanding their effects on sensitive surfaces such as mirrors, lenses, paints, and thermal blankets.

A Drosophila model of myeloproliferative neoplasm reveals a feed-forward loop in the JAK pathway mediated by p38 MAPK signalling

PubMed Central

Pérez, Lidia; Bray, Sarah J.

2017-01-01

ABSTRACT Myeloproliferative neoplasms (MPNs) of the Philadelphia-negative class comprise polycythaemia vera, essential thrombocythaemia and primary myelofibrosis (PMF). They are associated with aberrant numbers of myeloid lineage cells in the blood, and in the case of overt PMF, with development of myelofibrosis in the bone marrow and failure to produce normal blood cells. These diseases are usually caused by gain-of-function mutations in the kinase JAK2. Here, we use Drosophila to investigate the consequences of activation of the JAK2 orthologue in haematopoiesis. We have identified maturing haemocytes in the lymph gland, the major haematopoietic organ in the fly, as the cell population susceptible to induce hypertrophy upon targeted overexpression of JAK. We show that JAK activates a feed-forward loop, including the cytokine-like ligand Upd3 and its receptor, Domeless, which are required to induce lymph gland hypertrophy. Moreover, we present evidence that p38 MAPK signalling plays a key role in this process by inducing expression of the ligand Upd3. Interestingly, we also show that forced activation of the p38 MAPK pathway in maturing haemocytes suffices to generate hypertrophic organs and the appearance of melanotic tumours. Our results illustrate a novel pro-tumourigenic crosstalk between the p38 MAPK pathway and JAK signalling in a Drosophila model of MPNs. Based on the shared molecular mechanisms underlying MPNs in flies and humans, the interplay between Drosophila JAK and p38 signalling pathways unravelled in this work might have translational relevance for human MPNs. PMID:28237966

Heavy Fermions

NASA Astrophysics Data System (ADS)

Sugiyama, K.; Ónuki, Y.

Recent experimental results of high-field magnetization and de Haas-van Alphen experiments in f-electron systems are presented. The magnetic moment and the electronic state are simultaneously discussed because both properties are connected with each other. The first example is a drastic change of the Fermi surface in the antiferromagnet NdIn3. The second is the metamagnetic transition based on the quadrupolar interaction in PrCu2. The third is the metamagnetic transition in a typical heavy fermion compound CeRu2Si2, together with the heavy fermion uranium compounds such as UPd2Al3, URu2Si2 and UPt3.

The Implementation of Form-Based Interface for Relational Database

DTIC Science & Technology

1990-12-01

OFF REM ***** Verify wether the entry is correct or not REQUEST msl$,"", 130,a% IF a% = 0 THEN GOTO L1I 94 GOTO L15 L12: REM Wait here for a...REM Enter New record ON ERROR GOTO L99 upd$ = "n" MOUSE ON ENTER MOUSE OFF REM ***** Verify wether the entry is correct or not REQUEST ms 1 $,"", 130...Verify wether the entry is correct or not REQUEST msl$ ,"", 130,a% IF ao = 0 THEN GOTO LI GOTO ,15 L12: REM Wait here for a pushbutton to be

Using ecological indicators and a decision support system for integrated ecological assessment at two national park units in the Mid-Atlantic region, U.S.A.

USGS Publications Warehouse

Mahan, Carolyn G.; Young, John A.; Miller, Bruce; Saunders, Michael C.

2014-01-01

We implemented an integrated ecological assessment using a GIS-based decision support system model for Upper Delaware Scenic and Recreational River (UPDE) and Delaware Water Gap National Recreation Area (DEWA)—national park units with the mid-Atlantic region of the United States. Our assessment examined a variety of aquatic and terrestrial indicators of ecosystem components that reflect the parks’ conservation purpose and reference condition. Our assessment compared these indicators to ecological thresholds to determine the condition of park watersheds. Selected indicators included chemical and physical measures of water quality, biologic indicators of water quality, and landscape condition measures. For the chemical and physical measures of water quality, we used a water quality index and each of its nine components to assess the condition of water quality in each watershed. For biologic measures of water quality, we used the Ephemeroptera, Plecoptera, Trichoptera aquatic macroinvertebrate index and, secondarily, the Hilsenhoff aquatic macroinvertebrate index. Finally, for the landscape condition measures of our model, we used percent forest and percent impervious surface. Based on our overall assessment, UPDE and DEWA watersheds had an ecological assessment score of 0.433 on a −1 to 1 fuzzy logic scale. This score indicates that, in general, the natural resource condition within watersheds at these parks is healthy or ecologically unimpaired; however, we had only partial data for many of our indicators. Our model is iterative and new data may be incorporated as they become available. These natural parks are located within a rapidly urbanizing landscape—we recommend that natural resource managers remain vigilant to surrounding land uses that may adversely affect natural resources within the parks.

Using ecological indicators and a decision support system for integrated ecological assessment at two national park units in the mid-Atlantic region, USA.

PubMed

Mahan, Carolyn G; Young, John A; Miller, Bruce J; Saunders, Michael C

2015-02-01

We implemented an integrated ecological assessment using a GIS-based decision support system model for Upper Delaware Scenic and Recreational River (UPDE) and Delaware Water Gap National Recreation Area (DEWA)-national park units with the mid-Atlantic region of the United States. Our assessment examined a variety of aquatic and terrestrial indicators of ecosystem components that reflect the parks' conservation purpose and reference condition. Our assessment compared these indicators to ecological thresholds to determine the condition of park watersheds. Selected indicators included chemical and physical measures of water quality, biologic indicators of water quality, and landscape condition measures. For the chemical and physical measures of water quality, we used a water quality index and each of its nine components to assess the condition of water quality in each watershed. For biologic measures of water quality, we used the Ephemeroptera, Plecoptera, Trichoptera aquatic macroinvertebrate index and, secondarily, the Hilsenhoff aquatic macroinvertebrate index. Finally, for the landscape condition measures of our model, we used percent forest and percent impervious surface. Based on our overall assessment, UPDE and DEWA watersheds had an ecological assessment score of 0.433 on a -1 to 1 fuzzy logic scale. This score indicates that, in general, the natural resource condition within watersheds at these parks is healthy or ecologically unimpaired; however, we had only partial data for many of our indicators. Our model is iterative and new data may be incorporated as they become available. These natural parks are located within a rapidly urbanizing landscape-we recommend that natural resource managers remain vigilant to surrounding land uses that may adversely affect natural resources within the parks.

Constitutional SAMD9L mutations cause familial myelodysplastic syndrome and transient monosomy 7.

PubMed

Pastor, Victor B; Sahoo, Sushree S; Boklan, Jessica; Schwabe, Georg C; Saribeyoglu, Ebru; Strahm, Brigitte; Lebrecht, Dirk; Voss, Matthias; Bryceson, Yenan T; Erlacher, Miriam; Ehninger, Gerhard; Niewisch, Marena; Schlegelberger, Brigitte; Baumann, Irith; Achermann, John C; Shimamura, Akiko; Hochrein, Jochen; Tedgård, Ulf; Nilsson, Lars; Hasle, Henrik; Boerries, Melanie; Busch, Hauke; Niemeyer, Charlotte M; Wlodarski, Marcin W

2018-03-01

Familial myelodysplastic syndromes arise from haploinsufficiency of genes involved in hematopoiesis and are primarily associated with early-onset disease. Here we describe a familial syndrome in seven patients from four unrelated pedigrees presenting with myelodysplastic syndrome and loss of chromosome 7/7q. Their median age at diagnosis was 2.1 years (range, 1-42). All patients presented with thrombocytopenia with or without additional cytopenias and a hypocellular marrow without an increase of blasts. Genomic studies identified constitutional mutations (p.H880Q, p.R986H, p.R986C and p.V1512M) in the SAMD9L gene on 7q21, with decreased allele frequency in hematopoiesis. The non-random loss of mutated SAMD9L alleles was attained via monosomy 7, deletion 7q, UPD7q, or acquired truncating SAMD9L variants p.R1188X and p.S1317RfsX21. Incomplete penetrance was noted in 30% (3/10) of mutation carriers. Long-term observation revealed divergent outcomes with either progression to leukemia and/or accumulation of driver mutations (n=2), persistent monosomy 7 (n=4), and transient monosomy 7 followed by spontaneous recovery with SAMD9L -wildtype UPD7q (n=2). Dysmorphic features or neurological symptoms were absent in our patients, pointing to the notion that myelodysplasia with monosomy 7 can be a sole manifestation of SAMD9L disease. Collectively, our results define a new subtype of familial myelodysplastic syndrome and provide an explanation for the phenomenon of transient monosomy 7. Registered at: www.clinicaltrials.gov; #NCT00047268 . Copyright© 2018 Ferrata Storti Foundation.

Using Ecological Indicators and a Decision Support System for Integrated Ecological Assessment at Two National Park Units in the Mid-Atlantic Region, USA

NASA Astrophysics Data System (ADS)

Mahan, Carolyn G.; Young, John A.; Miller, Bruce J.; Saunders, Michael C.

2015-02-01

We implemented an integrated ecological assessment using a GIS-based decision support system model for Upper Delaware Scenic and Recreational River (UPDE) and Delaware Water Gap National Recreation Area (DEWA)—national park units with the mid-Atlantic region of the United States. Our assessment examined a variety of aquatic and terrestrial indicators of ecosystem components that reflect the parks' conservation purpose and reference condition. Our assessment compared these indicators to ecological thresholds to determine the condition of park watersheds. Selected indicators included chemical and physical measures of water quality, biologic indicators of water quality, and landscape condition measures. For the chemical and physical measures of water quality, we used a water quality index and each of its nine components to assess the condition of water quality in each watershed. For biologic measures of water quality, we used the Ephemeroptera, Plecoptera, Trichoptera aquatic macroinvertebrate index and, secondarily, the Hilsenhoff aquatic macroinvertebrate index. Finally, for the landscape condition measures of our model, we used percent forest and percent impervious surface. Based on our overall assessment, UPDE and DEWA watersheds had an ecological assessment score of 0.433 on a -1 to 1 fuzzy logic scale. This score indicates that, in general, the natural resource condition within watersheds at these parks is healthy or ecologically unimpaired; however, we had only partial data for many of our indicators. Our model is iterative and new data may be incorporated as they become available. These natural parks are located within a rapidly urbanizing landscape—we recommend that natural resource managers remain vigilant to surrounding land uses that may adversely affect natural resources within the parks.

Influence of Quercetin in the Temporal Regulation of Redox Homeostasis in Drosophila melanogaster.

PubMed

Subramanian, Perumal; Kaliyamoorthy, Kanimozhi; Jayapalan, Jaime Jacqueline; Abdul-Rahman, Puteri Shafinaz; Haji Hashim, Onn

2017-01-01

Numerous biological processes are governed by the biological clock. Studies using Drosophila melanogaster (L.) are valuable that could be of importance for their effective applications on rodent studies. In this study, the beneficial role of quercetin (a flavonoid) on H2O2 induced stress in D. melanogaster was investigated. D. melanogaster flies were divided into four groups (group I - control, group II - H2O2 (acute exposure), group III - quercetin, and group IV - quercetin + H2O2 treated). Negative geotaxis assay, oxidative stress indicators (protein carbonyls, thiobarbituric reactive substances [TBARS]), and antioxidants (superoxide dismutase [SOD], catalase [CAT], glutathione-S-transferase [GST], glutathione peroxidase, and reduced glutathione [GSH]) were measured at 4 h intervals over 24 h and temporal expression of heat shock protein-70 (Hsp70), Upd1 (homolog of IL-6 in Drosophila), and nitric oxide synthase (Nos) was analyzed by Western blotting. Groups II and IV showed altered biochemical rhythms (compared with controls). Decreased mesor values of negative geotaxis, SOD, CAT, GST, and GSH were noticed in H2O2, increased mesor of oxidative stress indicators (TBARS and protein carbonyl content) and a reversibility of the rhythmic characteristics were conspicuous after quercetin treatment. The expression levels of Hsp70, Upd1, and Nos were noticeably maximum at 04:00. Significant elevation of expression by H2O2 was nearly normalized by quercetin treatment. The possible mechanism by which quercetin modulates oxidant-antioxidant imbalance under oxidative stress could be ascribed to the modulation of the rhythmic properties. Our results will be helpful to understand the molecular interlink between circadian rhythm and oxidative stress mechanism. © The Author 2017. Published by Oxford University Press on behalf of the Entomological Society of America.

Investigating Autism-Related Symptoms in Children with Prader-Willi Syndrome: A Case Study

PubMed Central

Bennett, Jeffrey A.; Hodgetts, Sandra; Mackenzie, Michelle L.; Haqq, Andrea M.; Zwaigenbaum, Lonnie

2017-01-01

Prader-Willi syndrome (PWS), a rare genetic disorder caused by the lack of expression of paternal genes from chromosome 15q11-13, has been investigated for autism spectrum disorder (ASD) symptomatology in various studies. However, previous findings have been variable, and no studies investigating ASD symptomatology in PWS have exclusively studied children. We aimed to characterize social communication functioning and other ASD-related symptoms in children with PWS, and assessed agreement across measures and rates of ASD diagnosis. Measures included the Autism Diagnostic Observation Schedule-2 (ADOS-2), the Social Communication Questionnaire (SCQ), Social Responsiveness Scale-2 (SRS-2), Social Skills Improvement System-Rating Scales (SSIS-RS), and the Vineland Adaptive Behavioral Scales-II (VABS-II). General adaptive and intellectual skills were also assessed. Clinical best estimate (CBE) diagnosis was determined by an experienced developmental pediatrician, based on history and review of all available study measures, and taking into account overall developmental level. Participants included 10 children with PWS, aged 3 to 12 years. Three of the 10 children were male and genetic subtypes were two deletion (DEL) and eight uniparental disomy (UPD) (with a total of 6 female UPD cases). Although 8 of the 10 children exceeded cut-offs on at least one of the ASD assessments, agreement between parent questionnaires (SCQ, SRS-2, SSIS-RS) and observational assessment (ADOS-2) was very poor. None of the children were assigned a CBE diagnosis of ASD, with the caveat that the risk may have been lower because of the predominance of girls in the sample. The lack of agreement between the assessments emphasizes the complexity of interpreting ASD symptom measures in children with PWS. PMID:28264487

Investigating Autism-Related Symptoms in Children with Prader-Willi Syndrome: A Case Study.

PubMed

Bennett, Jeffrey A; Hodgetts, Sandra; Mackenzie, Michelle L; Haqq, Andrea M; Zwaigenbaum, Lonnie

2017-02-28

Prader-Willi syndrome (PWS), a rare genetic disorder caused by the lack of expression of paternal genes from chromosome 15q11-13, has been investigated for autism spectrum disorder (ASD) symptomatology in various studies. However, previous findings have been variable, and no studies investigating ASD symptomatology in PWS have exclusively studied children. We aimed to characterize social communication functioning and other ASD-related symptoms in children with PWS, and assessed agreement across measures and rates of ASD diagnosis. Measures included the Autism Diagnostic Observation Schedule-2 (ADOS-2), the Social Communication Questionnaire (SCQ), Social Responsiveness Scale-2 (SRS-2), Social Skills Improvement System-Rating Scales (SSIS-RS), and the Vineland Adaptive Behavioral Scales-II (VABS-II). General adaptive and intellectual skills were also assessed. Clinical best estimate (CBE) diagnosis was determined by an experienced developmental pediatrician, based on history and review of all available study measures, and taking into account overall developmental level. Participants included 10 children with PWS, aged 3 to 12 years. Three of the 10 children were male and genetic subtypes were two deletion (DEL) and eight uniparental disomy (UPD) (with a total of 6 female UPD cases). Although 8 of the 10 children exceeded cut-offs on at least one of the ASD assessments, agreement between parent questionnaires (SCQ, SRS-2, SSIS-RS) and observational assessment (ADOS-2) was very poor. None of the children were assigned a CBE diagnosis of ASD, with the caveat that the risk may have been lower because of the predominance of girls in the sample. The lack of agreement between the assessments emphasizes the complexity of interpreting ASD symptom measures in children with PWS.

Methylation-sensitive high-resolution melting-curve analysis of the SNRPN gene as a diagnostic screen for Prader-Willi and Angelman syndromes.

PubMed

White, Helen E; Hall, Victoria J; Cross, Nicholas C P

2007-11-01

Angelman syndrome (AS) and Prader-Willi syndrome (PWS) are 2 distinct neurodevelopmental disorders caused primarily by deficiency of specific parental contributions at an imprinted domain within the chromosomal region 15q11.2-13. Lack of paternal contribution results in PWS either by paternal deletion (approximately 70%) or maternal uniparental disomy (UPD) (approximately 25%). Most cases of AS result from the lack of a maternal contribution from this same region, by maternal deletion (70%) or paternal UPD (approximately 5%). Analysis of allelic methylation differences at the small nuclear ribonucleoprotein polypeptide N (SNRPN) locus differentiates the maternally and paternally inherited chromosome 15 and can be used as a diagnostic test for AS and PWS. Methylation-sensitive high-resolution melting-curve analysis (MS-HRM) using the DNA binding dye EvaGreen was used to analyze methylation differences at the SNRPN locus in anonymized DNA samples from individuals with PWS (n = 39) or AS (n = 31) and from healthy control individuals (n = 95). Results from the MS-HRM assay were compared to those obtained by use of a methylation-specific PCR (MSP) protocol that is used commonly in diagnostic practice. With the MS-HRM assay 97.6% of samples were unambiguously assigned to the 3 diagnostic categories (AS, PWS, normal) by use of automated calling with an 80% confidence percentage threshold, and the failure rate was 0.6%. One PWS sample showed a discordant result for the MS-HRM assay compared to MSP data. MS-HRM is a simple, rapid, and robust method for screening methylation differences at the SNRPN locus and could be used as a diagnostic screen for PWS and AS.

Optomotor-blind negatively regulates Drosophila eye development by blocking Jak/STAT signaling.

PubMed

Tsai, Yu-Chen; Grimm, Stefan; Chao, Ju-Lan; Wang, Shih-Chin; Hofmeyer, Kerstin; Shen, Jie; Eichinger, Fred; Michalopoulou, Theoni; Yao, Chi-Kuang; Chang, Chih-Hsuan; Lin, Shih-Han; Sun, Y Henry; Pflugfelder, Gert O

2015-01-01

Organ formation requires a delicate balance of positive and negative regulators. In Drosophila eye development, wingless (wg) is expressed at the lateral margins of the eye disc and serves to block retinal development. The T-box gene optomotor-blind (omb) is expressed in a similar pattern and is regulated by Wg. Omb mediates part of Wg activity in blocking eye development. Omb exerts its function primarily by blocking cell proliferation. These effects occur predominantly in the ventral margin. Our results suggest that the primary effect of Omb is the blocking of Jak/STAT signaling by repressing transcription of upd which encodes the Jak receptor ligand Unpaired.

Upgrading of data acquisition software for centralized radiation monitoring system in Malaysian Nuclear Agency

NASA Astrophysics Data System (ADS)

Yussup, F.; Ibrahim, M. M.; Haris, M. F.; Soh, S. C.; Hasim, H.; Azman, A.; Razalim, F. A. A.; Yapp, R.; Ramli, A. A. M.

2016-01-01

With the growth of technology, many devices and equipments can be connected to the network and internet to enable online data acquisition for real-time data monitoring and control from monitoring devices located at remote sites. Centralized radiation monitoring system (CRMS) is a system that enables area radiation level at various locations in Malaysian Nuclear Agency (Nuklear Malaysia) to be monitored centrally by using a web browser. The Local Area Network (LAN) in Nuclear Malaysia is utilized in CRMS as a communication media for data acquisition of the area radiation levels from radiation detectors. The development of the system involves device configuration, wiring, network and hardware installation, software and web development. This paper describes the software upgrading on the system server that is responsible to acquire and record the area radiation readings from the detectors. The recorded readings are called in a web programming to be displayed on a website. Besides the main feature which is acquiring the area radiation levels in Nuclear Malaysia centrally, the upgrading involves new features such as uniform time interval for data recording and exporting, warning system and dose triggering.

Magnetic and electrical properties of dhcp NpPd3 and (U1-xNpx)Pd3

NASA Astrophysics Data System (ADS)

Walker, H. C.; McEwen, K. A.; Boulet, P.; Colineau, E.; Griveau, J.-C.; Rebizant, J.; Wastin, F.

2007-11-01

We have made an extensive study of the magnetic and electrical properties of double-hexagonal close-packed NpPd3 and a range of (U1-xNpx)Pd3 compounds with x=0.01 , 0.02, 0.05, and 0.50 using magnetization, magnetic susceptibility, electrical resistivity, and heat capacity measurements on polycrystalline samples, performed in the temperature range 2-300K and in magnetic fields up to 9T . Two transitions are observed in NpPd3 at T=10 and 30K . Dilute Np samples (x⩽0.05) exhibit quadrupolar transitions, with the transition temperatures reduced from those of pure UPd3 .

Optomotor-Blind Negatively Regulates Drosophila Eye Development by Blocking Jak/STAT Signaling

PubMed Central

Tsai, Yu-Chen; Grimm, Stefan; Chao, Ju-Lan; Wang, Shih-Chin; Hofmeyer, Kerstin; Shen, Jie; Eichinger, Fred; Michalopoulou, Theoni; Yao, Chi-Kuang; Chang, Chih-Hsuan; Lin, Shih-Han; Sun, Y. Henry; Pflugfelder, Gert O.

2015-01-01

Organ formation requires a delicate balance of positive and negative regulators. In Drosophila eye development, wingless (wg) is expressed at the lateral margins of the eye disc and serves to block retinal development. The T-box gene optomotor-blind (omb) is expressed in a similar pattern and is regulated by Wg. Omb mediates part of Wg activity in blocking eye development. Omb exerts its function primarily by blocking cell proliferation. These effects occur predominantly in the ventral margin. Our results suggest that the primary effect of Omb is the blocking of Jak/STAT signaling by repressing transcription of upd which encodes the Jak receptor ligand Unpaired. PMID:25781970

Ultra-wideband pose detection system for boom-type roadheader based on Caffery transform and Taylor series expansion

NASA Astrophysics Data System (ADS)

Fu, Shichen; Li, Yiming; Zhang, Minjun; Zong, Kai; Cheng, Long; Wu, Miao

2018-01-01

To realize unmanned pose detection of a coalmine boom-type roadheader, an ultra-wideband (UWB) pose detection system (UPDS) for a roadheader is designed, which consists of four UWB positioning base stations and three roadheader positioning nodes. The positioning base stations are used in turn to locate the positioning nodes of the roadheader fuselage. Using 12 sets of distance measurement information, a time-of-arrival (TOA) positioning model is established to calculate the 3D coordinates of three positioning nodes of the roadheader fuselage, and the three attitude angles (heading, pitch, and roll angles) of the roadheader fuselage are solved. A range accuracy experiment of a UWB P440 module was carried out in a narrow and closed tunnel, and the experiment data show that the mean error and standard deviation of the module can reach below 2 cm. Based on the TOA positioning model of the UPDS, we propose a fusion-positioning algorithm based on a Caffery transform and Taylor series expansion (CTFPA). We derived the complete calculation process, designed a flowchart, and carried out a simulation of CTFPA in MATLAB, comparing 1000 simulated positioning nodes of CTFPA and the Caffery positioning algorithm (CPA) for a 95 m long tunnel. The positioning error field of the tunnel was established, and the influence of the spatial variation on the positioning accuracy of CPA and CTFPA was analysed. The simulation results show that, compared with CPA, the positioning accuracy of CTFPA is clearly improved, and the accuracy of each axis can reach more than 5 mm. The accuracy of the X-axis is higher than that of the Y- and Z-axes. In section X-Y of the tunnel, the root mean square error (RMSE) contours of CTFPA are clear and orderly, and with an increase in the measuring distance, RMSE increases linearly. In section X-Z, the RMSE contours are concentric circles, and the variation ratio is nonlinear.

Reduced cortical complexity in children with Prader-Willi Syndrome and its association with cognitive impairment and developmental delay.

PubMed

Lukoshe, Akvile; Hokken-Koelega, Anita C; van der Lugt, Aad; White, Tonya

2014-01-01

Prader-Willi Syndrome (PWS) is a complex neurogenetic disorder with symptoms involving not only hypothalamic, but also a global, central nervous system dysfunction. Previously, qualitative studies reported polymicrogyria in adults with PWS. However, there have been no quantitative neuroimaging studies of cortical morphology in PWS and no studies to date in children with PWS. Thus, our aim was to investigate and quantify cortical complexity in children with PWS compared to healthy controls. In addition, we investigated differences between genetic subtypes of PWS and the relationship between cortical complexity and intelligence within the PWS group. High-resolution structural magnetic resonance images were acquired in 24 children with genetically confirmed PWS (12 carrying a deletion (DEL), 12 with maternal uniparental disomy (mUPD)) and 11 age- and sex-matched typically developing siblings as healthy controls. Local gyrification index (lGI) was obtained using the FreeSurfer software suite. Four large clusters, two in each hemisphere, comprising frontal, parietal and temporal lobes, had lower lGI in children with PWS, compared to healthy controls. Clusters with lower lGI also had significantly lower cortical surface area in children with PWS. No differences in cortical thickness of the clusters were found between the PWS and healthy controls. lGI correlated significantly with cortical surface area, but not with cortical thickness. Within the PWS group, lGI in both hemispheres correlated with Total IQ and Verbal IQ, but not with Performance IQ. Children with mUPD, compared to children with DEL, had two small clusters with lower lGI in the right hemisphere. lGI of these clusters correlated with cortical surface area, but not with cortical thickness or IQ. These results suggest that lower cortical complexity in children with PWS partially underlies cognitive impairment and developmental delay, probably due to alterations in gene networks that play a prominent role in early brain development.

Reduced Cortical Complexity in Children with Prader-Willi Syndrome and Its Association with Cognitive Impairment and Developmental Delay

PubMed Central

Lukoshe, Akvile; Hokken-Koelega, Anita C.; van der Lugt, Aad; White, Tonya

2014-01-01

Background Prader-Willi Syndrome (PWS) is a complex neurogenetic disorder with symptoms involving not only hypothalamic, but also a global, central nervous system dysfunction. Previously, qualitative studies reported polymicrogyria in adults with PWS. However, there have been no quantitative neuroimaging studies of cortical morphology in PWS and no studies to date in children with PWS. Thus, our aim was to investigate and quantify cortical complexity in children with PWS compared to healthy controls. In addition, we investigated differences between genetic subtypes of PWS and the relationship between cortical complexity and intelligence within the PWS group. Methods High-resolution structural magnetic resonance images were acquired in 24 children with genetically confirmed PWS (12 carrying a deletion (DEL), 12 with maternal uniparental disomy (mUPD)) and 11 age- and sex-matched typically developing siblings as healthy controls. Local gyrification index (lGI) was obtained using the FreeSurfer software suite. Results Four large clusters, two in each hemisphere, comprising frontal, parietal and temporal lobes, had lower lGI in children with PWS, compared to healthy controls. Clusters with lower lGI also had significantly lower cortical surface area in children with PWS. No differences in cortical thickness of the clusters were found between the PWS and healthy controls. lGI correlated significantly with cortical surface area, but not with cortical thickness. Within the PWS group, lGI in both hemispheres correlated with Total IQ and Verbal IQ, but not with Performance IQ. Children with mUPD, compared to children with DEL, had two small clusters with lower lGI in the right hemisphere. lGI of these clusters correlated with cortical surface area, but not with cortical thickness or IQ. Conclusions These results suggest that lower cortical complexity in children with PWS partially underlies cognitive impairment and developmental delay, probably due to alterations in gene networks that play a prominent role in early brain development. PMID:25226172

Fortuitous detection of uniparental isodisomy of chromosome 6.

PubMed Central

Bittencourt, M C; Morris, M A; Chabod, J; Gos, A; Lamy, B; Fellmann, F; Antonarakis, S E; Plouvier, E; Herve, P; Tiberghien, P

1997-01-01

Uniparental isodisomy is defined as the inheritance of two copies of the same parental chromosome and can result in defects when it produces homozygosity for a recessive mutation or in the presence of imprinting. We describe the detection of a chromosome 6 uniparental isodisomy in a 9 year old girl, discovered during a search for an HLA identical sib. HLA typing, erythrocyte phenotyping, and genotypes of microsatellite polymorphisms were compatible with a paternal isodisomy of chromosome 6, with normal biparental origin of the other chromosomes. Paternal cells were not responsive to the patient's cells in mixed lymphocyte cultures. This fortuitous detection of a chromosome 6 isodisomy suggests that cases of chromosome 6 UPD may not be deleterious and may therefore go undetected. PMID:9032654

Stakeholder engagement for promoting the Comprehensive Nuclear-Test-Ban Treaty (CTBT): Malaysia’s experience

NASA Astrophysics Data System (ADS)

Rashid, F. I. A.; Zolkaffly, M. Z.; Jamal, N.

2018-01-01

In order to keep abreast on issues related to CTBT in Malaysia, Malaysian Nuclear Agency (Nuklear Malaysia), as the CTBT National Authority in Malaysia, has collaborated with local partners to implement various stakeholder engagement programme. This paper aims at highlighting Malaysia’s approach in promoting CTBT through stakeholder engagement programme targeted at multilevel stakeholders, both national and international. Such programmes includes participation in the international forums, inter-agency meetings, awareness seminars, training courses, technical visits to IMS station, promoting civil and scientific application of International Monitoring System (IMS) data and International Data Centre (IDC) products using Virtual Data Exploitation Center (vDEC), inviting youth groups to participate in the CTBTO Youth Group, and publications of CTBT-related topics. This approach has successfully fortify Malaysia’s commitments at the international level, enhanced national awareness of global multilateral framework, increased stakeholders awareness and their roles related to CTBT, as well as building domestic capacity on CTBT matters. In conclusion, stakeholder engagement is crucial in promoting and enhancing stakeholders understanding on CTBT. Continuous engagement with relevant stakeholders will enable effective dissemination and smooth implementation of CTBT related matters that will eventually support global universalization of CTBT.

Upgrading of data acquisition software for centralized radiation monitoring system in Malaysian Nuclear Agency

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

Yussup, F., E-mail: nolida@nm.gov.my; Ibrahim, M. M., E-mail: maslina-i@nm.gov.my; Soh, S. C.

With the growth of technology, many devices and equipments can be connected to the network and internet to enable online data acquisition for real-time data monitoring and control from monitoring devices located at remote sites. Centralized radiation monitoring system (CRMS) is a system that enables area radiation level at various locations in Malaysian Nuclear Agency (Nuklear Malaysia) to be monitored centrally by using a web browser. The Local Area Network (LAN) in Nuclear Malaysia is utilized in CRMS as a communication media for data acquisition of the area radiation levels from radiation detectors. The development of the system involves devicemore » configuration, wiring, network and hardware installation, software and web development. This paper describes the software upgrading on the system server that is responsible to acquire and record the area radiation readings from the detectors. The recorded readings are called in a web programming to be displayed on a website. Besides the main feature which is acquiring the area radiation levels in Nuclear Malaysia centrally, the upgrading involves new features such as uniform time interval for data recording and exporting, warning system and dose triggering.« less

#Proana: Pro-Eating Disorder Socialization on Twitter.

PubMed

Arseniev-Koehler, Alina; Lee, Hedwig; McCormick, Tyler; Moreno, Megan A

2016-06-01

Pro-eating disorder (ED) online movements support engagement with ED lifestyles and are associated with negative health consequences for adolescents with EDs. Twitter is a popular social media site among adolescents that provides a unique setting for Pro-ED content to be publicly exchanged. The purpose of this study was to investigate Pro-ED Twitter profiles' references to EDs and how their social connections (followers) reference EDs. A purposeful sample of 45 Pro-ED profiles was selected from Twitter. Profile information, all tweets, and a random sample of 100 of their followers' profile information were collected for content analysis using the Twitter Application Programming Interface. A codebook based on ED screening guidelines was applied to evaluate ED references. For each Pro-ED profile, proportion of tweets with ED references and proportion of followers with ED references in their own profile were evaluated. In total, our 45 Pro-ED profiles generated 4,245 tweets for analysis. A median of 36.4% of profiles' tweets contained ED references. Pro-ED profiles had a median of 173 followers, and a median of 44.5% of followers had ED references. Pro-ED profiles with more tweets with ED references also tended to have more followers with ED references (β = .37, p < .01). Findings suggest that profiles which self-identify as Pro-ED express disordered eating patterns through tweets and have an audience of followers, many of whom also reference ED in their own profiles. ED socialization on Twitter might provide social support, but in the Pro-ED context this activity might also reinforce an ED identity. Copyright © 2016 The Society for Adolescent Health and Medicine. All rights reserved.

Ten Novel Mutations in Chinese Patients with Megalencephalic Leukoencephalopathy with Subcortical Cysts and a Long-Term Follow-Up Research

PubMed Central

Cao, Binbin; Yan, Huifang; Guo, Mangmang; Xie, Han; Wu, Ye; Gu, Qiang; Xiao, Jiangxi; Shang, Jing; Yang, Yanling; Xiong, Hui; Niu, Zhengping; Wu, Xiru; Jiang, Yuwu; Wang, Jingmin

2016-01-01

Objective Megalencephalic leukoencephalopathy with subcortical cysts (MLC, OMIM 604004) is a rare neurological deterioration disease. We aimed to clarify clinical and genetic features of Chinese MLC patients. Methods Clinical information and peripheral venous blood of 20 patients and their families were collected, Sanger-sequencing and Multiple Ligation-dependent Probe Amplification were performed to make genetic analysis. Splicing-site mutation was confirmed with RT-PCR. UPD was detected by haplotype analysis. Follow-up study was performed through telephone for 27 patients. Results Out of 20 patients, macrocephaly, classic MRI features, motor development delay and cognitive impairment were detected in 20(100%), 20(100%), 17(85%) and 4(20%) patients, respectively. 20(100%) were clinically diagnosed with MLC. 19(95%) were genetically diagnosed with 10 novel mutations in MLC1, MLC1 and GlialCAM mutations were identified in 15 and 4 patients, respectively. Deletion mutation from exon4 to exon9 and a homozygous point mutation due to maternal UPD of chromosome22 in MLC1 were found firstly. c.598-2A>C in MLC1 leads to the skip of exon8. c.772-1G>C in MLC1 accounting for 15.5%(9/58) alleles in Chinese patients might be a founder or a hot-spot mutation. Out of 27 patients in the follow-up study, head circumference was ranged from 56cm to 61cm in patients older than 5yeas old, with a median of 57cm. Motor development delay and cognitive impairment were detected in 22(81.5%) and 5(18.5%) patients, respectively. Motor and cognitive deterioration was found in 5 (18.5%) and 2 patients (7.4%), respectively. Improvements and MRI recovery were first found in Chinese patients. Rate of seizures (45.5%), transient motor retrogress (45.5%) and unconsciousness (13.6%) after head trauma was much higher than that after fever (18.2%, 9.1%, 0%, respectively). Significance It’s a clinical and genetic analysis and a follow-up study for largest sample of Chinese MLC patients, identifying 10 novel mutations, expanding mutation spectrums and discovering clinical features of Chinese MLC patients. PMID:27322623

Analysis and visualization of chromosomal abnormalities in SNP data with SNPscan

PubMed Central

Ting, Jason C; Ye, Ying; Thomas, George H; Ruczinski, Ingo; Pevsner, Jonathan

2006-01-01

Background A variety of diseases are caused by chromosomal abnormalities such as aneuploidies (having an abnormal number of chromosomes), microdeletions, microduplications, and uniparental disomy. High density single nucleotide polymorphism (SNP) microarrays provide information on chromosomal copy number changes, as well as genotype (heterozygosity and homozygosity). SNP array studies generate multiple types of data for each SNP site, some with more than 100,000 SNPs represented on each array. The identification of different classes of anomalies within SNP data has been challenging. Results We have developed SNPscan, a web-accessible tool to analyze and visualize high density SNP data. It enables researchers (1) to visually and quantitatively assess the quality of user-generated SNP data relative to a benchmark data set derived from a control population, (2) to display SNP intensity and allelic call data in order to detect chromosomal copy number anomalies (duplications and deletions), (3) to display uniparental isodisomy based on loss of heterozygosity (LOH) across genomic regions, (4) to compare paired samples (e.g. tumor and normal), and (5) to generate a file type for viewing SNP data in the University of California, Santa Cruz (UCSC) Human Genome Browser. SNPscan accepts data exported from Affymetrix Copy Number Analysis Tool as its input. We validated SNPscan using data generated from patients with known deletions, duplications, and uniparental disomy. We also inspected previously generated SNP data from 90 apparently normal individuals from the Centre d'Étude du Polymorphisme Humain (CEPH) collection, and identified three cases of uniparental isodisomy, four females having an apparently mosaic X chromosome, two mislabelled SNP data sets, and one microdeletion on chromosome 2 with mosaicism from an apparently normal female. These previously unrecognized abnormalities were all detected using SNPscan. The microdeletion was independently confirmed by fluorescence in situ hybridization, and a region of homozygosity in a UPD case was confirmed by sequencing of genomic DNA. Conclusion SNPscan is useful to identify chromosomal abnormalities based on SNP intensity (such as chromosomal copy number changes) and heterozygosity data (including regions of LOH and some cases of UPD). The program and source code are available at the SNPscan website . PMID:16420694

Quaternary borocarbides: New class of intermetallic superconductors

NASA Technical Reports Server (NTRS)

Nagarajan, R.; Gupta, L. C.; Dhar, S. K.; Mazumdar, Chandan; Hossain, Zakir; Godart, C.; Levy-Clement, C.; Padalia, B. D.; Vijayaraghavan, R.

1995-01-01

Our recent discovery of superconductivity (SC) in the four-element multiphase Y-Ni-B-C system at an elevated temperature (TC approximately 12 K) has opened up great possibilities of identifying new superconducting materials and generating new physics. Superconductivity with Tc (greater than 20 K) higher than that known so far in bulk intermetallics has been observed in multiphase Y-Pd-B-C and Th-Pd-B-C systems and a family of single phase materials RENi2B2C (RE= Y, rare earth) have been found. Our investigations show YNi2B2C to be a strong coupling hard type-II SC. HC2(T) exhibits an unconventional temperature dependence. Specific heat and magnetization studies reveal coexistence of SC and magnetism in RNi2B2C (R = Ho, Er, Tm) with magnetic ordering temperatures (Tc approximately 8 K, 10.5 K, 11 K and Tm approximately 5 K, approximately 7K, approximately 4 K respectively) that are remarkably higher than those in known magnetic superconductors . Mu-SR studies suggest the possibility of Ni atoms carrying a moment in TmNi2B2C. Resistivity results suggests a double re-entrant transition (SC-normal-SC) in HoNi2B2C. RENi2B2C (RE = Ce, Nd, Gd) do not show SC down to 4.2 K. The Nd- and Gd-compounds order magnetically at approximately 4.5 K and approximately 19.5 K, respectively. Two SC transitions are observed in Y-Pd-B-C (Tc approximately 22 K, approximately 10 K) and in Th-Pd-B-C (Tc approximately 20 K, approximately 14 K) systems, which indicate that there are at least two structures which support SC in these borocarbides. In our multiphase ThNi2B2C we observe SC at approximately 6 K. No SC was seen in multiphase UNi2B2C, UPd2B2C, UOs2Ge2C and UPd5B3C(0.35) down to 4.2 K. Tc in YNi2B2C is depressed by substitutions (Gd, Th and U at Y-sites and Fe, Co at Ni-sites).

Water Quality of the Upper Delaware Scenic and Recreational River and Tributary Streams, New York and Pennsylvania

USGS Publications Warehouse

Siemion, Jason; Murdoch, Peter S.

2010-01-01

Water-quality samples were collected from the Upper Delaware Scenic and Recreational River (UPDE) and its tributaries during the period October 1, 2005, to September 30, 2007, to document existing water quality, determine relations between land use and water quality, and identify areas of water-quality concern. A tiered water-quality monitoring framework was used, with the tiers consisting of intensively sampled sites, gradient sites representing the range of land uses present in the basin, and regional stream-survey sites. Median nitrate and total phosphorous concentrations were 1.15 and 0.01 mg/L (milligrams per liter) for three sites on the mainstem Delaware River, 1.27 and 0.009 mg/L for the East Branch Delaware River, 2.04 and 0.01 mg/L for the West Branch Delaware River, and 0.68 and 0.006 mg/L for eight tributaries that represent the range of land uses resent in the basin, respectively. The percentage of agricultural land varied by basin from 0 to 30 percent and the percentage of suburbanization varied from 0 to 17 percent. There was a positive correlation between the percentage of agricultural land use in a basin and observed concentrations of acid neutralizing capacity, calcium, potassium, nitrate, and total dissolved nitrogen, whereas no correlation between the percentage of suburbanization and water quality was detected. Results of stream surveys showed that nitrate concentrations in 55 to 65 percent of the UPDE Basin exceeded the nitrate reference condition and a suggested water-quality guideline for ecological impairment in New York State (0.98 mg/L) during the spring. Many of the affected parts of the basin were more than 90 percent forested and showed signs of episodic acidification, indicating that the long-term effects of acid deposition play a role in the high nitrate levels. Nitrate concentrations in 75 percent of samples collected from agricultural sites exceeded the suggested nitrate water-quality guideline for ecological impairment. Concentrations of nitrate and total phosphorous in samples collected from agricultural sites also were twice and 25 percent higher than those in samples from reference sites, respectively.

Liver Cytochrome P450 3A Ubiquitination in Vivo by gp78/Autocrine Motility Factor Receptor and C Terminus of Hsp70-interacting Protein (CHIP) E3 Ubiquitin Ligases

PubMed Central

Kim, Sung-Mi; Acharya, Poulomi; Engel, Juan C.; Correia, Maria Almira

2010-01-01

CYP3A4 is a dominant human liver cytochrome P450 enzyme engaged in the metabolism and disposition of >50% of clinically relevant drugs and held responsible for many adverse drug-drug interactions. CYP3A4 and its mammalian liver CYP3A orthologs are endoplasmic reticulum (ER)-anchored monotopic proteins that undergo ubiquitin (Ub)-dependent proteasomal degradation (UPD) in an ER-associated degradation (ERAD) process. These integral ER proteins are ubiquitinated in vivo, and in vitro studies have identified the ER-integral gp78 and the cytosolic co-chaperone, CHIP (C terminus of Hsp70-interacting protein), as the relevant E3 Ub-ligases, along with their cognate E2 Ub-conjugating enzymes UBC7 and UbcH5a, respectively. Using lentiviral shRNA templates targeted against each of these Ub-ligases, we now document that both E3s are indeed physiologically involved in CYP3A ERAD/UPD in cultured rat hepatocytes. Accordingly, specific RNAi resulted in ≈80% knockdown of each hepatic Ub-ligase, with a corresponding ≈2.5-fold CYP3A stabilization. Surprisingly, however, such stabilization resulted in increased levels of functionally active CYP3A, thereby challenging the previous notion that E3 recognition and subsequent ERAD of CYP3A proteins required ab initio their structural and/or functional inactivation. Furthermore, coexpression in HepG2 cells of both CYP3A4 and gp78, but not its functionally inactive RING-finger mutant, resulted in enhanced CYP3A4 loss greater than that in corresponding cells expressing only CYP3A4. Stabilization of a functionally active CYP3A after RNAi knockdown of either of the E3s, coupled with the increased CYP3A4 loss on gp78 or CHIP coexpression, suggests that ERAD-associated E3 Ub-ligases can influence clinically relevant drug metabolism by effectively regulating the physiological CYP3A content and consequently its function. PMID:20819951

Nanomolar Trace Metal Analysis of Copper at Gold Microband Arrays

NASA Astrophysics Data System (ADS)

Wahl, A.; Dawson, K.; Sassiat, N.; Quinn, A. J.; O'Riordan, A.

2011-08-01

This paper describes the fabrication and electrochemical characterization of gold microband electrode arrays designated as a highly sensitive sensor for trace metal detection of copper in drinking water samples. Gold microband electrodes have been routinely fabricated by standard photolithographic methods. Electrochemical characterization were conducted in 0.1 M H2SO4 and found to display characteristic gold oxide formation and reduction peaks. The advantages of gold microband electrodes as trace metal sensors over currently used methods have been investigated by employing under potential deposition anodic stripping voltammetry (UPD-ASV) in Cu2+ nanomolar concentrations. Linear correlations were observed for increasing Cu2+ concentrations from which the concentration of an unknown sample of drinking water was estimated. The results obtained for the estimation of the unknown trace copper concentration in drinking was in good agreement with expected values.

Variable Access to Immediate Bedside Ultrasound in the Emergency Department

PubMed Central

Talley, Brad E.; Ginde, Adit A.; Raja, Ali S.; Sullivan, Ashley F.; Espinola, Janice A.; Camargo, Carlos A.

2011-01-01

Objective: Use of bedside emergency department (ED) ultrasound has become increasingly important for the clinical practice of emergency medicine (EM). We sought to evaluate differences in the availability of immediate bedside ultrasound based on basic ED characteristics and physician staffing. Methods: We surveyed ED directors in all 351 EDs in Colorado, Georgia, Massachusetts, and Oregon between January and April 2009. We assessed access to bedside ED ultrasound by the question: “Is bedside ultrasound available immediately in the ED?” ED characteristics included location, visit volume, admission rate, percent uninsured, total emergency physician full-time equivalents and proportion of EM board-certified (BC) or EM board-eligible (BE) physicians. Data analysis used chi-square tests and multivariable logistical regression to compare differences in access to bedside ED ultrasound by ED characteristics and staffing. Results: We received complete responses from 298 (85%) EDs. Immediate access to bedside ultrasound was available in 175 (59%) EDs. ED characteristics associated with access to bedside ultrasound were: location (39% for rural vs. 71% for urban, P<0.001); visit volume (34% for EDs with low volume [<1 patient/hour] vs. 79% for EDs with high volume [≥3 patients/hour], P<0.001); admission rate (39% for EDs with low [0–10%] admission rates vs. 84% for EDs with high [>20%] rates, P<0.001); and EM BC/BE physicians (26% for EDs with a low percentage [0–20%] vs.74% for EDs with a high percentage [≥80%], P<0.001). Conclusion: U.S. EDs differ significantly in their access to immediate bedside ultrasound. Smaller, rural EDs and those staffed by fewer EM BC/BE physicians more frequently lacked access to immediate bedside ultrasound in the ED. PMID:21691479

Development of integrated radioactive waste packaging and conditioning solutions in the UK

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

Sibley, Peter; Butter, Kevin; Zimmerman, Ian

2013-07-01

In order to offer a more cost effective, safer and efficient Intermediate Level Waste (ILW) management service, EnergySolutions EU Ltd. and Gesellschaft fur Nuklear-Service mbH (GNS) have been engaged in the development of integrated radioactive waste retrieval, packaging and conditioning solutions in the UK. Recognising the challenges surrounding regulatory endorsement and on-site implementation in particular, this has resulted in an alternative approach to meeting customer, safety regulator and disposability requirements. By working closely with waste producers and the organisation(s) responsible for endorsing radioactive waste management operations in the UK, our proposed solutions are now being implemented. By combining GNS' off-the-shelf,more » proven Ductile Cast Iron Containers (DCICs) and water removal technologies, with EnergySolutions EU Ltd.'s experience and expertise in waste retrieval, safety case development and disposability submissions, a fully integrated service offering has been developed. This has involved significant effort to overcome technical challenges such as onsite equipment deployment, active commissioning, conditioning success criteria and disposability acceptance. Our experience in developing such integrated solutions has highlighted the importance of working in collaboration with all parties to achieve a successful and viable outcome. Ultimately, the goal is to ensure reliable, safe and effective delivery of waste management solutions. (authors)« less

Where Do Freestanding Emergency Departments Choose to Locate? A National Inventory and Geographic Analysis in Three States.

PubMed

Schuur, Jeremiah D; Baker, Olesya; Freshman, Jaclyn; Wilson, Michael; Cutler, David M

2017-04-01

We determine the number and location of freestanding emergency departments (EDs) across the United States and determine the population characteristics of areas where freestanding EDs are located. We conducted a systematic inventory of US freestanding EDs. For the 3 states with the highest number of freestanding EDs, we linked demographic, insurance, and health services data, using the 5-digit ZIP code corresponding to the freestanding ED's location. To create a comparison nonfreestanding ED group, we matched 187 freestanding EDs to 1,048 nonfreestanding ED ZIP codes on land and population within state. We compared differences in demographic, insurance, and health services factors between matched ZIP codes with and without freestanding EDs, using univariate regressions with weights. We identified 360 freestanding EDs located in 30 states; 54.2% of freestanding EDs were hospital satellites, 36.6% were independent, and 9.2% were not classifiable. The 3 states with the highest number of freestanding EDs accounted for 66% of all freestanding EDs: Texas (181), Ohio (34), and Colorado (24). Across all 3 states, freestanding EDs were located in ZIP codes that had higher incomes and a lower proportion of the population with Medicaid. In Texas and Ohio, freestanding EDs were located in ZIP codes with a higher proportion of the population with private insurance. In Texas, freestanding EDs were located in ZIP codes that had fewer Hispanics, had a greater number of hospital-based EDs and physician offices, and had more physician visits and medical spending per year than ZIP codes without a freestanding ED. In Ohio, freestanding EDs were located in ZIP codes with fewer hospital-based EDs. In Texas, Ohio, and Colorado, freestanding EDs were located in areas with a better payer mix. The location of freestanding EDs in relation to other health care facilities and use and spending on health care varied between states. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Emergency department characteristics and capabilities in Beijing, China.

