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A dataset of recorded electricity outages by United States county 2014-2022. Sci Data 2024; 11:271. [PMID: 38443375 PMCID: PMC10915145 DOI: 10.1038/s41597-024-03095-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024] Open
Abstract
In this Data Descriptor, we present county-level electricity outage estimates at 15-minute intervals from 2014 to 2022. By 2022 92% of customers in the 50 US States, Washington DC, and Puerto Rico are represented. These data have been produced by the Environment for Analysis of Geo-Located Energy Information (EAGLE-ITM), a geographic information system and data visualization platform created at Oak Ridge National Laboratory to map the population experiencing electricity outages every 15 minutes at the county level. Although these data do not cover every US customer, they represent the most comprehensive outage information ever compiled for the United States. The rate of coverage increases through time between 2014 and 2022. We present a quantitative Data Quality Index for these data for the years 2018-2022 to demonstrate temporal changes in customer coverage rates by FEMA region and indicators of data collection gaps or other errors.
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Emergency dental treatment among patients waitlisted for the operating room. J Clin Pediatr Dent 2023; 47:54-58. [PMID: 37143421 DOI: 10.22514/jocpd.2023.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/09/2022] [Indexed: 05/06/2023] Open
Abstract
This restrospective chart review examined dental emergencies among patients waitlisted for the operating room at an outpatient community dental clinic in a large academic medical center. Dental records of ASA I or II patients, who had dental restorations and/or extractions in the operating room between July 2015 to May 2019 were reviewed. Length of time the patient was waitlisted and number of emergency dental treatments (i.e., therapeutic pulpotomy or a dental extraction due to acute dental pain or infection) completed in the outpatient dental clinic during the wait period were collected. Data were dichotomized as <2 and ≥2 emergency treatments. Kruskal-Wallis test was used to compare the groups. Of 417 charts reviewed, 294 patients met the inclusion criteria. The average time on the waitlist was 228 days. The majority of patients (n = 222; 75.3%) had no emergency dental treatment while waitlisted. Those who had two or more emergency treatments (n = 34; 11.5%) were waitlisted longer than those who had fewer than two (n = 261; 88.5%) (p < 0.05). This study highlights the importance of early intervention (e.g., scheduled periodic follow-ups, interim caries arresting medication) and an ongoing discussion of possible alternatives while waitlisted. Future research identifying predictors of utilization of emergency services while waitlisted is warranted and may help identify those at increased risk of developing acute dental emergencies.
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Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 2022; 109:943-950. [PMID: 35979802 PMCID: PMC10364691 DOI: 10.1093/bjs/znac198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER ISRCTN25616490 (http://www.controlled-trials.com).
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Probing Strong-Field QED with Doppler-Boosted Petawatt-Class Lasers. PHYSICAL REVIEW LETTERS 2021; 127:114801. [PMID: 34558937 DOI: 10.1103/physrevlett.127.114801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/10/2021] [Indexed: 05/07/2023]
Abstract
We propose a scheme to explore regimes of strong-field quantum electrodynamics (SF QED) otherwise unattainable with the currently available laser technology. The scheme relies on relativistic plasma mirrors curved by radiation pressure to boost the intensity of petawatt-class laser pulses by Doppler effect and focus them to extreme field intensities. We show that very clear SF QED signatures could be observed by placing a secondary target where the boosted beam is focused.
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P85.04 Capmatinib in Patients with METex14-Mutated Non-Small Cell Lung Cancer: GEOMETRY Mono-1 Asian Subgroup Analysis. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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103 Diabetes and Erectile Dysfunction: Does Evidence based Testing Inform Us? J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Oral manifestations of COVID-2019-related multisystem inflammatory syndrome in children: a review of 47 pediatric patients. J Am Dent Assoc 2020; 152:202-208. [PMID: 33632409 PMCID: PMC7832615 DOI: 10.1016/j.adaj.2020.11.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/21/2020] [Accepted: 11/23/2020] [Indexed: 12/20/2022]
Abstract
Background Although much is still unknown about the full effects of COVID-19, literature from the early stages of the COVID-19 pandemic (spring and summer 2020) supports a postviral immunologic reaction resulting in a multisystem inflammatory syndrome in children (MIS-C). The purpose of this study was to report the rates of documented oral and oropharyngeal manifestations among these patients and to determine the association of these findings with other MIS-C symptoms. Methods The authors conducted a retrospective review of pediatric patients with COVID-19 who were admitted to the Morgan Stanley Children’s Hospital of NewYork-Presbyterian. Patients fulfilling the Centers for Disease Control and Prevention criteria for MIS-C were included in this study. The documented signs, symptoms, and laboratory values were collected and compared with the presence of oral or oropharyngeal findings. Results The mean (standard deviation) age of MIS-C patients was 9.0 (5.0) years (range, 1.3-20.0 years), and there was no obvious sex difference (51.1% male, 48.9% female). With respect to oral findings, 23 patients (48.9%) had red or swollen lips, whereas only 5 (10.6%) had a strawberry tongue. Oral or oropharyngeal findings were associated significantly with the presence of systemic rash (P = .04) and conjunctivitis (P = .02). Conclusions The presence of oral or oropharyngeal changes may be an early indicator of MIS-C and should be considered suggestive of MIS-C in the setting of COVID-19 infection. Practical Implications Dental care providers may play an integral role both in the early detection of oral manifestations of MIS-C and in the identification of oral lesions in hospitalized patients with confirmed MIS-C.