PubMed

Wen, Leana S; Xu, Jun; Steptoe, Anne P; Sullivan, Ashley F; Walline, Joseph H; Yu, Xuezhong; Camargo, Carlos A

2013-06-01

Emergency Departments (EDs) are a critical, yet heterogeneous, part of international emergency care. We sought to describe the characteristics, resources, capabilities, and capacity of EDs in Beijing, China. Beijing EDs accessible to the general public 24 h per day/7 days per week were surveyed using the National ED Inventories survey instrument (www.emnet-nedi.org). ED staff were asked about ED characteristics during the calendar year 2008. Thirty-six EDs participated (88% response rate). All were located in hospitals and were independent hospital departments. Participating EDs saw a median of 80,000 patients (interquartile range 40,000-118,508). The vast majority (91%; 95% confidence interval [CI] 78-98%) had a contiguous layout, with medical and surgical care provided in one area. Most EDs (55%) saw only adults; 39% saw both adults and children, and 6% saw only children. Availability of technological and consultant resource in EDs was high. The typical ED length of stay was between 1 and 6 h in 49% of EDs (95% CI 32-67%), whereas in the other half, patients reportedly remained for over 6 h; 36% (95% CI 21-54%) of respondents considered their ED over capacity. Beijing EDs have high volume, long length of stay, and frequent reports of EDs being over capacity. To meet its rapidly growing health needs in urban areas, China should consider improving urban ED capacity and training more Emergency Medicine specialists capable of efficiently staffing its crowded EDs. Copyright © 2013 Elsevier Inc. All rights reserved.

Informing Intervention Strategies to Reduce Energy Drink Consumption in Young People: Findings From Qualitative Research.

PubMed

Francis, Jacinta; Martin, Karen; Costa, Beth; Christian, Hayley; Kaur, Simmi; Harray, Amelia; Barblett, Ann; Oddy, Wendy Hazel; Ambrosini, Gina; Allen, Karina; Trapp, Gina

2017-10-01

To determine young people's knowledge of energy drinks (EDs), factors influencing ED consumption, and intervention strategies to decrease ED consumption in young people. Eight group interviews with young people (aged 12-25 years). Community groups and secondary schools in Perth, Western Australia. Forty-one young people, 41% of whom were male and 73% of whom consumed EDs. Factors influencing ED consumption and intervention strategies informed by young people to reduce ED consumption. Two researchers conducted a qualitative content analysis on the data using NVivo software. Facilitators of ED consumption included enhanced energy, pleasant taste, low cost, peer pressure, easy availability, and ED promotions. Barriers included negative health effects, unpleasant taste, high cost, and parents' disapproval. Strategies to reduce ED consumption included ED restrictions, changing ED packaging, increasing ED prices, reducing visibility in retail outlets, and research and education. Because many countries allow the sale of EDs to people aged <18 years, identifying ways to minimize potential harm from EDs is critical. This study provided unique insights into intervention strategies suggested by young people to reduce ED consumption. In addition to more research and education, these strategies included policy changes targeting ED sales, packaging, price, and visibility. Future research might examine the feasibility of implementing such interventions. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Adolescent energy drink consumption: An Australian perspective.

PubMed

Costa, Beth M; Hayley, Alexa; Miller, Peter

2016-10-01

Caffeinated Energy Drinks (EDs) are not recommended for consumption by children, yet there is a lack of age-specific recommendations and restrictions on the marketing and sale of EDs. EDs are increasingly popular among adolescents despite growing evidence of their negative health effects. In the current study we examined ED consumption patterns among 399 Australian adolescents aged 12-18 years. Participants completed a self-report survey of consumption patterns, physiological symptoms, and awareness of current ED consumption guidelines. Results indicated that ED consumption was common among the sample; 56% reported lifetime ED consumption, with initial consumption at mean age 10 (SD = 2.97). Twenty-eight percent of the sample consumed EDs at least monthly, 36% had exceeded the recommended two standard EDs/day, and 56% of consumers had experienced negative physiological health effects following ED consumption. The maximum number of EDs/day considered appropriate for children, adolescents, and adults varied, indicating a lack of awareness of current consumption recommendations. These findings add to the growing body of international evidence of adolescent ED consumption, and the detrimental impact of EDs to adolescent health. Enforced regulation and restriction of EDs for children's and adolescents' consumption is urgently needed in addition to greater visibility of ED consumption recommendations. Copyright © 2016 Elsevier Ltd. All rights reserved.

Emergency department characteristics and capabilities in Bogotá, Colombia.

PubMed

Bustos, Yury; Castro, Jenny; Wen, Leana S; Sullivan, Ashley F; Chen, Dinah K; Camargo, Carlos A

2015-12-01

Emergency departments (EDs) are a critical, yet heterogeneous, part of international emergency care. The National ED Inventories (NEDI) survey has been used in multiple countries as a standardized method to benchmark ED characteristics. We sought to describe the characteristics, resources, capabilities, and capacity of EDs in the densely populated capital city of Bogotá, Colombia. Bogotá EDs accessible to the general public 24/7 were surveyed using the 23-item NEDI survey used in several other countries ( www.emnet-nedi.org ). ED staff were asked about ED characteristics with reference to calendar year 2011. Seventy EDs participated (82 % response). Most EDs (87 %) were located in hospitals, and 83 % were independent hospital departments. The median annual ED visit volume was approximately 50,000 visits. Approximately 90 % (95 % confidence interval (CI) 80-96 %) had a contiguous layout, with medical and surgical care provided in one area. Almost all EDs saw both adults and children (91 %), while 6 % saw only adults and 3 % saw only children. Availability of technological and consultant resources in EDs was variable. Nearly every ED had cardiac monitoring (99 %, 95 % CI 92-100 %), but less than half had a dedicated CT scanner (39 %, 95 % CI 28-52 %). While most EDs were able to treat trauma 24/7 (81 %, 95 % CI 69-89 %), few could manage oncological (22 %, 95 % CI 13-34 %) or dental (3 %, 95 % CI 0-11 %) emergencies 24/7. The typical ED length-of-stay was between 1 and 6 h in 59 % of EDs (95 % CI, 46-70 %), while most others reported that patients remained for >6 h (39 %). Almost half of respondents (46 %, 95 % CI 34-59 %) reported their ED was over capacity. Bogotá EDs have high annual visit volumes and long length-of-stay, and half are over capacity. To meet the emergency care needs of people in Bogotá and other large cities, Colombia should consider improving urban ED capacity and training more emergency medicine specialists capable of efficiently staffing its large and crowded EDs.

Effects of Using a Neuroeducational Intervention to Enhance Perseverance for Online EdD and EdS Students

ERIC Educational Resources Information Center

Cadle, Charles R.

2013-01-01

Developing and maintaining a "completion mindset" is a necessary mental condition for online educational doctorate (EdD) and educational specialist (EdS) students to obtain their advanced degrees. The purpose of this research study was to examine the effect of a neuroeducational intervention on a volunteer convenience sample of EdD and…

Increased risk of osteoporosis in patients with erectile dysfunction

PubMed Central

Wu, Chieh-Hsin; Lu, Ying-Yi; Chai, Chee-Yin; Su, Yu-Feng; Tsai, Tai-Hsin; Tsai, Feng-Ji; Lin, Chih-Lung

2016-01-01

Abstract In this study, we aimed to investigate the risk of osteoporosis in patients with erectile dysfunction (ED) by analyzing data from the Taiwan National Health Insurance Research Database (NHIRD). From the Taiwan NHIRD, we analyzed data on 4460 patients aged ≥40 years diagnosed with ED between 1996 and 2010. In total, 17,480 age-matched patients without ED in a 1:4 ratio were randomly selected as the non-ED group. The relationship between ED and the risk of osteoporosis was estimated using Cox proportional hazard regression models. During the follow-up period, 264 patients with ED (5.92%) and 651 patients without ED (3.65%) developed osteoporosis. The overall incidence of osteoporosis was 3.04-fold higher in the ED group than in the non-ED group (9.74 vs 2.47 per 1000 person-years) after controlling for covariates. Compared with patients without ED, patients with psychogenic and organic ED were 3.19- and 3.03-fold more likely to develop osteoporosis. Our results indicate that patients with a history of ED, particularly younger men, had a high risk of osteoporosis. Patients with ED should be examined for bone mineral density, and men with osteoporosis should be evaluated for ED. PMID:27368024

A Randomized Controlled Trial of a Citywide Emergency Department Care Coordination Program to Reduce Prescription Opioid Related ED Visits

PubMed Central

Paulozzi, Leonard J.; Howell, Donelle; McPherson, Sterling; Murphy, Sean M.; Grohs, Becky; Marsh, Linda; Lederhos, Crystal; Roll, Jon

2017-01-01

Background Increasing prescription overdose deaths have demonstrated the need for safer ED prescribing practices for patients who are frequent ED users. Objectives We hypothesized that the care of frequent ED users would improve using a citywide care coordination program combined with an ED care coordination information system, as measured by fewer ED visits by and decreased controlled substance prescribing to these patients. Methods We conducted a multi-site randomized controlled trial (RCT) across all EDs in a metropolitan area. 165 patients with the most ED visits for complaints of pain were randomized. For the treatment arm, drivers of ED use were identified by medical record review. Patients and their primary care providers were contacted by phone. Each patient was discussed at a community multidisciplinary meeting where recommendations for ED care were formed. The ED care recommendations were stored in an ED information exchange system that faxed them to the treating ED provider when the patient presented to the ED. The control arm was subjected to treatment as usual. Results The intervention arm experienced a 34% decrease (IRR = 0.66, p < 0.001; 95% CI: 0.57 – 0.78) in ED visits and an 80% decrease (OR = 0.21, p = 0.001) in the odds of receiving an opioid prescription from the ED relative to the control group. Declines of 43.7%, 53.1%, 52.9%, and 53.1% were observed in the treatment group for morphine milligram equivalents, controlled substance pills, prescriptions, and prescribers. Conclusion This RCT showed the effectiveness of a citywide ED care coordination program in reducing ED visits and controlled substance prescribing. PMID:27624507

State Regulation Of Freestanding Emergency Departments Varies Widely, Affecting Location, Growth, And Services Provided.

PubMed

Gutierrez, Catherine; Lindor, Rachel A; Baker, Olesya; Cutler, David; Schuur, Jeremiah D

2016-10-01

Freestanding emergency departments (EDs), which offer emergency medical care at sites separate from hospitals, are a rapidly growing alternative to traditional hospital-based EDs. We evaluated state regulations of freestanding EDs and describe their effect on the EDs' location, staffing, and services. As of December 2015, thirty-two states collectively had 400 freestanding EDs. Twenty-one states had regulations that allowed freestanding EDs, and twenty-nine states did not have regulations that applied specifically to such EDs (one state had hospital regulations that precluded them). State policies regarding freestanding EDs varied widely, with no standard requirements for location, staffing patterns, or clinical capabilities. States requiring freestanding EDs to have a certificate of need had fewer of such EDs per capita than states without such a requirement. For patients to better understand the capabilities and costs of freestanding EDs and to be able to choose the most appropriate site of emergency care, consistent state regulation of freestanding EDs is needed. Project HOPE—The People-to-People Health Foundation, Inc.

Executive dysfunction post-stroke: an insight into the perspectives of physiotherapists.

PubMed

Hayes, Sara; Donnellan, Claire; Stokes, Emma

2015-01-01

To gain an understanding of physiotherapy practice in relation to executive dysfunction (ED) post-stroke. Three focus groups were conducted using semi-structured interview schedules to highlight how ED post-stroke was understood by 12 physiotherapists with greater than 1 year of experience working in the area of stroke care. The focus group data were analysed using qualitative data analysis. The themes extracted from the data on physiotherapists' self-reported knowledge of ED post-stroke were: physiotherapists' lack of knowledge of ED post-stroke; current physiotherapy practice regarding ED post-stroke; the negative impact of ED on physiotherapy rehabilitation post-stroke and the future learning needs of physiotherapists regarding ED post-stroke. Current results demonstrate that ED has negative implications for physiotherapy rehabilitation post-stroke. Although further interdisciplinary research is warranted, the present results suggest that physiotherapists should be aware of the presence of ED in people post-stroke and develop strategies to minimise the impact of ED on physiotherapy rehabilitation. Implications for Rehabilitation Physiotherapists report a lack of knowledge of ED post-stroke and a requirement for future learning and training regarding the optimal management of people with ED undergoing physiotherapy rehabilitation post-stroke. ED has negative implications for physiotherapy rehabilitation post-stroke and physiotherapists should be aware of the presence of ED in people post-stroke and develop strategies to minimise the impact of ED on physiotherapy rehabilitation.

Association between reported screening and counseling about energy drinks and energy drink intake among U.S. adolescents.

PubMed

Kumar, Gayathri Suresh; Park, Sohyun; Onufrak, Stephen

2014-02-01

Possible adverse health consequences of excessive energy drink (ED) consumption have led to recommendations by the American Academy of Pediatrics discouraging ED intake by youth. However, limited information on ED counseling by health care providers exists. Data was obtained from the 2011 YouthStyles Survey administered to youth aged 12-17 (n=815). The outcome variable was ED consumption (none vs. ≥1 time/week) and exposure variables were screening and counseling about ED (if doctor/nurse asked about ED consumption and if doctor/nurse recommended against ED consumption). Approximately 8.5% of youth consumed energy drinks weekly, 11.5% reported being asked by their doctor/nurse about frequency of ED consumption, and 11.1% were advised by their doctor/nurse against ED intake. Multivariable logistic regression analysis revealed that the odds for drinking ED ≥1 time/week was significantly higher in youth who were asked how often they drank ED by their doctor/nurse (odds ratio=2.46) vs. those who were not asked. About 1 in 9 youth reported receiving counseling discouraging ED consumption from their doctor/nurse, and a greater proportion of youth who were screened about ED also reported ED consumption. Efforts by health care providers to educate youth about potential harms of consuming ED are needed. Published by Elsevier Ireland Ltd.

A Randomized Controlled Trial of a Citywide Emergency Department Care Coordination Program to Reduce Prescription Opioid Related Emergency Department Visits.

PubMed

Neven, Darin; Paulozzi, Leonard; Howell, Donelle; McPherson, Sterling; Murphy, Sean M; Grohs, Becky; Marsh, Linda; Lederhos, Crystal; Roll, John

2016-11-01

Increasing prescription overdose deaths have demonstrated the need for safer emergency department (ED) prescribing practices for patients who are frequent ED users. We hypothesized that the care of frequent ED users would improve using a citywide care coordination program combined with an ED care coordination information system, as measured by fewer ED visits by and decreased controlled substance prescribing to these patients. We conducted a multisite randomized controlled trial (RCT) across all EDs in a metropolitan area; 165 patients with the most ED visits for complaints of pain were randomized. For the treatment arm, drivers of ED use were identified by medical record review. Patients and their primary care providers were contacted by phone. Each patient was discussed at a community multidisciplinary meeting where recommendations for ED care were formed. The ED care recommendations were stored in an ED information exchange system that faxed them to the treating ED provider when the patient presented to the ED. The control arm was subjected to treatment as usual. The intervention arm experienced a 34% decrease (incident rate ratios = 0.66, p < 0.001; 95% confidence interval 0.57-0.78) in ED visits and an 80% decrease (odds ratio = 0.21, p = 0.001) in the odds of receiving an opioid prescription from the ED relative to the control group. Declines of 43.7%, 53.1%, 52.9%, and 53.1% were observed in the treatment group for morphine milligram equivalents, controlled substance pills, prescriptions, and prescribers, respectively. This RCT showed the effectiveness of a citywide ED care coordination program in reducing ED visits and controlled substance prescribing. Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.

Molecular cloning and characterization of enhanced disease susceptibility 1 (EDS1) from Gossypium barbadense.

PubMed

Su, Xiaofeng; Qi, Xiliang; Cheng, Hongmei

2014-06-01

Arabidopsis enhanced disease susceptibility 1 (EDS1) plays an important role in plant defense against biotrophic and necrotrophic pathogens. The necrotrophic pathogen Verticillium dahliae infection of Gossypium barbadense could lead to Verticillium wilt which seriously reduces the cotton production. Here, we cloned and characterized a G. barbadense homolog of EDS1, designated as GbEDS1. The full-length cDNA of the GbEDS1 gene was obtained by the technique of rapid-amplification of cDNA ends. The open reading frame of the GbEDS1 gene was 1,647 bp long and encoded a protein of 548 amino acids residues. Comparison of the cDNA and genomic DNA sequence of GbEDS1 indicated that this gene contained a single intron and two exons. Like other EDS1s, GbEDS1 contained a conserved N-terminal lipase domain and an EDS1-specific KNEDT motif. Subcellular localization assay revealed that GbEDS1-green fluorescence protein fusion protein was localized in both cytosol and nucleus. Interestingly, the transcript levels of GbEDS1 were dramatically increased in response to pathogen V. dahliae infection. To investigate the role of GbEDS1 in plant resistance against V. dahliae, a conserved fragment derived from GbEDS1 was used to knockdown the endogenous EDS1 in Nicotiana benthamiana by heterologous virus-induced gene silencing. Our data showed that silencing of NbEDS1 resulted in increased susceptibility to V. dahliae infection in N. benthamiana, suggesting a possible involvement of the novelly isolated GbEDS1 in the regulation of plant defense against V. dahliae.

The financial consequences of lost demand and reducing boarding in hospital emergency departments.

PubMed

Pines, Jesse M; Batt, Robert J; Hilton, Joshua A; Terwiesch, Christian

2011-10-01

Some have suggested that emergency department (ED) boarding is prevalent because it maximizes revenue as hospitals prioritize non-ED admissions, which reimburse higher than ED admissions. We explore the revenue implications to the overall hospital of reducing boarding in the ED. We quantified the revenue effect of reducing boarding-the balance of higher ED demand and the reduction of non-ED admissions-using financial modeling informed by regression analysis and discrete-event simulation with data from 1 inner-city teaching hospital during 2 years (118,000 ED visits, 22% ED admission rate, 7% left without being seen rate, 36,000 non-ED admissions). Various inpatient bed management policies for reducing non-ED admissions were tested. Non-ED admissions generated more revenue than ED admissions ($4,118 versus $2,268 per inpatient day). A 1-hour reduction in ED boarding time would result in $9,693 to $13,298 of additional daily revenue from capturing left without being seen and diverted ambulance patients. To accommodate this demand, we found that simulated management policies in which non-ED admissions are reduced without consideration to hospital capacity (ie, static policies) mostly did not result in higher revenue. Many dynamic policies requiring cancellation of various proportions of non-ED admissions when the hospital reaches specific trigger points increased revenue. The optimal strategies tested resulted in an estimated $2.7 million and $3.6 in net revenue per year, depending on whether left without being seen patients were assumed to be outpatients or mirrored ambulatory admission rates, respectively. Dynamic inpatient bed management in inner-city teaching hospitals in which non-ED admissions are occasionally reduced to ensure that EDs have reduced boarding times is a financially attractive strategy. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Evidence of mixed valence states in U M2Al 3 ( M = Ni, Pd) studied by X-ray photoemission spectroscopy

NASA Astrophysics Data System (ADS)

Fujimori, Shin-ichi; Saito, Yasuharu; Sato, Noriaki; Komatsubara, Takemi; Suzuki, Shoji; Sato, Shigeru; Ishii, Takehiko

1998-01-01

We have measured the XPS valence band and core-level spectra of U M2Al 3 ( M = Ni and Pd). The results are compared with those of reference materials, dilute alloy U 0.1La 0.9Pd 2Al 3 and itinerant 5 f compound URh 3. The similarity of the core-level spectra between UPd 2Al 3 and U 0.1La 0.9Pd 2Al 3 suggests that their core-level spectra are governed by the interaction between U 5 f and ligand states of neighboring palladium and aluminum sites, with negligible contributions from neighboring uranium states. A complex satellite structure, observed in the core-level spectra of U M2Al 3, suggests that the uranium atoms are in the strong mixed valence states with 5 f2(U 4+) and 5 f3(U 3+).

Determination of low levels of cadmium ions by the under potential deposition on a self-assembled monolayer on gold electrode.

PubMed

Noyhouzer, Tomer; Mandler, Daniel

2011-01-17

The electrochemical determination of low levels of Cd using a self-assembled monolayer (SAM) modified Au electrode is reported. Determination was based on the stripping of Cd, which was deposited by under potential deposition (UPD). A series of short alkanethiol SAMs bearing different end groups, i.e., sulfonate, carboxylate and ammonium, were examined. Lowest level of detection (ca. 50 ngL(-1)) was achieved with a 3-mercaptopropionic acid (MPA) monolayer using subtractive anodic square wave voltammetry (SASV). Additional surface methods, namely, reductive desorption and X-ray photoelectron spectroscopy, were applied to determine the interfacial structure of the electrodeposited Cd on the modified electrodes. We conclude that the deposited Cd forms a monoatomic layer, which bridges between the gold surface and the alkanethiol monolayer associating with both the gold and the sulfur atoms. Copyright © 2010 Elsevier B.V. All rights reserved.

Comparison of associated features and drug treatment between co-occurring unipolar and bipolar disorders in depressed eating disorder patients.

PubMed

Tseng, Mei-Chih Meg; Chang, Chin-Hao; Liao, Shih-Cheng; Chen, Hsi-Chung

2017-02-27

To examine the differences of associated characteristics and prescription drug use between co-occurring unipolar and bipolar disorders in patients with eating disorders (EDs). Patients with EDs and major depressive episode (MDE) were recruited from psychiatric outpatient clinics. They were interviewed and completed self-administered measures assessing eating and general psychopathology. The prescribed drugs at the index outpatient visit were recorded. Clinical characteristics and prescription drugs of groups with major depressive disorder (ED-MDD), MDE with lifetime mania (ED-BP I), and MDE with lifetime hypomania (ED-BP II) were compared. Continuous variables between groups were compared using generalized linear regression with adjustments of age, gender, and ED subtype for pair-wise comparisons. Multivariate logistic regression with adjustments of age, gender, and ED subtype was employed to estimate adjusted odds ratios with 95% confidence intervals between groups. Two hundred and twenty-seven patients with EDs had a current MDE. Among them, 17.2% and 24.2% experienced associated manic and hypomanic episodes, respectively. Bipolar I and II patients displayed significantly poorer weight regulation, more severe impulsivity and emotional lability, and higher rates of co-occurring alcohol use disorders than ED-MDD patients. ED-BP I patients were found to have the lowest IQ, poorest working memory, and the most severe depression, suicidality and functional impairment among all patients. Patients with ED-BP II shared affect and behavioral dysregulations with ED-BP I, but had less severe degrees of cognitive and functional impairments than ED-BP I. Patients with ED-BP I were significantly less likely than those in the ED-MDD and ED-BP II groups to be on antidepressant monotherapy, but a great rate (27%) of ED-BP I individuals taking antidepressant monotherapy had potential risk of mood switch during the course of treatment. Our study identified discriminative features of bipolar I and II disorders from MDD among a group of depressed ED patients. We suggest that the associated mania, hypomania, and mood lability are predictors of clinical severity and should be identified from ED patients presented with depressive features. Accurate diagnosis of bipolar disorders may have implications for pharmacotherapy in patients with EDs.

Effects of emergency department expansion on emergency department patient flow.

PubMed

Mumma, Bryn E; McCue, James Y; Li, Chin-Shang; Holmes, James F

2014-05-01

Emergency department (ED) crowding is an increasing problem associated with adverse patient outcomes. ED expansion is one method advocated to reduce ED crowding. The objective of this analysis was to determine the effect of ED expansion on measures of ED crowding. This was a retrospective study using administrative data from two 11-month periods before and after the expansion of an ED from 33 to 53 adult beds in an academic medical center. ED volume, staffing, and hospital admission and occupancy data were obtained either from the electronic health record (EHR) or from administrative records. The primary outcome was the rate of patients who left without being treated (LWBT), and the secondary outcome was total ED boarding time for admitted patients. A multivariable robust linear regression model was used to determine whether ED expansion was associated with the outcome measures. The mean (±SD) daily adult volume was 128 (±14) patients before expansion and 145 (±17) patients after. The percentage of patients who LWBT was unchanged: 9.0% before expansion versus 8.3% after expansion (difference = 0.6%, 95% confidence interval [CI] = -0.16% to 1.4%). Total ED boarding time increased from 160 to 180 hours/day (difference = 20 hours, 95% CI = 8 to 32 hours). After daily ED volume, low-acuity area volume, daily wait time, daily boarding hours, and nurse staffing were adjusted for, the percentage of patients who LWBT was not independently associated with ED expansion (p = 0.053). After ED admissions, ED intensive care unit (ICU) admissions, elective surgical admissions, hospital occupancy rate, ICU occupancy rate, and number of operational ICU beds were adjusted for, the increase in ED boarding hours was independently associated with the ED expansion (p = 0.005). An increase in ED bed capacity was associated with no significant change in the percentage of patients who LWBT, but had an unintended consequence of an increase in ED boarding hours. ED expansion alone does not appear to be an adequate solution to ED crowding. © 2014 by the Society for Academic Emergency Medicine.

The role of charity care and primary care physician assignment on ED use in homeless patients.

PubMed

Wang, Hao; Nejtek, Vicki A; Zieger, Dawn; Robinson, Richard D; Schrader, Chet D; Phariss, Chase; Ku, Jocelyn; Zenarosa, Nestor R

2015-08-01

Homeless patients are a vulnerable population with a higher incidence of using the emergency department (ED) for noncrisis care. Multiple charity programs target their outreach toward improving the health of homeless patients, but few data are available on the effectiveness of reducing ED recidivism. The aim of this study is to determine whether inappropriate ED use for nonemergency care may be reduced by providing charity insurance and assigning homeless patients to a primary care physician (PCP) in an outpatient clinic setting. A retrospective medical records review of homeless patients presenting to the ED and receiving treatment between July 2013 and June 2014 was completed. Appropriate vs inappropriate use of the ED was determined using the New York University ED Algorithm. The association between patients with charity care coverage, PCP assignment status, and appropriate vs inappropriate ED use was analyzed and compared. Following New York University ED Algorithm standards, 76% of all ED visits were deemed inappropriate with approximately 77% of homeless patients receiving charity care and 74% of patients with no insurance seeking noncrisis health care in the ED (P=.112). About 50% of inappropriate ED visits and 43.84% of appropriate ED visits occurred in patients with a PCP assignment (P=.019). Both charity care homeless patients and those without insurance coverage tend to use the ED for noncrisis care resulting in high rates of inappropriate ED use. Simply providing charity care and/or PCP assignment does not seem to sufficiently reduce inappropriate ED use in homeless patients. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

A profile of acute care in an aging America: snowball sample identification and characterization of United States geriatric emergency departments in 2013.

PubMed

Hogan, Teresita M; Olade, Tolulope Oyeyemi; Carpenter, Christopher R

2014-03-01

The aging of America poses a challenge to emergency departments (EDs). Studies show that elderly patients have poor outcomes despite increased testing, prolonged periods of observation, and higher admission rates. In response, emergency medicine (EM) leaders have implemented strategies for improved ED elder care, enhancing expertise, equipment, policies, and protocols. One example is the development of geriatric EDs gaining in popularity nationwide. To the authors' knowledge, this is the first research to systematically identify and qualitatively characterize the existence, locations, and features of geriatric EDs across the United States. The primary objective was to determine the number, distribution, and characteristics of geriatric EDs in the United States in 2013. This was a survey with potential respondents identified via a snowball sampling of known geriatric EDs, EM professional organizations' geriatric interest groups, and a structured search of the Internet using multiple search engines. Sites were contacted by telephone, and those confirming geriatric EDs presence received the survey via e-mail. Category questions included date of opening, location, volumes, staffing, physical plant changes, screening tools, policies, and protocols. Categories were reported based on general interest to those seeking to understand components of a geriatric ED. Thirty-six hospitals confirmed geriatric ED existence and received surveys. Thirty (83%) responded to the survey and confirmed presence or plans for geriatric EDs: 24 (80%) had existing geriatric EDs, and six (20%) were planning to open geriatric EDs by 2014. The majority of geriatric EDs are located in the Midwest (46%) and Northeast (30%) regions of the United States. Eighty percent serve from 5,000 to 20,000 elder patients annually. Seventy percent of geriatric EDs are attached to the main ED, and 66% have from one to 10 geriatric beds. Physical plant changes include modifications to beds (96%), lighting (90%), flooring (83%), visual aids (73%), and sound level (70%). Seventy-seven percent have staff overlapping with the nongeriatric portion of their ED, and 80% require geriatric staff didactics. Sixty-seven percent of geriatric EDs report discharge planning for geriatric ED patients, and 90% of geriatric EDs had direct follow-up through patient callbacks. The snowball sample identification of U.S. geriatric EDs resulted in 30 confirmed respondents. There is significant variation in the components constituting a geriatric ED. The United States should consider external validation of self-identified geriatric EDs to standardize the quality and type of care patients can expect from an institution with an identified geriatric ED. © 2014 by the Society for Academic Emergency Medicine.

The unsafe haven: Eating disorders as attachment relationships.

PubMed

Forsén Mantilla, Emma; Clinton, David; Birgegård, Andreas

2018-05-21

Some patients with eating disorders (EDs) seem to experience their illness as an entity, a symbolic other to whom they relate, and which may influence both symptom levels and self-image. Extending previous research, this study investigated whether the patient-ED relationship has attachment qualities. Structural Analysis of Social Behaviour was used to operationalize the patient-ED relationship, and the Attachment Style Questionnaire was used to measure attachment. We examined ED patients' (N = 148) relationship with their ED, attachment behaviour, symptoms, and self-image. Attachment dimensions of Confidence, Anxious/ambivalence, and Avoidance were found to be significantly correlated with aspects of the patient-ED relationship. Introjection (i.e., whether ED actions were incorporated into patients' self-image) was investigated by examining the match between self-image profiles and the actions of patients' EDs. A double mediation model was tested in which ED control/emancipation and patients' Self-blame mediated the effect of attachment security on ED symptoms. Attachment insecurity was associated with greater ED control and patient submission. In 28.5% of patients, there was a high degree of correlation between self-image and ED action profile. Data supported the mediation model. Attachment processes appear to be associated with the manner in which ED patients relate to their disorder, at least in some cases. Attempts to maintain psychological proximity to the ED as an introjected attachment figure may help to explain treatment resistance and ambivalence about change. This perspective may be useful in treatment. Attachment behaviours are associated with the patient-ED relationship, in which attachment insecurity is correlated with greater eating disorder control and patient submission. Some patients seem to incorporate the actions of the ED in their self-image, suggesting the presence of introjection. The patient-ED relationship may help explain patients' anxiety and ambivalence about change, seen from an attachment perspective. In treatment, it may be important to explore alternative safe havens and secure bases to the ED, such as interpersonal relationships and activities. © 2018 The British Psychological Society.

How do ED patients with criminal justice contact compare with other ED users? A retrospective analysis of ED visits in California.

PubMed

McConville, Shannon; Mooney, Alyssa C; Williams, Brie A; Hsia, Renee Y

2018-06-21

To assess the patterns of emergency department (ED) utilisation among those with and without criminal justice contact in California in 2014, comparing variation in ED use, visit frequency, diagnoses and insurance coverage. Retrospective, cross-sectional study. Analyses included ED visits to all licensed hospitals in California using statewide data on all ED encounters in 2014. Study participants included 3 757 870 non-elderly adult ED patients who made at least one ED visit in 2014. We assessed the patterns and characteristics of ED visits among those with criminal justice contact-patients who were either admitted to or discharged from the ED by a correctional institution-with patients who did not have criminal justice contact recorded during an ED visit. ED patients with criminal justice contact had higher proportions of frequent ED users (27.2% vs 9.4%), were at higher risk of an ED visit resulting in hospitalisation (26.6% vs 15.2%) and had higher prevalence of mental health conditions (52.8% vs 30.4%) compared with patients with no criminal justice contact recorded during an ED visit. Of the top 10, four primary diagnoses among patients with criminal justice contact were related to behavioural health conditions, accounting for 19.0% of all primary diagnoses in this population. In contrast, behavioural health conditions were absent from the top 10 primary diagnoses in ED patients with no observed criminal justice contact. Despite a high burden of disease, a lack of health insurance coverage was more common among those with criminal justice contact than those without (41.3% vs 14.1%). Given that a large proportion of ED patients with criminal justice contact are frequent users with considerable mental health conditions, current efforts in California's Medicaid programme to identify individuals in need of coordinated services could reduce costly ED utilisation among this group. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Frequent Users of Hospital Emergency Departments in Korea Characterized by Claims Data from the National Health Insurance: A Cross Sectional Study

PubMed Central

Woo, Jung Hoon; Grinspan, Zachary; Shapiro, Jason; Rhee, Sang Youl

2016-01-01

The Korean National Health Insurance, which provides universal coverage for the entire Korean population, is now facing financial instability. Frequent emergency department (ED) users may represent a medically vulnerable population who could benefit from interventions that both improve care and lower costs. To understand the nature of frequent ED users in Korea, we analyzed claims data from a population-based national representative sample. We performed both bivariate and multivariable analyses to investigate the association between patient characteristics and frequent ED use (4+ ED visits in a year) using claims data of a 1% random sample of the Korean population, collected in 2009. Among 156,246 total ED users, 4,835 (3.1%) were frequent ED users. These patients accounted for 14% of 209,326 total ED visits and 17.2% of $76,253,784 total medical expenses generated from all ED visits in the 1% data sample. Frequent ED users tended to be older, male, and of lower socio-economic status compared with occasional ED users (p < 0.001 for each). Moreover, frequent ED users had longer stays in the hospital when admitted, higher probability of undergoing an operative procedure, and increased mortality. Among 8,425 primary diagnoses, alcohol-related complaints and schizophrenia showed the strongest positive correlation with the number of ED visits. Among the frequent ED users, mortality and annual outpatient department visits were significantly lower in the alcohol-related patient subgroup compared with other frequent ED users; furthermore, the rate was even lower than that for non-frequent ED users. Our findings suggest that expanding mental health and alcohol treatment programs may be a reasonable strategy to decrease the dependence of these patients on the ED. PMID:26809051

Combined use of alcohol and energy drinks: Dose relationship with self-reported physiological stimulation and sedation side effects.

PubMed

Droste, Nicolas; Peacock, Amy; Bruno, Raimondo; Pennay, Amy; Zinkiewicz, Lucy; Lubman, Dan I; Miller, Peter

2017-08-01

Negative physiological stimulation and sedation side effects are experienced by a significant proportion of consumers who consume alcohol mixed with energy drinks (AmED). Few studies have compared the frequency of side effects between sessions of AmED and sessions of alcohol only within-subject, and none have explored a dose relationship. Explore the occurrence of self-reported physiological stimulant and sedative side effects between sessions of AmED and alcohol only, and at varying ED dosage levels within AmED sessions. A convenience sample of 2953 residents of New South Wales, Australia completed an online survey. N=731 AmED users reported daily caffeine intake, typical alcohol and AmED consumption, and past 12-month experience of physiological stimulation and sedation side effects during AmED and alcohol only sessions. Within-subject analyses compared occurrence of side effects between session types. Hierarchical binary logistic regression analyses explored the association of ED dose during AmED sessions with the experience of physiological side effects. There were greater odds of most stimulant side effects, and lower odds of sedation side effects, during AmED sessions compared to alcohol only sessions. Compared to one ED, consumption of three or more EDs was significantly associated with the majority of both stimulant and alcohol intoxication side effects after controlling for demographics and consumption covariates. AmED is associated with perceived changes in physiological stimulant and sedation side effects of alcohol. Experience of side effects is positively associated with ED dosage. Future research should account for varying ED dosage, and reflect real world consumption levels. Copyright © 2017 Elsevier Ltd. All rights reserved.

Can Eosinophil Count, Platelet Count, and Mean Platelet Volume Be a Positive Predictive Factor in Penile Arteriogenic Erectile Dysfunction Etiopathogenesis?

PubMed Central

Sönmez, Mehmet Giray; Göğer, Yunus Emre; Sönmez, Leyla Öztürk; Aydın, Arif; Balasar, Mehmet; Kara, Cengiz

2016-01-01

Blood count parameters of patients referring with erectile dysfunction (ED) were examined in this study and it was investigated whether eosinophil count (EC), platelet count (PC), and mean platelet volume values among the suspected predictive parameters which may play a role in especially penile arteriogenic ED etiopathogenesis had a contribution on pathogenesis. Patients referring with ED complaint were evaluated. Depending on the medical story, ED degree was determined by measuring International Index of Erectile Function. Penile Doppler ultrasonography was taken in patients suspected to have vasculogenic ED. According to penile Doppler ultrasonography result, patients with arterial deficiency were included in the penile arteriogenic ED group and the patients with normal results were included in the nonvasculogenic ED group. A total of 36 patients participated in the study from the penile arteriogenic ED group and 32 patients from the nonvasculogenic ED group. Compared with the nonvasculogenic ED group, the penile arteriogenic ED group’s low International Index of Erectile Function score, high EC, mean platelet volume and PC values were detected to be statistically significant (p < .001, p = .021, p = .018, p = .034, respectively). No statistically significant difference was observed among the two groups when age, white blood cells, red blood cells, and hemoglobin values were considered. Pansystolic volume velocities were detected as statistically significantly low compared with the nonvasculogenic ED group in the measurements made in 5th, 10th, 15th, and 20th minutes on the right and left sides in the penile arteriogenic ED group. High MPV value and PC is a significant predictive factor for penile arteriogenic ED and vasculogenic ED and high EC is specifically predictive of arteriogenic ED. PMID:27895254

Energy Drink and Alcohol mixed Energy Drink use among high school adolescents: Association with risk taking behavior, social characteristics.

PubMed

Scalese, Marco; Denoth, Francesca; Siciliano, Valeria; Bastiani, Luca; Cotichini, Rodolfo; Cutilli, Arianna; Molinaro, Sabrina

2017-09-01

The aims of the study were to: a) examine the prevalence of energy drink (ED) and alcohol mixed with energy drink (AmED) consumption; b) investigate the relationships between ED and AmED with alcohol, binge drinking and drugs accounting for at risk behaviors among a representative sample of Italian adolescents. A representative sample of 30,588 Italian high school students, aged 15-19years, was studied. Binary and multivariate logistic regression analyses were performed to determine the independent association of the potential predictors' characteristics with the ED and AmED drinking during the last year. Respectively 41.4% and 23.2% of respondents reported drinking EDs and AmEDs in the last year. Multivariate analysis revealed that consumption of EDs and AmEDs during the last year were significantly associated with daily smoking, binge drinking, use of cannabis and other psychotropic drugs. Among life habits and risky behaviors the following were positively associated: going out with friends for fun, participating in sports, experiencing physical fights/accidents or injury, engaging in sexual intercourse without protection and being involved in accidents while driving. This study demonstrates the popularity of ED and AmED consumption among the Italian school population aged 15-19years old: 4 out of 10 students consumed EDs in the last year and 2 out of 10 AmED. Multivariate analysis highlighted the association with illicit drug consumption and harming behaviors, confirming that consumption of EDs and AmEDs is a compelling issue especially during adolescence, as it can effect health as well as risk taking behaviors. Copyright © 2017 Elsevier Ltd. All rights reserved.

Pathological motivations for exercise and eating disorder specific health-related quality of life.

PubMed

Cook, Brian; Engel, Scott; Crosby, Ross; Hausenblas, Heather; Wonderlich, Stephen; Mitchell, James

2014-04-01

To examine associations among pathological motivations for exercise with eating disorder (ED) specific health-related quality of life (HRQOL). Survey data assessing ED severity (i.e., Eating Disorder Diagnostic Survey), ED specific HRQOL (i.e., Eating Disorders Quality of Life Instrument), and pathological motivations for exercise (i.e., Exercise Dependence Scale) were collected from female students (N = 387) at seven universities throughout the United States. Regression analyses were conducted to examine the associations among exercise dependence, ED-specific HRQOL and ED severity, and the interaction of exercise dependence and ED severity on HRQOL scores. The overall model examining the impact of ED severity and exercise dependence (independent variables) on HRQOL (dependent variable) was significant and explained 16.1% of the variance in HRQOL scores. Additionally, the main effects for ED severity and exercise dependence and the interaction among ED severity and exercise dependence were significant, suggesting that the combined effects of ED severity and exercise dependence significantly impacts HRQOL. Our results suggest that pathological motivations for exercise may exacerbate ED's detrimental impact on HRQOL. Our results offer one possible insight into why exercise may be associated with deleterious effects on ED HRQOL. Future research is needed to elucidate the relationship among psychological aspects of exercise, ED, and HRQOL. Copyright © 2013 Wiley Periodicals, Inc.

Excessive daytime sleepiness in Parkinson disease: a SPECT study.

PubMed

Matsui, Hideaki; Nishinaka, Kazuto; Oda, Masaya; Hara, Narihiro; Komatsu, Kenichi; Kubori, Tamotsu; Udaka, Fukashi

2006-07-01

The underlying pathologic mechanism of excessive daytime sleepiness (EDS) in Parkinson disease and the relative contributions of brain function to this process are poorly understood. We compared brain perfusion images between patients with Parkinson disease and EDS and those without EDS using n-isopropyl-p-1231 iodoamphetamine single photon emission computed tomography. Clinical study. Sumitomo Hospital. Thirteen patients with Parkinson disease with EDS (EDS group) and 27 patients with Parkinson disease without EDS (no-EDS group) were studied. Whether or not each case had EDS was determined according to the response to the Epworth Sleepiness Scale: patients with an Epworth Sleepiness Scale score > or = 10 were included in the EDS group, and patients with an Epworth Sleepiness Scale score < or = 9 were included in the no-EDS group. There were significant hypoperfusions in the left parietal and temporal association cortex in the EDS group. In the multivariable logistic regression model, attention and decreased regional cerebral blood flow of the left parietal association cortex and right caudate and increased regional cerebral blood flow of the right thalamus were the independent and significant factors. The cortical hypofunction relative to hyperfunction of the brain stem may relate to EDS in Parkinson disease. This is the first imaging study about EDS in Parkinson disease, and further studies are required.

Eating disorders and obstetric-gynecologic care.

PubMed

Leddy, Meaghan A; Jones, Candace; Morgan, Maria A; Schulkin, Jay

2009-09-01

Disordered eating can have consequences for gynecologic and obstetric patients and fetuses. Amenorrhea, infertility, hyperemesis gravidarum, and preterm birth have been linked to eating disorders (EDs). This study aimed to evaluate obstetrician-gynecologists' ED-related knowledge, attitudes, and practices. Questionnaires were sent to 968 Fellows of the American College of Obstetricians and Gynecologists between November 2007 and March 2008. Data were analyzed separately for generalists (provide obstetric and gynecologic care) and gynecologists only (treat only gynecologic patients). A majority of obstetrician-gynecologists assess body weight, exercise, body mass index, and dieting habits. Less than half assess ED history, body image concerns, weight-related cosmetic surgery, binging, and purging. Over half (54%) of generalists believed ED assessment falls within their purview. Most (90.8%) generalists agreed or strongly agreed that EDs can negatively impact pregnancy outcome. A majority rated residency training in diagnosing (88.5%) and treating (96.2%) EDs as barely adequate or less. Most knew low birth weight (91%) and postpartum depression (90%) are associated with maternal EDs, though over a third was unsure about several consequences. Some gender differences emerged; females screen for more ED indicators and are more likely to view ED assessment as within their role. Despite the consequences of EDs and the fact that most physicians agree EDs can negatively impact pregnancy, only about half view ED assessment as their responsibility. Only some weight- and diet-related topics are assessed, and there are gaps in knowledge of ED consequences. Obstetrician-gynecologists are not confident in their training regarding EDs. Improvement in knowledge and altering obstetrician-gynecologists' view of their responsibilities may improve ED screening rates.

Analysis of the Consumption of Caffeinated Energy Drinks among Polish Adolescents

PubMed Central

Nowak, Dariusz; Jasionowski, Artur

2015-01-01

Background: Energy drinks (EDs) are extremely popular among adults and adolescents. Regular intake of EDs may lead to an overdose of caffeine, loss of bone mass, overweight, hypertension and, in older age, osteoporosis and cardiovascular diseases. Some people mix EDs with alcohol, which adversely affects their health. The objective of this study was to analyze the consumption of EDs by adolescents. Methods: The study consisted of a questionnaire surveying amounts of drinks, preferences and product awareness among younger consumers. The study was carried out in junior and senior high schools in Poland (n = 2629). Results: EDs were consumed by 67% of students (quite frequently by 16%). Students who practiced sports were more willing to drink EDs. Also, boys drank them more often than girls. When selecting a particular ED, young people looked at the taste, price and effect. Most respondents consumed one ED (250 mL) daily, although there were individuals consuming two or more drinks daily. Most respondents knew the ingredients of EDs, and 24% admitted to mixing EDs with alcohol. Conclusions: EDs are extremely popular among adolescents. Young people drinking EDs every day are potentially at risk of taking an overdose of caffeine. PMID:26184263

Erectile dysfunction might be associated with chronic periodontal disease: two ends of the cardiovascular spectrum.

PubMed

Zadik, Yehuda; Bechor, Ron; Galor, Shay; Justo, Dan; Heruti, Rafi J

2009-04-01

Both chronic periodontal disease (CPD) and erectile dysfunction (ED) are associated with cardiovascular disease and its risk factors, including smoking and diabetes mellitus. However, the association between ED and CPD has never been studied. To study the association between ED and CPD. MAIN OUTCOME MEASURES. Prevalence of ED, prevalence of CPD, ED severity. The study population consisted of 305 men who filled the Sexual Health Inventory for Men (SHIM) questionnaire in order to detect ED and assess its severity, and underwent a pair of standardized posterior dental bitewing radiographs in order to detect CPD. SHIM questionnaire scores 21 or less represented ED. Alveolar bone loss of >or=6 mm represented CPD. The mean age of included men was 39.5 +/- 6.7 years. Overall, 70 (22.9%) men had ED and 13 (4.3%) had CPD. CPD was significantly more prevalent among men with mild ED (P = 0.004) and moderate to severe ED (P = 0.007) in comparison to men without ED. ED might be associated with CPD. These preliminary findings are consistent with theories that associate these conditions with systemic inflammation, endothelial dysfunction, and atherosclerosis.

Analysis of the Consumption of Caffeinated Energy Drinks among Polish Adolescents.

PubMed

Nowak, Dariusz; Jasionowski, Artur

2015-07-10

Energy drinks (EDs) are extremely popular among adults and adolescents. Regular intake of EDs may lead to an overdose of caffeine, loss of bone mass, overweight, hypertension and, in older age, osteoporosis and cardiovascular diseases. Some people mix EDs with alcohol, which adversely affects their health. The objective of this study was to analyze the consumption of EDs by adolescents. The study consisted of a questionnaire surveying amounts of drinks, preferences and product awareness among younger consumers. The study was carried out in junior and senior high schools in Poland (n = 2629). EDs were consumed by 67% of students (quite frequently by 16%). Students who practiced sports were more willing to drink EDs. Also, boys drank them more often than girls. When selecting a particular ED, young people looked at the taste, price and effect. Most respondents consumed one ED (250 mL) daily, although there were individuals consuming two or more drinks daily. Most respondents knew the ingredients of EDs, and 24% admitted to mixing EDs with alcohol. EDs are extremely popular among adolescents. Young people drinking EDs every day are potentially at risk of taking an overdose of caffeine.

Energy Density, Energy Intake, and Body Weight Regulation in Adults12345

PubMed Central

Karl, J. Philip; Roberts, Susan B.

2014-01-01

The role of dietary energy density (ED) in the regulation of energy intake (EI) is controversial. Methodologically, there is also debate about whether beverages should be included in dietary ED calculations. To address these issues, studies examining the effects of ED on EI or body weight in nonelderly adults were reviewed. Different approaches to calculating dietary ED do not appear to alter the direction of reported relations between ED and body weight. Evidence that lowering dietary ED reduces EI in short-term studies is convincing, but there are currently insufficient data to determine long-term effectiveness for weight loss. The review also identified key barriers to progress in understanding the role of ED in energy regulation, in particular the absence of a standard definition of ED, and the lack of data from multiple long-term clinical trials examining the effectiveness of low-ED diet recommendations for preventing both primary weight gain and weight regain in nonobese individuals. Long-term clinical trials designed to examine the impact of dietary ED on energy regulation, and including multiple ED calculation methods within the same study, are still needed to determine the importance of ED in the regulation of EI and body weight. PMID:25398750

Appropriateness of cases presenting in the emergency department following ambulance service secondary telephone triage: a retrospective cohort study

PubMed Central

Eastwood, Kathryn; Smith, Karen; Morgans, Amee; Stoelwinder, Johannes

2017-01-01

Objective To investigate the appropriateness of cases presenting to the emergency department (ED) following ambulance-based secondary telephone triage. Design A pragmatic retrospective cohort analysis of all the planned and unplanned ED presentations within 48 hours of a secondary telephone triage. Setting The secondary telephone triage service, called the Referral Service, and the hospitals were located in metropolitan Melbourne, Australia and operated 24 hours a day, servicing 4.25 million people. The Referral Service provides an in-depth secondary triage of cases classified as low acuity when calling the Australian emergency telephone number. Population Cases triaged by the Referral Service between September 2009 and June 2012 were linked to ED and hospital admission records (N=44,523). Planned ED presentations were cases referred to the ED following the secondary triage, unplanned ED presentations were cases that presented despite being referred to alternative care pathways. Main outcome measures Appropriateness was measured using an ED suitability definition and hospital admission rates. These were compared with mean population data which consisted of all of the ED presentations for the state (termed the ‘average Victorian ED presentation’). Results Planned ED presentations were more likely to be ED suitable than unplanned ED presentations (OR 1.62; 95% CI 1.5 to 1.7; p<0.001) and the average Victorian ED presentation (OR 1.85; 95% CI 1.01 to 3.4; p=0.046). They were also more likely to be admitted to the hospital than the unplanned ED presentation (OR 1.5; 95% CI 1.4 to 1.6; p<0.001) and the average Victorian ED presentation (OR 2.3, 95% CI 2.24 to 2.33; p<0.001). Just under 15% of cases diverted away from the emergency care pathways presented in the ED (unplanned ED attendances), and 9.5% of all the alternative care pathway cases were classified as ED suitable and 6.5% were admitted to hospital. Conclusions Secondary telephone triage was able to appropriately identify many ED suitable cases, and while most cases referred to alternative care pathways did not present in the ED. Further research is required to establish that these were not inappropriately triaged away from the emergency care pathways. PMID:29038180

Use of the Emergency Department for Severe Headache. A population-based study

PubMed Central

Friedman, Benjamin W.; Serrano, Daniel; Reed, Michael; Diamond, Merle; Lipton, Richard B.

2008-01-01

Background Although headache is a common emergency department (ED) chief complaint, the role of the ED in the management of primary headache disorders has rarely been assessed from a population perspective. We determined frequency of ED use and risk factors for use among patients suffering severe headache. Methods As part of the American Migraine Prevalence and Prevention study, a validated self-administered questionnaire was mailed to 24,000 severe headache sufferers, who were randomly drawn from a larger sample constructed to be socio-demographically representative of the US population. Participants were asked a series of questions on headache management, healthcare system use, socio-demographic features, and number of ED visits for management of headache in the previous 12 months. In keeping with the work of others, “frequent” ED use was defined as a particpants report of four or more visits to the ED for treatment of a headache in the previous 12 months. Headaches were categorized into specific diagnoses using a validated methodology. Results Of 24,000 surveys, 18,514 were returned, and 13,451 (56%) provided complete data on ED use. Socio-demographic characteristics did not differ substantially between responders and non-responders. Among the 13,451 responders, over the course of the previous year, 12,592 (94%) did not visit the ED at all, 415 (3%) visited the ED once, and 444 (3%) visited the ED more than once. Patients with severe episodic tension-type headache were less likely to use the ED than patients with severe episodic migraine (OR 0.4 [95%CI 0.3, 0.6]). Frequent ED use was reported by 1% of the total sample or 19% (95%CI: 17, 22%) of subjects who used the ED in the previous year, though frequent users accounted for 51% (95%CI: 49, 53) of all ED visits. Predictors of ED use included markers of disease severity, elevated depression scores, low socio-economic status, and a predilection for ED use for conditions other than headache. Conclusions Most individuals suffering severe headaches do not use the ED over the course of a single year. The majority of ED visits for severe headache are accounted for by a small subset of all ED users. Increasing disease severity and depression are the most readily addressable factors associated with ED use. PMID:19040677

Clinical Pharmacy Services in Canadian Emergency Departments: A National Survey

PubMed Central

Wanbon, Richard; Lyder, Catherine; Villeneuve, Eric; Shalansky, Stephen; Manuel, Leslie; Harding, Melanie

2015-01-01

Background: Providing clinical pharmacy services in emergency departments (EDs) is important because adverse drug events commonly occur before, during, and after ED encounters. Survey studies in the United States have indicated a relatively low presence of clinical pharmacy services in the ED setting, but a descriptive survey specific to Canada has not yet been performed. Objectives: To describe the current status of pharmacy services in Canadian EDs and potential barriers to implementing pharmacy services in this setting. Methods: All Canadian hospitals with an ED and at least 50 acute care beds were contacted to identify the presence of dedicated ED pharmacy services (defined as at least 0.5 full-time equivalent [FTE] position). Three different electronic surveys were then distributed by e-mail to ED pharmacy team members (if available), pharmacy managers (at hospitals without an ED pharmacy team), and ED managers (all hospitals). The surveys were completed between July and September 2013. Results: Of the 243 hospitals identified, 95 (39%) had at least 0.5 FTE clinical pharmacy services in the ED (based on initial telephone screening). Of the 60 ED pharmacy teams that responded to the survey, 56 had pharmacists (27 of which also had ED pharmacy technicians) and 4 had pharmacy technicians (without pharmacists). Forty-four (79%) of the 56 ED pharmacist services had been established within the preceding 10 years. Order clarification, troubleshooting, medication reconciliation, and assessment of renal dosing were the services most commonly provided. The large majority of pharmacy managers and ED managers identified the need for ED pharmacy services where such services do not yet exist. Inadequate funding, competing priorities, and lack of training were the most commonly reported barriers to providing this service. Conclusions: Although the establishment of ward-based pharmacy services in Canadian EDs has increased over the past 10 years, lack of funding and a lack of ED training for pharmacists were reported as significant barriers to the expansion of this role in most hospitals. PMID:26157180

Enhanced Disease Susceptibility1 Mediates Pathogen Resistance and Virulence Function of a Bacterial Effector in Soybean1[C][W][OPEN

PubMed Central

Wang, Jialin; Shine, M.B.; Gao, Qing-Ming; Navarre, Duroy; Jiang, Wei; Liu, Chunyan; Chen, Qingshan; Hu, Guohua; Kachroo, Aardra

2014-01-01

Enhanced disease susceptibility1 (EDS1) and phytoalexin deficient4 (PAD4) are well-known regulators of both basal and resistance (R) protein-mediated plant defense. We identified two EDS1-like (GmEDS1a/GmEDS1b) proteins and one PAD4-like (GmPAD4) protein that are required for resistance signaling in soybean (Glycine max). Consistent with their significant structural conservation to Arabidopsis (Arabidopsis thaliana) counterparts, constitutive expression of GmEDS1 or GmPAD4 complemented the pathogen resistance defects of Arabidopsis eds1 and pad4 mutants, respectively. Interestingly, however, the GmEDS1 and GmPAD4 did not complement pathogen-inducible salicylic acid accumulation in the eds1/pad4 mutants. Furthermore, the GmEDS1a/GmEDS1b proteins were unable to complement the turnip crinkle virus coat protein-mediated activation of the Arabidopsis R protein Hypersensitive reaction to Turnip crinkle virus (HRT), even though both interacted with HRT. Silencing GmEDS1a/GmEDS1b or GmPAD4 reduced basal and pathogen-inducible salicylic acid accumulation and enhanced soybean susceptibility to virulent pathogens. The GmEDS1a/GmEDS1b and GmPAD4 genes were also required for Resistance to Pseudomonas syringae pv glycinea2 (Rpg2)-mediated resistance to Pseudomonas syringae. Notably, the GmEDS1a/GmEDS1b proteins interacted with the cognate bacterial effector AvrA1 and were required for its virulence function in rpg2 plants. Together, these results show that despite significant structural similarities, conserved defense signaling components from diverse plants can differ in their functionalities. In addition, we demonstrate a role for GmEDS1 in regulating the virulence function of a bacterial effector. PMID:24872380

Erectile dysfunction (ED) is a shared sexual concern of couples II: association of female partner characteristics with male partner ED treatment seeking and phosphodiesterase type 5 inhibitor utilization.

PubMed

Fisher, William A; Eardley, Ian; McCabe, Marita; Sand, Michael

2009-11-01

Erectile dysfunction (ED) is a prevalent condition that impacts on both patients and their female partners. ED may therefore be regarded as a shared sexual concern for couples. The current analysis of the Female Experience of Men's Attitudes to Life Events and Sexuality (FEMALES) study data addresses women's perceptions, beliefs, and attitudes concerning their partner's ED, and whether these are associated with the likelihood of the male partner seeking medical advice and utilizing phosphodiesterase type 5 inhibitors. The current research sought to explore the association of female partners' perceptions of male partners' ED and male partners' medical consultation and treatment seeking for ED. Questionnaires were sent to partners of men who participated in the Men's Attitudes to Life Events and Sexuality (MALES) 2004 study, and who consented to their partner's involvement. A modified version of the questionnaire used in the MALES study was developed for the FEMALES study, reflecting the female partner's perspective. A 65-item questionnaire assessing women's perceptions, beliefs, and attitudes regarding various aspects of ED. Women's perceptions of the nature and causes of their partner's ED were significantly associated with men's treatment seeking and utilization. Significant associations were observed between women's level of satisfaction with the relationship before ED onset; perceptions of the impact of ED on quality of life; desire to deal with ED; attitudes to ED treatment; and the treatment-seeking behavior of the male partner. Multivariate regression analyses identified a mixture of female and male partner perceptions and attitudes that uniquely accounted for >30% of the variance in men's ED treatment-seeking behavior and treatment utilization. This study illustrates the importance of the female partner's attitudes to ED in men's ED treatment-seeking behavior. These findings strongly support the potential benefits of partner integration into ED consultation and treatment strategies.

The emergency department prediction of disposition (EPOD) study.

PubMed

Vaghasiya, Milan R; Murphy, Margaret; O'Flynn, Daniel; Shetty, Amith

2014-11-01

Emergency departments (ED) continue to evolve models of care and streaming as interventions to tackle the effects of access block and overcrowding. Tertiary ED may be able to design patient-flow based on predicted dispositions in the department. Segregating discharge-stream patients may help develop patient-flows within the department, which is less affected by availability of beds in a hospital. We aim to determine if triage nurses and ED doctors can predict disposition outcomes early in the patient journey and thus lead to successful streaming of patients in the ED. During this study, triage nurses and ED doctors anonymously predicted disposition outcomes for patients presenting to triage after their brief assessments. Patient disposition at the 24-h post ED presentation was considered as the actual outcome and compared against predicted outcomes. Triage nurses were able to predict actual discharges of 445 patients out of 490 patients with a positive predictive value (PPV) of 90.8% (95% CI 87.8-93.2%). ED registrars were able to predict actual discharges of 85 patients out of 93 patients with PPV of 91.4% (95% CI 83.3-95.9%). ED consultants were able to predict actual discharges of 111 patients out of 118 patients with PPV 94.1% (95% CI 87.7-97.4%). PPVs for admission among ED consultants, ED registrars and Triage nurses were 59.7%, 54.4% and 48.5% respectively. Triage nurses, ED consultants and ED registrars are able to predict a patient's discharge disposition at triage with high levels of confidence. Triage nurses, ED consultants, and ED registrars can predict patients who are likely to be admitted with equal ability. This data may be used to develop specific admission and discharge streams based on early decision-making in EDs by triage nurses, ED registrars or ED consultants. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Treatment of Nausea and Vomiting in Pregnancy: Factors Associated with ED Revisits

PubMed Central

Sharp, Brian R.; Sharp, Kristen M.; Patterson, Brian; Dooley-Hash, Suzanne

2016-01-01

Introduction Nausea and vomiting in pregnancy (NVP) is a condition that commonly affects women in the first trimester of pregnancy. Despite frequently leading to emergency department (ED) visits, little evidence exists to characterize the nature of ED visits or to guide its treatment in the ED. Our objectives were to evaluate the treatment of NVP in the ED and to identify factors that predict return visits to the ED for NVP. Methods We conducted a retrospective database analysis using the electronic medical record from a single, large academic hospital. Demographic and treatment variables were collected using a chart review of 113 ED patient visits with a billing diagnosis of “nausea and vomiting in pregnancy” or “hyperemesis gravidarum.” Logistic regression analysis was used with a primary outcome of return visit to the ED for the same diagnoses. Results There was wide treatment variability of nausea and vomiting in pregnancy patients in the ED. Of the 113 patient visits, 38 (33.6%) had a return ED visit for NVP. High gravidity (OR 1.31, 95% CI [1.06–1.61]), high parity (OR 1.50 95% CI [1.12–2.00]), and early gestational age (OR 0.74 95% CI [0.60–0.90]) were associated with an increase in return ED visits in univariate logistic regression models, while only early gestational age (OR 0.74 95% CI [0.59–0.91]) was associated with increased return ED visits in a multiple regression model. Admission to the hospital was found to decrease the likelihood of return ED visits (p=0.002). Conclusion NVP can be difficult to manage and has a high ED return visit rate. Optimizing care with aggressive, standardized treatment in the ED and upon discharge, particularly if factors predictive of return ED visits are present, may improve quality of care and reduce ED utilization for this condition. PMID:27625723

Are eating disorders "all about control?" The elusive psychopathology of nonfat phobic presentations.

PubMed

Murray, Helen B; Coniglio, Kathryn; Hartmann, Andrea S; Becker, Anne E; Eddy, Kamryn T; Thomas, Jennifer J

2017-11-01

There are a subset of individuals with eating disorders (EDs) who do not overevaluate body shape/weight (i.e., nonfat phobic ED; NFP-ED). According to the transdiagnostic cognitive-behavioral conceptualization of EDs, a need for control, in general, is hypothesized as the core psychopathology of NFP-EDs, with shape- and weight-related motivations for ED behavior merely superimposed in FP-ED presentations. This study tested the need for control as motivation for restriction in NFP-ED, using items aimed at assessing control from the Eating Disorder Examination (EDE) Restraint scale. Females ages 13-27 years consecutively admitted to residential treatment completed the EDE, Eating Disorder Inventory-3 Drive for Thinness subscale (EDI-DFT), and other self-report measures of psychopathology. We included patients with DSM-5 EDs, but excluded patients with avoidant/restrictive food intake disorder. Twenty participants had NFP-ED (≤14 on EDI-DFT) and 124 had fatphobic ED (FP-ED; >14 on EDI-DFT). NFP-ED scored significantly lower than FP-ED on EDE Restraint scale shape/weight [χ 2 (1) = 10.73-35.62, p's < .01] and on control items [χ 2 (1) = 10.72-20.62, p's < .01], in addition to scoring lower on measures of general psychopathology and impairment. Findings suggest those with NFP-ED report lower psychopathology overall and the new EDE Restraint scale control items do not capture additional motivation for restriction beyond that captured in the original Restraint scale shape/weight items. Future research should examine whether this latter finding is due to a minimizing response style in NFP-ED, an incomplete capture of desire for control by the EDE assessment method, or indeed reflects that need for control does not motivate restriction in NFP-EDs. © 2017 Wiley Periodicals, Inc.

100 midlife women with eating disorders: a phenomenological analysis of etiology.

PubMed

Kally, Zina; Cumella, Edward J

2008-10-01

This study analyzed eating disorder (ED) etiological factors for 100 midlife women ED inpatients, grouped by ED onset age: < 40 and > or = 40 years. Interpretative Phenomenological Analysis classified ED etiological influences into background contributors, immediate triggers, or sustainers. Family-of-origin issues, predominantly parental maltreatment, emerged as important background contributors, but not immediate ED triggers, regardless of onset age. Body image issues were also major background contributors regardless of onset age and further served as immediate ED triggers for many of the younger-onset patients, but not the older-onset patients. Family-of-choice and health issues were unimportant for younger-onset patients but were important ED contributors and triggers for older-onset patients. Emergent etiological differences suggest differential assessment and treatment needs for midlife ED patients based on ED onset age.

Mood and neural correlates of excessive daytime sleepiness in Parkinson's disease.

PubMed

Wen, M-C; Chan, L L; Tan, L C S; Tan, E K

2017-08-01

For patients with Parkinson's disease (PD), excessive daytime sleepiness (PD-EDS) is a debilitating non-motor symptom and may be affected by mood symptoms, especially depression and anxiety. Few neuroimaging works have attempted to identify the neural features of PD-EDS, but various findings were reported. The purpose of this study was to systematically review the literature on mood and neuroimaging correlates of PD-EDS. A MEDLINE, PubMed, EMBASE, and PsycInfo search for peer-reviewed original research articles on depression, anxiety, and neuroimaging in PD-EDS identified 26 studies on depression, nine on anxiety, and eight on neuroimaging. Half of the studies reported greater depression in PD-EDS-positive patients compared with PD-EDS-negative patients. There was a significantly positive correlation between depression and PD-EDS. Limited studies on anxiety in PD-EDS suggested a weak correlation between anxiety and EDS. For depression and anxiety, the effect sizes were medium when EDS was subjectively measured, but became small when EDS was objective measured. Current neuroimaging studies generally suggested diminished neural structural and functional features (eg, brain volume, white matter integrity as indicated by fractional anisotropy, and cerebral metabolism) in patients with PD-EDS. Future studies should apply objective and subjective measures of mood symptoms and EDS and improve the neuroimaging methodology via using multimodal techniques and whole-brain analysis to provide new clues on the mood and neural correlates of PD-EDS. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Emotional Dysregulation in Adults With Attention-Deficit/Hyperactivity Disorder-Validity, Predictability, Severity, and Comorbidity.

PubMed

Corbisiero, Salvatore; Mörstedt, Beatrice; Bitto, Hannes; Stieglitz, Rolf-Dieter

2017-01-01

Attention-deficit/hyperactivity disorder (ADHD) is characterized by inattention, hyperactivity, and impulsivity. However, this triad might not be able to explain the complete spectrum of ADHD symptoms, as emotional dysregulation (ED) frequently seems to accompany the disorder. The aim of this study was to further understand the role of ED in adult ADHD. The sample comprised 393 adults with ADHD without or with comorbidity, and 121 adults without ADHD or any other mental disorder. Additionally, the sample focused on ED. The contribution of core symptoms and the effect of comorbidity on ED were tested and the predictive value of ED for the ADHD diagnosis itself analyzed. Finally, all subjects were categorized into groups-No ADHD, ADHD, and ADHD + ED-to analyze the differences in the severity of ADHD symptomatology in the three groups. ED levels were found to be elevated in patients with ADHD. The core symptoms affected ED, and the ADHD diagnosis was predicted by ED. The addition of ED to a regression model with the core symptoms was shown to improve the predictability of the ADHD diagnosis. The presence of ED proved to be an indicator of the severity of adult ADHD independent of a present comorbidity. ED is a significant symptom in adult patients with ADHD and appears to be associated with ADHD itself. Whilst the presence of other mental disorders intensifies symptoms of ED, ED seems not to manifest solely as a consequence of comorbidity. © 2016 Wiley Periodicals, Inc.

Trends and predicted trends in presentations of older people to Australian emergency departments: effects of demand growth, population aging and climate change.

PubMed

Burkett, Ellen; Martin-Khan, Melinda G; Scott, Justin; Samanta, Mayukh; Gray, Leonard C

2017-07-01

Objectives The aim of the present study was to describe trends in and age and gender distributions of presentations of older people to Australian emergency departments (EDs) from July 2006 to June 2011, and to develop ED utilisation projections to 2050. Methods A retrospective analysis of data collected in the National Non-admitted Patient Emergency Department Care Database was undertaken to assess trends in ED presentations. Three standard Australian Bureau of Statistics population growth models, with and without adjustment for current trends in ED presentation growth and effects of climate change, were examined with projections of ED presentations across three age groups (0-64, 65-84 and ≥85 years) to 2050. Results From 2006-07 to 2010-11, ED presentations increased by 12.63%, whereas the Australian population over this time increased by only 7.26%. Rates of presentation per head of population were greatest among those aged ≥85 years. Projections of ED presentations to 2050 revealed that overall ED presentations are forecast to increase markedly, with the rate of increase being most marked for older people. Conclusion Growth in Australian ED presentations from 2006-07 to 2010-11 was greater than that expected from population growth alone. The predicted changes in demand for ED care will only be able to be optimally managed if Australian health policy, ED funding instruments and ED models of care are adjusted to take into account the specific care and resource needs of older people. What is known about the topic? Rapid population aging is anticipated over coming decades. International studies and specific local-level Australian studies have demonstrated significant growth in ED presentations. There have been no prior national-level Australian studies of ED presentation trends by age group. What does this paper add? The present study examined national ED presentation trends from July 2006 to June 2011, with specific emphasis on trends in presentation by age group. ED presentation growth was found to exceed population growth in all age groups. The rate of ED presentations per head of population was highest among those aged ≥85 years. ED utilisation projections to 2050, using standard Australian Bureau of Statistics population modelling, with and without adjustment for current ED growth, were developed. The projections demonstrated linear growth in ED presentation for those aged 0-84 years, with growth in ED presentations of the ≥85 year age group demonstrating marked acceleration after 2030. What are the implications for practitioners? Growth in ED presentations exceeding population growth suggests that current models of acute health care delivery require review to ensure that optimal care is delivered in the most fiscally efficient manner. Trends in presentation of older people emphasise the imperative for ED workforce planning and education in care of this complex patient cohort, and the requirement to review funding models to incentivise investment in ED avoidance and substitutive care models targeting older people.

Successful vitrification of bovine immature oocyte using liquid helium instead of liquid nitrogen as cryogenic liquid.

PubMed

Yu, Xue-Li; Xu, Ya-Kun; Wu, Hua; Guo, Xian-Fei; Li, Xiao-Xia; Han, Wen-Xia; Li, Ying-Hua

2016-04-01

The objectives of this study were to compare the effectiveness of liquid helium (LHe) and liquid nitrogen (LN2) as cryogenic liquid for vitrification of bovine immature oocytes with open-pulled straw (OPS) system and determine the optimal cryoprotectant concentration of LHe vitrification. Cumulus oocyte complexes were divided into three groups, namely, untreated group (control), LN2 vitrified with OPS group, and LHe vitrified with OPS group. Oocyte survival was assessed by morphology, nuclear maturation, and developmental capability. Results indicated that the rates of normal morphology, maturation, cleavage, and blastocyst (89.3%, 52.8%, 42.7%, and 10.1%, respectively) in the LHe-vitrified group were all higher than those (79.3%, 43.4%, 34.1%, and 4.7%) in the LN2-vitrified group (P < 0.05) although the corresponding rates in both treated groups decreased compared with the control group (100%, 75.0%, 64.9%, and 40.8%; P < 0.05). Normal calves were obtained after the transfer of blastocysts derived from LHe- and LN2-vitrified oocytes. The effects of the different vitrification solutions (EDS30, EDS35, EDS40, EDS45, and EDS50) in LHe vitrification for bovine immature oocytes vitrification were examined. No difference was found in the rates of morphologically normal oocytes among the EDS30 (87.9%), EDS35 (90.1%), EDS40 (89.4%), and EDS45 (87.2%) groups (P > 0.05). The maturation rate of the EDS35 group (65.0%) was higher than those of the EDS30 (51.3%), EDS40 (50.1%), EDS45 (52.1%), and EDS50 groups (36.9%; P < 0.05). No significant differences were observed in the cleavage and blastocyst rates between the EDS35 (49.0% and 12.1%) and EDS40 (41.7% and 10.2%) groups. However, the cleavage and blastocyst rates in the EDS35 group were higher (P < 0.05) than those of the EDS30 (36.2% and 6.8%), EDS45 (35.9% and 5.8%), and EDS50 (16.6% and 2.2%) groups. In conclusion, LHe can be used as a cryogenic liquid for vitrification of bovine immature oocytes, and it is more efficient than LN2-vitrified oocytes in terms of blastocyst production. EDS35 was the optimal cryoprotectant agent combination for LHe vitrification in this study. Copyright © 2016 Elsevier Inc. All rights reserved.

Analysis of the methylation status of the KCNQ1OT and H19 genes in leukocyte DNA for the diagnosis and prognosis of Beckwith-Wiedemann syndrome.

PubMed

Gaston, V; Le Bouc, Y; Soupre, V; Burglen, L; Donadieu, J; Oro, H; Audry, G; Vazquez, M P; Gicquel, C

2001-06-01

Beckwith-Wiedemann syndrome (BWS) is an overgrowth disorder involving developmental abnormalities, tissue and organ hyperplasia and an increased risk of embryonal tumours (most commonly Wilms tumour). This multigenic disorder is caused by dysregulation of the expression of imprinted genes in the 11p15 chromosomal region. Molecular diagnosis of BWS is currently difficult, mostly due to the large spectrum of genetic and epigenetic abnormalities. The other difficulty in managing BWS is the identification of patients at risk of tumour. An imprinted antisense transcript within KCNQ1, called KCNQ1OT (also known as LIT1), was recently shown to be normally expressed from the paternal allele. A loss of imprinting of the KCNQ1OT gene, associated with the loss of maternal allele-specific methylation of the differentially methylated region KvDMR1 has been described in BWS patients. The principal aim of this study was to evaluate the usefulness of KvDMR1 methylation analysis of leukocyte DNA for the diagnosis of BWS. The allelic status of the 11p15 region and the methylation status of the KCNQ1OT and H19 genes were investigated in leukocyte DNA from 97 patients referred for BWS and classified into two groups according to clinical data: complete BWS (CBWS) (n=61) and incomplete BWS (IBWS) (n=36). Fifty-eight (60%) patients (39/61 CBWS and 19/36 IBWS) displayed abnormal demethylation of KvDMR1. In 11 of the 56 informative cases, demethylation of KvDMR1 was related to 11p15 uniparental disomy (UPD) (nine CBWS and two IBWS). Thirteen of the 39 patients with normal methylation of KvDMR1 displayed hypermethylation of the H19 gene. These 13 patients included two siblings with 11p15 trisomy. These results show that analysis of the methylation status of KvDMR1 and the H19 gene in leukocyte DNA is useful in the diagnosis of 11p15-related overgrowth syndromes, resulting in the diagnosis of BWS in more than 70% of investigated patients. We also evaluated clinical and molecular features as prognostic factors for tumour and showed that mosaicism for 11p15 UPD and hypermethylation of the H19 gene in blood cells were associated with an increased risk of tumour.

Impact of the Four-Hour Rule in Western Australian hospitals: Trend analysis of a large record linkage study 2002-2013.

PubMed

Ngo, Hanh; Forero, Roberto; Mountain, David; Fatovich, Daniel; Man, Wing Nicola; Sprivulis, Peter; Mohsin, Mohammed; Toloo, Sam; Celenza, Antonio; Fitzgerald, Gerard; McCarthy, Sally; Hillman, Ken

2018-01-01

In 2009, the Western Australian (WA) Government introduced the Four-Hour Rule (FHR) program. The policy stated that most patients presenting to Emergency Departments (EDs) were to be seen and either admitted, transferred, or discharged within 4 hours. This study utilised de-identified data from five participating hospitals, before and after FHR implementation, to assess the impact of the FHR on several areas of ED functioning. A state (WA) population-based intervention study design, using longitudinal data obtained from administrative health databases via record linkage methodology, and interrupted time series analysis technique. There were 3,214,802 ED presentations, corresponding to 1,203,513 ED patients. After the FHR implementation, access block for patients admitted through ED for all five sites showed a significant reduction of up to 13.2% (Rate Ratio 0.868, 95%CI 0.814, 0.925) per quarter. Rate of ED attendances for most hospitals continued to rise throughout the entire study period and were unaffected by the FHR, except for one hospital. Pattern of change in ED re-attendance rate post-FHR was similar to pre-FHR, but the trend reduced for two hospitals. ED occupancy was reduced by 6.2% per quarter post-FHR for the most 'crowded' ED. ED length of stay and ED efficiency improved in four hospitals and deteriorated in one hospital. Time to being seen by ED clinician and Did-Not-Wait rate improved for some hospitals. Admission rates in post-FHR increased, by up to 1% per quarter, for two hospitals where the pre-FHR trend was decreasing. The FHR had a consistent effect on 'flow' measures: significantly reducing ED overcrowding and access block and enhancing ED efficiency. Time-based outcome measures mostly improved with the FHR. There is some evidence of increased ED attendance, but no evidence of increased ED re-attendance. Effects on patient disposition status were mixed. Overall, this reflects the value of investing resources into the ED/hospital system to improve efficiency and patient experience. Further research is required to illuminate the exact mechanisms of the effects of FHR on the ED and hospital functioning across Australia.

Trends in the supply of California’s emergency departments and inpatient services, 2005–2014: a retrospective analysis

PubMed Central

Chow, Jessica L; Niedzwiecki, Matthew J; Hsia, Renee Y

2017-01-01

Objectives Given increasing demand for emergency care, there is growing concern over the availability of emergency department (ED) and inpatient resources. Existing studies of ED bed supply are dated and often overlook hospital capacity beyond ED settings. We described recent statewide trends in the capacity of ED and inpatient hospital services from 2005 to 2014. Design Retrospective analysis. Setting Using California hospital data, we examined the absolute and per admission changes in ED beds and inpatient beds in all hospitals from 2005 to 2014. Participants Our sample consisted of all patients inpatient and outpatient) from 501 hospital facilities over 10-year period. Outcome measures We analysed linear trends in the total annual ED visits, ED beds, licensed and staffed inpatient hospital beds and bed types, ED beds per ED visit, and inpatient beds per admission (ED and non-ED). Results Between 2005 and 2014, ED visits increased from 9.8 million to 13.2 million (an increase of 35.0%, p<0.001). ED beds also increased (by 29.8%, p<0.001), with an average annual increase of 195.4 beds. Despite this growth, ED beds per visit decreased by 3.9%, from 6.0 ED beds per 10 000 ED visits in 2005 to 5.8 beds in 2014 (p=0.01). While overall admission numbers declined by 4.9% (p=0.06), inpatient medical/surgical beds per visit grew by 11.3%, from 11.6 medical/surgical beds per 1000 admissions in 2005 to 12.9 beds in 2014 (p<0.001). However, there were reductions in psychiatric and chemical dependency beds per admission, by −15.3% (p<0.001) and −22.4% (p=0.05), respectively. Conclusions These trends suggest that, in its current state, inadequate supply of ED and specific inpatient beds cannot keep pace with growing patient demand for acute care. Analysis of ED and inpatient supply should capture dynamic variations in patient demand. Our novel ‘beds pervisit’ metric offers improvements over traditional supply measures. PMID:28495813

Young adolescents' perceptions, patterns, and contexts of energy drink use. A focus group study.

PubMed

Costa, Beth M; Hayley, Alexa; Miller, Peter

2014-09-01

Caffeinated energy drinks (EDs) are purported to increase energy and improve performance, but have been associated with adverse health effects and death. EDs are popular among adolescents and young adults, yet little is known about their use among young adolescents. This study explored perceptions, patterns, and contexts of ED use in six focus groups with 40 adolescents aged 12-15 years from two regional Australian schools. A thematic analysis of the data was used to investigate knowledge about ED brands and content, ED use, reasons for ED use, physiological effects, and influences on ED use. Participants were familiar with EDs and most had used them at least once but had limited knowledge of ED ingredients, and some had difficulty differentiating them from soft and sports drinks. EDs were used as an alternative to other drinks, to provide energy, and in social contexts, and their use was associated with short-term physiological symptoms. Parents and advertising influenced participants' perceptions and use of EDs. These findings suggest young adolescents use EDs without knowing what they are drinking and how they are contributing to their personal risk of harm. The advertising, appeal, and use of EDs by adolescents appear to share similarities with alcohol and tobacco. Further research is needed to replicate and extend the current findings, informed by the lessons learned in alcohol research. Copyright © 2014 Elsevier Ltd. All rights reserved.

Balanced nuclear and cytoplasmic activities of EDS1 are required for a complete plant innate immune response.

PubMed

García, Ana V; Blanvillain-Baufumé, Servane; Huibers, Robin P; Wiermer, Marcel; Li, Guangyong; Gobbato, Enrico; Rietz, Steffen; Parker, Jane E

2010-07-01

An important layer of plant innate immunity to host-adapted pathogens is conferred by intracellular nucleotide-binding/oligomerization domain-leucine rich repeat (NB-LRR) receptors recognizing specific microbial effectors. Signaling from activated receptors of the TIR (Toll/Interleukin-1 Receptor)-NB-LRR class converges on the nucleo-cytoplasmic immune regulator EDS1 (Enhanced Disease Susceptibility1). In this report we show that a receptor-stimulated increase in accumulation of nuclear EDS1 precedes or coincides with the EDS1-dependent induction and repression of defense-related genes. EDS1 is capable of nuclear transport receptor-mediated shuttling between the cytoplasm and nucleus. By enhancing EDS1 export from inside nuclei (through attachment of an additional nuclear export sequence (NES)) or conditionally releasing EDS1 to the nucleus (by fusion to a glucocorticoid receptor (GR)) in transgenic Arabidopsis we establish that the EDS1 nuclear pool is essential for resistance to biotrophic and hemi-biotrophic pathogens and for transcriptional reprogramming. Evidence points to post-transcriptional processes regulating receptor-triggered accumulation of EDS1 in nuclei. Changes in nuclear EDS1 levels become equilibrated with the cytoplasmic EDS1 pool and cytoplasmic EDS1 is needed for complete resistance and restriction of host cell death at infection sites. We propose that coordinated nuclear and cytoplasmic activities of EDS1 enable the plant to mount an appropriately balanced immune response to pathogen attack.

The use of mechanical ventilation in the ED.

PubMed

Easter, Benjamin D; Fischer, Christopher; Fisher, Jonathan

2012-09-01

Although EDs are responsible for the initial care of critically ill patients and the amount of critical care provided in the ED is increasing, there are few data examining mechanical ventilation (MV) in the ED. In addition, characteristics of ED-based ventilation may affect planning for ventilator shortages during pandemic influenza or bioterrorist events. The study examined the epidemiology of MV in US EDs, including demographic, clinical, and hospital characteristics; indications for MV; ED length of stay (LOS); and in-hospital mortality. This study was a retrospective review of the 1993 to 2007 National Hospital Ambulatory Medical Care Survey ED data sets. Ventilated patients were compared with ED patients admitted to the intensive care unit (ICU) and to all other ED visits. There were 3.6 million ED MV visits (95% confidence interval [CI], 3.2-4.0 million) over the study period. Sex, age, race, and payment source were similar for mechanically ventilated and ICU patients (P > .05 for all). Approximately 12.5% of ventilated patients underwent cardiopulmonary resuscitation compared with 1.7% of ICU admissions and 0.2% of all other ED visits (P < .0001). Accordingly, in-hospital mortality was significantly higher for ventilated patients (24%; 95% CI, 13.1%-34.9%) than both comparison groups (9.3% and 2.5%, respectively). Median LOS for ventilated patients was 197 minutes (interquartile range, 112-313 minutes) compared with 224 minutes for ICU admissions and 140 minutes for all other ED visits. Patients undergoing ED MV have particularly high in-hospital mortality rates, but their ED LOS is sufficient for implementation of evidence-based ventilator interventions. Copyright © 2012 Elsevier Inc. All rights reserved.

Emergency Department Involvement in Accountable Care Organizations in Massachusetts: A Survey Study.

PubMed

Ali, Nissa J; McWilliams, J Michael; Epstein, Stephen K; Smulowitz, Peter B

2017-11-01

We assess Massachusetts emergency department (ED) involvement and internal ED constructs within accountable care organization contracts. An online survey was distributed to 70 Massachusetts ED directors. Questions attempted to assess involvement of EDs in accountable care organizations and the structures in place in EDs-from departmental resources to physician incentives-to help achieve accountable care organization goals of decreasing spending and improving quality. Of responding ED directors, 79% reported alignment between the ED and an accountable care organization. Almost all ED groups (88%) reported bearing no financial risk as a result of the accountable care organization contracts in which their organizations participated. Major obstacles to meeting accountable care organization objectives included care coordination challenges (62%) and lack of familiarity with accountable care organization goals (58%). The most common cost-reduction strategies included ED case management (85%) and information technology (61%). Limitations of this study include that information was self-reported by ED directors, a focus limited to Massachusetts, and a survey response rate of 47%. The ED directors perceived that the majority of physicians were not familiar with accountable care organization goals, many challenges remain in coordinating care for patients in the ED, and most EDs have no financial incentives tied to accountable care organizations. EDs in Massachusetts have begun to implement strategies aimed at reducing admissions, utilization, and overall cost, but these strategies are not widespread apart from case management, even in a state with heavy accountable care organization penetration. Our results suggest that Massachusetts EDs still lack clear directives and direct involvement in meeting accountable care organization goals. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Pediatric Emergency Department Resource Utilization among Children with Primary Care Clinic Contact in the Preceding 2 Days: A Cross-Sectional Study.

PubMed

Grech, Christina K; Laux, Molly A; Burrows, Heather L; Macy, Michelle L; Pomeranz, Elaine S

2017-09-01

To characterize pediatric patient contacts with their primary care clinic in the 2 days preceding a visit to the emergency department (ED) and explore how the type of clinic contact relates to ED resource use. We conducted a retrospective chart review of 368 pediatric ED visits in the first 7 days of each month, from September 2012 to August 2013. Visits were included if the family contacted their child's general pediatric clinic in the study health system in the 2 days preceding the ED visit. Descriptive statistics were calculated. Primary outcomes were ED resource use (tests, treatments) and disposition (admission or discharge). Outcomes by type of clinic contact were compared with χ 2 statistics. Of 1116 records with ED visits in the 12 study weeks extracted from the electronic medical record, 368 ED visits met inclusion criteria. Most ED visits followed a single clinic contact (78.8%). Of the 474 clinic contacts, 149 were in-person visits, 216 phone calls when clinic was open, and 109 phone calls when clinic was closed. ED visits that followed an in-person clinic contact with advice to go to the ED had significantly greater rates of testing and admission than those advised to go to the ED after phone contact and those never advised to go to the ED. In-person clinic visits with advice to go to the ED were associated with the greatest ED resource use. Limitations include a study of a single health system without a uniform process for triaging patients to the ED across clinics. Copyright © 2017 Elsevier Inc. All rights reserved.

Why do children present to emergency departments? Exploring motivators and measures of presentation appropriateness for children presenting to a paediatric emergency department.

PubMed

Cheek, John A; Braitberg, George; Craig, Simon; West, Adam

2017-05-01

To compare the parental motivators and referring general practitioner's (GP's) reasons for advising emergency department (ED) attendance with the assessment of ED medical staff. To compare ED clinician opinion with other published methods that have attempted to define 'primary care suitable' presentations to the ED. A prospective observational study and series of surveys regarding the attendance of children presenting to a single tertiary paediatric ED. Surveys were distributed to the treating ED clinician, the child's parent/guardian, and the referring GP. Results between the three groups were analysed and compared. There were a total of 1069 presentations during the study period. Six hundred (58.4%, 95% CI 55.3-61.4%) presentations were judged as 'ED appropriate' by the treating ED clinician. When compared with methods used to retrospectively judge whether ED patients are considered 'primary care suitable', ED clinicians disagree between 22.4 and 38.8% of the time. For patients who presented directly to ED, 85.6% did so for a medical reason, whilst 32.1% did so for a GP access reason. Being referred by a GP improved the ED clinicians' opinion of the appropriateness of the presentation (49.2 vs. 73.9%, P < 0.05). We caution that many strategies attempting to 'solve' the issue of increasing ED attendances by paediatric patients have been driven by opinion, and a better understanding of the motivators that drive this behaviour is needed. We believe the solution to increasing utilisation of EDs by children must be a balanced approach that addresses community expectations and appropriately resources EDs. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Prevalence, correlates, attitude and treatment seeking of erectile dysfunction among type 2 diabetic Chinese men attending primary care outpatient clinics

PubMed Central

Lo, Wai Hon; Fu, Sau Nga; Wong, Carlos King Ho; Chen, Ee San

2014-01-01

To investigate the prevalence, correlates, attitude and treatment seeking behavior of erectile dysfunction (ED) in type 2 diabetes mellitus (T2DM) patients in the primary care setting, a multi-center cross-sectional survey using a structured anonymous self-administered questionnaire was performed in 10 general outpatient clinics. Of the 603 subjects (91% response rate), the prevalence of ED men, as defined by the International Index of Erectile Function, was 79.1%. Most subjects had mild ED (28.9%), followed by mild-to-moderate ED (27.9%), then moderate ED (13.4%) and severe ED (9%). Nearly 55% of those with ED did not consider themselves as having ED. Less than 10% of them had ever sought medical treatment, although 76.1% of them wished to receive management from doctor(s) should they be diagnosed with ED. They considered the most important management from doctors to be clinical assessment (41.7%), followed by management of potential underlying cause (37.8%), referral to specialist (27.5%), education (23.9%), prescription of phosphodiesterase type 5 inhibitors (16.9%) and referral to counseling service (6.7%). The prevalence of ED was strongly associated with subjects who thought they had ED (odds ratio (OR) = 90.49 (20.00–409.48, P< 0.001)) and were from the older age group (OR = 1.043 (1.011–1.076, P = 0.008)). In conclusion, ED is highly prevalent among T2DM men. The majority of them wanted management from doctors should they have ED, but only a minority would actually voice out the request. Screening of ED among T2DM men using structural questionnaire allowed the diagnosis of more than half of the ED cases, which otherwise would have gone undiagnosed. PMID:24759587

Exercise dependence as a mediator of the exercise and eating disorders relationship: a pilot study.

PubMed

Cook, Brian; Hausenblas, Heather; Crosby, Ross D; Cao, Li; Wonderlich, Stephen A

2015-01-01

Excessive exercise is a common feature of eating disorders (ED) and is associated with earlier ED onset, more ED symptoms, and higher persistence of ED behavior. Research indicates that exercise amount alone is not associated with ED. The purpose of this study was to investigate pathological attitudes and behaviors related to exercise (e.g., exercise dependence) as a mediator of the exercise and ED relationship. Participants were 43 women with an ED who completed measures of ED symptoms, exercise behavior, and exercise dependence. Analyses were conducted using the indirect bootstrapping method for examining mediation. Exercise dependence mediated the relationship between exercise and ED. This mediation model accounted for 14.34% of the variance in the relationship. Our results extend the literature by offering preliminary evidence of a psychological variable that may be a candidate for future interventions on the exercise and ED relationship. Implications and suggestions for future research are discussed. Copyright © 2014 Elsevier Ltd. All rights reserved.

Emergency Department Utilization Report to Decrease Visits by Pediatric Gastroenterology Patients.

PubMed

Lee, Jarone; Greenspan, Peter T; Israel, Esther; Katz, Aubrey; Fasano, Alessio; Kaafarani, Haytham M A; Linov, Pamela L; Raja, Ali S; Rao, Sandhya K

2016-07-01

Emergency department (ED) utilization is a major driver of health care costs. Specialist physicians have an important role in addressing ED utilization, especially at highly specialized, academic medical centers. We sought to investigate whether reporting of ED utilization to specialist physicians can decrease ED visits. This study analyzed an intervention to reduce ED utilization among ED patients who were followed by pediatric gastroenterologists. In May 2013, each pediatric gastroenterologist began receiving reports with rates of ED use by their patients. The reports generated discussion that resulted in a cultural and process change in which patients with urgent gastrointestinal (GI)-related complaints were preferentially seen in the office. Using control charts, we examined GI-related and all-diagnoses ED use over a 2-year period. The rate of GI-related ED visits decreased by 60% after the intervention, from 4.89 to 1.95 per 1000 office visits (P < .001). Similarly, rates of GI-related ED visits during office hours decreased by 59% from 2.19 to 0.89 per 1000 (P < .001). Rates of all-diagnoses ED visits did not change. Physician-level reporting of ED utilization to pediatric gastroenterologists was associated with physician engagement and a cultural and process change to preferentially treat patients with urgent issues in the office. Copyright © 2016 by the American Academy of Pediatrics.

Erectile Dysfunction Among Patients on Methadone Maintenance Therapy and Its Association With Quality of Life.

PubMed

Teoh, Joni Bing Fei; Yee, Anne; Danaee, Mahmoud; Ng, Chong Guan; Sulaiman, Ahmad Hatim Bin

Erectile dysfunction (ED) is a problem commonly encountered by patients on methadone maintenance therapy (MMT). This study aimed to assess the prevalence of ED among this group of patients along with its risk factors and association with quality of life (QOL). Male patients on MMT in a tertiary hospital in Malaysia were included in the study. A total of 134 patients with sexual partners were assessed for ED using the International Index of Erectile Function. Patients were assessed for substance use using Opiate Treatment Index (OTI) and depression using the Malay version of the self-rated Montgomery-Asberg Depression Rating Scale (MADRS-BM). QOL was evaluated using World Health Organisation Quality of Life (WHOQOL)-BREF. The prevalence of ED among patients on MMT was 67%, with 26.1% having mild ED, 30.4% having mild-to-moderate ED, 7.0% having moderate ED, and 17.2% having severe ED. Patients with depression were 4 times more likely to have ED compared with patients without depression, whereas increasing age significantly correlated with the severity of ED. Having ED predicted a poorer QOL in the social relationships domain. Depression is highly associated with ED, which negatively influences the social aspect of QOL among patients on methadone maintenance therapy.

Associations of work characteristics, employee strain and self-perceived quality of care in Emergency Departments: A cross-sectional study.

PubMed

Weigl, Matthias; Schneider, Anna

2017-01-01

The individual and shared effects of adverse work characteristics on patient care in Emergency Departments (ED) are yet not well understood. We investigated the associations of self-reported ED work characteristics, work-related strain, and perceived quality of care. Questionnaire-based survey with standardized measures among N=53 ED professionals (i.e., nurses, physicians, and administration staff). The study was conducted in the interdisciplinary ED of a German community hospital. A high prevalence of work-related strain was observed: 66.0% of ED professionals showed high levels of emotional exhaustion and 55.6% showed irritation scores above the cut-off value. ED staff reported high supervisor support and autonomy, paired with high time pressure and patient-related stressors. Multivariate analyses revealed that high time pressure and low supervisor support were associated with high work-related strain. Low staffing was related to inferior quality of ED care. ED work systems involve high competing demands for ED professionals with substantial risks for work-related strain. Moreover, adverse ED work characteristics comprise risks for high quality patient care. Our results suggest that promoting work characteristics might foster ED staff functioning on the job as well as improve ED patient care. Copyright © 2016 Elsevier Ltd. All rights reserved.

Alcohol Mixed with Energy Drinks: Daily Context of Use.

PubMed

Linden-Carmichael, Ashley N; Lau-Barraco, Cathy

2017-04-01

The link between use of alcohol mixed with energy drinks (AmEDs) and alcohol-related harms is well established, but limited research has examined the context in which AmEDs are consumed. Identifying the social and environmental characteristics of use may illuminate whether AmEDs are used in settings that could increase the likelihood of engaging in risky behaviors or experiencing harms. This study used a 2-week daily diary assessment to compare days in which AmEDs were consumed ("AmED days") and days where other types of alcohol were used ("non-AmED days") on where, when, and with whom drinking occurred. Participants were 122 (90 women) heavy drinking college students who reported mixing caffeine with alcohol at least once in the past week. Data were collected across 389 drinking days; 40 of these days involved AmED use. Multilevel modeling findings revealed that odds of drinking AmEDs were higher on days where individuals drank at a bar or club and drank at home relative to other locations. In addition, odds of pregaming were higher on AmED days as compared to non-AmED days. AmED use was linked with lower odds of drinking game behavior. Overall, AmEDs appear to be consumed in potentially risky contexts. In combination with prior findings that AmED days are linked with heavier alcohol use and more harms experienced, these findings support the unique nature of AmED consumption in terms of the factors that may predict or maintain potentially hazardous drinking patterns. Copyright © 2017 by the Research Society on Alcoholism.

Low caregiver health literacy is associated with higher pediatric emergency department use and nonurgent visits.

PubMed

Morrison, Andrea K; Schapira, Marilyn M; Gorelick, Marc H; Hoffmann, Raymond G; Brousseau, David C

2014-01-01

We sought to determine the association between low caregiver health literacy and child emergency department (ED) use, both the number and urgency of ED visits. This year long cross-sectional study utilized the Newest Vital Sign questionnaire to measure the health literacy of caregivers accompanying children to a pediatric ED. Prior ED visits were extracted from a regional database. ED visit urgency was classified by resources utilized during the index ED visit. Regression analyses were used to model 2 outcomes-prior ED visits and ED visit urgency-stratified by chronic illness. Analyses were weighted by triage level. Overall, 503 caregivers completed the study; 55% demonstrated low health literacy. Children of caregivers with low health literacy had more prior ED visits (adjusted incidence rate ratio 1.5; 95% confidence interval 1.2, 1.8) and increased odds of a nonurgent index ED visit (adjusted odds ratio 2.4; 95% confidence interval 1.3, 4.4). Among children without chronic illness, low caregiver health literacy was associated with an increased proportion of nonurgent index ED visits (48% vs. 22%; adjusted odds ratio 3.2; 1.8, 5.7). Over half of caregivers presenting with their children to the ED have low health literacy. Low caregiver health literacy is an independent predictor of higher ED use and use of the ED for nonurgent conditions. In children without a chronic illness, low health literate caregivers had more than 3 times greater odds of presenting for a nonurgent condition than those with adequate health literacy. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

National Survey of Preventive Health Services in US Emergency Departments

PubMed Central

Delgado, M. Kit; Acosta, Colleen D.; Ginde, Adit A.; Wang, N. Ewen; Strehlow, Matthew C.; Khandwala, Yash S.; Camargo, Carlos A.

2012-01-01

Study objective We describe the availability of preventive health services in US emergency departments (EDs), as well as ED directors’ preferred service and perceptions of barriers to offering preventive services. Methods Using the 2007 National Emergency Department Inventory (NEDI)–USA, we randomly sampled 350 (7%) of 4,874 EDs. We surveyed directors of these EDs to determine the availability of (1) screening and referral programs for alcohol, tobacco, geriatric falls, intimate partner violence, HIV, diabetes, and hypertension; (2) vaccination programs for influenza and pneumococcus; and (3) linkage programs to primary care and health insurance. ED directors were asked to select the service they would most like to implement and to rate 5 potential barriers to offering preventive services. Results Two hundred seventy-seven EDs (80%) responded across 46 states. Availability of services ranged from 66% for intimate partner violence screening to 19% for HIV screening. ED directors wanted to implement primary care linkage most (17%) and HIV screening least (2%). ED directors “agreed/strongly agreed” that the following are barriers to ED preventive care: cost (74%), increased patient length of stay (64%), lack of follow-up (60%), resource shifting leading to worse patient outcomes (53%), and philosophical opposition (27%). Conclusion Most US EDs offer preventive services, but availability and ED director preference for type of service vary greatly. The majority of EDs do not routinely offer Centers for Disease Control and Prevention–recommended HIV screening. Most ED directors are not philosophically opposed to offering preventive services but are concerned with added costs, effects on ED operations, and potential lack of follow-up. PMID:20889237

Low Caregiver Health Literacy is Associated with Higher Pediatric Emergency Department Use and Non-urgent Visits

PubMed Central

Morrison, Andrea K.; Schapira, Marilyn M.; Gorelick, Marc H.; Hoffmann, Raymond G.; Brousseau, David C.

2014-01-01

Objective We sought to determine the association between low caregiver health literacy and child emergency department (ED) use, both the number and urgency of ED visits. Methods This year long cross-sectional study utilized the Newest Vital Sign to measure the health literacy of caregivers accompanying children to a pediatric ED. Prior ED visits were extracted from a regional database. ED visit urgency was classified by resources utilized during the index ED visit. Regression analyses were used to model the outcomes: 1) prior ED visits and 2) ED visit urgency, stratified by chronic illness. Analyses were weighted by triage level. Results Overall, 503 caregivers completed the study; 55% demonstrated low health literacy. Children of caregivers with low health literacy had more prior ED visits (aIRR 1.5; 95% C.I.1.2, 1.8) and increased odds of a non-urgent index ED visit (AOR 2.4; 1.3, 4.4). Among children without chronic illness, low caregiver health literacy was associated with an increased proportion of non-urgent index ED visits (48% vs 22%; AOR 3.2; 1.8, 5.7). Conclusions Over half of caregivers presenting with their children to the ED have low health literacy. Low caregiver health literacy is an independent predictor of higher ED use and use of the ED for non-urgent conditions. In children without a chronic illness, low health literate caregivers had more than three times great odds of presenting for a non-urgent condition than those with adequate health literacy. PMID:24767784

TaEDS1 genes positively regulate resistance to powdery mildew in wheat.

PubMed

Chen, Guiping; Wei, Bo; Li, Guoliang; Gong, Caiyan; Fan, Renchun; Zhang, Xiangqi

2018-04-01

Three EDS1 genes were cloned from common wheat and were demonstrated to positively regulate resistance to powdery mildew in wheat. The EDS1 proteins play important roles in plant basal resistance and TIR-NB-LRR protein-triggered resistance in dicots. Until now, there have been very few studies on EDS1 in monocots, and none in wheat. Here, we report on three common wheat orthologous genes of EDS1 family (TaEDS1-5A, 5B and 5D) and their function in powdery mildew resistance. Comparisons of these genes with their orthologs in diploid ancestors revealed that EDS1 is a conserved gene family in Triticeae. The cDNA sequence similarity among the three TaEDS1 genes was greater than 96.5%, and they shared sequence similarities of more than 99.6% with the respective orthologs from diploid ancestors. The phylogenetic analysis revealed that the EDS1 family originated prior to the differentiation of monocots and dicots, and EDS1 members have since undergone clear structural differentiation. The transcriptional levels of TaEDS1 genes in the leaves were obviously higher than those of the other organs, and they were induced by Blumeria graminis f. sp. tritici (Bgt) infection and salicylic acid (SA) treatment. The BSMV-VIGS experiments indicated that knock-down the transcriptional levels of the TaEDS1 genes in a powdery mildew-resistant variety of common wheat compromised resistance. Contrarily, transient overexpression of TaEDS1 genes in a susceptible common wheat variety significantly reduced the haustorium index and attenuated the growth of Bgt. Furthermore, the expression of TaEDS1 genes in the Arabidopsis mutant eds1-1 complemented its susceptible phenotype to powdery mildew. The above evidences strongly suggest that TaEDS1 acts as a positive regulator and confers resistance against powdery mildew in common wheat.

Analysis of patient flow in the emergency department and the effect of an extensive reorganisation

PubMed Central

Miro, O; Sanchez, M; Espinosa, G; Coll-Vinent, B; Bragulat, E; Milla, J; Wardrope, J

2003-01-01

Objectives: To evaluate the different internal factors influencing patient flow, effectiveness, and overcrowding in the emergency department (ED), as well as the effects of ED reorganisation on these indicators. Methods: The study compared measurements at regular intervals of three hours of patient arrivals and patient flow between two comparable periods (from 10 February to 2 March) of 1999 and 2000. In between, a structural and staff reorganisation of ED was undertaken. The main reason for each patient remaining in ED was recorded and allocated to one of four groups: (1) factors related to ED itself ; (2) factors related to ED-hospital interrelation; (3) factors related to hospital itself; and (4) factors related to neither ED nor hospital. The study measured the number of patients waiting to be seen and the waiting time to be seen as effectiveness markers, as well as the percentage of time that ED was overcrowded, as judged by numerical and functional criteria. Results: Effectiveness of ED was closely related with some ED related and hospital related factors. After the reorganisation, patients who remained in ED because of hospital related or non-ED-non-hospital related factors decreased. ED reorganisation reduced the number of patients waiting to be seen from 5.8 to 2.5 (p<0.001) and waiting time from 87 to 24 minutes (p<0.001). Before the reorganisation, 31% and 48% of the time was considered to be overcrowded in numerical and functional terms respectively. After the reorganisation, these figures were reduced to 8% and 15% respectively (p<0.001 for both). Conclusions: ED effectiveness and overcrowding are not only determined by external pressure, but also by internal factors. Measurement of patient flow across ED has proved useful in detecting these factors and in being used to plan an ED reorganisation. PMID:12642527

Eating disorder-specific health-related quality of life and exercise in college females.

PubMed

Cook, Brian J; Hausenblas, Heather A

2011-11-01

Although eating disorder (ED) symptoms result in reduced quality of life (QOL), research is needed to examine variables that influence this relationship. The purpose of our study was to conceptually examine the relationship among ED-specific QOL, ED symptoms, and exercise behavior. Female university students (N = 387) completed ED-specific QOL, exercise behavior, ED symptoms, and exercise dependence symptoms measures. We found support for the beneficial association of psychological QOL on ED symptoms as well as the detrimental association of exercise dependence on ED symptoms. Our results suggest that improvements in psychological aspects of QOL resulting from exercise may mediate ED symptoms when exercise motivations are not pathological. We discuss further research and intervention implications of our findings.

Affective predictors of the severity and change in eating psychopathology in residential eating disorder treatment: The role of social anxiety.

PubMed

Smith, Kathryn E; Mason, Tyler B; Leonard, Rachel C; Wetterneck, Chad T; Smith, Brad E R; Farrell, Nicholas R; Riemann, Brad C

2018-01-01

Despite evidence documenting relationships between eating disorder (ED) psychopathology, depression, and anxiety, little is known regarding how social anxiety is related to ED symptoms in treatment. Therefore this study examined associations between depression, general anxiety, social anxiety, and ED psychopathology at the beginning and end of treatment (EOT) among patients (N = 380) treated in a residential ED program. Participants completed measures of ED psychopathology and affective variables. Higher depression and general anxiety, but not social anxiety, were related to higher ED psychopathology at baseline. However, social anxiety emerged as a unique predictor of ED psychopathology at EOT such that participants with higher social anxiety evidenced less improvement in ED psychopathology. Findings suggest that social anxiety has specific relevance to treatment in EDs, which may reflect shared mechanisms and underlying deficits in emotion regulation.

Antenatal and Postnatal Psychopathology Among Women with Current and Past Eating Disorders: Longitudinal Patterns

PubMed Central

Easter, Abigail; Solmi, Francessca; Bye, Amanda; Taborelli, Emma; Corfield, Freya; Schmidt, Ulrike; Treasure, Janet; Micali, Nadia

2015-01-01

This study aims to investigate longitudinal patterns of psychopathology during the antenatal and postnatal periods among women with current (C-ED) and past (P-ED) eating disorders. Women were recruited to a prospective longitudinal study: C-ED (n = 31), P-ED (n = 29) and healthy control (HC; n = 57). Anxiety, depression and ED symptoms were measured at four time points: first/second trimester, third trimester, 8 weeks and 6 months postpartum. Linear mixed effects models were used to test for group differences. Women with C-ED and P-ED, in all diagnostic categories, had significantly higher levels of psychopathology at all time points. ED symptoms decreased in the C-ED group, compared with an overall increase in the other two groups but subsequently increased after pregnancy. Overall, depression and state and trait anxiety scores decreased in the C-ED group compared with the HC group throughout the antenatal and postnatal periods. High levels of psychopathology are common throughout the antenatal and postnatal periods among women with current and past ED, and despite some overall reductions, symptoms remain clinically significant. © 2014 The Authors. European Eating Disorders Review published by John Wiley & Sons, Ltd. PMID:25345371

Attitudes and beliefs of emergency department staff regarding alcohol-related presentations.

PubMed

Indig, Devon; Copeland, Jan; Conigrave, Katherine M; Rotenko, Irene

2009-01-01

This study examined emergency department (ED) staff attitudes and beliefs about alcohol-related ED presentations in order to recommend improved detection and brief intervention strategies. The survey was conducted at two inner-Sydney hospital EDs in 2006 to explore ED clinical staff's attitudes, current practice and barriers for managing alcohol-related ED presentations. The sample included N=78 ED staff (54% nurses, 46% doctors), representing a 30% response rate. Management of alcohol-related problems was not routine among ED staff, with only 5% usually formally screening for alcohol problems, only 16% usually conducting brief interventions, and only 27% usually providing a referral to specialist treatment services. Over 85% of ED staff indicated that lack of patient motivation made providing alcohol interventions very difficult. Significant predictors of good self-reported practice among ED staff for patients with alcohol problems included: being a doctor, being confident and having a sense of responsibility towards managing patients with alcohol-related problems. This study reported that many staff lack the confidence or sense of clinical responsibility to fully and appropriately manage ED patients with alcohol-related problems. ED staff appear to require additional training, resources and support to enhance their management of patients with alcohol-related problems.

Ambient versus traditional environment in pediatric emergency department.

PubMed

Robinson, Patricia S; Green, Jeanette

2015-01-01

We sought to examine the effect of exposure to an ambient environment in a pediatric emergency department. We hypothesized that passive distraction from ambient lighting in an emergency department would lead to reduction in patient pain and anxiety and increased caregiver satisfaction with services. Passive distraction has been associated with lower anxiety and pain in patients and affects perception of wait time. A pediatric ED was designed that optimized passive distraction techniques using colorful ambient lighting. Participants were nonrandomly assigned to either an ambient ED environment or a traditional ED environment. Entry and exit questionnaires assessed caregiver expectations and experiences. Pain ratings were obtained with age-appropriate scales, and wait times were recorded. A total of 70 participants were assessed across conditions, that is, 40 in the ambient ED group and 30 in the traditional ED group. Caregivers in the traditional ED group expected a longer wait, had higher anxiety pretreatment, and felt more scared than those in the ambient ED group. Caregivers in the ambient ED group felt more included in the care of their child and rated quality of care higher than caregivers in the traditional ED group. Pain ratings and administrations of pain medication were lower in the ambient ED group. Mean scores for the ambient ED group were in the expected direction on several items measuring satisfaction with ED experiences. Results were suggestive of less stress in caregivers, less pain in patients, and higher satisfaction levels in the ambient ED group. © The Author(s) 2015.

Analysis of Consumption of Energy Drinks by a Group of Adolescent Athletes.

PubMed

Nowak, Dariusz; Jasionowski, Artur

2016-07-29

Energy drinks (EDs) have become widely popular among young adults and, even more so, among adolescents. Increasingly, they are consumed by athletes, particularly those who have just begun their sporting career. Uncontrolled and high consumption of EDs, in addition to other sources of caffeine, may pose a threat to the health of young people. Hence, our objective was to analyze the consumption of EDs among teenagers engaged in sports, including quantity consumed, identification of factors influencing consumption, and risks associated with EDs and EDs mixed with alcohol (AmEDs). The study involved a specially designed questionnaire, which was completed by 707 students, 14.3 years of age on average, attending secondary sports schools. EDs were consumed by 69% of the young athletes, 17% of whom drank EDs quite often: every day or 1-3 times a week. Most respondents felt no effects after drinking EDs, but some reported symptoms, including insomnia, anxiety, tachycardia, nervousness and irritability. The major determinant of the choice of EDs was taste (47%), followed by price (21%). One in ten respondents admitted to consumption of AmEDs. Among the consequences reported were: abdominal pains, nausea, vomiting, amnesia, headache, and hangover. EDs consumption among adolescent athletes was relatively high. Considering the habit of AmEDs and literature data, it is worth emphasizing that it may lead to health problems in the near future, alcohol- or drug-dependence, as well as other types of risk behaviour.

Cost of health care utilization among homeless frequent emergency department users.

PubMed

Mitchell, Matthew S; León, Casey L K; Byrne, Thomas H; Lin, Wen-Chieh; Bharel, Monica

2017-05-01

Research demonstrates that homelessness is associated with frequent use of emergency department (ED) services, yet prior studies have not adequately examined the relationship between frequent ED use and utilization of non-ED health care services among those experiencing homelessness. There has also been little effort to assess heterogeneity among homeless individuals who make frequent use of ED services. To address these gaps, the present study used Medicaid claims data from 2010 to estimate the association between the number of ED visits and non-ED health care costs for a cohort of 6,338 Boston Health Care for the Homeless Program patients, and to identify distinct subgroups of persons in this cohort who made frequent use of ED services based on their clinical and demographic characteristics. A series of gamma regression models found more frequent ED use to be associated with higher non-ED costs, even after adjusting for demographic and clinical characteristics. Latent class analysis was used to examine heterogeneity among frequent ED users, and the results identified 6 characteristically distinct subgroups among these persons. The subgroup of persons with trimorbid illness had non-ED costs that far exceeded members of all 5 other subgroups. Study findings reinforce the connection between frequent ED use and high health care costs among homeless individuals and suggest that different groups of homeless frequent ED users may benefit from interventions that vary in terms of their composition and intensity. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Analysis of Consumption of Energy Drinks by a Group of Adolescent Athletes

PubMed Central

Nowak, Dariusz; Jasionowski, Artur

2016-01-01

Background: Energy drinks (EDs) have become widely popular among young adults and, even more so, among adolescents. Increasingly, they are consumed by athletes, particularly those who have just begun their sporting career. Uncontrolled and high consumption of EDs, in addition to other sources of caffeine, may pose a threat to the health of young people. Hence, our objective was to analyze the consumption of EDs among teenagers engaged in sports, including quantity consumed, identification of factors influencing consumption, and risks associated with EDs and EDs mixed with alcohol (AmEDs). Methods: The study involved a specially designed questionnaire, which was completed by 707 students, 14.3 years of age on average, attending secondary sports schools. Results: EDs were consumed by 69% of the young athletes, 17% of whom drank EDs quite often: every day or 1–3 times a week. Most respondents felt no effects after drinking EDs, but some reported symptoms, including insomnia, anxiety, tachycardia, nervousness and irritability. The major determinant of the choice of EDs was taste (47%), followed by price (21%). One in ten respondents admitted to consumption of AmEDs. Among the consequences reported were: abdominal pains, nausea, vomiting, amnesia, headache, and hangover. Conclusions: EDs consumption among adolescent athletes was relatively high. Considering the habit of AmEDs and literature data, it is worth emphasizing that it may lead to health problems in the near future, alcohol- or drug-dependence, as well as other types of risk behaviour. PMID:27483299

Travel distance and sociodemographic correlates of potentially avoidable emergency department visits in California, 2006-2010: an observational study.

PubMed

Chen, Brian K; Hibbert, James; Cheng, Xi; Bennett, Kevin

2015-03-21

Use of the hospital emergency department (ED) for medical conditions not likely to require immediate treatment is a controversial topic. It has been faulted for ED overcrowding, increased expenditures, and decreased quality of care. On the other hand, such avoidable ED utilization may be a manifestation of barriers to primary care access. A random 10% subsample of all ED visits with unmasked variables, or approximately 7.2% of all ED visits in California between 2006 and 2010 are used in the analysis. Using panel data methods, we employ linear probability and fractional probit models with hospital fixed effects to analyze the associations between avoidable ED utilization in California and observable patient characteristics. We also test whether shorter estimated road distances to the hospital ED are correlated with non-urgent ED utilization, as defined by the New York University ED Algorithm. We then investigate whether proximity of a Federally Qualified Health Center (FQHC) is correlated with reductions in non-urgent ED utilization among Medicaid patients. We find that relative to the reference group of adults aged 35-64, younger patients generally have higher scores for non-urgent conditions and lower scores for urgent conditions. However, elderly patients (≥65) use the ED for conditions more likely to be urgent. Relative to male and white patients, respectively, female patients and all identified racial and ethnic minorities use the ED for conditions more likely to be non-urgent. Patients with non-commercial insurance coverage also use the ED for conditions more likely to be non-urgent. Medicare and Medicaid patients who live closer to the hospital ED have higher probability scores for non-emergent visits. However, among Medicaid enrollees, those who live in zip codes with an FQHC within 0.5 mile of the zip code population centroid visit the ED for medical conditions less likely to be non-emergent. These patterns of ED utilization point to potential barriers to care among historically vulnerable groups, observable even when using rough estimates of travel distances and avoidable ED utilization.

Analysis of Inappropriate Admissions of Residents of Medicalized Nursing Homes to Emergency Departments: A Prospective Multicenter Study in Burgundy.

PubMed

Manckoundia, Patrick; Menu, Didier; Turcu, Alin; Honnart, Didier; Rossignol, Sylvie; Alixant, Jean-Christophe; Sylvestre, Franck-Henry; Bailly, Vanessa; Dion, Michèle; Putot, Alain

2016-07-01

To determine the rate of inappropriate admissions to emergency departments (EDs) and to identify determinants of these admissions. Prospective multicenter study. Burgundy (France), EDs and medical nursing homes (MNHs). 1000 Burgundy MNH residents admitted to EDs, from April 17 to June 20, 2013. For each subject, a questionnaire was completed. Data included age, gender, type of health professional who referred the resident to the ED (THP), whether or not a medical dispatcher organized the transfer to the ED, transport mode, reason for admission to the ED, level of independence according to the Groupes Iso-Ressource score (GIRS), and diagnosis made in the ED. The French version of the Appropriateness Evaluation Protocol grid was applied to each admission to the ED, and in some situations, the expert committee ruled on the appropriateness of the admission to the ED. MNH characteristics were also recorded. Two groups were constituted according to the appropriateness or not of admission to the ED. Mean age of the 1000 residents was 87. There were 706 women. Two-thirds were referred to the EDs by a physician, mainly a general practitioner. In 91.7%, the transfer to the ED was organized by a medical dispatcher, and 8.8% were transported by medicalized transport. More than 95% had a GIRS ≤4. Among the admissions to EDs, 18.1% were inappropriate. Female gender (P = .017), nonmedicalized transport (P = .002), public MNH (P = .044), and nonaccess to a geriatric opinion in an emergency (P = .043) were determinants of inappropriate admission to EDs. In this first study on admissions to EDs of MNH residents using French data, we found a lower rate of admissions to the ED than that reported in the literature. Female gender, nonmedicalized transport, public MNH, and nonaccess to a geriatric opinion in an emergency were associated with inappropriate admission to EDs. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Portrait of rural emergency departments in Québec and utilization of the provincial emergency department management Guide: cross sectional survey.

PubMed

Fleet, Richard; Poitras, Julien; Archambault, Patrick; Tounkara, Fatoumata Korika; Chauny, Jean-Marc; Ouimet, Mathieu; Gauthier, Josée; Dupuis, Gilles; Tanguay, Alain; Lévesque, Jean-Frédéric; Simard-Racine, Geneviève; Haggerty, Jeannie; Légaré, France

2015-12-23

Rural emergency departments (EDs) constitute crucial safety nets for the 20% of Canadians who live in rural areas. Pilot data suggests that the province of Québec appears to provide more comprehensive access to services than do other provinces. A difference that may be attributable to provincial policy/guidelines "the provincial ED management Guide". The aim of this study was to provide a detailed description of rural EDs in Québec and utilization of the provincial ED management Guide. We selected EDs offering 24/7 medical coverage, with hospitalization beds, located in rural or small towns. We collected data via telephone, paper, and online surveys with rural ED/hospital staff. Data were also collected from Québec's Ministry of Health databases and from Statistics Canada. We computed descriptive statistics, ANOVA and t-tests were used to examine the relationship between ED census, services and inter-facility transfer requirements. A total of 23 of Québec's 26 rural EDs (88%) consented to participate in the study. The mean annual ED visits was 18 813 (Standard Deviation = 6 151). Thirty one percent of ED physicians were recent graduates with fewer than 5 years of experience. Only 6 % had residency training or certification in emergency medicine. Teams have good local access (24/7) to diagnostic equipment such as CT scanner (74%), intensive unit care (78%) and general surgical services (78%), but limited access to other consultants. Sixty one percent of participants have reported good knowledge of the provincial ED management Guide, but only 23% of them have used the guidelines. Furthermore, more than 40% of EDs were more than 300 km from levels 1 to 2 trauma centers, and only 30% had air transport access. Rural EDs in Québec are staffed by relatively new graduates working as solo physicians in well-resourced and moderately busy (by rural standards) EDs. The provincial ED management Guide may have contributed to this model of service attribution. However, the majority of rural ED staff report limited knowledge or use of the provincial ED management Guide and increased efforts at disseminating this Guide are warranted.

A comparative, epidemiological study of acute renal colic presentations to emergency departments in Doha, Qatar, and Melbourne, Australia.

PubMed

Pathan, Sameer A; Mitra, Biswadev; Bhutta, Zain A; Qureshi, Isma; Spencer, Elle; Hameed, Asmaa A; Nadeem, Sana; Tahir, Ramsha; Anjum, Shahzad; Cameron, Peter A

2018-01-03

This study aimed to compare the epidemiology, clinical presentations, management, and outcomes of renal colic presentations in two major academic centers from geographically diverse populations: Qatar (a country in the Afro-Asian stone belt) and South-Eastern Australia (not within a stone belt). We undertook a retrospective cohort study of patients with renal colic who presented to the Hamad General Hospital Emergency Department (HGH-ED), Qatar, and The Alfred ED, Melbourne, Australia, during a period of 1 year from August 1, 2012, to July 31, 2013. Cases were identified using ICD-9-CM codes, and an electronic template was used to record the data on predefined clinical variables. A total of 12,223 from the HGH-ED and 384 from The Alfred ED were identified as renal colic presentations during the study period. The rate of renal colic presentations at the HGH-ED was 27.9 per 1000 ED visits compared to 6.7 per 1000 ED visits at The Alfred ED. Patients presenting to the HGH-ED were significantly younger [34.9 years (29.0-43.4) than The Alfred ED [48 years (37-60); P < 0.001]. The median stone size was larger in the HGH-ED group [6 (4-8) mm] versus The Alfred ED group [4 (3-6) mm, P < 0.001]. The intervention rate in the stone-positive population was significantly higher in the HGH-ED group as opposed to The Alfred ED group (38.7 versus 11.9%, P < 0.001). At the time of discharge, The Alfred ED group received fewer analgesic prescriptions (55.8 versus 83.5%, P < 0.001) and more tamsulosin prescriptions (25.3 versus 11.7%, P < 0.001). Renal colic presentations to the HGH-ED, Qatar, were younger, with larger stone size mostly located in the lower ureter, compared to The Alfred ED, Melbourne, Australia. The findings suggest that the benefits of treatment including medical expulsion therapy will vary between the two populations. Differences in epidemiology and patient mix should be considered while tailoring strategies for effective management of patients with renal colic in a given setting.

Economic comparison of reproductive programs for dairy herds using estrus detection, timed artificial insemination, or a combination.

PubMed

Galvão, K N; Federico, P; De Vries, A; Schuenemann, G M

2013-04-01

The objective of this study was to compare the economic outcome of reproductive programs using estrus detection (ED), timed artificial insemination (TAI), or a combination of both (TAI-ED) using a stochastic dynamic Monte-Carlo simulation model. Programs evaluated were (1) ED only; (2) TAI: Presynch-Ovsynch for first AI, and Ovsynch for resynchronization of open cows at 32 d after AI; (3) TAI-ED: Presynch-Ovsynch for first AI, but cows underwent ED and AI after first AI, and cows diagnosed open 32 d after AI were resynchronized using Ovsynch. Evaluated were the effect of ED rate (40 vs. 60%; ED40 or ED60), accuracy of estrus detection (85 vs. 95%), compliance with the timed AI protocol (85 vs. 95%), and milk price ($0.33 vs. 0.44/kg). Conception rate to first service was set at 33.9% and then decreased by 2.6% for every subsequent service. Abortion was set at 11.3%. Cows were not AI after 366 d in milk, and open cows were culled after 450 d in milk. Culled cows were immediately replaced. Herd size was maintained at 1,000 cows, and the model accounted for all incomes and costs. Simulation was performed until steady state was reached (3,000 d), and then average daily values for the subsequent 2,000 d were used to calculate profit/cow per year. Net daily value was calculated by subtracting the costs (replacement, feeding, breeding, and other costs) from the daily income (milk sales, cow sales, and calf sales). The ED40 models resulted in greater profits than the TAI-85 model but lower profits than the TAI-95 model. Both ED60 models resulted in greater profits than the TAI-95 model. Combining TAI and ED increased profits within each level of accuracy or compliance. Adding TAI to ED would increase overall profit/cow per year by $46.8 to $74.7 with 40% ED, and by $8.9 to $30.5 with 60% ED. Adding ED to TAI would increase profit/cow per year by $64.2 to $99.4 with 85% compliance and by $31.8 to $59.7 with 95% compliance. Although combining TAI and ED increased profits within each level of accuracy or compliance, when evaluated separately, ED60 with 95% accuracy or TAI with 95% compliance were as profitable as or more profitable than TAI-ED with low ED, accuracy, or compliance. Therefore, producers can improve their profits by combining TAI and ED as reproductive management; however, if a herd can achieve high ED with high accuracy or have high compliance with injections, using only ED or TAI might be more profitable than trying to do both. Copyright © 2013 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

New Zealand's emergency department target - did it reduce ED length of stay, and if so, how and when?

PubMed

Tenbensel, Tim; Chalmers, Linda; Jones, Peter; Appleton-Dyer, Sarah; Walton, Lisa; Ameratunga, Shanthi

2017-09-26

In 2009, the New Zealand government introduced a hospital emergency department (ED) target - 95% of patients seen, treated or discharged within 6 h - in order to alleviate crowding in public hospital EDs. While these targets were largely met by 2012, research suggests that such targets can be met without corresponding overall reductions in ED length-of-stay (LOS). Our research explores whether the NZ ED time target actually reduced ED LOS, and if so, how and when. We adopted a mixed-methods approach with integration of data sources. After selecting four hospitals as case study sites, we collected all ED utilisation data for the period 2006 to 2012. ED LOS data was derived in two forms-reported ED LOS, and total ED LOS - which included time spent in short-stay units. This data was used to identify changes in the length of ED stay, and describe the timing of these changes to these indicators. Sixty-eight semi-structured interviews and two surveys of hospital clinicians and managers were conducted between 2011 and 2013. This data was then explored to identify factors that could account for ED LOS changes and their timing. Reported ED LOS reduced in all sites after the introduction of the target, and continued to reduce in 2011 and 2012. However, total ED LOS only decreased from 2008 to 2010, and did not reduce further in any hospital. Increased use of short-stay units largely accounted for these differences. Interview and survey data showed changes to improve patient flow were introduced in the early implementation period, whereas increased ED resources, better information systems to monitor target performance, and leadership and social marketing strategies mainly took throughout 2011 and 2012 when total ED LOS was not reducing. While the ED target clearly stimulated improvements in patient flow, our analysis also questions the value of ED targets as a long term approach. Increased use of short-stay units suggests that the target became less effective in 'standing for' improved timeliness of hospital care in response to increasing acute demand. As such, the overall challenges in managing demand for acute and urgent care in New Zealand hospitals remain.

Impact of the Four-Hour Rule in Western Australian hospitals: Trend analysis of a large record linkage study 2002-2013

PubMed Central

Ngo, Hanh; Forero, Roberto; Mountain, David; Fatovich, Daniel; Man, Wing Nicola; Sprivulis, Peter; Mohsin, Mohammed; Toloo, Sam; Celenza, Antonio; Fitzgerald, Gerard; McCarthy, Sally; Hillman, Ken

2018-01-01

Background In 2009, the Western Australian (WA) Government introduced the Four-Hour Rule (FHR) program. The policy stated that most patients presenting to Emergency Departments (EDs) were to be seen and either admitted, transferred, or discharged within 4 hours. This study utilised de-identified data from five participating hospitals, before and after FHR implementation, to assess the impact of the FHR on several areas of ED functioning. Methods A state (WA) population-based intervention study design, using longitudinal data obtained from administrative health databases via record linkage methodology, and interrupted time series analysis technique. Findings There were 3,214,802 ED presentations, corresponding to 1,203,513 ED patients. After the FHR implementation, access block for patients admitted through ED for all five sites showed a significant reduction of up to 13.2% (Rate Ratio 0.868, 95%CI 0.814, 0.925) per quarter. Rate of ED attendances for most hospitals continued to rise throughout the entire study period and were unaffected by the FHR, except for one hospital. Pattern of change in ED re-attendance rate post-FHR was similar to pre-FHR, but the trend reduced for two hospitals. ED occupancy was reduced by 6.2% per quarter post-FHR for the most ‘crowded’ ED. ED length of stay and ED efficiency improved in four hospitals and deteriorated in one hospital. Time to being seen by ED clinician and Did-Not-Wait rate improved for some hospitals. Admission rates in post-FHR increased, by up to 1% per quarter, for two hospitals where the pre-FHR trend was decreasing. Conclusions The FHR had a consistent effect on ‘flow’ measures: significantly reducing ED overcrowding and access block and enhancing ED efficiency. Time-based outcome measures mostly improved with the FHR. There is some evidence of increased ED attendance, but no evidence of increased ED re-attendance. Effects on patient disposition status were mixed. Overall, this reflects the value of investing resources into the ED/hospital system to improve efficiency and patient experience. Further research is required to illuminate the exact mechanisms of the effects of FHR on the ED and hospital functioning across Australia. PMID:29538401

Physician Impressions of Physical Therapist Practice in the Emergency Department: Descriptive, Comparative Analysis Over Time.

PubMed

Fruth, Stacie J; Wiley, Steve

2016-09-01

Emergency department (ED) use in the United States is expected to rapidly increase. Nearly half of all ED visits are classified as semiurgent or nonurgent, and many fall into the musculoskeletal category. Despite growing international evidence that patients are appropriately and safely managed by ED physical therapists in a time-efficient manner, physical therapist practice in EDs is not widely understood or utilized in the United States. To date, no studies have reported the impressions of ED physicians about this practice. The purposes of this study were: (1) to assess ED physicians' impressions of ED physical therapist practice 2 years after practice was initiated and (2) to determine whether physicians' impressions changed 7 years later. All ED staff physicians and medical residents at a level I trauma hospital were invited to complete a survey in 2004 and 2011. In both years, a majority of physicians reported favorable impressions of ED physical therapist practice. Physical therapists were valued for educating patients about safety and injury prevention, providing appropriate gait training, assisting with disposition planning, and providing interventions as alternatives to pain medication. Many physicians supported standing physical therapist orders for certain musculoskeletal conditions. The most common concern was the additional time that patients spend in the ED for a physical therapist consult. The results of this study may not reflect the impressions of physicians in all EDs that employ physical therapists. Emergency department physicians reported favorable impressions of ED physical therapist practice 2 years and 9 years following its implementation in this hospital. This study showed that ED physicians support standing physical therapist orders for certain musculoskeletal conditions, which suggests that direct triage to ED physical therapists for these conditions could be considered. © 2016 American Physical Therapy Association.

Frequent use of emergency departments by older people: a comparative cohort study of characteristics and outcomes.

PubMed

Street, Maryann; Berry, Debra; Considine, Julie

2018-04-12

To characterise older people who frequently use emergency departments (EDs) and compare patient outcomes with older non-frequent ED attenders. Retrospective comparative cohort study. Logistic regression modelling of patient characteristics and health service usage, comparing older frequent ED attenders (≥4 ED attendances in 12 months) to non-frequent ED attenders. Three Australian public hospital EDs, with a total of 143 327 emergency attendances in the 12 months. People aged ≥65 years attending the ED in financial year 2013/2014. The primary outcome was frequent ED use; secondary outcomes were ED length of stay, discharge destination from ED, hospital length of stay, re-presentation within 48 h, hospital readmission within 30 days and in-hospital mortality. Five percent of older people were frequent attenders (n = 1046/21 073), accounting for 16.9% (n = 5469/32 282) of all attendances by older people. Frequent ED attenders were more likely to be male, aged 75-84 years, arrive by ambulance and have a diagnosis relating to chronic illness. Frequent attenders stayed 0.4 h longer in ED (P < 0.001), were more likely to be admitted to hospital (69.2% vs 67.2%; P = 0.004), and had a 1 day longer hospital stay (P < 0.001). In-hospital mortality for older frequent ED attenders was double that of non-frequent attenders (7.0% vs 3.2%, P < 0.001) over 12 months. Older frequent ED attenders had more chronic disease and care needs requiring hospital admission than non-frequent attenders. A new approach to care planning and coordination is recommended, to optimise the patient journey and improve outcomes.

Feasibility of an ED-to-Home Intervention to Engage Patients: A Mixed-Methods Investigation.

PubMed

Schumacher, Jessica R; Lutz, Barbara J; Hall, Allyson G; Pines, Jesse M; Jones, Andrea L; Hendry, Phyllis; Kalynych, Colleen; Carden, Donna L

2017-06-01

Older, chronically ill patients with limited health literacy are often under-engaged in managing their health and turn to the emergency department (ED) for healthcare needs. We tested the impact of an ED-initiated coaching intervention on patient engagement and follow-up doctor visits in this high-risk population. We also explored patients' care-seeking decisions. We conducted a mixed-methods study including a randomized controlled trial and in-depth interviews in two EDs in northern Florida. Participants were chronically ill older ED patients with limited health literacy and Medicare as a payer source. Patients were assigned to an evidence-based coaching intervention (n= 35) or usual post-ED care (n= 34). Qualitative interviews (n=9) explored patients' reasons for ED use. We assessed average between-group differences in patient engagement over time with the Patient Activation Measure (PAM) tool, using logistic regression and a difference-in-difference approach. Between-group differences in follow-up doctor visits were determined. We analyzed qualitative data using open coding and thematic analysis. PAM scores fell in both groups after the ED visit but fell significantly more in "usual care" (average decline -4.64) than "intervention" participants (average decline -2.77) (β=1.87, p=0.043). There were no between-group differences in doctor visits. Patients described well-informed reasons for ED visits including onset and severity of symptoms, lack of timely provider access, and immediate and comprehensive ED care. The coaching intervention significantly reduced declines in patient engagement observed after usual post-ED care. Patients reported well-informed reasons for ED use and will likely continue to make ED visits unless strategies, such as ED-initiated coaching, are implemented to help vulnerable patients better manage their health and healthcare.

Temporal trends in emergency department visits for bronchiolitis in the United States, 2006 to 2010.

PubMed

Hasegawa, Kohei; Tsugawa, Yusuke; Brown, David F M; Mansbach, Jonathan M; Camargo, Carlos A

2014-01-01

To examine temporal trends in emergency departments (EDs) visits for bronchiolitis among US children between 2006 and 2010. Serial, cross-sectional analysis of the Nationwide Emergency Department Sample, a nationally representative sample of ED patients. We used International Classification of Diseases, Ninth Revision, Clinical Modification code 466.1 to identify children <2 years of age with bronchiolitis. Primary outcome measures were rate of bronchiolitis ED visits, hospital admission rate and ED charges. Between 2006 and 2010, weighted national discharge data included 1,435,110 ED visits with bronchiolitis. There was a modest increase in the rate of bronchiolitis ED visits, from 35.6 to 36.3 per 1000 person-years (2% increase; Ptrend = 0.008), due to increases in the ED visit rate among children from 12 months to 23 months (24% increase;Ptrend < 0.001). By contrast, there was a significant decline in the ED visit rate among infants (4% decrease; Ptrend < 0.001). Although unadjusted admission rate did not change between 2006 and 2010 (26% in both years), admission rate declined significantly after adjusting for potential patient- and ED-level confounders (adjusted odds ratio for comparison of 2010 with 2006, 0.84; 95% confidence interval: 0.76-0.93; P < 0.001). Nationwide ED charges for bronchiolitis increased from $337 million to $389 million (16% increase; Ptrend < 0.001), adjusted for inflation. This increase was driven by a rise in geometric mean of ED charges per case from $887 to $1059 (19% increase; Ptrend < 0.001). Between 2006 and 2010, we found a divergent temporal trend in the rate of bronchiolitis ED visits by age group. Despite a significant increase in associated ED charges, ED-associated hospital admission rates for bronchiolitis significantly decreased over this same period.

Alcohol mixed with energy drinks: Associations with risky drinking and functioning in high school.

PubMed

Tucker, Joan S; Troxel, Wendy M; Ewing, Brett A; D'Amico, Elizabeth J

2016-10-01

Mixing alcohol with energy drinks is associated with heavier drinking and related problems among college students. However, little is known about how high school drinkers who mix alcohol with energy drinks (AmED) compare to those who do not (AwoED). This study compares high school AmED and AwoED users on their alcohol use during middle and high school, as well as key domains of functioning in high school. Two surveys were conducted three years apart in adolescents initially recruited from 16 middle schools in Southern California. The analytic sample consists of 696 past month drinkers. Multivariable models compared AmED and AwoED users on alcohol use, mental health, social functioning, academic orientation, delinquency and other substance use at age 17, and on their alcohol use and related cognitions at age 14. AmED was reported by 13% of past month drinkers. AmED and AwoED users did not differ on alcohol use or cognitions in middle school, but AmED users drank more often, more heavily, and reported more negative consequences in high school. AmED users were also more likely to report poor grades, delinquent behavior, substance use-related unsafe driving, public intoxication, and drug use than AwoED users in high school. Group differences were not found on mental health, social functioning, or academic aspirations. AmED use is common among high school drinkers. The higher risk behavioral profile of these young AmED users, which includes drug use and substance use-related unsafe driving, is a significant cause for concern and warrants further attention. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The meaning of (quality of) life in patients with eating disorders: a comparison of generic and disease-specific measures across diagnosis and outcome.

PubMed

Ackard, Diann M; Richter, Sara; Egan, Amber; Engel, Scott; Cronemeyer, Catherine L

2014-04-01

Compare general and disease-specific health-related quality of life (HRQoL) among female patients with an eating disorder (ED). Female patients (n = 221; 95.3% Caucasian; 94.0% never married) completed the Medical Outcome Short Form Health Survey (SF-36) and Eating Disorders Quality of Life (EDQoL) as part of a study of treatment outcomes. Multivariate regression models were used to compare HRQoL differences across initial ED diagnosis (85 AN-R, 19 AN-B/P, 27 BN, 90 EDNOS) and ED diagnostic classification at time of outcome assessment (140 no ED, 38 subthreshold ED, 43 full threshold ED). There were no significant differences across ED diagnosis at initial assessment on either of the SF-36 Component Summary scores. However, patients with AN-B/P scored poorer on the work/school EDQoL subscales than other ED diagnoses, and on the psychological EDQoL subscale compared to AN-R and EDNOS. At outcome assessment, comparisons across full threshold, subthreshold and no ED classification indicated that those with no ED reported better HRQoL than those with full threshold ED on the SF-36 Mental Components Summary and three of four EDQoL subscales. Furthermore, those with no ED reported better psychological HRQoL than those with subthreshold ED. Disease-specific HRQOL measures are important to use when comparing HRQoL in ED patients across treatment and outcome, and may have the sensitivity to detect meaningful differences by diagnosis more so than generic instruments. EDQoL scores from patients remitted from symptoms approach but do not reach scores for unaffected college females; thus, treatment should continue until quality of life is restored. Copyright © 2013 Wiley Periodicals, Inc.

Feasibility of an ED-to-Home Intervention to Engage Patients: A Mixed-Methods Investigation

PubMed Central

Schumacher, Jessica R.; Lutz, Barbara J.; Hall, Allyson G.; Pines, Jesse M.; Jones, Andrea L.; Hendry, Phyllis; Kalynych, Colleen; Carden, Donna L.

2017-01-01

Introduction Older, chronically ill patients with limited health literacy are often under-engaged in managing their health and turn to the emergency department (ED) for healthcare needs. We tested the impact of an ED-initiated coaching intervention on patient engagement and follow-up doctor visits in this high-risk population. We also explored patients’ care-seeking decisions. Methods We conducted a mixed-methods study including a randomized controlled trial and in-depth interviews in two EDs in northern Florida. Participants were chronically ill older ED patients with limited health literacy and Medicare as a payer source. Patients were assigned to an evidence-based coaching intervention (n= 35) or usual post-ED care (n= 34). Qualitative interviews (n=9) explored patients’ reasons for ED use. We assessed average between-group differences in patient engagement over time with the Patient Activation Measure (PAM) tool, using logistic regression and a difference-in-difference approach. Between-group differences in follow-up doctor visits were determined. We analyzed qualitative data using open coding and thematic analysis. Results PAM scores fell in both groups after the ED visit but fell significantly more in “usual care” (average decline −4.64) than “intervention” participants (average decline −2.77) (β=1.87, p=0.043). There were no between-group differences in doctor visits. Patients described well-informed reasons for ED visits including onset and severity of symptoms, lack of timely provider access, and immediate and comprehensive ED care. Conclusion The coaching intervention significantly reduced declines in patient engagement observed after usual post-ED care. Patients reported well-informed reasons for ED use and will likely continue to make ED visits unless strategies, such as ED-initiated coaching, are implemented to help vulnerable patients better manage their health and healthcare. PMID:28611897

The association of weather on pediatric emergency department visits in Changwon, Korea (2005-2014).

PubMed

Lee, Hae Jeong; Jin, Mi Hyeon; Lee, Jun Hwa

2016-05-01

It is widely believed that patients are less likely to visit hospitals during bad weather. We hypothesized that weather and emergency department (ED) visits are associated. Thus, we investigated the association between pediatric ED visits and weather, and sought to determine whether admissions to the ED are affected by meteorological factors. We retrospectively analyzed all 87,242 emergency visits to Samsung Changwon Hospital by pediatric patients under 19years of age from January 2005 to December 2014. ED visits were categorized by disease. We used Poisson regression and generalized linear model to examine the relationships between current weather and ED visits. Additionally a distributed lag non-linear model was used to investigate the effect of weather on ED visits. During this 10-year study period, the average temperature and diurnal temperature range (DTR) were 14.7°C and 8.2°C, respectively. There were 1,145days of rain or snow (31.4%) during the 3,652-day study period. The volume of ED visits decreased on days of rain or snow. Additionally ED visits increased 2days after rainy or snowy days. The volume of ED visits increased 1.013 times with every 1°C increase in DTR. The volume of ED visits by patients with trauma, digestive diseases, and respiratory diseases increased when DTR was over 10°C. As rainfall increased to over 25mm, the ward admission rate (23.8%, p=0.018) of ED patients increased significantly. The volume of ED visits decreased on days of rain or snow and the ED visits were increased 2days after rainy or snowy days. The volume of ED visits increased for every 1°C increase in DTR. Copyright © 2016. Published by Elsevier B.V.

A multicenter observational study of US adults with acute asthma: who are the frequent users of the emergency department?

PubMed

Hasegawa, Kohei; Sullivan, Ashley F; Tovar Hirashima, Eva; Gaeta, Theodore J; Fee, Christopher; Turner, Stuart J; Massaro, Susan; Camargo, Carlos A

2014-01-01

Despite the substantial burden of asthma-related emergency department (ED) visits, there have been no recent multicenter efforts to characterize this high-risk population. We aimed to characterize patients with asthma according to their frequency of ED visits and to identify factors associated with frequent ED visits. A multicenter chart review study of 48 EDs across 23 US states. We identified ED patients ages 18 to 54 years with acute asthma during 2011 and 2012. Primary outcome was frequency of ED visits for acute asthma in the past year, excluding the index ED visit. Of the 1890 enrolled patients, 863 patients (46%) had 1 or more (frequent) ED visits in the past year. Specifically, 28% had 1 to 2 visits, 11% had 3 to 5 visits, and 7% had 6 or more visits. Among frequent ED users, guideline-recommended management was suboptimal. For example, of patients with 6 or more ED visits, 85% lacked evidence of prior evaluation by an asthma specialist, and 43% were not treated with inhaled corticosteroids. In a multivariable model, significant predictors of frequent ED visits were public insurance, no insurance, and markers for chronic asthma severity (all P < .05). Stronger associations were found among those with a higher frequency of asthma-related ED visits (eg, 6 or more ED visits). This multicenter study of US adults with acute asthma demonstrated many frequent ED users and suboptimal preventive management in this high-risk population. Future reductions in asthma morbidity and associated health care utilization will require continued efforts to bridge these major gaps in asthma care. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Patient nonadherence to filling discharge medication prescriptions from the emergency department: Barriers and clinical implications.

PubMed

Farris, Brian; Shakowski, Courtney; Mueller, Scott W; Phong, Suzanne; Kiser, Tyree H; Jacknin, Gabrielle

2018-03-01

Barriers to and clinical implications of patient nonadherence to filling discharge medication prescriptions from the emergency department (ED) were evaluated. This was a retrospective, observational analysis of patients discharged from the ED from April 2013 through May 2015 with medication prescriptions. Patients age 18-89 years who were seen in the ED and did not retrieve discharge medication prescriptions from the onsite, 24-hour ED discharge pharmacy were included in this study. Patients who did not pick up prescriptions were called and asked about barriers to prescription filling. These charts were then retrospectively reviewed and categorized. The primary study outcome was the frequency of nonadherence to filling discharge medications prescribed during the ED visit at the ED outpatient pharmacy. Secondary outcomes included identifying barriers to medication adherence, the rate of return ED visits within 30 days of ED discharge, and the rate of 30-day hospital admissions. Associations between patient and medication variables and the rates of return ED visits within 30 days of discharge and 30-day hospital admissions were analyzed. Of the 4,444 patients discharged from the ED with a prescription to be filled at the satellite pharmacy, 510 were nonadherent. Of these patients, 505 had complete chart information available for evaluation. A large proportion of nonadherent patients revisited the ED within 30 days of ED discharge. Multivariate logistic regression found payer class, ethnicity, and sex were independently associated with return ED visits. The majority of patients who received a prescription during an ED visit filled their discharge medications. Sex, ethnicity, and payer class were independently associated with nonadherence. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Risk of eating disorders in a non-western setting: an exploratory study in Khartoum state, Sudan.

PubMed

Lau, Charlotte C L; Ambrosino, Elena

2017-12-01

Recent research suggests an emergence of eating disorders [ED] in non-western settings for unknown reasons. This research investigates the presence of ED in Khartoum State [Sudan], and explores relevant factors amongst women at risk of ED and stakeholders involved with mental health care and policy-making. Women from four summer schools were approached and screened for risk of ED using a validated and adapted form of the Eating Attitudes Test-26. Focus groups were performed within the schools, selected participants at high risk were interviewed, and interviews with stakeholders were performed. Around a third (32.6%) of participants scored as having high risk of ED. Interviews showed recurring themes determining eating attitudes including: intention, knowledge, environment and habit. Stakeholders' opinions depended on whether they work directly with those affected by ED or in policy-making. The former advocated increased attention on ED, the latter did not. Overall, services for ED were lacking. A high presence of negative eating attitudes was found amongst screened participants with high risk of ED. Individual intention overrides all other determinants for abnormal eating. Moreover, evidence suggests that westernization may attribute to ED, supporting the view that ED are culturally bound. The differing stakeholders' views, together with other data found in this study, allow a number of recommendations for increasing awareness and identification of ED in Sudan.

Emergency Department Length of Stay: Accuracy of Patient Estimates

PubMed Central

Parker, Brendan T.; Marco, Catherine

2014-01-01

Introduction Managing a patient’s expectations in the emergency department (ED) environment is challenging. Previous studies have identified several factors associated with ED patient satisfaction. Lengthy wait times have shown to be associated with dissatisfaction with ED care. Understanding that patients are inaccurate at their estimation of wait time, which could lead to lower satisfaction, provides administrators possible points of intervention to help improve accuracy of estimation and possibly satisfaction with the ED. This study was undertaken to examine the accuracy of patient estimates of time periods in an ED and identify factors associated with accuracy. Method In this prospective convenience sample survey at UTMC ED, we collected data between March and July 2012. Outcome measures included duration of each phase of ED care and patient estimates of these time periods. Results Among 309 participants, the majority underestimated the total length of stay (LOS) in the ED (median difference −7 minutes (IQR −29-12)). There was significant variability in ED LOS (median 155 minutes (IQR 75–240)). No significant associations were identified between accuracy of time estimates and gender, age, race, or insurance status. Participants with longer ED LOS demonstrated lower patient satisfaction scores (p<0.001). Conclusion Patients demonstrated inaccurate time estimates of ED treatment times, including total LOS. Patients with longer ED LOS had lower patient satisfaction scores. PMID:24672606

The role of leader behaviors in hospital-based emergency departments' unit performance and employee work satisfaction.

PubMed

Lin, Blossom Yen-Ju; Hsu, Chung-Ping C; Juan, Chi-Wen; Lin, Cheng-Chieh; Lin, Hung-Jung; Chen, Jih-Chang

2011-01-01

The role of the leader of a medical unit has evolved over time to expand from simply a medical role to a more managerial one. This study aimed to explore how the behavior of a hospital-based emergency department's (ED's) leader might be related to ED unit performance and ED employees' work satisfaction. One hundred and twelve hospital-based EDs in Taiwan were studied: 10 in medical centers, 32 in regional hospitals, and 70 in district hospitals. Three instruments were designed to assess leader behaviors, unit performance and employee satisfaction in these hospital-based EDs. A mail survey revealed that task-oriented leader behavior was positively related to ED unit performance. Both task- and employee-oriented leader behaviors were found to be positively related to ED nurses' work satisfaction. However, leader behaviors were not shown to be related to ED physicians' work satisfaction at a statistically significant level. Some ED organizational characteristics, however, namely departmentalization and hospital accreditation level, were found to be related to ED physicians' work satisfaction. Copyright © 2010 Elsevier Ltd. All rights reserved.

Characteristics on electodynamic suspension simulator with HTS levitation magnet

NASA Astrophysics Data System (ADS)

Lee, J.; Bae, D. K.; Sim, K.; Chung, Y. D.; Lee, Y.-S.

2009-10-01

High- Tc superconducting (HTSC) electrodynamic suspension (EDS) system basically consists of the HTSC levitation magnet and the ground conductor. The levitation force of EDS system is forms by the interaction between the moving magnetic field produced by the onboard levitation magnet and the induced magnetic field produced by eddy current in the ground conductor. This paper deals with the characteristics of the EDS simulators with high- Tc superconducting (HTS) levitation magnet. Two EDS simulator systems, rotating type EDS simulator and static type EDS simulator, were studied in this paper. The rotating type EDS simulator consists of a HTS levitation magnet and a 1.5 m diameter rotating ground conductor, a motor, the supporting structure and force measuring devices. In the static type EDS simulator, instead of moving magnetic field, AC current was applied to the fixed HTS levitation magnet to induce the eddy current. The static type EDS simulator consists of a HTS levitation magnet, a ground conductor, force measuring devices and supporting structure. The double-pancake type HTSC levitation magnet was designed, manufactured and tested in the EDS simulator.

When the visit to the emergency department is medically nonurgent: provider ideologies and patient advice.

PubMed

Guttman, N; Nelson, M S; Zimmerman, D R

2001-03-01

It is estimated that more than half of pediatric hospital emergency department (ED) visits are medically nonurgent. Anecdotal impressions suggest that ED providers castigate medically nonurgent visits, yet studies on such visits are scarce. This study explored the perspectives of 26 providers working in the EDs of two urban hospitals regarding medically nonurgent pediatric ED visits and advising parents or guardians on appropriate ED use. Three provider ideologies regarding the appropriateness of medically nonurgent ED use were identified and found to be linked to particular communication strategies that providers employed with ED users: restrictive, pragmatic, and all-inclusive. The analysis resulted in the development of a typology of provider ideological orientations toward ED use, distinguished according to different orientations toward professional dominance.

Patient compliance with managed care emergency department referral: an orthopaedic view.

PubMed

Saroff, Don; Dell, Rick; Brown, E Richard

2002-04-01

Patient compliance with emergency department (ED)-generated referral is an important part of the delivery of quality health care. Although many studies from non-managed care health centers have reported on ED patient compliance, no studies have reported on this in a managed care setting. The objective of this study is to examine patient compliance with ED-generated referral and to produce a benchmark of follow-up rates possible in a capitated managed care system. That is to say, in a health care system whose members pay a uniform per capita payment or fee, one that has salaried physicians, owns its own hospitals, and has a mechanism of transition from ED to outpatient clinic that ensures referral accessibility. Retrospective review of consecutive ED patient compliance with ED-generated referral. All consecutive patients who presented to a managed care hospital's ED with an acute fracture and who were given an outpatient referral during the period from 23rd December 1998 to 23rd January, 1999. Of 8000 consecutive ED patients, 234 were included in the study. Compliance with ED-generated referral was determined from outpatient clinic records. Of the 234 patients treated in the ED and referred, 222 (94.9%) complied with follow-up appointments. We have demonstrated that an ED patient follow-up compliance rate of 94.9% can be obtained. It is probable that the high compliance rate is due to the features of the system studied. The high rate may also be related to the specific diagnosis studied, although previous literature reports poor ED patient compliance for the same diagnosis in a different ED setting. Additional research is needed to determine whether the high compliance rate reported in this study can be obtained in ED settings that are not part of a similar managed care system and to determine the role of referral accessibility (or inaccessibility) in current ED settings.

Leukemia

MedlinePlus

... JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology . 5th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap ... JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology . 5th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap ...

Myelomeningocele

MedlinePlus

... Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, ... Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, ...

Actinomycosis

MedlinePlus

... R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases . 8th ed. Philadelphia, ... R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases . 8th ed. Philadelphia, ...

Thrombocytopenia

MedlinePlus

... EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice . 7th ed. Philadelphia, PA: Elsevier; 2018: ... EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice . 7th ed. Philadelphia, PA: Elsevier; 2018: ...

Arteriogram

MedlinePlus

... eds. Rutherford's Vascular Surgery . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 102. Goldstein LB. Approach to ... eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 406. Kern M. Catheterization and ...

Hyperthyroidism

MedlinePlus

... Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier; 2016:chap 12. ... Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ...

Osteomalacia

MedlinePlus

... Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier; 2016:chap 28. ... Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ...

Stent

MedlinePlus

... of coronary artery disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: ... Atherosclerotic peripheral arterial disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: ...

Keratosis pilaris

MedlinePlus

... eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 118. ... appendages. In: Patterson JW, ed. Weedon's Skin Pathology . 4th ed. Philadelphia, PA: Elsevier; 2016:chap 15.

Tinea versicolor

MedlinePlus

... eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 236. ... infections. In: Patterson JW, ed. Weedon's Skin Pathology . 4th ed. Philadelphia, PA: Elsevier; 2015:chap 25.

Mittelschmerz

MedlinePlus

... Little M, eds. Textbook of Adult Emergency Medicine . 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2015:626- ... abdomen. In: Goldbloom RB, eds. Pediatric Clinical Skills . 4th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 12. ...

Chemosis

MedlinePlus

... conjunctivitis. In: Yanoff M, Duker JS, eds. Ophthalmology . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 4. ... noninfectious. In: Yanoff M, Duker JS, eds. Ophthalmology . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 4. ...

Vitiligo

MedlinePlus

... eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 245. ... pigmentation. In: Patterson JW, ed. Weedon's Skin Pathology . 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2016:chap ...

Presbyopia

MedlinePlus

... presbyopia. In: Yanoff M, Duker JS, eds. Ophthalmology . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 3. ... accommodation. In: Yanoff M, Duker JS, eds. Ophthalmology . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 9. ...

Emergency department visits of Syrian refugees and the cost of their healthcare.

PubMed

Gulacti, Umut; Lok, Ugur; Polat, Haci

2017-07-01

The aim of this study was to evaluate the demographic and clinical characteristics of Emergency Department (ED) visits made by Syrian refugees and to assess the cost of their healthcare. This retrospective study was conducted in adult Syrians who visited the ED of Adiyaman University Training and Research Hospital, Adiyaman Province, Turkey, between 01 January and 31 December 2015. We evaluated 10,529 Syrian refugees who visited the ED, of whom 9,842 were included in the study. The number of ED visits significantly increased in 2015 compared with 2010; the increase in the proportion of total ED visits was 8% (n = 11,275, dif: 8%, CI 95%: 7.9- 8.2, p < 0.001). Of this 8%, 6.5% were visits made by Syria refugees and the remaining 1.5% accounted for the visits made by other individuals. Upper respiratory tract infections (URTI) were the diseases most frequently presented (n = 4,656; 47.3%), and 68.5% of ED visits were inappropriate (n = 6,749). The median ED length of stay (LOS) of the Syrian refugees was significantly longer than that of the other individuals visiting the ED (p < 0.001). The total cost of the healthcare of the Syrian refugees who visited the ED was calculated as US$ 773,374.63. This study showed that Syrian refugees have increased the proportion of ED visits and the financial healthcare burden. The majority of ED visits made by Syrian refugees were inappropriate. In addition, their ED LOS was longer than that of other individuals making ED visits.

Pharmaceutical advertising in emergency departments.

PubMed

Marco, Catherine A

2004-04-01

Promotion of prescription drugs represents a growing source of pharmaceutical marketing expenditures. This study was undertaken to identify the frequency of items containing pharmaceutical advertising in clinical emergency departments (EDs). In this observational study, emergency physician on-site investigators quantified a variety of items containing pharmaceutical advertising present at specified representative times and days, in clinical EDs. Measurements were obtained by 65 on-site investigators, representing 22 states. Most EDs in this study were community EDs (87% community and 14% university or university affiliate), and most were in urban settings (50% urban, 38% suburban, and 13% rural). Investigators measured 42 items per ED (mean = 42; median = 31; interquartile range of 14-55) containing pharmaceutical advertising in the clinical area. The most commonly observed items included pens (mean 15 per ED; median 10), product brochures (mean 5; median 3), stethoscope labels (mean 4; median 2), drug samples (mean 3; median 0), books (mean 3.4), mugs (mean 2.4), and published literature (mean 3.1). EDs with a policy restricting pharmaceutical representatives in the ED had significantly fewer items containing pharmaceutical advertising (median 7.5; 95% CI = 0 to 27) than EDs without such a policy (median 35; 95% CI = 27 to 47, p = 0.005, nonparametric Wilcoxon two-sample test). There were no differences in quantities of pharmaceutical advertising for EDs in community compared with university settings (p = 0.5), rural compared with urban settings (p = 0.3), or annual ED volumes (p = 0.9). Numerous items containing pharmaceutical advertising are frequently observed in EDs. Policies restricting pharmaceutical representatives in the ED are associated with reduced pharmaceutical advertising.

Consumption of energy drinks among Québec college students.

PubMed

Picard-Masson, Marianne; Loslier, Julie; Paquin, Pierre; Bertrand, Karine

2017-03-01

Consumption of energy drinks (ED) raises concerns because of adverse health effects possibly linked with high levels of caffeine and sugar intake. The study looks at the scope of ED consumption as well as some of the associated characteristics. Thirty-six public colleges in the Canadian province of Québec agreed to participate in a descriptive cross-sectional study (n = 36). In February 2013, participating colleges invited their students to answer an online questionnaire on consumption of ED, alcoholic ED (AED), and ED in combination with other psychotropic drugs. A descriptive and correlational analysis was carried out. Logistic regressions explored associations between ED consumption and associated characteristics. Of the students who successfully completed the questionnaire and participated in the study (n = 10,283), a low proportion consumed ED (9.1%; n = 935) and/or AED (1.1%; n = 109) at least once a week in the previous month. Although low in proportion, a number of participants reported having used ED with other stimulant psychoactive substances (n = 247) and ≥3 ED/day (n = 193) or ≥3 AED/occasion (n = 167), which can pose a risk for serious adverse effects. Weekly ED consumption was associated with consumption of ≥20 cups of coffee/week, smoking, excessive use of alcohol and past use of cannabis, glues or solvents and amphetamines. A majority of respondents are not heavy users of ED, AED, or ED with drugs. Yet, the profiles of ED consumption potentially harmful to health that characterize some participants indicate that the potential health consequences of such behaviour are of concern.

Elementary science teachers' integration of engineering design into science instruction: results from a randomised controlled trial

NASA Astrophysics Data System (ADS)

Maeng, Jennifer L.; Whitworth, Brooke A.; Gonczi, Amanda L.; Navy, Shannon L.; Wheeler, Lindsay B.

2017-07-01

This randomised controlled trial used a mixed-methods approach to investigate the frequency and how elementary teachers integrated engineering design (ED) principles into their science instruction following professional development (PD). The ED components of the PD were aligned with Cunningham and Carlsen's [(2014). Teaching engineering practices. Journal of Science Teacher Education, 25, 197-210] guidelines for ED PD and promoted inclusion of ED within science teaching. The treatment group included 219 teachers from 83 schools. Participants in the control group included 145 teachers from 60 schools in a mid-Atlantic state. Data sources, including lesson overviews and videotaped classroom observations, were analysed quantitatively to determine the frequency of ED integration and qualitatively to describe how teachers incorporated ED into instruction after attending the PD. Results indicated more participants who attended the PD (55%) incorporated ED into instruction compared with the control participants (24%), χ2(1, n = 401) = 33.225, p < .001, ? = 0.308. Treatment and control teachers taught similar science content (p's > .05) through ED lessons. In ED lessons, students typically conducted research and created and tested initial designs. The results suggest the PD supported teachers in implementing ED into their science instruction and support the efficacy of using Cunningham and Carlsen's (2014) guidelines to inform ED PD design.

Antenatal and postnatal psychopathology among women with current and past eating disorders: longitudinal patterns.

PubMed

Easter, Abigail; Solmi, Francessca; Bye, Amanda; Taborelli, Emma; Corfield, Freya; Schmidt, Ulrike; Treasure, Janet; Micali, Nadia

2015-01-01

This study aims to investigate longitudinal patterns of psychopathology during the antenatal and postnatal periods among women with current (C-ED) and past (P-ED) eating disorders. Women were recruited to a prospective longitudinal study: C-ED (n = 31), P-ED (n = 29) and healthy control (HC; n = 57). Anxiety, depression and ED symptoms were measured at four time points: first/second trimester, third trimester, 8 weeks and 6 months postpartum. Linear mixed effects models were used to test for group differences. Women with C-ED and P-ED, in all diagnostic categories, had significantly higher levels of psychopathology at all time points. ED symptoms decreased in the C-ED group, compared with an overall increase in the other two groups but subsequently increased after pregnancy. Overall, depression and state and trait anxiety scores decreased in the C-ED group compared with the HC group throughout the antenatal and postnatal periods. High levels of psychopathology are common throughout the antenatal and postnatal periods among women with current and past ED, and despite some overall reductions, symptoms remain clinically significant. © 2014 The Authors. European Eating Disorders Review published by John Wiley & Sons, Ltd. © 2014 The Authors. European Eating Disorders Review published by John Wiley & Sons, Ltd.

Vascular phenotypes in nonvascular subtypes of the Ehlers-Danlos syndrome: a systematic review

PubMed Central

D'hondt, Sanne; Van Damme, Tim; Malfait, Fransiska

2018-01-01

Purpose Within the spectrum of the Ehlers-Danlos syndromes (EDS), vascular complications are usually associated with the vascular subtype of EDS. Vascular complications are also observed in other EDS subtypes, but the reports are anecdotal and the information is dispersed. To better document the nature of vascular complications among “nonvascular” EDS subtypes, we performed a systematic review. Methods We queried three databases for English-language studies from inception until May 2017, documenting both phenotypes and genotypes of patients with nonvascular EDS subtypes. The outcome included the number and nature of vascular complications. Results A total of 112 papers were included and data were collected from 467 patients, of whom 77 presented with a vascular phenotype. Severe complications included mainly hematomas (53%), frequently reported in musculocontractural and classical-like EDS; intracranial hemorrhages (18%), with a high risk in dermatosparaxis EDS; and arterial dissections (16%), frequently reported in kyphoscoliotic and classical EDS. Other, more minor, vascular complications were reported in cardiac-valvular, arthrochalasia, spondylodysplastic, and periodontal EDS. Conclusion Potentially life-threatening vascular complications are a rare but important finding in several nonvascular EDS subtypes, highlighting a need for more systematic documentation. This review will help familiarize clinicians with the spectrum of vascular complications in EDS and guide follow-up and management. PMID:28981071

Antibody

MedlinePlus

... AK, Litchman AH, Pillai S, eds. Cellular and Molecular Immunology . 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap ... D, Brostoff J, Roth DB, Roitt IM, eds. Immunology . 8th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap ...

CPR - infant

MedlinePlus

... Hill M, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 9th ed. Philadelphia, PA: Elsevier; ... Hill M, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 9th ed. Philadelphia, PA: Elsevier; ...

Wood stains

MedlinePlus

... RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 9th ed. Philadelphia, PA: Elsevier; ... RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 9th ed. Philadelphia, PA: Elsevier; ...

Aftershave poisoning

MedlinePlus

... RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 9th ed. Philadelphia, PA: Elsevier; ... RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 9th ed. Philadelphia, PA: Elsevier; ...

Pancreatitis - children

MedlinePlus

... Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; ... Pancreatic disease. In: Marcdante KJ, Kliegman RM, eds. Nelson Essentials of Pediatrics. 7th ed. Philadelphia, PA: Elsevier ...

Selective mutism

MedlinePlus

... Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, ... Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, ...

Phonological disorder

MedlinePlus

... Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, ... Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, ...

Crohn disease

MedlinePlus

... eds. Current Surgical Therapy . 12th ed. Philadelphia, PA: Elsevier; 2017:164-171. Lichenstein GR. Inflammatory bowel disease. ... eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 141. Mahmoud NN, Bleier JIS, ...

Toxic megacolon

MedlinePlus

... eds. Current Surgical Therapy . 12th ed. Philadelphia, PA: Elsevier; 2017:161-164. Lichtenstein GR. Inflammatory bowel disease. ... eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 141. Peterson MA, Wu AW. ...

Pancreatic pseudocyst

MedlinePlus

... eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 144. Nealon WH. The management ... eds. Current Surgical Therapy . 12th ed. Philadelphia, PA: Elsevier; 2017:516-523. Tenner SC, Steinberg WM. Acute ...

Endometrial polyps

MedlinePlus

... Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier; 2016:chap 17. ... Strauss JF, Barbieri RL, eds. Yen & Jaffe's Reproductive Endocrinology . 7th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap ...

Thyroid ultrasound

MedlinePlus

... imaging. In: Jameson JL, De Groot LJ, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ... Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier; 2016:chap 11. ...

Echocardiogram -- children

MedlinePlus

... RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier ... RO, Braunwald E, eds. Braunworld's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier ...

Cystometric study

MedlinePlus

... dysfunction. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, ... children. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, ...

Uterine prolapse

MedlinePlus

... devices. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ... prolapse. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ...

Penis pain

MedlinePlus

... Priapism. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ... disease. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ...

Elimination patterns

MedlinePlus

... urethra. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ... disorders. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ...

Retrograde ejaculation

MedlinePlus

... ejaculation. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ... infertility. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ...

Granuloma annulare

MedlinePlus

... pattern. In: Patterson JW, ed. Weedon's Skin Pathology . 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2016:chap ... eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 91.

Mucous cyst

MedlinePlus

... pits. In: Patterson JW, ed. Weedon's Skin Pathology . 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2016:chap ... eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 151. ...

Ichthyosis vulgaris

MedlinePlus

... eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 107. ... keratinization. In: Patterson JW, ed. Weedon's Skin Pathology . 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2016:chap ...

Cataract - adult

MedlinePlus

... JA, Vander JF, eds. Ophthalmology Secrets in Color . 4th ed. Philadelphia, PA: Elsevier; 2015:chap 21. Wevill ... cataract. In: Yanoff M, Duker JS, eds. Ophthalmology . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 5. ...

Brain response to images of food varying in energy density is associated with body composition in 7- to 10-year-old children: Results of an exploratory study.

PubMed

Fearnbach, S Nicole; English, Laural K; Lasschuijt, Marlou; Wilson, Stephen J; Savage, Jennifer S; Fisher, Jennifer O; Rolls, Barbara J; Keller, Kathleen L

2016-08-01

Energy balance is regulated by a multifaceted system of physiological signals that influence energy intake and expenditure. Therefore, variability in the brain's response to food may be partially explained by differences in levels of metabolically active tissues throughout the body, including fat-free mass (FFM) and fat mass (FM). The purpose of this study was to test the hypothesis that children's body composition would be related to their brain response to food images varying in energy density (ED), a measure of energy content per weight of food. Functional magnetic resonance imaging (fMRI) was used to measure brain response to High (>1.5kcal/g) and Low (<1.5kcal/g) ED food images, and Control images, in 36 children ages 7-10years. Body composition was measured using bioelectrical impedance analysis. Multi-subject random effects general linear model (GLM) and two-factor repeated measures analysis of variance (ANOVA) were used to test for main effects of ED (High ED vs. Low ED) in a priori defined brain regions of interest previously implicated in energy homeostasis and reward processing. Pearson's correlations were then calculated between activation in these regions for various contrasts (High ED-Low ED, High ED-Control, Low ED-Control) and child body composition (FFM index, FM index, % body fat). Relative to Low ED foods, High ED foods elicited greater BOLD activation in the left thalamus. In the right substantia nigra, BOLD activation for the contrast of High ED-Low ED foods was positively associated with child FFM. There were no significant results for the High ED-Control or Low ED-Control contrasts. Our findings support literature on FFM as an appetitive driver, such that greater amounts of lean mass were associated with greater activation for High ED foods in an area of the brain associated with dopamine signaling and reward (substantia nigra). These results confirm our hypothesis that brain response to foods varying in energy content is related to measures of child body composition. Copyright © 2016 Elsevier Inc. All rights reserved.

Unconsciousness - first aid

MedlinePlus

... Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier ... Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier ...

Pine oil poisoning

MedlinePlus

... Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier ... Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier ...

Frontal bossing

MedlinePlus

... BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016: ... and neck. In: Coady AM, Bower S, eds. Twining's Textbook of Fetal Abnormalities . 3rd ed. Philadelphia, PA: Elsevier ...

Gross motor control

MedlinePlus

... Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; ... Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; ...

Diarrhea in infants

MedlinePlus

... Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; ... Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; ...

Absent pulmonary valve

MedlinePlus

... Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, ... Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, ...

Metachromatic leukodystrophy

MedlinePlus

... Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, ... diseases. In: Swaiman KF, Ashwal S, Ferriero DM, Schor NF, eds. Swaiman's Pediatric Neurology . 5th ed. Philadelphia, PA: ...

Eosinophil count - absolute

MedlinePlus

... BS, Burks AW, et al, eds. Middleton's Allergy: Principles and Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; ... HE, Weitz JI, Anastasi J, eds. Hematology: Basic Principles and Practice . 6th ed. Philadelphia, PA: Elsevier Saunders; ...

Orbital cellulitis

MedlinePlus

... Blaser MJ, eds. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases . 8th ed. Philadelphia, ... ER. Periorbital and orbital infections. In: Long SS, ed. Principles and Practice of Pediatric Infectious Diseases . 4th ed. ...

Type 1 diabetes

MedlinePlus

... Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier; 2016:chap 32. ... Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ...

Calcitonin blood test

MedlinePlus

... Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier; 2016:chap 28. ... Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ...

Type 2 diabetes

MedlinePlus

... Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier ... Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier; 2016:chap 31. ...

Radioactive iodine uptake

MedlinePlus

... Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier; 2016:chap 11. ... Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ...

T4 test

MedlinePlus

... Larsen PR, et al, eds. Williams Textbook of Endocrinology . 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap ... testing. In: Jameson JL, De Groot LJ, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ...

Antithyroid microsomal antibody

MedlinePlus

... Larsen PR, et al, eds. Williams Textbook of Endocrinology . 12th ed. Philadelphia, PA: Elsevier; 2016:chap 11. ... testing. In: Jameson JL, De Groot LJ, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ...

TBG - blood test

MedlinePlus

... Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier; 2016:chap 11. ... Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ...

T3 test

MedlinePlus

... Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier; 2016:chap 11. ... Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ...

Intrauterine devices (IUD)

MedlinePlus

... Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ... Strauss JF, Barbieri RL, eds. Yen & Jaffe's Reproductive Endocrinology . 7th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap ...

Toxic nodular goiter

MedlinePlus

... Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ... Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ...

ACTH blood test

MedlinePlus

... Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier; 2016:chap 9. ... Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier; 2016:chap 15. ...

Cardiomyopathy

MedlinePlus

... the myocardium and endocardium. In Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine . 25th ed. Philadelphia, PA: ... failure: management and diagnosis. In Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine . 25th ed. Philadelphia, PA: ...

Centipede

MedlinePlus

... Arthropod bites and stings. In: Adams JG, ed. Emergency Medicine . 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap ... RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 9th ed. Philadelphia, PA: ...

Patent urachus repair

MedlinePlus

... children. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ... surgery. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ...

Inflatable artificial sphincter

MedlinePlus

... children. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ... women. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ...

Bladder outlet obstruction

MedlinePlus

... failure. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ... failure. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ...

Polymorphous light eruption

MedlinePlus

... eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 189. ... agents. In: Patterson JW, ed. Weedon's Skin Pathology. 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2016:chap ...

Vaginal dryness alternative treatments

MedlinePlus

... JE, Murray MT, eds. Textbook of Natural Medicine . 4th ed. St Louis, MO: Elsevier Churchill Livingstone; 2013: ... Vaginal dryness. In: Rakel D, ed. Integrative Medicine . 4th ed. Philadelphia, PA: Elsevier; 2018:chap 59.

California Emergency Department Closures Are Associated With Increased Inpatient Mortality At Nearby Hospitals

PubMed Central

Liu, Charles; Srebotnjak, Tanja; Hsia, Renee Y.

2014-01-01

Between 1996 and 2009 the annual number of emergency department (ED) visits in the United States increased by 51 percent while the number of EDs nationwide decreased by 6 percent, which placed unprecedented strain on the nation’s EDs. To investigate the effects of an ED closing on surrounding communities, we identified all ED closures in California during the period 1999–2010 and examined their association with inpatient mortality rates at nearby hospitals. We found that 24.9 percent of hospital admissions in this period occurred near an ED closure, and that these admissions had 5 percent higher odds of inpatient mortality than admissions not occurring near a closure. This association persisted whether we considered ED closures as affecting all future nearby admissions or only those occurring in the subsequent two years. These results suggest that ED closures have ripple effects on patient outcomes that should be considered when health systems and policy makers decide how to regulate ED closures. PMID:25092832

Influence of Price and Labeling on Energy Drink Purchasing in an Experimental Convenience Store.

PubMed

Temple, Jennifer L; Ziegler, Amanda M; Epstein, Leonard H

2016-01-01

To examine the impact of energy drink (ED) pricing and labeling on the purchase of EDs. Participants visited a laboratory-based convenience store 3 times and purchased a beverage under different ED labeling (none, caffeine content, and warning labels) and pricing conditions. The 36 participants (aged 15-30 years) were classified as energy drink consumers (≥ 2 energy drinks/wk) and nonconsumers (< 1 energy drink/mo). Data were log transformed to generate elasticity coefficients. The authors analyzed changes in elasticity as a function of price and labeling using mixed-effects regression models. Increasing the price of EDs reduced ED purchases and increased purchasing of other caffeinated beverages among ED consumers. Energy drink labels affected ED sales in adolescents. These data suggest that ED pricing and labeling may influence the purchasing of ED, especially in adolescent consumers. Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Breathing - slowed or stopped

MedlinePlus

... Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier ... Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier ...

Heimlich maneuver on self

MedlinePlus

... RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; ... RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; ...

Bed rest during pregnancy

MedlinePlus

... SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies . 7th ed. Philadelphia, PA: ... SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies . 7th ed. Philadelphia, PA: ...

Day care health risks

MedlinePlus

... Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; ... Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; ...

Skin findings in newborns

MedlinePlus

... Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; ... Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; ...

Developmental milestones record - 4 months

MedlinePlus

... Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; ... Normal development. In: Marcdante KJ, Kliegman RM, eds. Nelson Essentials of Pediatrics . 7th ed. Philadelphia, PA: Elsevier ...

Spitting up - self-care

MedlinePlus

... Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, ... Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, ...

Insect bites and stings

MedlinePlus

... eds. Auerbach's Wilderness Medicine . 7th ed. Philadelphia, PA: Elsevier; 2017:chap 43. Elston DM. Arthropods and leeches. ... eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 359. Otten EJ. Venomous animal ...

Cedar leaf oil poisoning

MedlinePlus

... eds. Auerbach's Wilderness Medicine . 7th ed. Philadelphia, PA: Elsevier; 2017:chap 45. Graeme KA. Toxic plant ingestions. ... eds. Auerbach's Wilderness Medicine . 7th ed. Philadelphia, PA: Elsevier; 2017:chap 65. Meehan TJ. Approach to the ...

Meperidine hydrochloride overdose

MedlinePlus

... JG, ed. Emergency Medicine . 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 147. Lank PM, Kusin S. Ethanol ... JG, ed. Emergency Medicine . 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 154. Nikolaides JK, Thompson TM. ...

Deciding about an IUD

MedlinePlus

... Groot LJ, de Krester DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ... Strauss JF, Barbieri RL, eds. Yen & Jaffe's Reproductive Endocrinology . 7th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap ...

T3RU test

MedlinePlus

... Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier; 2016:chap 11. ... Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ...

Type 2 diabetes - self-care

MedlinePlus

... Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier; 2016:chap 33. ... Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ...

ACTH (cosyntropin) stimulation test

MedlinePlus

... Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ... Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier; 2016:chap 15. ...

Women and sexual problems

MedlinePlus

... Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier; 2016:chap 20. ... Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ...

Home blood sugar testing

MedlinePlus

... Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ... Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ...

What causes bone loss?

MedlinePlus

... Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier; 2016:chap 29. ... Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ...

Chronic thyroiditis (Hashimoto disease)

MedlinePlus

... Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ... Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier; 2016:chap 13. ...

Delayed puberty in boys

MedlinePlus

... Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier ... Groot LJ, de Kretser DM, et al. eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier ...

Cribs and crib safety

MedlinePlus

... BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016: ... the newborn. In: Rakel RE, Rakel D, eds. Textbook of Family Medicine . 9th ed. Philadelphia, PA: Elsevier; ...

Carotid artery surgery - discharge

MedlinePlus

... Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery . 20th ed. Philadelphia, PA: Elsevier; 2017: ... RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier ...

Antidiarrheal drug overdose

MedlinePlus

... OJ, Yealy DM, Meckler GD, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide . 8th ed. New York, ... RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 9th ed. Philadelphia, PA: ...

Periactin overdose

MedlinePlus

... Brown A, Little M, eds. Textbook of Adult Emergency Medicine . 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2015: ... Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: ...

Lomotil overdose

MedlinePlus

... RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 9th ed. Philadelphia, PA: ... RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 9th ed. Philadelphia, PA: ...

Facial swelling

MedlinePlus

... Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap ... Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap ...

Isopropanol alcohol poisoning

MedlinePlus

... VJ, Pons PT, Bakes KM, Buchanan JA, eds. Emergency Medicine Secrets . 6th ed. Philadelphia, PA: Elsevier; 2016:chap ... RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 9th ed. Philadelphia, PA: ...

Prostate resection - minimally invasive - discharge

MedlinePlus

... approaches. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ... hyperplasia. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ...

Dislocated shoulder - aftercare

MedlinePlus

... GJ, Provencher MT, eds. Orthopaedic Rehabilitation in Athlete . 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 1. ... Thompson SR, eds. DeLee & Drez's Orthopaedic Sports Medicine . 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 46.

Lasik eye surgery - discharge

MedlinePlus

... Technique. In: Mannis MJ, Holland EJ, eds. Cornea . 4th ed. Philadelphia, PA: Elsevier; 2017:chap 166. Sierra ... LASIK. In: Yanoff M, Duker JS, eds. Ophthalmology . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 3. ...

Cosmetic breast surgery - discharge

MedlinePlus

... Higdon KK. Reduction mammaplasty. In: Neligan PC, ed. Plastic Surgery . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2013: ... Gabriel A. Breast augmentation. In: Neligan PC, ed. Plastic Surgery . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2013: ...

Erectile dysfunction. A guide to diagnosis and management.

PubMed

Arduca, Paul

2003-06-01

Erectile dysfunction (ED) is a common age related problem best managed in general practice. The incidence of ED will thus increase as men live longer. It is only in the past decade that the pathophysiology of ED has been well understood. This article discusses the mechanisms of normal erectile function and dysfunction and the assessment and management of ED. The success of currently available and newly emerging oral agents has revolutionised the management of ED. However, the majority of men with ED remain undiagnosed and untreated and patients are often unable to distinguish between a problem of ED, desire or libido. It is particularly important for general practitioners to enquire about ED in middle aged and older men, diabetics and patients with vascular disease. Appropriate management goes beyond management of the actual condition, and involves addressing lifestyle and psychosocial issues.

Recent advances in the treatment of erectile dysfunction.

PubMed

Mobley, David F; Khera, Mohit; Baum, Neil

2017-11-01

Erectile dysfunction (ED) is one of the most common conditions affecting middle-aged and older men. Nearly every primary care physician, internist and geriatrician will be called upon to manage this condition or to make referrals to urologists, endocrinologists and cardiologists who will assist in the treatment of ED. This article will briefly discuss the diagnosis and management of ED. In addition, emerging concepts in ED management will be discussed, such as the use of testosterone to treat ED, the role of the endothelium in men with ED and treating the partner of the man with ED. Finally, future potential therapies for ED will be discussed. © 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.

Why Do Cancer Patients Die in the Emergency Department? An Analysis of 283 Deaths in NC EDs

PubMed Central

Leak, Ashley; Mayer, Deborah K.; Wyss, Annah; Travers, Debbie; Waller, Anna

2013-01-01

Emergency department (ED) visits are made by cancer patients for symptom management, treatment effects, oncologic emergencies, or end of life care. While most patients prefer to die at home, many die in health care institutions. The purpose of this study is to describe visit characteristics of cancer patients who died in the ED and their most common chief complaints using 2008 ED visit data from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT). Of the 37,760 cancer-related ED visits, 283 resulted in death. For lung cancer patients, 104 died in the ED with 70.9% dying on their first ED visit. Research on factors precipitating ED visits by cancer patients is needed to address end of life care needs. PMID:22556288

National survey of emergency departments in Denmark.

PubMed

Wen, Leana S; Anderson, Philip D; Stagelund, Søren; Sullivan, Ashley F; Camargo, Carlos A

2013-06-01

Emergency departments (EDs) are the basic unit of emergency medicine, but often differ in fundamental features. We sought to describe and characterize EDs in Denmark. All EDs open 24/7 to the general public were surveyed using the National ED Inventories survey instrument (http://www.emnet-nedi.org). ED staff were asked about ED characteristics with reference to the calendar year 2008. Twenty-eight EDs participated (82% response). All were located in hospitals. Less than half [43%, 95% confidence interval (CI) 24-63%] were independent departments. Thirty-nine percent (95% CI 22-59%) had a contiguous layout, with medical and surgical care provided in one area. The vast majority of EDs saw both adults and children; only 10% saw adults only and none saw children only. The median number of annual visits was 32 000 (interquartile range, 14 700-47 000). The majority (68%, 95% CI 47-89%) believed that their ED was at good balance or capacity, with 22% responding that they were under capacity and 9% reporting overcapacity. Technological resources were generally available, with the exception of dedicated computed tomography scanners and negative-pressure rooms. Almost all common emergencies were identified as being treatable 24/7 in the EDs. Although there is some variation in their layout and characteristics, most Danish EDs have a high degree of resource availability and are able to treat common emergencies. As Denmark seeks to reform emergency care through ED consolidation, this national survey helps to establish a benchmark for future comparisons.

Symptom profile of major depressive disorder in women with eating disorders.

PubMed

Fernandez-Aranda, Fernando; Pinheiro, Andrea Poyastro; Tozzi, Federica; Thornton, Laura M; Fichter, Manfred M; Halmi, Katherine A; Kaplan, Allan S; Klump, Kelly L; Strober, Michael; Woodside, D Blake; Crow, Scott; Mitchell, James; Rotondo, Alessandro; Keel, Pamela; Plotnicov, Katherine H; Berrettini, Wade H; Kaye, Walter H; Crawford, Steven F; Johnson, Craig; Brandt, Harry; La Via, Maria; Bulik, Cynthia M

2007-01-01

Based on the well-documented association between eating disorders (EDs) and affective disorders, the patterns of comorbidity of EDs and major depressive disorder (MDD) were investigated. The temporal relation between EDs and MDD onset was analyzed to determine differences in the course and nature of MDD when experienced prior to versus after the onset of the ED. Lifetime MDD and depressive symptoms were assessed in 1371 women with a history of ED. The prevalence of MDD was first explored across ED subtypes, and ages of onset of MDD and EDs were compared. Depressive symptoms were examined in individuals who developed MDD before and after ED onset. The lifetime prevalence of MDD was 72.9%. Among those with lifetime MDD (n =963), 34.5% reported MDD onset before the onset of ED. Those who experienced MDD first reported greater psychomotor agitation (OR =1.53; 95%CI =1.14-2.06), and thoughts of own death (but not suicide attempts or ideation; OR =1.73; 95%CI =1.31-2.30). Among individuals who had MDD before ED, 26.5% had the MDD onset during the year before the onset of ED; 67% of individuals had the onset of both disorders within the same 3 year window. Clinicians treating individuals with new-onset ED or MDD should remain vigilant for the emergence of additional psychopathology, especially during the initial 3 year window following the onset of the first disorder.

Emergency Department Telepsychiatry Service Model for a Rural Regional Health System: The First Steps.

PubMed

Meyer, James D; McKean, Alastair J S; Blegen, Rebecca N; Demaerschalk, Bart M

2018-05-09

Emergency departments (EDs) have recognized an increasing number of patients presenting with mental health (MH) concerns. This trend imposes greater demands upon EDs already operating at capacity. Many ED providers do not feel they are optimally prepared to provide the necessary MH care. One consideration in response to this dilemma is to use advanced telemedicine technology for psychiatric consultation. We examined a rural- and community-based health system operating 21 EDs, none of which has direct access to psychiatric consultation. Dedicated beds to MH range from zero (in EDs with only 3 beds) to 6 (in an ED with 38 beds). We conducted a needs assessment of this health system. This included a survey of emergency room providers with a 67% response rate and site visits to directly observe patient flow and communication with ED staff. A visioning workshop provided input from ED staff. Data were also obtained, which reflected ED admissions for the year 2015. The data provide a summary of provider concerns, a summary of MH presentations and diagnosis, and age groupings. The data also provide a time when most MH concerns present to the ED. Based upon these results, a proposed model for delivering comprehensive regional emergency telepsychiatry and behavioral health services is proposed. Emergency telepsychiatry services may be a tenable solution for addressing the shortage of psychiatric consultation to EDs in light of increasing demand for MH treatment in the ED.

Causes and prognostic factors for early death in patients with acute promyelocytic leukemia treated with single-agent arsenic trioxide.

PubMed

Hou, Jinxiao; Wang, Shuye; Zhang, Yingmei; Fan, Dachuan; Li, Haitao; Yang, Yiju; Ge, Fei; Hou, Wenyi; Fu, Jinyue; Wang, Ping; Zhao, Hongli; Sun, Jiayue; Yang, Kunpeng; Zhou, Jin; Li, Xiaoxia

2017-12-01

Early death (ED) is one of the most critical issues involved in the current care of patients with acute promyelocytic leukemia (APL). Factors identified as independent predictors of ED varied among published studies. We retrospectively analyzed the incidence, causes, and prognostic factors of ED in a series of 216 patients with newly diagnosed APL who received arsenic trioxide (ATO) as induction therapy. Multivariate logistic regression analysis was used to determine the association of clinical factors with overall ED, hemorrhagic ED, death within 7 days, and death within 8-30 days. In total, 35 EDs (16.2%) occurred that were caused by hemorrhage, differentiation syndrome (DS), infection, and other causes, in order of prevalence. The independent prognostic factors for overall ED and death within 8-30 days were the same and included serum creatinine level, Eastern Cooperative Oncology Group (ECOG) score, sex, and fibrinogen level. The risk factors for hemorrhagic ED and death within 7 days were similar and included serum creatinine level, ECOG score, and white blood cell count, while hemorrhagic ED was also associated with D-dimer. Our findings revealed a high rate of ED, and the causes of ED were similar to those among patients who received ATRA-based therapy. Increased creatinine level was the most powerful predictor, and an ECOG score greater than 2 was another strong prognostic factor for all four types of ED.

Comparing methods of detecting alcohol-related emergency department presentations.

PubMed

Indig, D; Copeland, J; Conigrave, K M

2009-08-01

To assess the strengths and limitations of different methods for detecting alcohol-related emergency department (ED) presentations and to compare the characteristics of patients who present to the ED with an alcohol-related presentation with ED patients who are found to be risky drinkers by a questionnaire. Survey at two Sydney Australia ED over four weekends of 389 patients. Alcohol-related presentations were identified using a range of methods and were compared with presentations in ED patients who reported risky drinking using the alcohol use disorders identification test (AUDIT). Overall, 20% of ED patients had alcohol-related presentations and 28% were identified as risky drinkers by AUDIT. Diagnostic codes detected only 7% of all alcohol-related ED presentations, compared with 34% detected by nursing triage text, 60% by medical record audits and 69% by self-report. Among risky drinkers, just over half (51%) were not attending for an alcohol-related reason, whereas among alcohol-related ED presentations, nearly a third (31%) were not identified as risky drinkers by AUDIT. Not all patients with an alcohol-related ED presentation usually drink at risky levels, nor do all risky drinkers present to the ED for an alcohol-related reason. The use of routinely recorded nursing triage text detects over a third of alcohol-related ED presentations with no additional burden on busy clinicians. As these data are potentially readily accessible, further research is needed to evaluate their validity for the detection of alcohol-related ED presentations.

A Survey of Workplace Violence Across 65 U.S. Emergency Departments

PubMed Central

Kansagra, Susan M.; Rao, Sowmya R.; Sullivan, Ashley F.; Gordon, James A.; Magid, David J.; Kaushal, Rainu; Camargo, Carlos A.; Blumenthal, David

2012-01-01

Objectives Workplace violence is a concerning issue. Healthcare workers represent a significant portion of the victims, especially those who work in the emergency department (ED). The objective of this study was to examine ED workplace violence and staff perceptions of physical safety. Methods Data were obtained from the National Emergency Department Safety Study (NEDSS), which surveyed staff across 69 U.S. EDs including physicians, residents, nurses, nurse practitioners, and physician assistants. The authors also conducted surveys of key informants (one from each site) including ED chairs, medical directors, nurse managers, and administrators. The main outcome measures included physical attacks against staff, frequency of guns or knives in the ED, and staff perceptions of physical safety. Results A total of 5,695 staff surveys were distributed, and 3,518 surveys from 65 sites were included in the final analysis. One-fourth of surveyed ED staff reported feeling safe sometimes, rarely, or never. Key informants at the sampled EDs reported a total of 3,461 physical attacks (median of 11 attacks per ED) over the 5-year period. Key informants at 20% of EDs reported that guns or knives were brought to the ED on a daily or weekly basis. In multivariate analysis, nurses were less likely to feel safe “most of the time” or “always” when compared to other surveyed staff. Conclusions This study showed that violence and weapons in the ED are common, and nurses were less likely to feel safe than other ED staff. PMID:18976337

System Level Health Disparities in California Emergency Departments: Minorities and Medicaid Patients are at Higher Risk of Losing Their EDs

PubMed Central

Hsia, Renee Y.; Srebotnjak, Tanja; Kanzaria, Hemal K.; McCulloch, Charles; Auerbach, Andrew D.

2015-01-01

Study Objective Emergency Department (ED) closures threaten community access to emergency services, but few data exist to describe factors associated with closure. We evaluated factors associated with ED closure in California and sought to determine if hospitals serving more vulnerable populations have a higher rate of ED closure. Methods Retrospective cohort study of California hospital EDs between 1998 and 2008, using hospital and patient level data from the California Office of Statewide Planning and Development (OSHPD), as well as OSHPD Patient Discharge Data. We examined the effects of hospital and patient factors on the hospital's likelihood of ED closure using Cox proportional hazards models. Results In 4,411 hospital-years of observation, 29 of 401 (7.2%) EDs closed. In a model adjusted for total ED visits, hospital discharges, trauma center and teaching status, ownership, operating margin, and urbanicity, hospitals with more black patients (OR 1.41 per increase in proportion of blacks by 0.1, 95% CI 1.16-1.72) and Medi-Cal recipients (OR 1.17 per increase in proportion insured by Medi-Cal by 0.1, 95% CI 1.02-1.34) had higher odds for ED closure, as did for-profit institutions (OR 1.65, 95% CI 1.13-2.41). Conclusion The population served by EDs and hospitals’ profit model are associated with ED closure. Whether our findings are a manifestation of poorer reimbursement in at-risk EDs is unclear. PMID:22093435

Development of Guidelines and Resource Materials on Latin America for Use in Grades 1-12. Final Report.

ERIC Educational Resources Information Center

Gill, Clark C.; Conroy, William B.

The Latin America Project (1966-69) consisted of two phases: (1) completion of background studies and (2) preparation, field testing, and evaluation of instructional materials. Five background bulletins were prepared and distributed (See ED 012 832, ED 012 833, ED 012 365, ED 013 342, ED 022 781) and instructional materials organized around…

The Diverse Sources of Federal Financial Support of Schools. School Finance Project. Working Paper.

ERIC Educational Resources Information Center

Miller, Vic

Federal programs outside the Department of Education (ED) provide significant financial support to elementary and secondary education, according to this paper. The authors give capsule descriptions of over two dozen such non-ED programs, compare changes in non-ED funding with shifts in ED aid, evaluate the impact of non-ED aid on different regions…

Regional Energy Deployment System (ReEDS) | Energy Analysis | NREL

Science.gov Websites

System Model The Regional Energy Deployment System (ReEDS) model helps the U.S. Department of model. Visualize Future Capacity Expansion of Renewable Energy Watch this video of the ReEDS model audio. Model Documentation ReEDS Model Documentation: Version 2016 ReEDS Map with Numbered Regions

Emergency department throughput, crowding, and financial outcomes for hospitals.

PubMed

Handel, Daniel A; Hilton, Joshua A; Ward, Michael J; Rabin, Elaine; Zwemer, Frank L; Pines, Jesse M

2010-08-01

Emergency department (ED) crowding has been identified as a major public health problem in the United States by the Institute of Medicine. ED crowding not only is associated with poorer patient outcomes, but it also contributes to lost demand for ED services when patients leave without being seen and hospitals must go on ambulance diversion. However, somewhat paradoxically, ED crowding may financially benefit hospitals. This is because ED crowding allows hospitals to maximize occupancy with well-insured, elective patients while patients wait in the ED. In this article, the authors propose a more holistic model of hospital flow and revenue that contradicts this notion and offer suggestions for improvements in ED and hospital management that may not only reduce crowding and improve quality, but also increase hospital revenues. Also proposed is that increased efficiency and quality in U.S. hospitals will require changes in systematic microeconomic and macroeconomic incentives that drive the delivery of health services in the United States. Finally, the authors address several questions to propose mutually beneficial solutions to ED crowding that include the realignment of hospital incentives, changing culture to promote flow, and several ED-based strategies to improve ED efficiency.

The organizational culture of emergency departments and the effect on care of older adults: a modified scoping study.

PubMed

Skar, Pål; Bruce, Anne; Sheets, Debra

2015-04-01

How does the organizational micro culture in emergency departments (EDs) impact the care of older adults presenting with a complaint or condition perceived as non-acute? This scoping study reviews the literature and maps three levels of ED culture (artifacts, values and beliefs, and assumptions). Findings on the artifact level indicate that EDs are poorly designed for the needs of older adults. Findings on the ED value and belief level indicate that EDs are for urgent cases (not geriatric care), that older adults do not receive the care and respect they should be given, that older adults require too much time, and that the basic nursing needs of older adults are not a priority for ED nurses. Finally, finding on the assumptions level underpinning ED behaviors suggest that older adults do not belong in the ED, most older adults in the ED are not critically ill and therefore can wait, and staff need to be available for acute cases at all times. A systematic review on the effect of ED micro culture on the quality of geriatric care is warranted. Copyright © 2014. Published by Elsevier Ltd.

Time-trends, Predictors and Outcome of Emergency Department Utilization for Gout: A Nationwide U.S. Study

PubMed Central

Singh, Jasvinder A.; Yu, Shaohua

2016-01-01

Objective To assess gout-related emergency department (ED) utilization/charges and discharge disposition. Methods We used the U.S. National ED Sample (NEDS) data to examine the time-trends in total ED visits and charges and ED-related hospitalizations with gout as the primary diagnosis. We assessed multivariable-adjusted predictors of ED charges and hospitalization for gout-related visits using the 2012 NEDS data. Results There were 180,789, 201,044 and 205,152 ED visits in years 2009, 2010 and 2012 with gout as the primary diagnosis, with total ED charges of $195, $239 and $287 million, respectively; these accounted for 0.14-0.16% of all ED visits. Mean/median 2012 ED charges/visit were $1,398/$956. Of all gout-related ED visits, 7.7% were admitted to the hospital in 2012. Mean/median length of hospital stay was 3.9/2.6 days and mean/median inpatient charge/admission was $22,066/$15,912 in 2012. In multivariable-adjusted analyses, older age, female gender, highest income quartile, being uninsured, metropolitan residence, Western U.S. hospital location, heart disease, renal failure, congestive heart failure (CHF), hypertension, diabetes, osteoarthritis and chronic obstructive pulmonary disease (COPD) were associated with higher ED charges. Older age, Northeast location, Metropolitan teaching hospital, higher income quartile, heart disease, renal failure, CHF, hyperlipidemia, hypertension, diabetes, COPD, and osteoarthritis were associated with higher odds where as self-pay insurance status was associated with lower odds of hospitalization following an ED visit for gout. Conclusions Absolute ED utilization and charges for gout increased over time, but relative utilization remained stable. Modifiable comorbidity factors associated with higher gout-related utilization should be targeted to reduce morbidity and healthcare utilization. PMID:27134260

Evaluating the effect of clinical decision units on patient flow in seven Canadian emergency departments.

PubMed

Schull, Michael J; Vermeulen, Marian J; Stukel, Therese A; Guttmann, Astrid; Leaver, Chad A; Rowe, Brian H; Sales, Anne

2012-07-01

To evaluate the effect of emergency department (ED) clinical decision units (CDUs) on overall ED patient flow in a pilot project funded in 2008 by the Ontario Ministry of Health and Long-Term Care (MOHLTC). A retrospective analysis of unscheduled ED visits at seven CDU pilot and nine control sites was conducted using administrative data. The authors examined trends in CDU utilization and compared outcomes between pilot-CDU and control sites 1 year prior to implementation, with the first 18 months of CDU operation. Sites that were unsuccessful in their applications for CDU program funding served as controls. Outcomes included ED length of stay (LOS), admission rates, and ED revisit rates. At CDU sites, roughly 4% of ED patients were admitted to CDUs. The presence of a pilot-CDU was independently associated with a small reduction in ED LOS for all low-acuity patients (-0.14 hour, 95% confidence interval [CI]=-0.22 to -0.07) and nonadmitted patients (-0.11 hour, 95% CI=-0.16 to -0.07). A small independent effect on absolute hospital admission rate for all high-acuity patients (-0.8%, 95% CI=-1.5% to -0.03%) and moderate-acuity patients (-0.6%, 95% CI=-1.1% to -0.2%) was also observed. Pilot-CDUs were not associated with changes in ED revisit rates. With only 4% of ED patients admitted to CDUs, the potential for efficiency gains in these EDs was limited. Nonetheless, these findings suggest small improvements in the operation of the ED through CDU implementation. Although marginal, the observed effects of CDU operation were in the desired direction of reduced ED LOS, reduced admission rate, and no increase in ED revisit rate. © 2012 by the Society for Academic Emergency Medicine.

An investigation of the mediating role of personality and family functioning in the association between attachment styles and eating disorder status.

PubMed

Münch, Anna Lena; Hunger, Christina; Schweitzer, Jochen

2016-07-12

This study examined relationships between attachment style, eating disorders (EDs), personality variables and family functioning. In our study, 253 women (M = 25.72 years, SD = 8.73) were grouped into one of four categories either according to self-reported ED diagnosis or by exceeding cut-offs for a clinical diagnosis on the Eating Disorder Examination Questionnaire (EDE-Q) or Short Evaluation of Eating Disorders (SEED): anorexia nervosa (AN), bulimia nervosa (BN), other eating disorder (O-ED), no eating disorder (Non-ED). The ED group (AN, BN, O-ED) included 106 women (M = 24.74 years, SD = 7.71), and the Non-ED group 147 women (M = 26.42 years, SD = 9.37). Approximately half of the ED group had a comorbid disorder (59.4 %), while the majority of the Non-ED group had no psychological disorder (89.1 %). Participants with an ED were significantly more often insecurely attached (Adult Attachment Scale; AAS), emotionally unstable, less extraverted (Big-Five-Test of Personality; B5T) and showed less positive family functioning (Experiences in Personal Social Systems Questionnaire; EXIS.pers). Results showed partial mediation for attachment and EDs through neuroticism, extraversion and family functioning. The study found further evidence for elevated problems with attachment, personality, and family experiences in individuals with EDs, while suggesting mechanisms that may link these constructs. Implications for research and practice were discussed. This study supports findings that acknowledge the mediating role played by personality factors and family functioning in the relationship between attachment and EDs.

Hiding vegetables to reduce energy density: an effective strategy to increase children's vegetable intake and reduce energy intake123

PubMed Central

Spill, Maureen K; Birch, Leann L; Roe, Liane S

2011-01-01

Background: Strategies are needed to increase children's intake of a variety of vegetables, including vegetables that are not well liked. Objective: We investigated whether incorporating puréed vegetables into entrées to reduce the energy density (ED; in kcal/g) affected vegetable and energy intake over 1 d in preschool children. Design: In this crossover study, 3- to 5-y-old children (n = 40) were served all meals and snacks 1 d/wk for 3 wk. Across conditions, entrées at breakfast, lunch, dinner, and evening snack were reduced in ED by increasing the proportion of puréed vegetables. The conditions were 100% ED (standard), 85% ED (tripled vegetable content), and 75% ED (quadrupled vegetable content). Entrées were served with unmanipulated side dishes and snacks, and children were instructed to eat as much as they liked. Results: The daily vegetable intake increased significantly by 52 g (50%) in the 85% ED condition and by 73 g (73%) in the 75% ED condition compared with that in the standard condition (both P < 0.0001). The consumption of more vegetables in entrées did not affect the consumption of the vegetable side dishes. Children ate similar weights of food across conditions; thus, the daily energy intake decreased by 142 kcal (12%) from the 100% to 75% ED conditions (P < 0.05). Children rated their liking of manipulated foods similarly across ED amounts. Conclusion: The incorporation of substantial amounts of puréed vegetables to reduce the ED of foods is an effective strategy to increase the daily vegetable intake and decrease the energy intake in young children. This trial was registered at clinicaltrials.gov as NCT01252433. PMID:21775554

Characteristics of older people with cognitive impairment attending emergency departments: A descriptive study.

PubMed

Schnitker, Linda M; Beattie, Elizabeth R A; Martin-Khan, Melinda; Burkett, Ellen; Gray, Leonard C

2016-05-01

The objective of this paper is to describe the profile of older people with cognitive impairment (CI) presenting to emergency departments (EDs). This was a multi-centre (n=8) observational study of a convenience sample of older (≥70y) ED patients (n=579). Participants were prospectively assessed for CI and surveyed for the duration of their ED stay (n=191). A picture of patients' health status and ED responses to care needs was obtained through application of standardised assessment tools. Additionally, observations of care processes in ED were undertaken. Demographic data were collected through both ED's information system and survey. Outcome data were collected 28 days post-ED visit using follow-up telephone interviews. Of 579 older persons, 191 (33%) persons met criteria for CI. The majority of older ED patients with CI in ED lived in the community (157/177, 88.7%), arrived by ambulance (116/172, 67%), were accompanied by a support person (94/149, 63%), were triaged as urgent to semi-urgent (157/191, 82%), and were hospitalised (108/172, 57%). The median ED length of stay was 6h. In ED, 53% of the sample experienced pain (92/173). Older ED patients with CI pose the following characteristics: prior hospital admissions (43/129, 33%), incontinence (61/178, 34%), dependence in activities in daily living (81/190, 43%), issues in nutrition (73/182, 40%), vision and hearing impairment (93% (160/172) and 26% (44/171) respectively). Increased understanding of these presenting characteristics and their impacts on patient risk facilitates tailoring the quality of emergency care to better suit the needs and improve outcomes of this increasing ED population. Copyright © 2016 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

Public health and clinical impact of increasing emergency department-based HIV testing: perspectives from the 2007 conference of the National Emergency Department HIV Testing Consortium.

PubMed

Kecojevic, Aleksandar; Lindsell, Christopher J; Lyons, Michael S; Holtgrave, David; Torres, Gretchen; Heffelfinger, James; Brown, Jeremy; Couture, Eileen; Jung, Julianna; Connell, Samantha; Rothman, Richard E

2011-07-01

Understanding perceived benefits and disadvantages of HIV testing in emergency departments (EDs) is imperative to overcoming barriers to implementation. We codify those domains of public health and clinical care most affected by implementing HIV testing in EDs, as determined by expert opinion. Opinions were systematically collected from attendees of the 2007 National ED HIV Testing Consortium meeting. Structured evaluation of strengths, weaknesses, opportunities, and threats analysis was conducted to assess the impact of ED-based HIV testing on public health. A modified Delphi method was used to assess the impact of ED-based HIV testing on clinical care from both individual patient and individual provider perspectives. Opinions were provided by 98 experts representing 42 academic and nonacademic institutions. Factors most frequently perceived to affect public health were (strengths) high volume of ED visits and high prevalence of HIV, (weaknesses) undue burden on EDs, (opportunities) reduction of HIV stigma, and (threats) lack of resources in EDs. Diagnostic testing and screening for HIV were considered to have a favorable impact on ED clinical care from both individual patient and individual provider perspectives; however, negative test results were not perceived to have any benefit from the provider's perspective. The need for HIV counseling in the ED was considered to have a negative impact on clinical care from the provider's perspective. Experts in ED-based HIV testing perceived expanded ED HIV testing to have beneficial impacts for both the public health and individual clinical care; however, limited resources were frequently cited as a possible impediment. Many issues must be resolved through further study, education, and policy changes if the full potential of HIV testing in EDs is to be realized. Copyright © 2011. Published by Mosby, Inc.

Characterization of an antigenic site that contains a dominant, type-specific neutralization determinant on the envelope protein domain III (ED3) of dengue 2 virus

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

Gromowski, Gregory D.; Barrett, Alan D.T.

2007-09-30

The surface of the mature dengue virus (DENV) particle consists of 90 envelope (E) protein dimers that mediate both receptor binding and fusion. The E protein ectodomain can be divided into three structural domains designated ED1, ED2, and ED3, of which ED3 contains the critical and dominant virus-specific neutralization sites. In this study the ED3 epitopes recognized by seven, murine, IgG1 DENV-2 type-specific, monoclonal antibodies (MAbs) were determined using site-directed mutagenesis of a recombinant DENV-2 ED3 (rED3) protein. A total of 41 single amino acid substitutions were introduced into the rED3 at 30 different surface accessible residues. The affinity ofmore » each MAb with the mutant rED3s was assessed by indirect ELISA and the results indicate that all seven MAbs recognize overlapping epitopes with residues K305 and P384 critical for binding. These residues are conserved among DENV-2 strains and cluster together on the upper lateral face of ED3. A linear relationship was observed between relative occupancy of ED3 on the virion by MAb and neutralization of the majority of virus infectivity ({approx} 90%) for all seven MAbs. Depending on the MAb, it is predicted that between 10% and 50% relative occupancy of ED3 on the virion is necessary for virus neutralization and for all seven MAbs occupancy levels approaching saturation were required for 100% neutralization of virus infectivity. Overall, the conserved antigenic site recognized by all seven MAbs is likely to be a dominant DENV-2 type-specific, neutralization determinant.« less

Performance of Emergency Department Screening Criteria for an Early ECG to Identify ST-Segment Elevation Myocardial Infarction.

PubMed

Yiadom, Maame Yaa A B; Baugh, Christopher W; McWade, Conor M; Liu, Xulei; Song, Kyoung Jun; Patterson, Brian W; Jenkins, Cathy A; Tanski, Mary; Mills, Angela M; Salazar, Gilberto; Wang, Thomas J; Dittus, Robert S; Liu, Dandan; Storrow, Alan B

2017-02-23

Timely diagnosis of ST-segment elevation myocardial infarction (STEMI) in the emergency department (ED) is made solely by ECG. Obtaining this test within 10 minutes of ED arrival is critical to achieving the best outcomes. We investigated variability in the timely identification of STEMI across institutions and whether performance variation was associated with the ED characteristics, the comprehensiveness of screening criteria, and the STEMI screening processes. We examined STEMI screening performance in 7 EDs, with the missed case rate (MCR) as our primary end point. The MCR is the proportion of primarily screened ED patients diagnosed with STEMI who did not receive an ECG within 15 minutes of ED arrival. STEMI was defined by hospital discharge diagnosis. Relationships between the MCR and ED characteristics, screening criteria, and STEMI screening processes were assessed, along with differences in door-to-ECG times for captured versus missed patients. The overall MCR for all 7 EDs was 12.8%. The lowest and highest MCRs were 3.4% and 32.6%, respectively. The mean difference in door-to-ECG times for captured and missed patients was 31 minutes, with a range of 14 to 80 minutes of additional myocardial ischemia time for missed cases. The prevalence of primarily screened ED STEMIs was 0.09%. EDs with the greatest informedness (sensitivity+specificity-1) demonstrated superior performance across all other screening measures. The 29.2% difference in MCRs between the highest and lowest performing EDs demonstrates room for improving timely STEMI identification among primarily screened ED patients. The MCR and informedness can be used to compare screening across EDs and to understand variable performance. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

The ED use and non-urgent visits of elderly patients.

PubMed

Gulacti, Umut; Lok, Ugur; Celik, Murat; Aktas, Nurettin; Polat, Haci

2016-12-01

To evaluate the use of the emergency department (ED) by elderly patients, their non-urgent visits and the prevalence of main disease for ED visits. This cross-sectional study was conducted on patients aged 65 years and over who visited the ED of a tertiary care university hospital in Turkey between January 2015 and January 2016 retrospectively. A total of 36,369 elderly patients who visited the ED were included in the study. The rate of ED visits by elderly patients was higher than their representation within the general population (p < 0.001). While the rate of elderly patients visiting polyclinics was 15.8%, the rate of elderly patients visiting the ED was 24.3% (p < 0.001). For both genders, the rates of ED visits for patients between 65 and 74 years old was higher than for other elderly age groups (p < 0.001). The prevalence of upper respiratory tract infection (URTI) was the highest within the elderly population (17.5%, CI: 17.1-17.9). The proportion of ED visits for non-urgent conditions was 23.4%. Most of the ED visits were during the non-business hours (51.1%), and they were highest in the winter season (25.9%) and in January (10.2%). The hospitalization rate was 9.4%, and 37.9% of hospitalized patients were admitted to intensive care units. The proportion of ED visits by elderly patients was higher than their representation within the general population. Elderly patients often visited the ED instead of a polyclinic. The rate of inappropriate ED use by elderly patients in this hospital was higher than in other countries.

Longitudinal assessment of excessive daytime sleepiness in early Parkinson's disease.

PubMed

Amara, Amy W; Chahine, Lama M; Caspell-Garcia, Chelsea; Long, Jeffrey D; Coffey, Christopher; Högl, Birgit; Videnovic, Aleksandar; Iranzo, Alex; Mayer, Geert; Foldvary-Schaefer, Nancy; Postuma, Ron; Oertel, Wolfgang; Lasch, Shirley; Marek, Ken; Simuni, Tanya

2017-08-01

Excessive daytime sleepiness (EDS) is common and disabling in Parkinson's disease (PD). Predictors of EDS are unclear, and data on biological correlates of EDS in PD are limited. We investigated clinical, imaging and biological variables associated with longitudinal changes in sleepiness in early PD. The Parkinson's Progression Markers Initiative is a prospective cohort study evaluating progression markers in participants with PD who are unmedicated at baseline (n=423) and healthy controls (HC; n=196). EDS was measured with the Epworth Sleepiness Scale (ESS). Clinical, biological and imaging variables were assessed for associations with EDS for up to 3 years. A machine learning approach (random survival forests) was used to investigate baseline predictors of incident EDS. ESS increased in PD from baseline to year 3 (mean±SD 5.8±3.5 to 7.55±4.6, p<0.0001), with no change in HC. Longitudinally, EDS in PD was associated with non-tremor dominant phenotype, autonomic dysfunction, depression, anxiety and probable behaviour disorder, but not cognitive dysfunction or motor severity. Dopaminergic therapy was associated with EDS at years 2 and 3, as dose increased. EDS was also associated with presynaptic dopaminergic dysfunction, whereas biofluid markers at year 1 showed no significant associations with EDS. A predictive index for EDS was generated, which included seven baseline characteristics, including non-motor symptoms and cerebrospinal fluid phosphorylated-tau/total-tau ratio. In early PD, EDS increases significantly over time and is associated with several clinical variables. The influence of dopaminergic therapy on EDS is dose dependent. Further longitudinal analyses will better characterise associations with imaging and biomarkers. © 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.

Levels of uric acid in erectile dysfunction of different aetiology.

PubMed

Barassi, Alessandra; Corsi Romanelli, Massimiliano Marco; Pezzilli, Raffaele; Dozio, Elena; Damele, Clara Anna Linda; Vaccalluzzo, Liborio; Di Dario, Marco; Goi, Giancarlo; Papini, Nadia; Massaccesi, Luca; Colpi, Giovanni Maria; Melzi d'Eril, Gian Vico

2018-01-12

Erectile dysfunction is a common disease characterized by endothelial dysfunction. The aetiology of ED is often multifactorial but evidence is being accumulated in favor of the proper function of the vascular endothelium that is essential to achieving and maintaining penile erection. Uric acid itself causes endothelial dysfunction via decreased nitric oxide production. This study aims to evaluate the serum uric acid (SUA) levels in 180 ED patients, diagnosed with the International Index of Erectile Function-5 (IIEF-5) and 30 non-ED control. Serum uric acid was analyzed with a commercially available kit using ModularEVO (Roche, Monza, Italy). Within-assay and between-assay variations were 3.0% and 6.0%, respectively. Out of the ED patients, 85 were classified as arteriogenic (A-ED) and 95 as non-arteriogenic (NA-ED) with penile-echo-color-Doppler. Uric acid levels (median and range in mg/dL) in A-ED patients (5.8, 4.3-7.5) were significantly higher (p < .001) than in NA-ED patients (4.4, 2.6-5.9) and in control group (4.6, 3.1-7.2). There was a significant difference (p < .001) between uric acid levels in patients with mild A-ED (IIEF-5 16-20) and severe/complete A-ED (IIEF-5 ≤ 10) that were 5.4 (range 4.3-6.5) mg/dL and 6.8 (range 6.4-7.2) mg/dL, respectively. There was no difference between the levels of uric acid in patients with different degree of NA-ED. Our findings reveal that SUA is a marker of ED but only of ED of arteriogenic aetiology.

Hiding vegetables to reduce energy density: an effective strategy to increase children's vegetable intake and reduce energy intake.

PubMed

Spill, Maureen K; Birch, Leann L; Roe, Liane S; Rolls, Barbara J

2011-09-01

Strategies are needed to increase children's intake of a variety of vegetables, including vegetables that are not well liked. We investigated whether incorporating puréed vegetables into entrées to reduce the energy density (ED; in kcal/g) affected vegetable and energy intake over 1 d in preschool children. In this crossover study, 3- to 5-y-old children (n = 40) were served all meals and snacks 1 d/wk for 3 wk. Across conditions, entrées at breakfast, lunch, dinner, and evening snack were reduced in ED by increasing the proportion of puréed vegetables. The conditions were 100% ED (standard), 85% ED (tripled vegetable content), and 75% ED (quadrupled vegetable content). Entrées were served with unmanipulated side dishes and snacks, and children were instructed to eat as much as they liked. The daily vegetable intake increased significantly by 52 g (50%) in the 85% ED condition and by 73 g (73%) in the 75% ED condition compared with that in the standard condition (both P < 0.0001). The consumption of more vegetables in entrées did not affect the consumption of the vegetable side dishes. Children ate similar weights of food across conditions; thus, the daily energy intake decreased by 142 kcal (12%) from the 100% to 75% ED conditions (P < 0.05). Children rated their liking of manipulated foods similarly across ED amounts. The incorporation of substantial amounts of puréed vegetables to reduce the ED of foods is an effective strategy to increase the daily vegetable intake and decrease the energy intake in young children. This trial was registered at clinicaltrials.gov as NCT01252433.

Relationship between office-based provider visits and emergency department encounters among publicly-insured adults with epilepsy.

PubMed

Lekoubou, Alain; Bishu, Kinfe G; Ovbiagele, Bruce

2018-03-01

The proportion of adults with epilepsy using the emergency department (ED) is high. Among this patient population, increased frequency of office-based provider visits may be associated with lesser frequency of ED encounters, and key patient features may be linked to more ED encounters. We analyzed the Medical Expenditure Panel Survey Household Component (MEPS-HC) dataset for years 2003-2014, which represents a weighted sample of 842,249 publicly-insured US adults aged ≥18years. The Hurdle Poisson model that accommodates excess zeros was used to estimate the association between office-based and ED visits. Annual mean ED and office-based visits for publicly-insured adults with epilepsy were 0.70 and 10.8 respectively. Probability of at least one ED visit was 0.4% higher for every unit of office-based visit. Individuals in the high income category were less likely to visit the ED at least once while women with epilepsy had a higher likelihood of visiting the ED at least once. Among those who visited the ED at least once, there was a 0.3% higher likelihood of visiting the ED for every unit of office-based visit. Among individuals who visited the ED at least once, being aged 45-64years, residing in the West, and the year 2011/14 were associated with higher ED visits. In this representative sample of publicly-insured adults with epilepsy, higher frequency of office visits was not associated with lower ED utilization, which may be due to underlying greater disease severity or propensity for more treatment complications. Copyright © 2018 Elsevier Inc. All rights reserved.

Choking - adult or child over 1 year

MedlinePlus

... Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier ... Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier ...

Paint, lacquer, and varnish remover poisoning

MedlinePlus

... Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier ... Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier ...

Prenatal care in your second trimester

MedlinePlus

... SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies . 7th ed. Philadelphia, PA: ... JC, Hobel CJ, eds. Hacker & Moore's Essentials of Obstetrics and Gynecology . 6th ed. Philadelphia, PA: Elsevier; 2016: ...

Peripheral artery bypass - leg - discharge

MedlinePlus

... RO, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier ... RO, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier ...

Warning signs and symptoms of heart disease

MedlinePlus

... RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier ... RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier ...

Eye - foreign object in

MedlinePlus

... JR, ed. Roberts and Hedges' Clinical Procedures in Emergency Medicine . 6th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap ... RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 9th ed. Philadelphia, PA: ...

Urinary catheters - what to ask your doctor

MedlinePlus

... incontinence. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ... incontinence. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ...

Hearing loss and music

MedlinePlus

... BH, Lund V, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 6th ed. Philadelphia, PA: Elsevier Saunders; 2015: ... BH, Lund V, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 6th ed. Philadelphia, PA: Elsevier Saunders; 2015: ...

Fusion of the ear bones

MedlinePlus

... BH, Lund V, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 6th ed. Philadelphia, PA: Elsevier Saunders; 2015: ... BH, Lund V, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 6th ed. Philadelphia, PA: Elsevier Saunders; 2015: ...

A National Study of Outpatient Health Care Providers' Effect on Emergency Department Visit Acuity and Likelihood of Hospitalization.

PubMed

Raven, Maria C; Steiner, Faye

2018-06-01

Many policymakers believe that expanding access to outpatient care will reduce emergency department (ED) use. However, outpatient health care providers often refer their patients to EDs for evaluation and management. We examine the factors underlying outpatient provider referral, its effect on ED visit volume, and whether referred ED visits are more likely to result in hospitalization than self-referred visits. We conducted a cross-sectional study of 19,342 adult (>18 years) respondents to the 2012 to 2014 National Health Interview Survey who reported they had visited an ED at least once in the past 12 months, representing an estimated 44,152,870 US adults. We categorized individuals as having been referred to the ED by an outside health care provider if they responded affirmatively to "your health care provider advised you to go" as a reason for their most recent ED visit. We performed descriptive analyses and logistic regressions to examine factors associated with outpatient health care provider referral to the ED. Respondents could choose multiple other reasons for their most recent ED visit, and we used existing Centers for Disease Control and Prevention guidelines to group these reasons into 2 categories: seriousness of the medical condition and lack of access to other providers. Our 2 main outcomes were whether an outpatient health care provider referred an individual to the ED and whether that ED visit resulted in hospitalization. Of the 44,152,870 US adults (18.58%; 95% confidence interval [CI] 18.21% to 18.95%) with one or more ED visits in the previous 12 months, 10,913,271 (24.72%; 95% CI 23.80% to 25.64%) were referred to the ED by an outpatient provider. Respondents who reported their ED visit was due to the seriousness of their medical condition were more likely to be referred to the ED (odds ratio [OR] 2.18; 95% CI 1.91 to 2.49), whereas those reporting a lack of access to other providers were less likely to be referred (OR 0.58; 95% CI 0.52 to 0.64). Visits referred to the ED were more likely to result in hospitalization than self-referrals (OR 2.07; 95% CI 1.87 to 2.31). Almost one quarter of individuals' most recent ED visits were driven by referrals from outpatient health care providers. Being referred to the ED by an outpatient provider is strongly associated with the seriousness of one's medical condition, which also increases the odds of hospitalization compared with ED discharge. After controlling for seriousness of medical condition, ED referral by an outpatient provider continues to have an independent association with hospitalization. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Double trouble: Portion size and energy density combine to increase preschool children’s lunch intake

PubMed Central

Kling, Samantha M.R.; Roe, Liane S.; Keller, Kathleen L.; Rolls, Barbara J.

2016-01-01

Background Both portion size and energy density (ED) have substantial effects on intake; however, their combined effects on preschool children’s intake have not been examined when multiple foods are varied at a meal. Objective We tested the effects on intake of varying the portion size and ED of lunches served to children in their usual eating environment. Design In a crossover design, lunch was served in 3 childcare centers once a week for 6 weeks to 120 children aged 3 to 5 y. Across the 6 meals, all items were served at 3 levels of portion size (100%, 150%, or 200%) and 2 levels of ED (100% or 142%). The lunch menu had either lowerED or higher-ED versions of chicken, macaroni and cheese, vegetables, applesauce, ketchup, and milk. Children’s ratings of the foods indicated that the lower-ED and higher-ED meals were similarly well liked. Results The weight of food and milk consumed at meals was increased by serving larger portions (P<0.0001) but was unaffected by varying the ED (P=0.22). Meal energy intake, however, was independently affected by portion size and ED (both P<0.0001). Doubling the portions increased energy intake by 24% and increasing meal ED by 42% increased energy intake by 40%. These effects combined to increase intake by 175±12 kcal or 79% at the higherED meal with the largest portions compared to the lower-ED meal with the smallest portions. The foods contributing the most to this increase were chicken, macaroni and cheese, and applesauce. The effects of meal portion size and ED on intake were not influenced by child age or body size, but were significantly affected by parental ratings of child eating behavior. Conclusion Strategically moderating the portion size and ED of foods typically consumed by children could substantially reduce their energy intake without affecting acceptability. PMID:26879105

Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers.

PubMed

Ho, Vivian; Metcalfe, Leanne; Dark, Cedric; Vu, Lan; Weber, Ellerie; Shelton, George; Underwood, Howard R

2017-12-01

We compare utilization, price per visit, and the types of care delivered across freestanding emergency departments (EDs), hospital-based EDs, and urgent care centers in Texas. We analyzed insurance claims processed by Blue Cross Blue Shield of Texas from 2012 to 2015 for patient visits to freestanding EDs, hospital-based EDs, or urgent care centers in 16 Texas metropolitan statistical areas containing 84.1% of the state's population. We calculated the aggregate number of visits, average price per visit, proportion of price attributable to facility and physician services, and proportion of price billed to Blue Cross Blue Shield of Texas versus out of pocket, by facility type. Prices for the top 20 diagnoses and procedures by facility type are compared. Texans use hospital-based EDs and urgent care centers much more than freestanding EDs, but freestanding ED utilization increased 236% between 2012 and 2015. The average price per visit was lower for freestanding EDs versus hospital-based EDs in 2012 ($1,431 versus $1,842), but prices in 2015 were comparable ($2,199 versus $2,259). Prices for urgent care centers were only $164 and $168 in 2012 and 2015. Out-of-pocket liability for consumers for all these facilities increased slightly from 2012 to 2015. There was 75% overlap in the 20 most common diagnoses at freestanding EDs versus urgent care centers and 60% overlap for hospital-based EDs and urgent care centers. However, prices for patients with the same diagnosis were on average almost 10 times higher at freestanding and hospital-based EDs relative to urgent care centers. Utilization of freestanding EDs is rapidly expanding in Texas. Higher prices at freestanding and hospital-based EDs relative to urgent care centers, despite substantial overlap in services delivered, imply potential inefficient use of emergency facilities. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Three-dimensional electron diffraction as a complementary technique to powder X-ray diffraction for phase identification and structure solution of powders.

PubMed

Yun, Yifeng; Zou, Xiaodong; Hovmöller, Sven; Wan, Wei

2015-03-01

Phase identification and structure determination are important and widely used techniques in chemistry, physics and materials science. Recently, two methods for automated three-dimensional electron diffraction (ED) data collection, namely automated diffraction tomography (ADT) and rotation electron diffraction (RED), have been developed. Compared with X-ray diffraction (XRD) and two-dimensional zonal ED, three-dimensional ED methods have many advantages in identifying phases and determining unknown structures. Almost complete three-dimensional ED data can be collected using the ADT and RED methods. Since each ED pattern is usually measured off the zone axes by three-dimensional ED methods, dynamic effects are much reduced compared with zonal ED patterns. Data collection is easy and fast, and can start at any arbitrary orientation of the crystal, which facilitates automation. Three-dimensional ED is a powerful technique for structure identification and structure solution from individual nano- or micron-sized particles, while powder X-ray diffraction (PXRD) provides information from all phases present in a sample. ED suffers from dynamic scattering, while PXRD data are kinematic. Three-dimensional ED methods and PXRD are complementary and their combinations are promising for studying multiphase samples and complicated crystal structures. Here, two three-dimensional ED methods, ADT and RED, are described. Examples are given of combinations of three-dimensional ED methods and PXRD for phase identification and structure determination over a large number of different materials, from Ni-Se-O-Cl crystals, zeolites, germanates, metal-organic frameworks and organic compounds to intermetallics with modulated structures. It is shown that three-dimensional ED is now as feasible as X-ray diffraction for phase identification and structure solution, but still needs further development in order to be as accurate as X-ray diffraction. It is expected that three-dimensional ED methods will become crucially important in the near future.

Neurobehavioural and cognitive development in infants born to mothers with eating disorders.

PubMed

Barona, Manuela; Taborelli, Emma; Corfield, Freya; Pawlby, Susan; Easter, Abigail; Schmidt, Ulrike; Treasure, Janet; Micali, Nadia

2017-08-01

Although recent research has focused on the effects of maternal eating disorders (EDs) on children, little is known about the effect of maternal EDs on neurobiological outcomes in newborns and infants. This study is the first to investigate neurobehavioural regulation and cognitive development in newborns and infants of mothers with EDs. Women with an active and past ED and healthy controls were recruited to a prospective longitudinal study during their first trimester or second trimester of pregnancy. Newborns and infants of mothers with ED were compared with newborns and infants of healthy controls on (a) neurobehavioural dysregulation using the Brazelton Neonatal Behavioural Assessment Scale at 8 days postpartum (active ED, n = 15; past ED, n = 20; healthy controls, n = 28); and (b) cognitive development using the Bayley Scales of Infant and Toddler Development at 1-year postpartum (active ED, n = 18; past ED, n = 19; healthy controls, n = 28). In order to maintain the largest possible sample at each time point, sample size varied across time points. Newborns of mothers with an active ED had worse autonomic stability when compared with newborns of healthy controls [B = -0.34 (-1.81, -0.26)]. Infants of mothers with a past ED had poorer language [B = -0.33 (-13.6, -1.9)] and motor development [B = -0.32 (-18.4, -1.3)] compared with healthy controls. Children of mothers with ED display neurobehavioural dysregulation early after birth and poorer language and motor development at 1 year. These characteristics suggest evidence of early neurobiological markers in children at risk. Differential outcomes in children of women with active versus past ED suggest that active symptomatology during pregnancy might have an effect on physiological reactivity while cognitive characteristics might be more stable markers of risk for ED. © 2017 Association for Child and Adolescent Mental Health.

Is there a relationship between chronic periodontitis and erectile dysfunction?

PubMed

Oğuz, Fatih; Eltas, Abubekir; Beytur, Ali; Akdemir, Ender; Uslu, Mustafa Özay; Güneş, Ali

2013-03-01

Chronic periodontitis (CP) is characterized with inflammation of the gingival tissues, which causes endothelial dysfunction in different organs. In this study, we investigated the association of CP with the erectile dysfunction (ED). The study group included 80 male patients with ED and 82 male patients without ED (control), aged between 30 and 40 years. The International Index of Erectile Function (IIEF) questionnaire was used to assess male sexual function, particularly the presence or absence of ED. The patients in the study and control groups were statistically compared according to their plaque index (PI), bleeding on probing (BoP), probing depth (PD), and clinical attachment level (CAL). In the non-ED and the ED groups, the mean age was 35.7 ± 4.8 and 34.9 ± 4.9 years, respectively. Patients' characteristics including body mass index, household income, and education status were similar in both groups (P > 0.05). Nineteen patients (23%) had severe CP in the non-ED group; 42 patients (53%) had severe CP in the ED group. Logistic regression analysis showed a significantly high association between ED and the severity of CP (odds ratio: 3.29, 95% confidence interval: 1.36-9.55, P < 0.01). The mean values of PI, BoP, and the percentages of sites with PD >4 mm and sites with CAL >4 mm were significantly higher in the ED group than in the control group (P < 0.05). The mean values of PD and CAL were not significantly different in the two groups (P > 0.05). The decayed, missing, filled teeth scores were also significantly higher in the ED group than in the non-ED group (P < 0.05).   Our results have suggested that CP had a high association with ED in young adults at 30-40 years. We think that it will be of benefit to consider periodontal disease as a causative clinical condition of ED in such patients. © 2012 International Society for Sexual Medicine.

Double trouble: Portion size and energy density combine to increase preschool children's lunch intake.

PubMed

Kling, Samantha M R; Roe, Liane S; Keller, Kathleen L; Rolls, Barbara J

2016-08-01

Both portion size and energy density (ED) have substantial effects on intake; however, their combined effects on preschool children's intake have not been examined when multiple foods are varied at a meal. We tested the effects on intake of varying the portion size and ED of lunches served to children in their usual eating environment. In a crossover design, lunch was served in 3 childcare centers once a week for 6weeks to 120 children aged 3-5y. Across the 6 meals, all items were served at 3 levels of portion size (100%, 150%, or 200%) and 2 levels of ED (100% or 142%). The lunch menu had either lower-ED or higher-ED versions of chicken, macaroni and cheese, vegetables, applesauce, ketchup, and milk. Children's ratings of the foods indicated that the lower-ED and higher-ED meals were similarly well liked. The total weight of food and milk consumed at meals was increased by serving larger portions (P<0.0001) but was unaffected by varying the ED (P=0.22). Meal energy intake, however, was independently affected by portion size and ED (both P<0.0001). Doubling the portions increased energy intake by 24% and increasing meal ED by 42% increased energy intake by 40%. These effects combined to increase intake by 175±12kcal or 79% at the higher-ED meal with the largest portions compared to the lower-ED meal with the smallest portions. The foods contributing the most to this increase were chicken, macaroni and cheese, and applesauce. The effects of meal portion size and ED on intake were not influenced by child age or body size, but were significantly affected by parental ratings of child eating behavior. Strategically moderating the portion size and ED of foods typically consumed by children could substantially reduce their energy intake without affecting acceptability. Copyright © 2016 Elsevier Inc. All rights reserved.

Effect of a brief emergency medicine education course on emergency department work intensity of family physicians.

PubMed

Vaillancourt, Samuel; Schultz, Susan E; Leaver, Chad; Stukel, Thérèse A; Schull, Michael J

2013-01-01

Recently, many Canadian emergency departments (EDs) have struggled with physician staffing shortages. In 2006, the Ontario Ministry of Health and Long-Term Care funded a brief "emergency medicine primer" (EMP) course for family physicians to upgrade or refresh skills, with the goal of increasing their ED work intensity. We sought to determine the effect of the EMP on the ED work intensity of family physicians. A retrospective longitudinal study was conducted of the ED work of 239 family physicians in the 2 years before and after a minimum of 6 months and up to 2 years from completing an EMP course in 2006 to 2008 compared to non-EMP physicians. ED work intensity was defined as the number of ED shifts per month and the number of ED patients seen per month. We conducted two analyses: a before and after comparison of all EMP physicians and a matched cohort analysis matching each EMP physician to four non-EMP physicians on sex, year of medical school graduation, rurality, and pre-EMP ED work intensity. Postcourse, EMP physicians worked 0.5 more ED shifts per month (13% increase, p  =  0.027). Compared to their matched controls, EMP physicians worked 0.7 more shifts per month (13% increase, p  =  0.0032) and saw 15 more patients per month (17% increase, p  =  0.0008) compared to matched non-EMP physicians. The greatest increases were among EMP physicians who were younger, were urban, had previous ED experience, or worked in a high-volume ED. The effect of the EMP course was negligible for physicians with no previous ED experience or working in rural areas. The EMP course is associated with modest increases in ED work intensity among some family physicians, in particular younger physicians in urban areas. No increase was seen among physicians without previous ED experience or working in rural areas.

Characterizing New England Emergency Departments by Telemedicine Use.

PubMed

Zachrison, Kori S; Hayden, Emily M; Schwamm, Lee H; Espinola, Janice A; Sullivan, Ashley F; Boggs, Krislyn M; Raja, Ali S; Camargo, Carlos A

2017-10-01

Telemedicine connects emergency departments (ED) with resources necessary for patient care; its use has not been characterized nationally, or even regionally. Our primary objective was to describe the prevalence of telemedicine use in New England EDs and the clinical applications of use. Secondarily, we aimed to determine if telemedicine use was associated with consultant availability and to identify ED characteristics associated with telemedicine use. We analyzed data from the National Emergency Department Inventory-New England survey, which assessed basic ED characteristics in 2014. The survey queried directors of every ED (n=195) in the six New England states (excluding federal hospitals and college infirmaries). Descriptive statistics characterized ED telemedicine use; multivariable logistic regression identified independent predictors of use. Of the 169 responding EDs (87% response rate), 82 (49%) reported using telemedicine. Telemedicine EDs were more likely to be rural (18% of users vs. 7% of non-users, p=0.03); less likely to be academic (1% of users vs. 11% of non-users, p=0.01); and less likely to have 24/7 access to neurology (p<0.001), neurosurgery (p<0.001), orthopedics (p=0.01), plastic surgery (p=0.01), psychiatry (p<0.001), and hand surgery (p<0.001) consultants. Neuro/stroke (68%), pediatrics (11%), psychiatry (11%), and trauma (10%) were the most commonly reported applications. On multivariable analysis, telemedicine was more likely in rural EDs (odds ratio [OR] 4.39, 95% confidence interval [CI] 1.30-14.86), and less likely in EDs with 24/7 neurologist availability (OR 0.21, 95% CI [0.09-0.49]), and annual volume <20,000 (OR 0.24, 95% CI [0.08-0.68]). Telemedicine is commonly used in New England EDs. In 2014, use was more common among rural EDs and EDs with limited neurology consultant availability. In contrast, telemedicine use was less common among very low-volume EDs.

Comparing Emergency Department Use Among Medicaid and Commercial Patients Using All-Payer All-Claims Data.

PubMed

Kim, Hyunjee; McConnell, K John; Sun, Benjamin C

2017-08-01

The high rate of emergency department (ED) use by Medicaid patients is not fully understood. The objective of this paper is (1) to provide context for ED service use by comparing Medicaid and commercial patients' differences across ED and non-ED health service use, and (2) to assess the extent to which Medicaid-commercial differences in ED use can be explained by observable factors in administrative data. Statistical decomposition methods were applied to ED, mental health, and inpatient care using 2011-2013 Medicaid and commercial insurance claims from the Oregon All Payer All Claims database. Demographics, comorbidities, health services use, and neighborhood characteristics accounted for 44% of the Medicaid-commercial difference in ED use, compared to 83% for mental health care and 75% for inpatient care. This suggests that relative to mental health and inpatient care, a large portion of ED use cannot be explained by administrative data. Models that further accounted for patient access to different primary care physicians explained an additional 8% of the Medicaid-commercial difference in ED use, suggesting that the quality of primary care may influence ED use. The remaining unexplained difference suggests that appropriately reducing ED use remains a credible target for policy makers, although success may require knowledge about patients' perceptions and behaviors as well as social determinants of health.

Cranial sutures

MedlinePlus

... BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 94. Netter FH. Head and neck. In: Netter FH, ed. Atlas of Human Anatomy . 6th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap ...

Emergency department and 'Google flu trends' data as syndromic surveillance indicators for seasonal influenza.

PubMed

Thompson, L H; Malik, M T; Gumel, A; Strome, T; Mahmud, S M

2014-11-01

We evaluated syndromic indicators of influenza disease activity developed using emergency department (ED) data - total ED visits attributed to influenza-like illness (ILI) ('ED ILI volume') and percentage of visits attributed to ILI ('ED ILI percent') - and Google flu trends (GFT) data (ILI cases/100 000 physician visits). Congruity and correlation among these indicators and between these indicators and weekly count of laboratory-confirmed influenza in Manitoba was assessed graphically using linear regression models. Both ED and GFT data performed well as syndromic indicators of influenza activity, and were highly correlated with each other in real time. The strongest correlations between virological data and ED ILI volume and ED ILI percent, respectively, were 0·77 and 0·71. The strongest correlation of GFT was 0·74. Seasonal influenza activity may be effectively monitored using ED and GFT data.

The use of hospital emergency departments for nonurgent health problems: a national perspective.

PubMed

Cunningham, P J; Clancy, C M; Cohen, J W; Wilets, M

1995-11-01

The use of the hospital emergency department (ED) for nonurgent health problems has been a subject of considerable controversy, in part because there is no widely accepted definition of "nonurgent." Elimination or substantial reduction in nonurgent ED use is frequently offered as a strategy for reducing health expenditures. Previous studies, often limited to individual hospitals or communities, have limited generalizability and do not permit examination of multiple factors likely to influence nonurgent ED utilization or examination of ED use for nonurgent problems in the context of overall outpatient utilization. This analysis of the 1987 National Medical Expenditure Survey (NMES) provides a nationally representative examination of nonurgent ED utilization that describes the frequency of ED use for nonurgent problems, characteristics of individuals that are associated with an increased likelihood of nonurgent ED use, the use of other outpatient physician services, and expenditures associated with nonurgent ED visits.

An Instrument to Study State-Wide Implementation of edTPA: Validating the Levels of edTPA Integration Survey

ERIC Educational Resources Information Center

Bhatnagar, Ruchi; Kim, Jihye; Many, Joyce E.

2017-01-01

Use of edTPA for preservice teacher assessment is becoming increasingly common across the country, with some states, including Georgia, mandating the passing of the edTPA for initial teacher licensure. This state-wide study investigated whether edTPA as a new policy initiative was being integrated by the teacher education programs and faculty in…

Nonurgent patients in emergency departments: rational or irresponsible consumers? Perceptions of professionals and patients.

PubMed

Durand, Anne-Claire; Palazzolo, Sylvie; Tanti-Hardouin, Nicolas; Gerbeaux, Patrick; Sambuc, Roland; Gentile, Stéphanie

2012-09-25

For several decades, overcrowding in emergency departments (EDs) has been intensifying due to the increased number of patients seeking care in EDs. Demand growth is partly due to misuse of EDs by patients who seek care for nonurgent problems. This study explores the reasons why people with nonurgent complaints choose to come to EDs, and how ED health professionals perceive the phenomenon of "nonurgency". Semi-structured interviews were conducted in 10 EDs with 87 nonurgent patients and 34 health professionals. Interviews of patients revealed three themes: (1) fulfilled health care needs, (2) barriers to primary care providers (PCPs), and (3) convenience. Patients chose EDs as discerning health consumers: they preferred EDs because they had difficulties obtaining a rapid appointment. Access to technical facilities in EDs spares the patient from being overwhelmed with appointments with various specialists. Four themes were identified from the interviews of health professionals: (1) the problem of defining a nonurgent visit, (2) explanations for patients' use of EDs for nonurgent complaints, (3) consequences of nonurgent visits, and (4) solutions to counter this tendency. Studies on the underlying reasons patients opt for the ED, as well as on their decision-making process, are lacking. The present study highlighted discrepancies between the perceptions of ED patients and those of health professionals, with a special focus on patient behaviour. To explain the use of ED, health professionals based themselves on the acuity and urgency of medical problems, while patients focused on rational reasons to initiate care in the ED (accessibility to health care resources, and the context in which the medical problem occurred). In spite of some limitations due to the slightly outdated nature of our data, as well as the difficulty of categorizing nonurgent situations, our findings show the importance of conducting a detailed analysis of the demand for health care. Understanding it is crucial, as it is the main determining factor in the utilization of health care resources, and provides promising insights into the phenomenon of ED usage increase. For reforms to be successful, the process of decision-making for unscheduled patients will have to be thoroughly investigated.

Prevalence and correlates of erectile dysfunction (ED) and treatment seeking for ED in Asian Men: the Asian Men's Attitudes to Life Events and Sexuality (MALES) study.

PubMed

Tan, Hui-Meng; Low, Wah Yun; Ng, Chirk Jenn; Chen, Kuang-Kuo; Sugita, Minoru; Ishii, Nobuhisa; Marumo, Ken; Lee, Sung Won; Fisher, William; Sand, Michael

2007-11-01

There have been limited multiregional studies in Asia examining the parameters of men's general and sexual health and quality of life in the general population vs. those in clinical cohorts of patients with erectile dysfunction (ED). The aims of the Asian Men's Attitudes to Life Events and Sexuality (Asian MALES) study were to investigate the prevalence of ED, associated health conditions, and ED treatment-seeking patterns in the general male population in five regions of Asia (China, Japan, Korea, Malaysia, and Taiwan). Standardized questionnaire previously used in a similar multiregional study and modified to ensure culturally appropriate content for Asia. Phase I of the study involved 10,934 adult men, aged 20-75 years, who were interviewed using the standardized questionnaire. Phase II of the study involved men with self-reported ED recruited from Phase I and via physician referral, invitations in general practitioner offices, and street interception (total Phase II sample, N = 1,209). The overall prevalence of self-reported ED in the Phase I study population was 6.4%. ED prevalence varied by region and significantly increased with age (P < 0.01). Men with ED reported significantly greater rates of comorbid illness (P < 0.0001) and a reduced quality of life (P = 0.0001), compared with men without ED. Phase II of the study revealed that fewer than half of men with self-reported ED had sought treatment for their problem. Men were more likely to seek help for erection difficulties from Western doctors than from traditional medicine practitioners (P = 0.0001). A man's partner/spouse was the most common influencer of treatment seeking in all regions except Malaysia. The findings confirm those of existing research on ED in both Asian and non-Asian males: ED is a prevalent condition; the prevalence of ED increases with age and is strongly associated with comorbid conditions; and the majority of men have never sought treatment for their condition. This study highlights a substantial need for the evaluation and treatment of ED in Asian men.

The Effect of Utilization Review on Emergency Department Operations.

PubMed

Desai, Shoma; Gruber, Phillip F; Eiting, Erick; Seabury, Seth A; Mack, Wendy J; Voyageur, Christian; Vasquez, Veronica; Kim, Hyung T; Terp, Sophie

2017-11-01

Increasingly, hospitals are using utilization review software to reduce hospital admissions in an effort to contain costs. Such practices have the potential to increase the number of unsafe discharges, particularly in public safety-net hospitals. Utilization review software tools are not well studied with regard to their effect on emergency department (ED) operations. We study the effect of prospectively used admission decision support on ED operations. In 2012, Los Angeles County + University of Southern California Medical Center implemented prospective use of computerized admission criteria. After implementation, only ED patients meeting primary review (diagnosis-based criteria) or secondary review (medical necessity as determined by an on-site emergency physician) were assigned inpatient beds. Data were extracted from electronic medical records from September 2011 through December 2013. Outcomes included operational metrics, 30-day ED revisits, and 30-day admission rates. Excluding a 6-month implementation period, monthly summary metrics were compared pre- and postimplementation with nonparametric and negative binomial regression methods. All adult ED visits, excluding incarcerated and purely behavioral health visits, were analyzed. The primary outcomes were disposition rates. Secondary outcomes were 30-day ED revisits, 30-day admission rate among return visitors to the ED, and estimated cost. Analysis of 245,662 ED encounters was performed. The inpatient admission rate decreased from 14.2% to 12.8%. Increases in discharge rate (82.4% to 83.4%) and ED observation unit utilization (2.5% to 3.4%) were found. Thirty-day revisits increased (20.4% to 24.4%), although the 30-day admission rate decreased (3.2% to 2.8%). Estimated cost savings totaled $193.17 per ED visit. The prospective application of utilization review software in the ED led to a decrease in the admission rate. This was tempered by a concomitant increase in ED observation unit utilization and 30-day ED revisits. Cost savings suggest that resources should be redirected to the more highly affected ED and ED observation unit, although more work is needed to confirm the generalizability of these findings. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

"It's not healthy and it's decidedly not masculine": a media analysis of UK newspaper representations of eating disorders in males.

PubMed

MacLean, Alice; Sweeting, Helen; Walker, Laura; Patterson, Chris; Räisänen, Ulla; Hunt, Kate

2015-05-29

Recent qualitative research found young men reporting that an expectation that eating disorders (EDs) mainly affect young women led them, and others, to only recognise their symptoms when their ED had become entrenched. This raises questions about how these stereotypes persist. We therefore explored how EDs in males were represented in articles published in UK newspapers over a 10-year period (7.12.2002-7.12.2012), specifically attending to whether newsprint media represent EDs in males as 'gender appropriate', 'gender anomalous' or 'gender neutral'. A qualitative thematic analysis of UK newspaper articles. We searched two databases, Newsbank and LexisNexis, for newspaper articles including ED and male terms in the lead/first paragraph. Following de-duplication, 420 articles were scrutinised; 138 met inclusion criteria for detailed textual analysis and were imported into NVivo10. The number of articles peaked in 2008 when a UK politician announced that he had experienced bulimia nervosa. Analysis of how the articles portrayed male ED-related characterisations and experiences revealed that they conveyed ambiguous messages about EDs in males. Despite apparently aiming to dispel stereotypes that only young women experience EDs and to address stigma surrounding EDs in males, many aspects of the articles, including repetition of phrases such as 'a young woman's illness', serve to reinforce messages that EDs are inherently 'female' and so 'anomalous' for men. Newspaper articles represent men with EDs as atypical of men, as a result of having an ED (and any feminising or demasculinising characteristics associated with this), and as atypical of people with EDs, who are still usually portrayed as teenage girls. Such media representations frame a cultural paradigm in which there is an expectation that men may feel shame about or strive to conceal EDs, potentially contributing to men with EDs delaying help-seeking, gaining late access to treatments and reducing chances of successful outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

“It's not healthy and it's decidedly not masculine”: a media analysis of UK newspaper representations of eating disorders in males

PubMed Central

MacLean, Alice; Sweeting, Helen; Walker, Laura; Patterson, Chris; Räisänen, Ulla; Hunt, Kate

2015-01-01

Objectives Recent qualitative research found young men reporting that an expectation that eating disorders (EDs) mainly affect young women led them, and others, to only recognise their symptoms when their ED had become entrenched. This raises questions about how these stereotypes persist. We therefore explored how EDs in males were represented in articles published in UK newspapers over a 10-year period (7.12.2002–7.12.2012), specifically attending to whether newsprint media represent EDs in males as ‘gender appropriate’, ‘gender anomalous’ or ‘gender neutral’. Design A qualitative thematic analysis of UK newspaper articles. Methods We searched two databases, Newsbank and LexisNexis, for newspaper articles including ED and male terms in the lead/first paragraph. Following de-duplication, 420 articles were scrutinised; 138 met inclusion criteria for detailed textual analysis and were imported into NVivo10. Findings The number of articles peaked in 2008 when a UK politician announced that he had experienced bulimia nervosa. Analysis of how the articles portrayed male ED-related characterisations and experiences revealed that they conveyed ambiguous messages about EDs in males. Despite apparently aiming to dispel stereotypes that only young women experience EDs and to address stigma surrounding EDs in males, many aspects of the articles, including repetition of phrases such as ‘a young woman's illness’, serve to reinforce messages that EDs are inherently ‘female’ and so ‘anomalous’ for men. Conclusions Newspaper articles represent men with EDs as atypical of men, as a result of having an ED (and any feminising or demasculinising characteristics associated with this), and as atypical of people with EDs, who are still usually portrayed as teenage girls. Such media representations frame a cultural paradigm in which there is an expectation that men may feel shame about or strive to conceal EDs, potentially contributing to men with EDs delaying help-seeking, gaining late access to treatments and reducing chances of successful outcomes. PMID:26024997

Early dynamic 18F-FDG PET to detect hyperperfusion in hepatocellular carcinoma liver lesions.

PubMed

Schierz, Jan-Henning; Opfermann, Thomas; Steenbeck, Jörg; Lopatta, Eric; Settmacher, Utz; Stallmach, Andreas; Marlowe, Robert J; Freesmeyer, Martin

2013-06-01

In addition to angiographic data on vascularity and vascular access, demonstration of hepatocellular carcinoma (HCC) liver nodule hypervascularization is a prerequisite for certain intrahepatic antitumor therapies. Early dynamic (ED) (18)F-FDG PET/CT could serve this purpose when the current standard method, contrast-enhanced (CE) CT, or other CE morphologic imaging modalities are unsuitable. A recent study showed ED (18)F-FDG PET/CT efficacy in this setting but applied a larger-than-standard (18)F-FDG activity and an elaborate protocol likely to hinder routine use. We developed a simplified protocol using standard activities and easily generated visual and descriptive or quantitative endpoints. This pilot study assessed the ability of these endpoints to detect HCC hyperperfusion and, thereby, evaluated the suitability in of the protocol everyday practice. Twenty-seven patients with 34 HCCs (diameter ≥ 1.5 cm) with hypervascularization on 3-phase CE CT underwent liver ED (18)F-FDG PET for 240 s, starting with (18)F-FDG (250-MBq bolus injection). Four frames at 15-s intervals, followed by 3 frames at 60-s intervals were reconstructed. Endpoints included focal tracer accumulation in the first 4 frames (60 s), subsequent focal washout, and visual and quantitative differences between tumor and liver regions of interest in maximum and mean ED standardized uptake value (ED SUVmax and ED SUVmean, respectively) 240-s time-activity curves. All 34 lesions were identified by early focal (18)F-FDG accumulation and faster time-to-peak ED SUVmax or ED SUVmean than in nontumor tissue. Tumor peak ED SUVmax and ED SUVmean exceeded liver levels in 85% and 53%, respectively, of lesions. Nadir tumor signal showed no consistent pattern relative to nontumor signal. HCC had a significantly shorter time to peak and significantly faster rate to peak for both ED SUVmax and ED SUVmean curves and a significantly higher peak ED SUVmax but not peak ED SUVmean than the liver. This pilot study provided proof of principle that our simplified ED (18)F-FDG PET/CT protocol includes endpoints that effectively detect HCC hypervascularization; this finding suggests that the protocol can be used routinely.

Tadalafil once daily in the treatment of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) in men without erectile dysfunction.

PubMed

Brock, Gerald; Broderick, Gregory; Roehrborn, Claus G; Xu, Lei; Wong, David; Viktrup, Lars

2013-11-01

To assess the safety and efficacy of tadalafil once daily on lower urinary tract symptoms suggestive of clinical benign prostatic hyperplasia (BPH-LUTS) in men without erectile dysfunction (ED). To compare these with effects in men with ED. After a 4-week washout period and 4-week placebo run-in period, 1089 men without ED (n = 338) and with ED (n = 751) were randomly assigned to placebo or tadalafil 5 mg once daily for 12 weeks in three global clinical studies with similar designs. In the pooled dataset, post hoc analyses of covariance assessed the impact and severity of BPH-LUTS using the International Prostate Symptom Score (IPSS) and the BPH Impact Index (BII) and IPSS quality-of-life (IPSS-QoL) subscores. Safety was assessed using treatment-emergent adverse events. The treatment-by-ED-status interaction was used to assess efficacy differences between the with/without ED subgroups. Men without ED were similar in BPH-LUTS severity/previous therapy to men with ED. Tadalafil significantly reduced BPH-LUTS from baseline when compared with placebo in men without ED (IPSS -5.4 vs -3.3, P < 0.01; IPSS voiding subscore -3.5 vs -2.0, P < 0.01; IPSS storage subscore -1.9 vs -1.3, P < 0.05). Tadalafil also significantly improved quality of life from baseline when compared with placebo in men without ED (IPSS-QoL -1.0 vs -0.7, BII -1.4 vs -1.0; both P < 0.05). Between-ED-subgroup interactions were not significant (all P > 0.68). Tadalafil was safe and well tolerated. Tadalafil 5 mg once daily improved BPH-LUTS in men without ED by a magnitude similar to that observed in men with ED. The adverse event profile in men without ED was consistent with that observed in men with ED. © 2013 The Authors. BJU International © 2013 BJU International.

[Erectile dysfunction: results of the Brazilian Sexual Life Study].

PubMed

Abdo, Carmita Helena Najjar; Oliveira, Waldemar Mendes de; Scanavino, Marco de Tubino; Martins, Fernando Gonini

2006-01-01

To estimate the prevalence of ED and related risk factors in a sample of the Brazilian male population. Cross-sectional study was carried out with a convenience sample of 2,862 men, 18 years of age or older, using an anonymous self-administered questionnaire. ED prevalence in the sample was obtained by a general question which was directly derived from the ED definition. Data were submitted to chi-square or Student's t tests. Logistic regression analyses were used for risk factor calculations. The prevalence of ED was 45.1% (31.2% mild, 12.2% moderate and 1.7% complete). Subjects with ED presented lower self-esteem, hindered interpersonal relationships, fewer sexual intercourses per week, more extra-marital relationships, complaints of lack of libido and premature ejaculation. When compared with men aged 18-39 years, men aged 60-69 presented 2.2 higher risk of ED (95% CI; 1.4-3.4; p < 0.01), whereas men aged 70 or older presented 3.0 higher risk of ED (95% CI; 1.4-6.3; p < 0.01). Level of education was inversely proportional to risk of ED. Yellow race, unemployment, religious affiliation, prostate tumor, hypertension and depression were variables that increased ED risk. The prevalence of ED was high and comparable to that found in other studies. Subjects with ED suffer from less sexual activity and poorer quality of life. Age and lower socioeconomic level are directly proportional to ED risk. Therapeutic and preventive measures should be implemented to minimize the negative impact of this condition, especially in developing countries.

Erectile dysfunction is frequent in systemic sclerosis and associated with severe disease: a study of the EULAR Scleroderma Trial and Research group.

PubMed

Foocharoen, Chingching; Tyndall, Alan; Hachulla, Eric; Rosato, Edoardo; Allanore, Yannick; Farge-Bancel, Dominique; Caramaschi, Paola; Airó, Paolo; Nikolaevna, Starovojtova M; Pereira da Silva, José António; Stamenkovic, Bojana; Riemekasten, Gabriela; Rednic, Simona; Sibilia, Jean; Wiland, Piotr; Tarner, Ingo; Smith, Vanessa; Onken, Anna T; Abdel Atty Mohamed, Walid Ahmed; Distler, Oliver; Morović-Vergles, Jadranka; Himsel, Andrea; de la Peña Lefebvre, Paloma Garcia; Hügle, Thomas; Walker, Ulrich A

2012-02-20

Erectile dysfunction (ED) is common in men with systemic sclerosis (SSc) but the demographics, risk factors and treatment coverage for ED are not well known. This study was carried out prospectively in the multinational EULAR Scleroderma Trial and Research database by amending the electronic data-entry system with the International Index of Erectile Function-5 and items related to ED risk factors and treatment. Centres participating in this EULAR Scleroderma Trial and Research substudy were asked to recruit patients consecutively. Of the 130 men studied, only 23 (17.7%) had a normal International Index of Erectile Function-5 score. Thirty-eight per cent of all participants had severe ED (International Index of Erectile Function-5 score ≤ 7). Men with ED were significantly older than subjects without ED (54.8 years vs. 43.3 years, P < 0.001) and more frequently had simultaneous non-SSc-related risk factors such as alcohol consumption. In 82% of SSc patients, the onset of ED was after the manifestation of the first non-Raynaud's symptom (median delay 4.1 years). ED was associated with severe cutaneous, muscular or renal involvement of SSc, elevated pulmonary pressures and restrictive lung disease. ED was treated in only 27.8% of men. The most common treatment was sildenafil, whose efficacy is not established in ED of SSc patients. Severe ED is a common and early problem in men with SSc. Physicians should address modifiable risk factors actively. More research into the pathophysiology, longitudinal development, treatment and psychosocial impact of ED is needed.

Trends of CT utilisation in an emergency department in Taiwan: a 5-year retrospective study

PubMed Central

Hu, Sung-Yuan; Hsieh, Ming-Shun; Lin, Meng-Yu; Hsu, Chiann-Yi; Lin, Tzu-Chieh; How, Chorng-Kuang; Wang, Chen-Yu; Tsai, Jeffrey Che-Hung; Wu, Yu-Hui; Chang, Yan-Zin

2016-01-01

Objectives To investigate the association between the trends of CT utilisation in an emergency department (ED) and changes in clinical imaging practice and patients' disposition. Setting A hospital-based retrospective observational study of a public 1520-bed referral medical centre in Taiwan. Participants Adult ED visits (aged ≥18 years) during 2009–2013, with or without receiving CT, were enrolled as the study participants. Main outcome measures For all enrolled ED visits, we retrospectively analysed: (1) demographic characteristics, (2) triage categories, (3) whether CT was performed and the type of CT scan, (4) further ED disposition, (5) ED cost and (6) ED length of stay. Results In all, 269 239 adult ED visits (148 613 male patients and 120 626 female patients) were collected during the 5-year study period, comprising 38 609 CT scans. CT utilisation increased from 11.10% in 2009 to 17.70% in 2013 (trend test, p<0.001). Four in 5 types of CT scan (head, chest, abdomen and miscellaneous) were increasingly utilised during the study period. Also, CT was increasingly ordered annually in all age groups. Although ED CT utilisation rates increased markedly, the annual ED visits did not actually increase. Moreover, the subsequent admission rate, after receiving ED CT, declined (59.9% in 2009 to 48.2% in 2013). Conclusions ED CT utilisation rates increased significantly during 2009–2013. Emergency physicians may be using CT for non-emergent studies in the ED. Further investigation is needed to determine whether increasing CT utilisation is efficient and cost-effective. PMID:27279477

Scientific principles for the identification of endocrine-disrupting chemicals: a consensus statement.

PubMed

Solecki, Roland; Kortenkamp, Andreas; Bergman, Åke; Chahoud, Ibrahim; Degen, Gisela H; Dietrich, Daniel; Greim, Helmut; Håkansson, Helen; Hass, Ulla; Husoy, Trine; Jacobs, Miriam; Jobling, Susan; Mantovani, Alberto; Marx-Stoelting, Philip; Piersma, Aldert; Ritz, Vera; Slama, Remy; Stahlmann, Ralf; van den Berg, Martin; Zoeller, R Thomas; Boobis, Alan R

2017-02-01

Endocrine disruption is a specific form of toxicity, where natural and/or anthropogenic chemicals, known as "endocrine disruptors" (EDs), trigger adverse health effects by disrupting the endogenous hormone system. There is need to harmonize guidance on the regulation of EDs, but this has been hampered by what appeared as a lack of consensus among scientists. This publication provides summary information about a consensus reached by a group of world-leading scientists that can serve as the basis for the development of ED criteria in relevant EU legislation. Twenty-three international scientists from different disciplines discussed principles and open questions on ED identification as outlined in a draft consensus paper at an expert meeting hosted by the German Federal Institute for Risk Assessment (BfR) in Berlin, Germany on 11-12 April 2016. Participants reached a consensus regarding scientific principles for the identification of EDs. The paper discusses the consensus reached on background, definition of an ED and related concepts, sources of uncertainty, scientific principles important for ED identification, and research needs. It highlights the difficulty in retrospectively reconstructing ED exposure, insufficient range of validated test systems for EDs, and some issues impacting on the evaluation of the risk from EDs, such as non-monotonic dose-response and thresholds, modes of action, and exposure assessment. This report provides the consensus statement on EDs agreed among all participating scientists. The meeting facilitated a productive debate and reduced a number of differences in views. It is expected that the consensus reached will serve as an important basis for the development of regulatory ED criteria.

Predicting frequent emergency department visits among children with asthma using EHR data.

PubMed

Das, Lala T; Abramson, Erika L; Stone, Anne E; Kondrich, Janienne E; Kern, Lisa M; Grinspan, Zachary M

2017-07-01

For children with asthma, emergency department (ED) visits are common, expensive, and often avoidable. Though several factors are associated with ED use (demographics, comorbidities, insurance, medications), its predictability using electronic health record (EHR) data is understudied. We used a retrospective cohort study design and EHR data from one center to examine the relationship of patient factors in 1 year (2013) and the likelihood of frequent ED use (≥2 visits) in the following year (2014), using bivariate and multivariable statistics. We applied and compared several machine-learning algorithms to predict frequent ED use, then selected a model based on accuracy, parsimony, and interpretability. We identified 2691 children. In bivariate analyses, future frequent ED use was associated with demographics, co-morbidities, insurance status, medication history, and use of healthcare resources. Machine learning algorithms had very good AUC (area under the curve) values [0.66-0.87], though fair PPV (positive predictive value) [48-70%] and poor sensitivity [16-27%]. Our final multivariable logistic regression model contained two variables: insurance status and prior ED use. For publicly insured patients, the odds of frequent ED use were 3.1 [2.2-4.5] times that of privately insured patients. Publicly insured patients with 4+ ED visits and privately insured patients with 6+ ED visits in a year had ≥50% probability of frequent ED use the following year. The model had an AUC of 0.86, PPV of 56%, and sensitivity of 23%. Among children with asthma, prior frequent ED use and insurance status strongly predict future ED use. © 2017 Wiley Periodicals, Inc.

Impact of an ABCDE team triage process combined with public guidance on the division of work in an emergency department.

PubMed

Kantonen, Jarmo; Lloyd, Robert; Mattila, Juho; Kauppila, Timo; Menezes, Ricardo

2015-06-01

To study the effects of applying an emergency department (ED) triage system, combined with extensive publicity in local media about the "right" use of emergency services, on the division of work between ED nurses and general practitioners (GPs). An observational and quasi-experimental study based on before-after comparisons. Implementation of the ABCDE triage system in a Finnish combined ED where secondary care is adjacent, and in a traditional primary care ED where secondary care is located elsewhere. GPs and nurses from two different primary care EDs. Numbers of monthly visits to different professional groups before and after intervention in the studied primary care EDs and numbers of monthly visits to doctors in the local secondary care ED. The beginning of the triage process increased temporarily the number of independent consultations and patient record entries by ED nurses in both types of studied primary care EDs and reduced the number of patient visits to a doctor compared with previous years but had no effect on doctor visits in the adjacent secondary care ED. No further decrease in the number of nurse or GP visits was observed by inhibiting the entrance of non-urgent patients. The ABCDE triage system combined with public guidance may reduce non-urgent patient visits to doctors in different kinds of primary care EDs without increasing visits in the secondary care ED. However, the additional work to implement the ABCDE system is mainly directed to nurses, which may pose a challenge for staffing.

Increased Emergency Department Use in Illinois After Implementation of the Patient Protection and Affordable Care Act.

PubMed

Dresden, Scott M; Powell, Emilie S; Kang, Raymond; McHugh, Megan; Cooper, Andrew J; Feinglass, Joe

2017-02-01

We examine emergency department (ED) use and hospitalizations through the ED after Patient Protection and Affordable Care Act (ACA) health insurance expansion in Illinois, a Medicaid expansion state. Using statewide hospital administrative data from 2011 through 2015 from 201 nonfederal Illinois hospitals for patients aged 18 to 64 years, mean monthly ED visits were compared before and after ACA implementation by disposition from the ED and primary payer. Visit data were combined with 2010 to 2014 census insurance estimates to compute payer-specific ED visit rates. Interrupted time-series analyses tested changes in ED visit rates and ED hospitalization rates by insurance type after ACA implementation. Average monthly ED visit volume increased by 14,080 visits (95% confidence interval [CI] 4,670 to 23,489), a 5.7% increase, after ACA implementation. Changes by payer were as follows: uninsured decreased by 24,158 (95% CI -27,037 to -21,279), Medicaid increased by 28,746 (95% CI 23,945 to 33,546), and private insurance increased by 9,966 (95% 6,241 to 13,690). The total monthly ED visit rate increased by 1.8 visits per 1,000 residents (95% CI 0.6 to 3.0). The monthly ED visit rate decreased by 8.7 visit per 1,000 uninsured residents (95% CI -11.1 to -6.3) and increased by 10.2 visit per 1,000 Medicaid beneficiaries (95% CI 4.4 to 16.1) and 1.3 visits per 1,000 privately insured residents (95% CI 0.6 to 1.9). After adjusting for baseline trends and season, these changes remained statistically significant. The total number of hospitalizations through the ED was unchanged. ED visits by adults aged 18 to 64 years in Illinois increased after ACA health insurance expansion. The increase in total ED visits was driven by an increase in visits resulting in discharge from the ED. A large post-ACA increase in Medicaid visits and a modest increase in privately insured visits outpaced a large reduction in ED visits by uninsured patients. These changes are larger than can be explained by population changes alone and are significantly different from trends in ED use before ACA implementation. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Trends in Adult Cancer-Related Emergency Department Utilization: An Analysis of Data From the Nationwide Emergency Department Sample.

PubMed

Rivera, Donna R; Gallicchio, Lisa; Brown, Jeremy; Liu, Benmei; Kyriacou, Demetrios N; Shelburne, Nonniekaye

2017-10-12

The emergency department (ED) is used to manage cancer-related complications among the 15.5 million people living with cancer in the United States. However, ED utilization patterns by the population of US adults with cancer have not been previously evaluated or described in published literature. To estimate the proportion of US ED visits made by adults with a cancer diagnosis, understand the clinical presentation of adult patients with cancer in the ED, and examine factors related to inpatient admission within this population. Nationally representative data comprised of 7 survey cycles (January 2006-December 2012) from the Nationwide Emergency Department Sample were analyzed. Identification of adult (age ≥18 years) cancer-related visits was based on Clinical Classifications Software diagnoses documented during the ED visit. Weighted frequencies and proportions of ED visits among adult patients with cancer by demographic, geographic, and clinical characteristics were calculated. Weighted multivariable logistic regression was used to examine the associations between inpatient admission and key demographic and clinical variables for adult cancer-related ED visits. Adult cancer-related ED utilization patterns; identification of primary reason for ED visit; patient-related factors associated with inpatient admission from the ED. Among an estimated 696 million weighted adult ED visits from January 2006 to December 2012, 29.5 million (4.2%) were made by a patient with a cancer diagnosis. The most common cancers associated with an ED visit were breast, prostate, and lung cancer, and most common primary reasons for visit were pneumonia (4.5%), nonspecific chest pain (3.7%), and urinary tract infection (3.2%). Adult cancer-related ED visits resulted in inpatient admissions more frequently (59.7%) than non-cancer-related visits (16.3%) (P < .001). Septicemia (odds ratio [OR], 91.2; 95% CI, 81.2-102.3) and intestinal obstruction (OR, 10.94; 95% CI, 10.6-11.4) were associated with the highest odds of inpatient admission. Consistent with national prevalence statistics among adults, breast, prostate, and lung cancer were the most common cancer diagnoses presenting to the ED. Pneumonia was the most common reason for adult cancer-related ED visits with an associated high inpatient admission rate. This analysis highlights cancer-specific ED clinical presentations and the opportunity to inform patient and system-directed prevention and management strategies.

Use of the emergency department for less-urgent care among type 2 diabetics under a disease management program

PubMed Central

2009-01-01

Background This study analyzed the likelihood of less-urgent emergency department (ED) visits among type 2 diabetic patients receiving care under a diabetes disease management (DM) program offered by the Louisiana State University Health Care Services Division (LSU HCSD). Methods All ED and outpatient clinic visits made by 6,412 type 2 diabetic patients from 1999 to 2006 were extracted from the LSU HCSD Disease Management (DM) Evaluation Database. Patient ED visits were classified as either urgent or less-urgent, and the likelihood of a less-urgent ED visit was compared with outpatient clinic visits using the Generalized Estimating Equation methodology for binary response to time-dependent variables. Results Patients who adhered to regular clinic visit schedules dictated by the DM program were less likely to use the ED for less urgent care with odds ratio of 0.1585. Insured patients had 1.13 to 1.70 greater odds of a less-urgent ED visit than those who were uninsured. Patients with better-managed glycated hemoglobin (A1c or HbA1c) levels were 82 times less likely to use less-urgent ED visits. Furthermore, being older, Caucasian, or a longer participant in the DM program had a modestly lower likelihood of less-urgent ED visits. The patient's Charlson Comorbidity Index (CCI), gender, prior hospitalization, and the admitting facility showed no effect. Conclusion Patients adhering to the DM visit guidelines were less likely to use the ED for less-urgent problems. Maintaining normal A1c levels for their diabetes also has the positive impact to reduce less-urgent ED usages. It suggests that successful DM programs may reduce inappropriate ED use. In contrast to expectations, uninsured patients were less likely to use the ED for less-urgent care. Patients in the DM program with Medicaid coverage were 1.3 times more likely to seek care in the ED for non-emergencies while commercially insured patients were nearly 1.7 times more likely to do so. Further research to understand inappropriate ED use among insured patients is needed. We suggest providing visit reminders, a call centre, or case managers to reduce the likelihood of less-urgent ED visit use among DM patients. By reducing the likelihood of unnecessary ED visits, successful DM programs can improve patient care. PMID:19968871

Use of the emergency department for less-urgent care among type 2 diabetics under a disease management program.

PubMed

Chiou, Shang-Jyh; Campbell, Claudia; Horswell, Ronald; Myers, Leann; Culbertson, Richard

2009-12-07

This study analyzed the likelihood of less-urgent emergency department (ED) visits among type 2 diabetic patients receiving care under a diabetes disease management (DM) program offered by the Louisiana State University Health Care Services Division (LSU HCSD). All ED and outpatient clinic visits made by 6,412 type 2 diabetic patients from 1999 to 2006 were extracted from the LSU HCSD Disease Management (DM) Evaluation Database. Patient ED visits were classified as either urgent or less-urgent, and the likelihood of a less-urgent ED visit was compared with outpatient clinic visits using the Generalized Estimating Equation methodology for binary response to time-dependent variables. Patients who adhered to regular clinic visit schedules dictated by the DM program were less likely to use the ED for less urgent care with odds ratio of 0.1585. Insured patients had 1.13 to 1.70 greater odds of a less-urgent ED visit than those who were uninsured. Patients with better-managed glycated hemoglobin (A1c or HbA1c) levels were 82 times less likely to use less-urgent ED visits. Furthermore, being older, Caucasian, or a longer participant in the DM program had a modestly lower likelihood of less-urgent ED visits. The patient's Charlson Comorbidity Index (CCI), gender, prior hospitalization, and the admitting facility showed no effect. Patients adhering to the DM visit guidelines were less likely to use the ED for less-urgent problems. Maintaining normal A1c levels for their diabetes also has the positive impact to reduce less-urgent ED usages. It suggests that successful DM programs may reduce inappropriate ED use. In contrast to expectations, uninsured patients were less likely to use the ED for less-urgent care. Patients in the DM program with Medicaid coverage were 1.3 times more likely to seek care in the ED for non-emergencies while commercially insured patients were nearly 1.7 times more likely to do so. Further research to understand inappropriate ED use among insured patients is needed. We suggest providing visit reminders, a call centre, or case managers to reduce the likelihood of less-urgent ED visit use among DM patients. By reducing the likelihood of unnecessary ED visits, successful DM programs can improve patient care.

Eating disorders and associated mental health comorbidities in female veterans.

PubMed

Mitchell, Karen S; Rasmusson, Ann; Bartlett, Brooke; Gerber, Megan R

2014-11-30

Eating disorders (EDs) remain understudied among veterans, possibly due to the perception that primarily male population does not suffer from EDs. However, previous research suggests that male and female veterans do experience EDs. The high rates of posttraumatic stress disorder (PTSD), depression, and obesity observed among veterans may make this group vulnerable to disordered eating. Retrospective chart review was used to obtain data from 492 female veterans who were presented to a women's primary care center at a large, urban VA medical center between 2007 and 2009. A total of 2.8% of this sample had been diagnosed with an ED. In bivariate analyses, presence of PTSD and depression were significantly associated with having an ED diagnosis. However, when these two disorders were included in a multivariate model controlling for age, only depression diagnosis and lower age were significantly related to ED status. In sum, the rate of EDs in this sample is comparable to prevalence estimates of EDs in the general population. Current findings underscore the importance of assessing for EDs among VA patients and the need for further research among veterans. Published by Elsevier Ireland Ltd.

Does vitamin D deficiency contribute to erectile dysfunction?

PubMed Central

Sorenson, Marc; Grant, William B.

2012-01-01

Erectile dysfunction (ED) is a multifactorial disease, and its causes can be neurogenic, psychogenic, hormonal and vascular. ED is often an important indicator of cardiovascular disease (CVD) and a powerful early marker for asymptomatic CVD. Erection is a vascular event, and ED is often a vascular disease caused by endothelial damage and subsequent inhibition of vasodilation. We show here that risk factors associated with a higher CVD risk also associate with a higher ED risk. Such factors include diabetes mellitus, hypertension, arterial calcification and Inflammation in the vascular endothelium. Vitamin D deficiency is one of several dynamics that associates with increased CVD risk, but to our knowledge, it has not been studied as a possible contributor to ED. Here we examine research linking ED and CVD and discuss how vitamin D influences CVD and its classic risk factors—factors that also associate to increased ED risk. We also summarize research indicating that vitamin D associates with reduced risk of several nonvascular contributing factors for ED. We conclude that VDD contributes to ED. This hypothesis should be tested through observational and intervention studies. PMID:22928068

Eating disorders in patients with obsessive-compulsive disorder: prevalence and clinical correlates.

PubMed

Sallet, Paulo C; de Alvarenga, Pedro Gomes; Ferrão, Ygor; de Mathis, Maria Alice; Torres, Albina R; Marques, Andrea; Hounie, Ana G; Fossaluza, Victor; do Rosario, Maria Conceição; Fontenelle, Leonardo F; Petribu, Katia; Fleitlich-Bilyk, Bacy

2010-05-01

The objective is to evaluate the prevalence and associated clinical characteristics of eating disorders (ED) in patients with obsessive-compulsive disorder (OCD). This is a cross-sectional study comparing 815 patients with OCD. Participants were assessed with structured interviews and scales: SCID-I, Y-BOCS, Dimensional Y-BOCS, BABS, Beck Depression and Anxiety Inventories. Ninety-two patients (11.3%) presented the following EDs: binge-eating disorders [= 59 (7.2%)], bulimia nervosa [= 16 (2.0%)], or anorexia nervosa [= 17 (2.1%)]. Compared to OCD patients without ED (OCD-Non-ED), OCD-ED patients were more likely to be women with previous psychiatric treatment. Mean total scores in Y-BOCS, Dimensional Y-BOCS, and BABS were similar within groups. However, OCD-ED patients showed higher lifetime prevalence of comorbid conditions, higher anxiety and depression scores, and higher frequency of suicide attempts than did the OCD-Non-ED group. Primarily diagnosed OCD patients with comorbid ED may be associated with higher clinical severity. Future longitudinal studies should investigate dimensional correlations between OCD and ED. 2009 by Wiley Periodicals, Inc.

Transient ischameic attack/stroke electronic decision support: a 14-month safety audit.

PubMed

Lavin, Timothy L; Ranta, Annemarei

2014-02-01

To assess the safety of a Transient Ischameic Attack (TIA)/Stroke Electronic Decision Support (EDS) tool in the primary care setting intended to aid general practitioners in the timely management of transient ischemic attacks (TIAs). A 14-month safety audit reviewing all patients managed with the help of the TIA/Stroke EDS tool. Major morbidity and mortality were assessed by screening patients for subsequent hospital admissions and investigating potential links to EDS use. Seventy-nine patients were managed with the aid of the TIA/Stroke EDS. EDS use resulted in 8 appropriate immediate hospital admissions because of patients being at high risk of stroke. Three patients had delayed admission, but care was fully guideline based and patients had no adverse outcome. Eleven admissions were unrelated to EDS use. Two deaths occurred; these did not result from inappropriate EDS advice. Results suggest that TIA/Stroke EDS use is not associated with major morbidity or mortality. Larger studies are needed to draw more definite conclusions regarding the utility of this TIA/Stroke EDS in preventing strokes. Copyright © 2014 National Stroke Association. All rights reserved.

The Benefits and Risks of Energy Drinks in Young Adults and Military Service Members.

PubMed

Manchester, Julianne; Eshel, Inbal; Marion, Donald W

2017-07-01

Energy drinks (EDs) have become an integral part of the young adult, athletic, and military culture. Many athletes are convinced that EDs enhance performance, and service members as well as college students frequently use EDs as stimulants to counter sleep deprivation, or to improve academic performance. However, concerns have been raised by some military leaders about potential adverse effects of EDs. A needs assessment survey of a convenience sample of military health care providers was conducted and identified EDs as a top knowledge need for those providers working in the area of traumatic brain injury (TBI). The instrument demonstrated high interitem consistency (Cronbach's α > .80). To further explore the state of knowledge on EDs, and to prompt further discussion of ED use and how it may related to military treatment protocols and supporting educational products, we conducted a literature review of English language publications listed in the National Library of Medicine using the search term "energy drinks" and published during the last 5 years to determine what is known about EDs in terms of their potential benefits and health risks. The active ingredients in most EDs are caffeine, and to a lesser extent taurine and sugars. Several reports suggest that the combination of these ingredients is more active than the caffeine alone. Despite the positive attributes of EDs, there are increasing reports of serious and potentially life-threatening side effects. Most recently there also has been a dramatic increase in the use of ED/alcohol combination drinks, and there are preliminary studies that suggest important adverse effects with this combination. A 2013 National Institutes of Health expert workshop concluded that more clinical studies are needed to clearly define the health risks associated with ED use. The needs assessment points to a desire for more ED knowledge of health providers working with TBI patients. A few key themes emerged from the exploratory literature review that can be taken into consideration when educating health providers and delivering knowledge-based resources. Adverse effects of EDs are most closely associated with the dose of caffeine consumed. In general, the combination of ED with alcohol should be avoided because the ED can mask the level of intoxication, and the combination may be associated with increased risk-taking behavior. Overall, the risks and benefits of EDs remain controversial and good-quality long-term clinical trials are needed to inform policymaking, regulation, and the development of prevention and treatment resources. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Identification of Emergency Department Visits in Medicare Administrative Claims: Approaches and Implications.

PubMed

Venkatesh, Arjun K; Mei, Hao; Kocher, Keith E; Granovsky, Michael; Obermeyer, Ziad; Spatz, Erica S; Rothenberg, Craig; Krumholz, Harlan M; Lin, Zhenqui

2017-04-01

Administrative claims data sets are often used for emergency care research and policy investigations of healthcare resource utilization, acute care practices, and evaluation of quality improvement interventions. Despite the high profile of emergency department (ED) visits in analyses using administrative claims, little work has evaluated the degree to which existing definitions based on claims data accurately captures conventionally defined hospital-based ED services. We sought to construct an operational definition for ED visitation using a comprehensive Medicare data set and to compare this definition to existing operational definitions used by researchers and policymakers. We examined four operational definitions of an ED visit commonly used by researchers and policymakers using a 20% sample of the 2012 Medicare Chronic Condition Warehouse (CCW) data set. The CCW data set included all Part A (hospital) and Part B (hospital outpatient, physician) claims for a nationally representative sample of continuously enrolled Medicare fee-for-services beneficiaries. Three definitions were based on published research or existing quality metrics including: 1) provider claims-based definition, 2) facility claims-based definition, and 3) CMS Research Data Assistance Center (ResDAC) definition. In addition, we developed a fourth operational definition (Yale definition) that sought to incorporate additional coding rules for identifying ED visits. We report levels of agreement and disagreement among the four definitions. Of 10,717,786 beneficiaries included in the sample data set, 22% had evidence of ED use during the study year under any of the ED visit definitions. The definition using provider claims identified a total of 4,199,148 ED visits, the facility definition 4,795,057 visits, the ResDAC definition 5,278,980 ED visits, and the Yale definition 5,192,235 ED visits. The Yale definition identified a statistically different (p < 0.05) collection of ED visits than all other definitions including 17% more ED visits than the provider definition and 2% fewer visits than the ResDAC definition. Differences in ED visitation counts between each definition occurred for several reasons including the inclusion of critical care or observation services in the ED, discrepancies between facility and provider billing regulations, and operational decisions of each definition. Current operational definitions of ED visitation using administrative claims produce different estimates of ED visitation based on the underlying assumptions applied to billing data and data set availability. Future analyses using administrative claims data should seek to validate specific definitions and inform the development of a consistent, consensus ED visitation definitions to standardize research reporting and the interpretation of policy interventions. © 2016 by the Society for Academic Emergency Medicine.

Identification of Emergency Department Visits in Medicare Administrative Claims: Approaches and Implications

PubMed Central

Venkatesh, Arjun K.; Mei, Hao; Kocher, Keith E.; Granovsky, Michael; Obermeyer, Ziad; Spatz, Erica S.; Rothenberg, Craig; Krumholz, Harlan M.; Lin, Zhenqui

2018-01-01

Objectives Administrative claims data sets are often used for emergency care research and policy investigations of healthcare resource utilization, acute care practices, and evaluation of quality improvement interventions. Despite the high profile of emergency department (ED) visits in analyses using administrative claims, little work has evaluated the degree to which existing definitions based on claims data accurately captures conventionally defined hospital-based ED services. We sought to construct an operational definition for ED visitation using a comprehensive Medicare data set and to compare this definition to existing operational definitions used by researchers and policymakers. Methods We examined four operational definitions of an ED visit commonly used by researchers and policymakers using a 20% sample of the 2012 Medicare Chronic Condition Warehouse (CCW) data set. The CCW data set included all Part A (hospital) and Part B (hospital outpatient, physician) claims for a nationally representative sample of continuously enrolled Medicare fee-for-services beneficiaries. Three definitions were based on published research or existing quality metrics including: 1) provider claims–based definition, 2) facility claims–based definition, and 3) CMS Research Data Assistance Center (ResDAC) definition. In addition, we developed a fourth operational definition (Yale definition) that sought to incorporate additional coding rules for identifying ED visits. We report levels of agreement and disagreement among the four definitions. Results Of 10,717,786 beneficiaries included in the sample data set, 22% had evidence of ED use during the study year under any of the ED visit definitions. The definition using provider claims identified a total of 4,199,148 ED visits, the facility definition 4,795,057 visits, the ResDAC definition 5,278,980 ED visits, and the Yale definition 5,192,235 ED visits. The Yale definition identified a statistically different (p < 0.05) collection of ED visits than all other definitions including 17% more ED visits than the provider definition and 2% fewer visits than the ResDAC definition. Differences in ED visitation counts between each definition occurred for several reasons including the inclusion of critical care or observation services in the ED, discrepancies between facility and provider billing regulations, and operational decisions of each definition. Conclusion Current operational definitions of ED visitation using administrative claims produce different estimates of ED visitation based on the underlying assumptions applied to billing data and data set availability. Future analyses using administrative claims data should seek to validate specific definitions and inform the development of a consistent, consensus ED visitation definitions to standardize research reporting and the interpretation of policy interventions. PMID:27864915

Endophthalmitis

MedlinePlus

... JS, eds. Ophthalmology . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 7.9. Yanoff M, Cameron JD. Diseases of the visual system. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 423. Review Date 8/26/2017 ...

"Exercise dependence"--a problem or natural result of high activity?

PubMed

Phelan, Suzanne; Bond, Dale S; Lang, Wei; Jordan, Dustin; Wing, Rena R

2011-11-01

To compare physical activity (PA) and exercise dependence (ED) in 267 weight-loss maintainers (WLM) and 213 normal-weight (NW) controls. PA and ED assessed via accelerometery and the Exercise Dependence Questionnaire. WLM had higher PA levels and ED scores than those of NW (P< 0.0001). WLM status (P=.006) and higher PA (P=.0001) were independently related to higher ED, although effect sizes were larger for PA. Exercising for weight control was the ED domain that most discriminated WLM from NW. WLM have higher ED scores than do NW, but this is mostly due to exercising for weight control.

Erectile dysfunction and fruit/vegetable consumption among diabetic Canadian men.

PubMed

Wang, Feng; Dai, Sulan; Wang, Mingdong; Morrison, Howard

2013-12-01

To evaluate the association between fruit/vegetable consumption and erectile dysfunction (ED) among Canadian men with diabetes. Data from the 2011 Survey on Living with Chronic Diseases in Canada - Diabetes Component were analyzed using Statistical Analysis System Enterprise Guide (SAS EG). Respondents were asked a series questions related to their sociodemographics, lifestyle, and chronic health conditions. The association between fruit/vegetable consumption and ED was examined using logistic regression after controlling for potential confounding factors. Bootstrap procedure was used to estimate sample distribution and calculate confidence intervals. Overall, 26.2% of respondents reported having ED. The prevalence increased with age and duration of diabetes. Compared with respondents without ED, those with ED were more likely to be obese, smokers, physically inactive, and either divorced, widowed, or separated. Diabetes complications such as nerve damage, circulation problems, and kidney failure or kidney disease were also significantly associated with ED. After controlling for potential confounding factors, a 10% risk reduction of ED was found with each additional daily serving of fruit/vegetable consumed. ED is common among Canadian men with diabetes. ED was highly associated with age, duration of diabetes, obesity, smoking, and the presence of other diabetes-related complications. Fruit and vegetable consumption might have a protective effect against ED. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

Next day discharge rate has little use as a quality measure for individual physician performance.

PubMed

Inabnit, Christopher; Markwell, Stephen; Gruwell, Jack; Jaeger, Cassie; Millburg, Lance; Griffen, David

2018-06-18

Emergency Department (ED) physicians' next day discharge rate (NDDR), the percentage of patients who were admitted from the ED and subsequently discharged within the next calendar day was hypothesized as a potential measure for unnecessary admissions. The objective was to determine if NDDR has validity as a measure for quality of individual ED physician performance. Hospital admission data was obtained for thirty-six ED physicians for calendar year 2015. Funnel plots were used to identify NDDR outliers beyond 95% control limits. A mixed model logistic regression was built to investigate factors contributing to NDDR. To determine yearly variation, data from calendar years 2014 and 2016 were analyzed, again by funnel plots and logistic regression. Intraclass correlation coefficient was used to estimate the percent of total variation in NDDR attributable to individual ED physicians. NDDR varied significantly among ED physicians. Individual ED physician outliers in NDDR varied year to year. Individual ED physician contribution to NDDR variation was minimal, accounting for 1%. Years of experience in Emergency Medicine practice was not correlated with NDDR. NDDR does not appear to be a reliable independent quality measure for individual ED physician performance. The percent of variance attributable to the ED physician was 1%. Copyright © 2018. Published by Elsevier Inc.

Chronic Pain in the Emergency Department: A Pilot Mixed-Methods Cross-Sectional Study Examining Patient Characteristics and Reasons for Presentations.

PubMed

Poulin, Patricia A; Nelli, Jennifer; Tremblay, Steven; Small, Rebecca; Caluyong, Myka B; Freeman, Jeffrey; Romanow, Heather; Stokes, Yehudis; Carpino, Tia; Carson, Amanda; Shergill, Yaadwinder; Stiell, Ian G; Taljaard, Monica; Nathan, Howard; Smyth, Catherine E

2016-01-01

Background . Chronic pain (CP) accounts for 10-16% of emergency department (ED) visits, contributing to ED overcrowding and leading to adverse events. Objectives . To describe patients with CP attending the ED and identify factors contributing to their visit. Methods . We used a mixed-method design combining interviews and questionnaires addressing pain, psychological distress, signs of opioid misuse, and disability. Participants were adults who attended the EDs of a large academic tertiary care center for their CP problem. Results . Fifty-eight patients (66% women; mean age 46.5, SD = 16.9) completed the study. The most frequently cited reason (60%) for ED visits was inability to cope with pain. Mental health problems were common, including depression (61%) and anxiety (45%). Participants had questions about the etiology of their pain, concerns about severe pain-related impairment, and problems with medication renewals or efficacy and sometimes felt invalidated in the ED. Although most participants had a primary care physician, the ED was seen as the only or best option when pain became unmanageable. Conclusions . Patients with CP visiting the ED often present with complex difficulties that cannot be addressed in the ED. Better access to interdisciplinary pain treatment is needed to reduce the burden of CP on the ED.

The Natural History of Erectile Dysfunction After Prostatic Radiotherapy: A Systematic Review and Meta-Analysis.

PubMed

Gaither, Thomas W; Awad, Mohannad A; Osterberg, E Charles; Murphy, Gregory P; Allen, Isabel E; Chang, Albert; Rosen, Raymond C; Breyer, Benjamin N

2017-09-01

Erectile dysfunction (ED) after treatment for prostate cancer with radiotherapy (RT) is well known, and pooled estimates of ED after RT will provide more accurate patient education. To systematically evaluate the natural history of ED in men with previous erectile function after prostate RT and to determine clinical factors associated with ED. We performed a review of the PubMed and Medline, Embase, Cochrane Library, and Web of Science databases in April 2016 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Identified reports included a measurement of ED before and after prostate RT. Two hundred seventy-eight abstracts were screened and 105 publications met the criteria for inclusion. Only men with known erectile function before RT were included in the analysis. ED after RT of the prostate. In total, 17,057 men underwent brachytherapy (65%), 8,166 men underwent external-beam RT (31%), and 1,046 men underwent both (4%). Seven common instruments were used to measure ED, including 23 different cutoffs for ED. The Sexual Health Inventory for Men (SHIM) was used in 31 studies (30%). Pooled estimates of SHIM-confirmed ED (score <10-17) suggested the prevalence of ED after RT is 34% of men (95% CI = 0.29-0.39) at 1 year and 57% (95% CI = 0.53-0.61) at 5.5 years. Compared with brachytherapy, studies of the two types of radiation increased the proportion of new-onset ED found by 12.3% of studies (95% CI = 2.3-22.4). For every 10% who were lost to follow-up, the proportion of ED reported increased by 2.3% (95% CI = 0.03-4.7). ED is common regardless of RT modality and increases during each year of follow-up. Using the SHIM, ED is found in approximately 50% patients at 5 years. The strengths of this systematic review include strict inclusion criteria of studies that measured baseline erectile function, no evidence for large effect size bias, and a large number of studies, which allow for modeling techniques. However, all data included in this analysis were observational, which leaves the possibility that residual confounding factors increase the rates of ED. Definitions and measurements of ED after RT vary considerably in published series and could account for variability in the prevalence of reported ED. Loss to follow-up in studies could bias the results to overestimate ED. Gaither TW, Awad MA, Osterberg EC, et al. The Natural History of Erectile Dysfunction After Prostatic Radiotherapy: A Systematic Review and Meta-Analysis. J Sex Med 2017;14:1071-1078. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Natural history of excessive daytime sleepiness: role of obesity, weight loss, depression, and sleep propensity.

PubMed

Fernandez-Mendoza, Julio; Vgontzas, Alexandros N; Kritikou, Ilia; Calhoun, Susan L; Liao, Duanping; Bixler, Edward O

2015-03-01

Excessive daytime sleepiness (EDS) is highly prevalent in the general population and is associated with occupational and public safety hazards. However, no study has examined the clinical and polysomnographic (PSG) predictors of the natural history of EDS. Representative longitudinal study. Sleep laboratory. From a random, general population sample of 1,741 individuals of the Penn State Adult Cohort, 1,395 were followed up after 7.5 years. Full medical evaluation and 1-night PSG at baseline and standardized telephone interview at follow-up. The incidence of EDS was 8.2%, while its persistence and remission were 38% and 62%, respectively. Obesity and weight gain were associated with the incidence and persistence of EDS, while weight loss was associated with its remission. Significant interactions between depression and PSG parameters on incident EDS showed that, in depressed individuals, incident EDS was associated with sleep disturbances, while in non-depressed individuals, incident EDS was associated with increased physiologic sleep propensity. Diabetes, allergy/ asthma, anemia, and sleep complaints also predicted the natural history of EDS. Obesity, a disorder of epidemic proportions, is a major risk factor for the incidence and chronicity of EDS, while weight loss is associated with its remission. Interestingly, objective sleep disturbances predict incident EDS in depressed individuals, whereas physiologic sleep propensity predicts incident EDS in those without depression. Weight management and treatment of depression and sleep disorders should be part of our public health policies. © 2015 Associated Professional Sleep Societies, LLC.

Expression of fibronectin ED-A+ and ED-B+ isoforms by human and experimental colorectal cancer. Contribution of cancer cells and tumor-associated myofibroblasts.

PubMed Central

Pujuguet, P.; Hammann, A.; Moutet, M.; Samuel, J. L.; Martin, F.; Martin, M.

1996-01-01

Alternative splicing of primary fibronectin (FN) mRNA results in the synthesis of different isoforms. ED-A+ and ED-B+ FN isoforms are absent from plasma FN and are representative of cellular FN. Their expression was studied in human and rat normal colon, in human colorectal carcinomas, and in transplanted tumors derived from a chemically-induced rat colon cancer. In normal colon, only the ED-A+ FN isoform was expressed as a thin deposit between crypt colonocytes and pericryptal myofibroblasts. Conversely, heavy ED-A+ FN deposits and lighter ED-B+ FN expression were found in the stroma of colorectal tumors in association with myofibroblasts surrounding tumor glands. Some colonic cancer cells also contained intracellular FN isoform granules and expressed FN mRNA. Tumor-associated myofibroblasts and some cancer cell lines were able to synthesize and deposit extracellular ED-A+ and ED-B+ FN in vitro. FN isoform deposition by tumor-associated myofibroblasts was not modulated by colon cancer cell-conditioned medium, but was strongly enhanced when myofibroblasts were cultured on colon cancer cell extracellular matrix or on laminin. These results show that the ED-A+ and ED-B+ FN isoforms were overexpressed in colorectal cancer. Cancer cells can deposit these FN isoforms directly and also stimulate their deposition by tumor-associated myofibroblasts. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 7 PMID:8579120

A study on the enhancement of opto-electronic properties of CdS thin films: seed-assisted fabrication

NASA Astrophysics Data System (ADS)

Kumarage, W. G. C.; Wijesundera, R. P.; Seneviratne, V. A.; Jayalath, C. P.; Dassanayake, B. S.

2017-04-01

A novel method of fabricating chemical bath deposited CdS thin films (CBD-CdS) by using electrodeposited CdS (ED-CdS) as a seed layer is reported. The resulting thin, compact, uniform and adherent seed-assisted CdS films (ED/CBD-CdS) show enhanced effective surface area compared to both ED-CdS and CBD-CdS. The phase of these CdS films was determined to be hexagonal. The fabricated ED/CBD-CdS films show higher photoelectrochemical (PEC) cell efficiency than either ED-CdS and CBD-CdS thin films. Carrier concentration and flat band potential values for ED/CBD-CdS systems are also found to be superior compared to both ED-CdS and CBD-CdS systems.

Increased Risk of Osteoporosis in Depressive Patients with Erectile Dysfunction: A Cross-sectional Study from Malaysia

PubMed Central

Nahas, Abdul Rahman Fata; Sulaiman, Syed Azhar Syed

2017-01-01

Background: Depression imposes numerous changes on depressive men, promoting for low bone mineral density (BMD) and erectile dysfunction (ED), yet no published data on exploring the possible association between these two disorders among depressive men. We therefore investigated whether low BMD is associated with ED among depressive men and highlighted the possible mutual underlying factors that might give rise to these two disorders in this specific group of patients. Materials and Methods: In this cross-sectional study, 119 depressive men were recruited and their sociodemographic and clinical characteristics were obtained. Erectile function was evaluated using the 5-item International Index of Erectile Function. All patients received a calcaneal BMD scanning. Chi-square test was conducted to determine if a significant association exists between ED and low BMD. Results: Of the study participants, ninety patients reported ED, while 29 patients reported no ED. Within the ED group, there was a significantly higher proportion of patients with low BMD compared to the non-ED group (85.6% vs. 62.1%, P = 0.006). In addition, among younger participants (i.e., aged < 50 years old), the difference in T-score between ED patients (Md = −2.2, n = 41) and non-ED patients (Md = −1.3, n = 20) was significant (P = 0.001); but held no significance among older participants. Conclusions: While our findings are considered prefatory, we reported that low BMD was significantly associated with ED in depressive men and that only among young depressive patients, BMD was significantly lower in ED patients compared to non-ED patients. More research investigating these findings and the possible underlying mechanisms for such association are warranted. PMID:28979072

Increased Risk of Osteoporosis in Depressive Patients with Erectile Dysfunction: A Cross-sectional Study from Malaysia.

PubMed

Nahas, Abdul Rahman Fata; Sulaiman, Syed Azhar Syed

2017-01-01

Depression imposes numerous changes on depressive men, promoting for low bone mineral density (BMD) and erectile dysfunction (ED), yet no published data on exploring the possible association between these two disorders among depressive men. We therefore investigated whether low BMD is associated with ED among depressive men and highlighted the possible mutual underlying factors that might give rise to these two disorders in this specific group of patients. In this cross-sectional study, 119 depressive men were recruited and their sociodemographic and clinical characteristics were obtained. Erectile function was evaluated using the 5-item International Index of Erectile Function. All patients received a calcaneal BMD scanning. Chi-square test was conducted to determine if a significant association exists between ED and low BMD. Of the study participants, ninety patients reported ED, while 29 patients reported no ED. Within the ED group, there was a significantly higher proportion of patients with low BMD compared to the non-ED group (85.6% vs. 62.1%, P = 0.006). In addition, among younger participants (i.e., aged < 50 years old), the difference in T-score between ED patients ( Md = -2.2, n = 41) and non-ED patients ( Md = -1.3, n = 20) was significant ( P = 0.001); but held no significance among older participants. While our findings are considered prefatory, we reported that low BMD was significantly associated with ED in depressive men and that only among young depressive patients, BMD was significantly lower in ED patients compared to non-ED patients. More research investigating these findings and the possible underlying mechanisms for such association are warranted.

Erectile function after anastomotic urethroplasty for pelvic fracture urethral injuries.

PubMed

El-Assmy, A; Harraz, A M; Benhassan, M; Nabeeh, A; Ibrahiem, El Hi

2016-07-01

There is an established association between ED and pelvic fracture urethral injuries (PFUIs). However, ED can occur after the injury and/or the urethral repair. To our knowledge, only one study of erectile function (EF) after urethroplasty for PFUIs used a validated questionnaire. This study was carried out to determine the impact of anastomotic posterior urethroplasty for PFUIs on EF. We retrospectively reviewed the computerized surgical records to identify patients who underwent anastomotic urethroplasty for PFUIs from 1998 to 2014. Those patients were contacted by phone or mail and were re-evaluated in the outpatient clinic by International Index of Erectile Function questionnaire; in unmarried men, the single-question self-report of ED was used for evaluation of EF, clinical examination and penile color Doppler ultrasonography (CDU) for men with ED. Overall, 58 patients were included in the study among whom 36 (62%) men were sexually active and the remaining 22 (38%) were single. The incidence of ED among our group is 72%. All patients developed ED after initial pelvic trauma and none of our patients had impaired EF after urethroplasty. The incidence of ED increased proportionally with severity of pelvic trauma. All patients with type-C pelvic fracture, associated symphysis pubis diastasis, sacroiliac joints diastasis and bilateral pubic ramus fractures had ED. Men with PFUIs had worse EF than men in other series with pelvic fractures without urethral injury. The majority (88%) of men with ED showed veno-occlusive dysfunction on penile CDU. So we concluded that men with PFUIs had a high incidence of ED up to 72%. Anastomotic posterior urethroplasty had no negative impact on EF and the development of ED after PFUIs was related to the severity of the original pelvic trauma. Veno-occlusive dysfunction is the commonest etiology of ED on penile CDU.

Predictive factors for erectile dysfunction in men with prostate cancer after brachytherapy: Is dose to the penile bulb important?

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

Macdonald, A. Graham; Keyes, Mira; Kruk, Alexandra

2005-09-01

Purpose: To determine predictive factors for postimplant erectile dysfunction (ED) in a cohort of patients, according to prospectively collected data; specifically, to assess the impact of penile bulb volume and D50 and D95 (dose covering 50% and 95% of the penile bulb volume, respectively) on ED. Methods and Materials: Three hundred forty-two patients were identified who were potent before implant and who had at least 2 years' follow-up. Patient, tumor, treatment, and dosimetric data were collected on all patients. Postimplant ED was defined according to both physician-documented and patient-documented outcome data. Binary logistic regression analysis was used to create multivariablemore » models of predictors for ED at 1, 2, and 3 years after implant. Results: Physician-documented rates of ED were 57%, 48%, and 38% at 1, 2, and 3 years after implant, respectively. Patient-documented rates of ED were 70% and 66% at 1 and 2 years, respectively. Multivariable analyses revealed age and degree of preimplant erectile function to be consistently significant predictors of ED. Use of hormones was significant at the 1-year physician-documented ED endpoint but not thereafter, in keeping with the time course of testosterone recovery. Penile bulb volume, D50, and D95 were not found to be predictive for ED at any time point, in contrast to previous studies. In addition, planning ultrasound target volume, number of needles, and institutional case sequence number were significant predictors of ED at various time points, consistent with a traumatic etiology of ED. Conclusions: We found no evidence to support penile bulb dosimetry as an independent predictive factor for ED after implant, using physician-documented or patient-documented outcomes.« less

Trends of CT utilisation in an emergency department in Taiwan: a 5-year retrospective study.

PubMed

Hu, Sung-Yuan; Hsieh, Ming-Shun; Lin, Meng-Yu; Hsu, Chiann-Yi; Lin, Tzu-Chieh; How, Chorng-Kuang; Wang, Chen-Yu; Tsai, Jeffrey Che-Hung; Wu, Yu-Hui; Chang, Yan-Zin

2016-06-08

To investigate the association between the trends of CT utilisation in an emergency department (ED) and changes in clinical imaging practice and patients' disposition. A hospital-based retrospective observational study of a public 1520-bed referral medical centre in Taiwan. Adult ED visits (aged ≥18 years) during 2009-2013, with or without receiving CT, were enrolled as the study participants. For all enrolled ED visits, we retrospectively analysed: (1) demographic characteristics, (2) triage categories, (3) whether CT was performed and the type of CT scan, (4) further ED disposition, (5) ED cost and (6) ED length of stay. In all, 269 239 adult ED visits (148 613 male patients and 120 626 female patients) were collected during the 5-year study period, comprising 38 609 CT scans. CT utilisation increased from 11.10% in 2009 to 17.70% in 2013 (trend test, p<0.001). Four in 5 types of CT scan (head, chest, abdomen and miscellaneous) were increasingly utilised during the study period. Also, CT was increasingly ordered annually in all age groups. Although ED CT utilisation rates increased markedly, the annual ED visits did not actually increase. Moreover, the subsequent admission rate, after receiving ED CT, declined (59.9% in 2009 to 48.2% in 2013). ED CT utilisation rates increased significantly during 2009-2013. Emergency physicians may be using CT for non-emergent studies in the ED. Further investigation is needed to determine whether increasing CT utilisation is efficient and cost-effective. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Risk Factors for Increased ED Utilization in a Multinational Cohort of Children with Sickle Cell Disease

PubMed Central

Glassberg, Jeffrey A.; Wang, Jason; Cohen, Robyn; Richardson, Lynne D.; DeBaun, Michael R.

2012-01-01

Objectives To identify clinical, social, and environmental risk factors for increased emergency department (ED) use in children with sickle cell disease (SCD). Methods This study was a secondary analysis of ED utilization data from the international multicenter Silent Cerebral Infarct Transfusion (SIT) trial. Between December 2004 and June 2010, baseline demographic, clinical, and laboratory data were collected from children with SCD participating in the trial. The primary outcome was the frequency of ED visits for pain. A secondary outcome was the frequency of ED visits for acute chest syndrome. Results The sample included 985 children from the US, Canada, England, and France, for a total of 2,955 patient-years of data. There were 0.74 ED visits for pain per patient-year. A past medical history of asthma was associated with an increased risk of ED utilization for both pain (RR = 1.28, 95% CI = 1.04 to 1.58) and acute chest syndrome (RR = 1.60, 95% CI = 1.03 to 2.49). Exposure to environmental tobacco smoke in the home was associated with 73% more ED visits for acute chest syndrome (RR 1.73, 95% CI = 1.09 to 2.74). Each $10,000 increase in household income was associated with 5% fewer ED visits for pain (RR 0.95, 95% CI = 0.91 to 1.00, p = 0.05). The association between low income and ED utilization was not significantly different in the USA vs. countries with universal health care (p = 0.51). Conclusions Asthma and exposure to environmental tobacco smoke are potentially modifiable risk factors for greater ED use in children with SCD. Low income is associated with greater ED use for SCD pain in countries with and without universal health care. PMID:22687181

A Preliminary Examination of Loss of Control Eating Disorder (LOC-ED) in Middle Childhood

PubMed Central

Matherne, Camden E.; Tanofsky-Kraff, Marian; Altschul, Anne M.; Shank, Lisa M.; Schvey, Natasha A.; Brady, Sheila M.; Galescu, Ovidiu; Demidowich, Andrew P.; Yanovski, Susan Z.; Yanovski, Jack A.

2015-01-01

Loss of Control Eating Disorder (LOC-ED) has been proposed as a diagnostic category for children 6–12y with binge-type eating. However, characteristics of youth with LOC-ED have not been examined. We tested the hypothesis that the proposed criteria for LOC-ED would identify children with greater adiposity, more disordered eating attitudes, and greater mood disturbance than those without LOC-ED. Participants were 251 youth (10.29y ± 1.54, 53.8% female, 57.8 % White, 35.5% Black, 2.0% Asian, 4.8% Hispanic, 53.0% overweight). Youth were interviewed regarding eating attitudes and behaviors, completed questionnaires to assess general psychopathology, and underwent measurements of body fat mass. Using previously proposed criteria for LOC-ED, children were classified as LOC-ED (n = 19), LOC in the absence of the full disorder (subLOC, n = 33), and youth not reporting LOC (noLOC, n = 199). LOC-ED youth had higher BMIz (p = 0.001) and adiposity (p = 0.003) and reported greater disordered eating concerns (p < 0.001) compared to noLOC youth. Compared to subLOC youth, LOC-ED youth had non-significantly higher BMIz (p = 0.11), and significantly higher adiposity (p = 0.04) and disordered eating attitudes (p = 0.02). SubLOC youth had greater disordered eating concerns (p < 0.001) and BMIz (p = 0.03) but did not differ in adiposity (p = 0.33) compared to noLOC youth. These preliminary data suggest that LOC-ED youth are elevated on disordered eating cognitions and anthropometric measures compared to youth without LOC-ED. Longitudinal studies are needed to determine if those with LOC-ED are at particularly increased risk for progression of disordered eating and excess weight gain. PMID:25913008

Characteristics of seeking treatment among U.S. adolescents with eating disorders.

PubMed

Forrest, Lauren N; Smith, April R; Swanson, Sonja A

2017-07-01

The majority of persons with eating disorders (EDs) do not seek ED treatment, yet little is known about treatment-seeking barriers or facilitators. The aim of the study is to describe the characteristics associated with seeking ED treatment among U.S. adolescents with EDs. Data from a nationally representative cross-sectional study of U.S. adolescents ages 13-18 years were used for these analyses. Specifically, adolescents who met criteria for lifetime EDs (N = 281) were included. Sociodemographic information, characteristics of EDs, psychiatric comorbidities, and other mental health service use were assessed via interview. Only 20% of adolescents sought ED treatment. Females were 2.2 (95% CI 0.8, 6.4) times more likely to seek treatment than males (19.9% vs. 8.9%). Adolescents who met criteria for anorexia nervosa or bulimia nervosa were 2.4 (95% CI 0.9, 6.3) and 1.9 (95% CI 1.0, 3.8) times more likely to seek treatment than adolescents who met criteria for binge-eating disorder (27.5% and 22.3% vs. 11.6%). Specific ED behaviors (restriction and purging), ED-related impairment, and any mental health service use were also associated with adolescent treatment seeking. Adolescent treatment seeking was infrequent overall, with individuals with counter-stereotypic ED presentations least likely to have sought treatment. Adolescent treatment seeking could be promoted through increasing awareness among the public and healthcare professionals that EDs affect a heterogeneous group of people. More generally, research involving both treatment-seeking and non-treatment-seeking individuals holds great potential to refine the field's knowledge of ED etiology, prevalence, treatment, and prevention. © 2017 Wiley Periodicals, Inc.

Nature versus intensity of intoxication: Co-ingestion of alcohol and energy drinks and the effect on objective and subjective intoxication.

PubMed

Forward, Jessica; Akhurst, Jane; Bruno, Raimondo; Leong, Xiao; VanderNiet, Amelia; Bromfield, Holly; Erny, Jacqueline; Bellamy, Tessa; Peacock, Amy

2017-11-01

We report a series of studies examining the effect of alcohol mixed with energy drinks (AmEDs) versus alcohol on objective intoxication (breath alcohol concentration; BrAC), intensity, and nature of intoxication. We also aimed to disentangle the role of energy drink (ED) ingredients in any effects. Three within-subject double-blind placebo-controlled studies measured BrAC, subjective intoxication and impairment ('intensity of intoxication'), stimulation and sedation ('nature of intoxication') following administration of ED, Cola, Caffeine+Sugar, and Placebo with alcohol (Study 1, n=18); ED, Caffeine-only, Sugar-only and Placebo with alcohol (Study 2, n=20); and ED and Placebo with alcohol (Study 3, n=27). Significant moderate-to-large magnitude BrAC decrements and delayed time to peak BrAC were observed after ED administration versus Placebo. However, no meaningful BrAC differences between ED and other active conditions were observed in Study 1 and 2. After BrAC adjustment, moderate-to-large magnitude reductions in intoxication and impairment ratings were observed after ED versus Placebo on the ascending limb in all studies and at peak in Study 2 and 3. No meaningful differences were observed in intoxication and impairment ratings between ED and Caffeine+Sugar and Cola conditions (Study 1); ratings were lower after ED versus Sugar-only (Study 2). Stimulation and sedation ratings did not differ between ED and Placebo. Reductions in objective intoxication and perceived intensity of intoxication, but not nature of intoxication, were observed after AmED consumption. However, effects may be common to alcohol mixers containing sugars (objective intoxication) and caffeine (intensity of intoxication) and specific to a laboratory setting. Copyright © 2017. Published by Elsevier B.V.

A preliminary examination of Loss of Control Eating Disorder (LOC-ED) in middle childhood.

PubMed

Matherne, Camden E; Tanofsky-Kraff, Marian; Altschul, Anne M; Shank, Lisa M; Schvey, Natasha A; Brady, Sheila M; Galescu, Ovidiu; Demidowich, Andrew P; Yanovski, Susan Z; Yanovski, Jack A

2015-08-01

Loss of Control Eating Disorder (LOC-ED) has been proposed as a diagnostic category for children 6-12years with binge-type eating. However, characteristics of youth with LOC-ED have not been examined. We tested the hypothesis that the proposed criteria for LOC-ED would identify children with greater adiposity, more disordered eating attitudes, and greater mood disturbance than those without LOC-ED. Participants were 251 youth (10.29years±1.54, 53.8% female, 57.8% White, 35.5% Black, 2.0% Asian, 4.8% Hispanic, 53.0% overweight). Youth were interviewed regarding eating attitudes and behaviors, completed questionnaires to assess general psychopathology, and underwent measurements of body fat mass. Using previously proposed criteria for LOC-ED, children were classified as LOC-ED (n=19), LOC in the absence of the full disorder (subLOC, n=33), and youth not reporting LOC (noLOC, n=199). LOC-ED youth had higher BMIz (p=0.001) and adiposity (p=0.003) and reported greater disordered eating concerns (p<0.001) compared to noLOC youth. Compared to subLOC youth, LOC-ED youth had non-significantly higher BMIz (p=0.11), and significantly higher adiposity (p=0.04) and disordered eating attitudes (p=0.02). SubLOC youth had greater disordered eating concerns (p<0.001) and BMIz (p=0.03) but did not differ in adiposity (p=0.33) compared to noLOC youth. These preliminary data suggest that LOC-ED youth are elevated on disordered eating cognitions and anthropometric measures compared to youth without LOC-ED. Longitudinal studies are needed to determine if those with LOC-ED are at particularly increased risk for progression of disordered eating and excess weight gain. Published by Elsevier Ltd.

Magnitude of daily energy deficit predicts frequency but not severity of menstrual disturbances associated with exercise and caloric restriction.

PubMed

Williams, Nancy I; Leidy, Heather J; Hill, Brenna R; Lieberman, Jay L; Legro, Richard S; De Souza, Mary Jane

2015-01-01

We assessed the impact of energy deficiency on menstrual function using controlled feeding and supervised exercise over four menstrual cycles (1 baseline and 3 intervention cycles) in untrained, eumenorrheic women aged 18-30 yr. Subjects were randomized to either an exercising control (EXCON) or one of three exercising energy deficit (ED) groups, i.e., mild (ED1; -8 ± 2%), moderate (ED2; -22 ± 3%), or severe (ED3; -42 ± 3%). Menstrual cycle length and changes in urinary concentrations of estrone-1-glucuronide, pregnanediol glucuronide, and midcycle luteinizing hormone were assessed. Thirty-four subjects completed the study. Weight loss occurred in ED1 (-3.8 ± 0.2 kg), ED2 (-2.8 ± 0.6 kg), and ED3 (-2.6 ± 1.1 kg) but was minimal in EXCON (-0.9 ± 0.7 kg). The overall sum of disturbances (luteal phase defects, anovulation, and oligomenorrhea) was greater in ED2 compared with EXCON and greater in ED3 compared with EXCON AND ED1. The average percent energy deficit was the main predictor of the frequency of menstrual disturbances (f = 10.1, β = -0.48, r(2) = 0.23, P = 0.003) even when weight loss was included in the model. The estimates of the magnitude of energy deficiency associated with menstrual disturbances ranged from -22 (ED2) to -42% (ED3), reflecting an energy deficit of -470 to -810 kcal/day, respectively. This is the first study to demonstrate a dose-response relationship between the magnitude of energy deficiency and the frequency of exercise-related menstrual disturbances; however, the severity of menstrual disturbances was not dependent on the magnitude of energy deficiency. Copyright © 2015 the American Physiological Society.

Emergency Department Patient Perceptions of Transvaginal Ultrasound for Complications of First-Trimester Pregnancy.

PubMed

Panebianco, Nova; Shofer, Frances; O'Conor, Katie; Wihbey, Tristan; Mulugeta, Lakeisha; Baston, Cameron M; Suzuki, Evan; Alghamdi, Adel; Dean, Anthony

2018-01-30

Emergency department (ED) transvaginal ultrasound (US) is underused in clinical practice. This study assessed pregnant women's perceptions of ED transvaginal US in terms of pain, embarrassment, anxiety, and willingness to receive the procedure. Secondary variables include physicians' perceptions of patients' experiences. Women undergoing US examinations for complications of first-trimester pregnancy were prospectively surveyed before any US and after ED and/or radiology transvaginal US. Patients' and physicians' assessments of pain, embarrassment, and anxiety were measured with visual analog scales (0-100). A total of 398 women were enrolled. In the pre-US survey, the median anxiety score was 14 (interquartile range, 3-51), and 96% of patients were willing to have an ED transvaginal US if necessary. Of those who had ED transvaginal US, 96% would agree to have another examination. Patients reported minimal pain/embarrassment, and there was no difference if performed in the ED versus radiology (median pain, 11.5 versus 13; P = .433; median embarrassment, 7 versus 4; P = .345). Of the 48 who had both ED and radiology transvaginal US, 85% thought the ED transvaginal US was worthwhile. Physicians accurately assessed patient's embarrassment and pain (mean differences, 3.5 and -1.9, respectively; P > .25 for both); however, they overestimated them relative to the pelvic examination (mean difference for embarrassment, 12.8; P < .0001; pain, 8.0; P = .01). Pregnant ED patients report low levels of anxiety, pain, and embarrassment, and after ED transvaginal US, 96% would agree to have the examination again. There is no difference in pain/embarrassment between ED and radiology transvaginal US. Emergency department physicians accurately assessed patients' pain and embarrassment with ED transvaginal US but overestimated them compared to the pelvic examination. © 2018 by the American Institute of Ultrasound in Medicine.

Audit of demand for after-hours CT scanning services in RANZCR-accredited training departments.

PubMed

Goergen, Stacy K; Grimm, Jane; Paul, Eldho; Fabiny, Robert; Lee, Wai Kit; Blome, Steven; Zhou, Kim; Munro, Philip L

2016-02-01

The aims of this study were to measure: (i) the growth in after-hours emergency department--referred CT (ED-CT) performed in accredited training departments between 2011 and 2013; (ii) the growth in ED CT relative to growth in ED presentations at the same hospitals; and (iii) trainee workload resulting from after-hours ED CT. Ethics approval was obtained for all participating sites. Accredited training facilities in Australia and New Zealand with three or more trainees and serving one or more EDs were invited to participate (N = 32). Four nights were surveyed between August and December 2013. For data collection, the number of ED patients having one or more CT scans; ED CT scan total images; non-contrast head CTs; and ED patients (total and categories 1 and 2) attending the ED in the preceding 24 h and first half of calendar year were collected for 2013 and corresponding days in 2012 and 2011. Trainee staffing levels were measured. Eleven of 32 sites provided data for all four nights and 14 of 32 for one or more nights. A 15.7% increase in number of ED CTs between 1700 and 2200 h and 16.8% increase between 2201 and 0730 h occurred in the 2 years between 2011 and 2013 compared with a 6.9% increase in overall ED and 26% increase in categories 1 and 2 presentations over the same period. The number of CT images, however, increased 23%. Growth in demand by EDs for after-hours CT services has implications for service provision and trainee workloads in Royal Australian and New Zealand College of Radiologists-accredited training departments. © 2015 The Royal Australian and New Zealand College of Radiologists.

Sample size requirements for estimating effective dose from computed tomography using solid-state metal-oxide-semiconductor field-effect transistor dosimetry

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

Trattner, Sigal; Cheng, Bin; Pieniazek, Radoslaw L.

2014-04-15

Purpose: Effective dose (ED) is a widely used metric for comparing ionizing radiation burden between different imaging modalities, scanners, and scan protocols. In computed tomography (CT), ED can be estimated by performing scans on an anthropomorphic phantom in which metal-oxide-semiconductor field-effect transistor (MOSFET) solid-state dosimeters have been placed to enable organ dose measurements. Here a statistical framework is established to determine the sample size (number of scans) needed for estimating ED to a desired precision and confidence, for a particular scanner and scan protocol, subject to practical limitations. Methods: The statistical scheme involves solving equations which minimize the sample sizemore » required for estimating ED to desired precision and confidence. It is subject to a constrained variation of the estimated ED and solved using the Lagrange multiplier method. The scheme incorporates measurement variation introduced both by MOSFET calibration, and by variation in MOSFET readings between repeated CT scans. Sample size requirements are illustrated on cardiac, chest, and abdomen–pelvis CT scans performed on a 320-row scanner and chest CT performed on a 16-row scanner. Results: Sample sizes for estimating ED vary considerably between scanners and protocols. Sample size increases as the required precision or confidence is higher and also as the anticipated ED is lower. For example, for a helical chest protocol, for 95% confidence and 5% precision for the ED, 30 measurements are required on the 320-row scanner and 11 on the 16-row scanner when the anticipated ED is 4 mSv; these sample sizes are 5 and 2, respectively, when the anticipated ED is 10 mSv. Conclusions: Applying the suggested scheme, it was found that even at modest sample sizes, it is feasible to estimate ED with high precision and a high degree of confidence. As CT technology develops enabling ED to be lowered, more MOSFET measurements are needed to estimate ED with the same precision and confidence.« less

Delirium in the Emergency Department and Its Extension into Hospitalization (DELINEATE) Study: Effect on 6-month Function and Cognition.

PubMed

Han, Jin H; Vasilevskis, Eduard E; Chandrasekhar, Rameela; Liu, Xulei; Schnelle, John F; Dittus, Robert S; Ely, E Wesley

2017-06-01

The natural course and clinical significance of delirium in the emergency department (ED) is unclear. We sought to (1) describe the extent to which delirium in the ED persists into hospitalization (ED delirium duration) and (2) determine how ED delirium duration is associated with 6-month functional status and cognition. Prospective cohort study. Tertiary care, academic medical center. ED patients ≥65 years old who were admitted to the hospital. The modified Brief Confusion Assessment Method was used to ascertain delirium in the ED and hospital. Premorbid and 6-month function were determined using the Older American Resources and Services Activities of Daily Living (OARS ADL) questionnaire which ranged from 0 (completely dependent) to 28 (completely dependent). Premorbid and 6-month cognition were determined using the short form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) which ranged from 1 to 5 (severe dementia). Multiple linear regression was performed to determine if ED delirium duration was associated with 6-month function and cognition adjusted for baseline OARS ADL and IQCODE, and other confounders. A total of 228 older ED patients were enrolled. Of the 105 patients who were delirious in the ED, 81 (77.1%) patients' delirium persisted into hospitalization. For every ED delirium duration day, the 6-month OARS ADL decreased by 0.63 points (95% CI: -1.01 to -0.24), indicating poorer function. For every ED delirium duration day, the 6-month IQCODE increased 0.06 points (95% CI: 0.01-0.10) indicating poorer cognition. Delirium in the ED is not a transient event and frequently persists into hospitalization. Longer ED delirium duration is associated with an incremental worsening of 6-month functional and cognitive outcomes. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Changes in erectile dysfunction over time in relation to Framingham cardiovascular risk in the Boston Area Community Health (BACH) Survey.

PubMed

Fang, Shona C; Rosen, Raymond C; Vita, Joseph A; Ganz, Peter; Kupelian, Varant

2015-01-01

Erectile dysfunction (ED) is associated with cardiovascular disease (CVD); however, the association between change in ED status over time and future underlying CVD risk is unclear. The aim of this study was to investigate the association between change in ED status and Framingham CVD risk, as well change in Framingham risk. We studied 965 men free of CVD in the Boston Area Community Health (BACH) Survey, a longitudinal cohort study with three assessments. ED was assessed with the five-item International Index of Erectile Function at BACH I (2002-2005) and BACH II (2007-2010) and classified as no ED/transient ED/persistent ED. CVD risk was assessed with 10-year Framingham CVD risk algorithm at BACH I and BACH III (2010-2012). Linear regression models controlled for baseline age, socio-demographic and lifestyle factors, as well as baseline Framingham risk. Models were also stratified by age (≥/< 50 years). Framingham CVD risk and change in Framingham CVD risk were the main outcome measures. Transient and persistent ED was significantly associated with increased Framingham risk and change in risk over time in univariate and age-adjusted models. In younger men, persistent ED was associated with a Framingham risk that was 1.58 percentage points higher (95% confidence interval [CI]: 0.11, 3.06) and in older men, a Framingham risk that was 2.54 percentage points higher (95% CI: -1.5, 6.59), compared with those without ED. Change in Framingham risk over time was also associated with transient and persistent ED in men <50 years, but not in older men. Data suggest that even after taking into account other CVD risk factors, transient and persistent ED is associated with Framingham CVD risk and a greater increase in Framingham risk over time, particularly in younger men. Findings further support clinical assessment of CVD risk in men presenting with ED, especially those under 50 years. © 2014 International Society for Sexual Medicine.

Influence of erectile dysfunction course on its progress and efficacy of treatment with phosphodiesterase type 5 inhibitors.

PubMed

Liu, De-Feng; Jiang, Hui; Hong, Kai; Zhao, Lian-Ming; Tang, Wen-Hao; Ma, Lu-Lin

2010-11-01

Erectile dysfunction (ED) is a common impairment among older men, and the prevalence rates increase sharply after age of 60 years. Most studies have focused on the prevalence rate or dangerous factors. The aim of this study was to investigate the basic epidemiologic data about ED patients with different ED courses. The purpose of this research was to understand the therapeutic effect of phosphodiesterase type 5 inhibitor (PDE5-I) and see how and why the ED course impact the progress of ED and the therapeutic effect of PDE5-I treatment. From June 2008 to June 2009, 4252 questionnaires (Quality of Erection Questionnaire, QEQ) were gathered from 46 centers by urology or andrology doctors all around China. Patients with ED (age ≥ 20 years) filled in first half of the questionnaires when they came for the first time, and then completed the second half 4 weeks after PDE5-I therapy. ED courses of most patients were less than 5 years (< 5 years, 74.0%; 5 - 10 years 20.8%; > 10 years, 5.2%). As ED course increasing, the incidence of the risk factors of ED, such as smoking, drinking, hypertension, diabetes, heart disease and hyperlipidemia also increase (P ≤ 0.01). PDE5-I was effective in improving the quality of sexual activities (P ≤ 0.01). Administration of PDE5-I improves satisfaction, enjoyment and frequency of sexual activities. The longer the ED course, the worse the therapeutic effect (< 5 years, 96.1%; 5 - 10 years, 94.9%; > 10 years, 89.0%) (P ≤ 0.01). The ED course greatly affected the therapeutic effect of PDE5-1, the patients with ED should consult doctor at early stage of the disease. Administration of PDE5-I effectively improves the penile erection and the quality of sexual life of the patients hence should be considered as first-line medicine in the treatment of ED.

Oncologic emergencies in a cancer center emergency department and in general emergency departments countywide and nationwide.

PubMed

Yang, Zhi; Yang, Runxiang; Kwak, Min Ji; Qdaisat, Aiham; Lin, Junzhong; Begley, Charles E; Reyes-Gibby, Cielito C; Yeung, Sai-Ching Jim

2018-01-01

Although cancer patients (CPs) are increasingly likely to visit emergency department (ED), no population-based study has compared the characteristics of CPs and non-cancer patients (NCPs) who visit the ED and examined factors associated with hospitalization via the ED. In this study, we (1) compared characteristics and diagnoses between CPs and NCPs who visited the ED in a cancer center or general hospital; (2) compared characteristics and diagnoses between CPs and NCPs who were hospitalized via the ED in a cancer center or general hospital; and (3) investigated important factors associated with such hospitalization. We analyzed patient characteristic and diagnosis [based on International Classification of Diseases-9 (ICD-9) codes] data from the ED of a comprehensive cancer center (MDACC), 24 general EDs in Harris County, Texas (HCED), and the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1/1/2007-12/31/2009. Approximately 3.4 million ED visits were analyzed: 47,245, 3,248,973, and 104,566 visits for MDACC, HCED, and NHAMCS, respectively, of which 44,143 (93.4%), 44,583 (1.4%), and 632 (0.6%) were CP visits. CPs were older than NCPs and stayed longer in EDs. Lung, gastrointestinal (excluding colorectal), and genitourinary (excluding prostate) cancers were the three most common diagnoses related to ED visits at general EDs. CPs visiting MDACC were more likely than CPs visiting HCED to be privately insured. CPs were more likely than NCPs to be hospitalized. Pneumonia and influenza, fluid and electrolyte disorders, and fever were important predictive factors for CP hospitalization; coronary artery disease, cerebrovascular disease, and heart failure were important factors for NCP hospitalization. CPs consumed more ED resources than NCPs and had a higher hospitalization rate. Given the differences in characteristics and diagnoses between CPs and NCPs, ED physicians must pay special attention to CPs and be familiar with their unique set of oncologic emergencies.

International perspectives on emergency department crowding.

PubMed

Pines, Jesse M; Hilton, Joshua A; Weber, Ellen J; Alkemade, Annechien J; Al Shabanah, Hasan; Anderson, Philip D; Bernhard, Michael; Bertini, Alessio; Gries, André; Ferrandiz, Santiago; Kumar, Vijaya Arun; Harjola, Veli-Pekka; Hogan, Barbara; Madsen, Bo; Mason, Suzanne; Ohlén, Gunnar; Rainer, Timothy; Rathlev, Niels; Revue, Eric; Richardson, Drew; Sattarian, Mehdi; Schull, Michael J

2011-12-01

The maturation of emergency medicine (EM) as a specialty has coincided with dramatic increases in emergency department (ED) visit rates, both in the United States and around the world. ED crowding has become a public health problem where periodic supply and demand mismatches in ED and hospital resources cause long waiting times and delays in critical treatments. ED crowding has been associated with several negative clinical outcomes, including higher complication rates and mortality. This article describes emergency care systems and the extent of crowding across 15 countries outside of the United States: Australia, Canada, Denmark, Finland, France, Germany, Hong Kong, India, Iran, Italy, The Netherlands, Saudi Arabia, Catalonia (Spain), Sweden, and the United Kingdom. The authors are local emergency care leaders with knowledge of emergency care in their particular countries. Where available, data are provided about visit patterns in each country; however, for many of these countries, no national data are available on ED visits rates or crowding. For most of the countries included, there is both objective evidence of increases in ED visit rates and ED crowding and also subjective assessments of trends toward higher crowding in the ED. ED crowding appears to be worsening in many countries despite the presence of universal health coverage. Scandinavian countries with robust systems to manage acute care outside the ED do not report crowding is a major problem. The main cause for crowding identified by many authors is the boarding of admitted patients, similar to the United States. Many hospitals in these countries have implemented operational interventions to mitigate crowding in the ED, and some countries have imposed strict limits on ED length of stay (LOS), while others have no clear plan to mitigate crowding. An understanding of the causes and potential solutions implemented in these countries can provide a lens into how to mitigate ED crowding in the United States through health policy interventions and hospital operational changes. © 2011 by the Society for Academic Emergency Medicine.

Affordable Care Act and healthcare delivery: A comparison of California and Florida hospitals and emergency departments.

PubMed

Barakat, Monique T; Mithal, Aditi; Huang, Robert J; Mithal, Alka; Sehgal, Amrita; Banerjee, Subhas; Singh, Gurkirpal

2017-01-01

The Affordable Care Act (ACA) has expanded access to health insurance for millions of Americans, but the impact of Medicaid expansion on healthcare delivery and utilization remains uncertain. To determine the early impact of the Medicaid expansion component of ACA on hospital and ED utilization in California, a state that implemented the Medicaid expansion component of ACA and Florida, a state that did not. Analyze all ED encounters and hospitalizations in California and Florida from 2009 to 2014 and evaluate trends by payer and diagnostic category. Data were collected from State Inpatient Databases, State Emergency Department Databases and the California Office of Statewide Health Planning and Development. Hospital and ED encounters. Population-based study of California and Florida state residents. Implementation of Medicaid expansion component of ACA in California in 2014. Changes in ED visits and hospitalizations by payer, percentage of patients hospitalized after an ED encounter, top diagnostic categories for ED and hospital encounters. In California, Medicaid ED visits increased 33% after Medicaid expansion implementation and self-pay visits decreased by 25% compared with a 5.7% increase in the rate of Medicaid patient ED visits and a 5.1% decrease in rate of self-pay patient visits in Florida. In addition, California experienced a 15.4% increase in Medicaid inpatient stays and a 25% decrease in self pay stays. Trends in the percentage of patients admitted to the hospital from the ED were notable; a 5.4% decrease in hospital admissions originating from the ED in California, and a 2.1% decrease in Florida from 2013 to 2014. We observed a significant shift in payer for ED visits and hospitalizations after Medicaid expansion in California without a significant change in top diagnoses or overall rate of these ED visits and hospitalizations. There appears to be a shift in reimbursement burden from patients and hospitals to the government without a dramatic shift in patterns of ED or hospital utilization.

Sample size requirements for estimating effective dose from computed tomography using solid-state metal-oxide-semiconductor field-effect transistor dosimetry

PubMed Central

Trattner, Sigal; Cheng, Bin; Pieniazek, Radoslaw L.; Hoffmann, Udo; Douglas, Pamela S.; Einstein, Andrew J.

2014-01-01

Purpose: Effective dose (ED) is a widely used metric for comparing ionizing radiation burden between different imaging modalities, scanners, and scan protocols. In computed tomography (CT), ED can be estimated by performing scans on an anthropomorphic phantom in which metal-oxide-semiconductor field-effect transistor (MOSFET) solid-state dosimeters have been placed to enable organ dose measurements. Here a statistical framework is established to determine the sample size (number of scans) needed for estimating ED to a desired precision and confidence, for a particular scanner and scan protocol, subject to practical limitations. Methods: The statistical scheme involves solving equations which minimize the sample size required for estimating ED to desired precision and confidence. It is subject to a constrained variation of the estimated ED and solved using the Lagrange multiplier method. The scheme incorporates measurement variation introduced both by MOSFET calibration, and by variation in MOSFET readings between repeated CT scans. Sample size requirements are illustrated on cardiac, chest, and abdomen–pelvis CT scans performed on a 320-row scanner and chest CT performed on a 16-row scanner. Results: Sample sizes for estimating ED vary considerably between scanners and protocols. Sample size increases as the required precision or confidence is higher and also as the anticipated ED is lower. For example, for a helical chest protocol, for 95% confidence and 5% precision for the ED, 30 measurements are required on the 320-row scanner and 11 on the 16-row scanner when the anticipated ED is 4 mSv; these sample sizes are 5 and 2, respectively, when the anticipated ED is 10 mSv. Conclusions: Applying the suggested scheme, it was found that even at modest sample sizes, it is feasible to estimate ED with high precision and a high degree of confidence. As CT technology develops enabling ED to be lowered, more MOSFET measurements are needed to estimate ED with the same precision and confidence. PMID:24694150

Genital image, sexual anxiety, and erectile dysfunction among young male military personnel.

PubMed

Wilcox, Sherrie L; Redmond, Sarah; Davis, Teaniese L

2015-06-01

More than a third of young military personnel report experiencing some level of erectile dysfunction (ED). Preoccupation with body image, particularly genitals, is a distraction that can influence sexual anxiety (SA) and sexual functioning problems (SFPs), particularly ED. This study assessed the relationships between male genital self-image (MGSI), SA, and ED in a sample of male military personnel age 40 or younger. Data were from a larger study on SFPs in military populations. This sample consisted of 367 male military personnel age 40 or younger. Hierarchical regression analyses and process modeling using mediation analysis were performed to examine the effects of MGSI on ED with SA as an intermediate variable. We predicted that SA would mediate the relationship between MGSI and ED. ED severity was assessed with the International Index of Erectile Function. MGSI was assessed using the MGSI Scale. SA was assessed with the SA subscale of the Sexual Needs Scale. As hypothesized, greater satisfaction with MGSI was predictive of significantly lower SA (F[8, 352] = 4.07, P = 0.001) and lower ED (F[8, 352] = 13.20, P = 0.001). Lower levels of SA were predictive of lower levels of ED (F[8, 354] = 21.35, P < 0.001). Additionally, results also revealed a significant indirect effect of MGSI on ED through SA (b = -0.07, standard error = 0.03, confidence interval = [-0.14,-0.02], P < 0.05), indicating mediation of MGSI on ED via SA. This study underscores the complex etiologic basis of SFPs, particularly ED, and highlights the importance of considering psychologic contributors to ED, such as SA and MGSI. Strategies aimed at reducing SA may be useful in improving ED in young military populations and are worth considering as complements to strategies that improve SFPs. © 2015 International Society for Sexual Medicine.

Estimates of electronic medical records in U.S. Emergency departments.

PubMed

Geisler, Benjamin P; Schuur, Jeremiah D; Pallin, Daniel J

2010-02-17

Policymakers advocate universal electronic medical records (EMRs) and propose incentives for "meaningful use" of EMRs. Though emergency departments (EDs) are particularly sensitive to the benefits and unintended consequences of EMR adoption, surveillance has been limited. We analyze data from a nationally representative sample of US EDs to ascertain the adoption of various EMR functionalities. We analyzed data from the National Hospital Ambulatory Medical Care Survey, after pooling data from 2005 and 2006, reporting proportions with 95% confidence intervals (95% CI). In addition to reporting adoption of various EMR functionalities, we used logistic regression to ascertain patient and hospital characteristics predicting "meaningful use," defined as a "basic" system (managing demographic information, computerized provider order entry, and lab and imaging results). We found that 46% (95% CI 39-53%) of US EDs reported having adopted EMRs. Computerized provider order entry was present in 21% (95% CI 16-27%), and only 15% (95% CI 10-20%) had warnings for drug interactions or contraindications. The "basic" definition of "meaningful use" was met by 17% (95% CI 13-21%) of EDs. Rural EDs were substantially less likely to have a "basic" EMR system than urban EDs (odds ratio 0.19, 95% CI 0.06-0.57, p = 0.003), and Midwestern (odds ratio 0.37, 95% CI 0.16-0.84, p = 0.018) and Southern (odds ratio 0.47, 95% CI 0.26-0.84, p = 0.011) EDs were substantially less likely than Northeastern EDs to have a "basic" system. EMRs are becoming more prevalent in US EDs, though only a minority use EMRs in a "meaningful" way, no matter how "meaningful" is defined. Rural EDs are less likely to have an EMR than metropolitan EDs, and Midwestern and Southern EDs are less likely to have an EMR than Northeastern EDs. We discuss the nuances of how to define "meaningful use," and the importance of considering not only adoption, but also full implementation and consequences.

Feasibility, Safety and Efficacy of a Novel Pre-Shaped Nitinol Esophageal Deviator to Successfully Deflect the Esophagus and Ablate Left Atrium without Esophageal Temperature Rise during Atrial Fibrillation Ablation - The DEFLECT GUT study.

PubMed

Parikh, Valay; Swarup, Vijay; Hantla, Jacob; Vuddanda, Venkat; Dar, Tawseef; Yarlagadda, Bharath; Di Biase, Luigi; Al-Ahmad, Amin; Natale, Andrea; Lakkireddy, Dhanunjaya

2018-04-17

Esophageal thermal injury is a feared complication of radiofrequency ablation (RFA) for atrial fibrillation (AF). Rise in luminal esophageal temperature (LET) limits the ability to deliver RF energy on posterior wall of LA. The aim of this registry was to evaluate feasibility, safety and efficacy of a mechanical esophageal deviation (ED) tool during AF ablation. We evaluated 687 patients who underwent RFA for AF. In 209 patients, EsoSure® was used to deflect esophagus away from ablation site. Propensity-score matching was performed to obtain 180 patients each in ED and non-ED arms. ED was used for LET rise seen in 61.7% (111/180) patients and was used if esophagus was in the line of ablation on fluoroscopy in 38.3% (69/180) patients. The mean deviation of trailing edge of esophagus with EsoSure® was 2.45 ± 0.9 cm (range: 1-4.5 cm). LET rise >1°C was significantly lower in ED than non-ED group (3% vs 79.4%, p<0.001). Mean LET rise (ED 0.34 ± 0.59 vs non-ED 1.66 ± 0.54, p<0.001). Intra-procedural success of PVAI, was slightly improved in ED arm than in non-ED arm without statistical significance. AF recurrence was lower in ED arm at 3-month, 6-month and 1-year follow-up than non-ED arm. No ED-related complications were noted. Mechanical displacement of esophagus with EsoSure® appears to be feasible, safe and efficacious in enabling adequate RF energy delivery to posterior wall of LA without significant LET rise and obvious clinical signs of esophageal injury. Copyright © 2018. Published by Elsevier Inc.

Eating disorders and non-suicidal self-injury: Structural equation modelling of a conceptual model.

PubMed

Vieira, Ana Isabel; Machado, Bárbara C; Moreira, Célia S; Machado, Paulo P P; Brandão, Isabel; Roma-Torres, António; Gonçalves, Sónia

2018-06-14

Evidence suggests several risk factors for both eating disorders (ED) and nonsuicidal self-injury (NSSI), but the relationships between these factors are not well understood. Considering our previous work and a conceptual model, this cross-sectional study aimed to assess the relationships among distal and proximal factors for the presence of NSSI in ED. We assessed 245 ED patients with the Oxford Risk Factor Interview for ED. Structural equation modelling revealed that both distal and proximal factors were related to the presence of NSSI in ED, disclosing a mediating role of the proximal factors. Stressful life events mediated the relationship between childhood sexual abuse, peer aggression, and both ED and NSSI. Childhood physical abuse was related to ED and NSSI via substance use, negative self-evaluation, and suicide attempts. Findings provided support for the conceptual model and highlight the possible mechanisms by which psychosocial factors may lead to ED and NSSI. Copyright © 2018 John Wiley & Sons, Ltd and Eating Disorders Association.

Two sides of the same coin? A new instrument to assess body checking and avoidance behaviors in eating disorders.

PubMed

Legenbauer, Tanja; Martin, Franziska; Blaschke, Ariane; Schwenzfeier, Anne; Blechert, Jens; Schnicker, Katja

2017-06-01

Body checking (BC) and avoidance behaviors (BA) are the dominant behavioral features of body image disturbances (BID) that characterize most individuals with eating disorders (EDs). Whereas BC can be reliably assessed, a valid assessment tool for BA is lacking, preventing an adequate assessment of BID differences across different EDs (anorexia nervosa, AN; bulimia nervosa, BN; binge eating disorder, BED). A total of 310 women with EDs and 112 nonclinical controls completed measures of BC-, BA- and ED-related symptoms. BA did not differentiate between EDs, whereas BC did: it was highest in AN and BN, and lowest in BED. Multivariate analyses also discriminated AN from BN based on BC. Given that results are of preliminary nature, evidence is promising that EDs can be discriminated from healthy controls and that differential BID profiles for the behavioral component among ED subgroups exist. However, replication of the factor structure remains open within ED subsamples. Copyright © 2017 Elsevier Ltd. All rights reserved.