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Polygenic Risk Score Analysis of Alzheimer's Disease in Cases without APOE4 or APOE2 Alleles. JPAD-JOURNAL OF PREVENTION OF ALZHEIMERS DISEASE 2020; 6:16-19. [PMID: 30569081 PMCID: PMC6399990 DOI: 10.14283/jpad.2018.46] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The We and others have previously shown that polygenic risk score analysis (PRS)
has considerable predictive utility for identifying those at high risk of developing
Alzheimer’s disease (AD) with an area under the curve (AUC) of >0.8. However, by
far the greatest determinant of this risk is the apolipoprotein E locus with the E4
allele alone giving an AUC of ∼0.68 and the inclusion of the protective E2 allele
increasing this to ∼0.69 in a clinical cohort. An important question is to determine
how good PRS is at predicting risk in those who do not carry the E4 allele (E3
homozygotes, E3E2 and E2E2) and in those who carry neither the E4 or E2 allele (i.e.
E3 homozygotes). Previous studies have shown that PRS remains a significant
predictor of AD risk in clinical cohorts after controlling for APOE ε4 carrier
status. In this study we assess the accuracy of PRS prediction in a cohort of
pathologically confirmed AD cases and controls. The exclusion of APOE4 carriers has
surprisingly little effect on the PRS prediction accuracy (AUC ∼0.83 [95% CI:
0.80-0.86]), and the accuracy remained higher than that in clinical cohorts with
APOE included as a predictor. From a practical perspective this suggests that PRS
analysis will have predictive utility even in E4 negative individuals and may be
useful in clinical trial design.
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0340 Regional Changes in Sleep Electroencephalography Power in Youth with Sleep-Disordered Breathing: A High-Density EEG Study. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Daytime neurobehavioral impairments are commonly associated with sleep disordered breathing (SDB) in children. However, a large number of studies have shown only minimal differences in sleep between children with SDB relative to control children, suggesting that sleep dysfunction is not responsible for daytime impairment. Importantly, however, previous studies have measured sleep EEG using only frontal scalp electrodes, failing to capture the regional features of sleep that are prominent during development. Here we measure sleep using hdEEG in SDB and healthy children to determine if regional sleep impairment is related to daytime neurobehavioral performance.
Methods
Overnight high-density electroencephalography (hdEEG, 256 channels) was recorded in 17 children with sleep disordered breathing (SDB) (age: M = 8.46, SD = 1.82, AHI: M = 11.3, SD = 8.6, 53% female) and 17 age and sex matched controls (age: M = 8.47, SD = 1.66, AHI: M = 1.5, SD = .64). Attentional capacity was assessed using the Test of Variables of Attention (TOVA) before and after sleep. Group differences in sleep macrostructure variables were assessed using unpaired t-tests. All-night spectral analysis was performed for NREM sleep and averaged across groups. Topographic differences between groups were assessed using statistical non-parametric mapping. Pearson correlations were used to determine associations between sleep and TOVA variables.
Results
Sleep macrostructure did not differ between groups. All-night spectral density analysis revealed a global increase in high-frequency activity in N2N3 and N3, in the alpha band (8-12 Hz, p<0.05). Global alpha power was higher in SDB youth, although this effect reached significance during N3 in a large cluster of posterior channels (N=55, p=.02).
Conclusion
Elevated alpha during NREM is frequently considered a correlate of nonrestorative sleep. In this sample of youth with SDB, posterior alpha is robustly increased during the deepest stage of NREM sleep. In this small sample, however, alpha power did not predict performance on an attentional task sensitive to the effects of impaired sleep.
Support
R21 HD092986-02 to SJ
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Sleep And Attention In Youth With Sleep Disordered Breathing. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
INTRODUCTION Biology of aging is focused on elucidating the biochemical and genetic pathways that contribute to cellular damage accumulation over time. Thirty years of research are beginning to bear fruit as the first pharmacological interventions based on biology of aging go through clinical trials. Evolutionary theories of aging suggest that naturally selected traits believed to impart fitness in young organisms may be damaging in later life. Three major areas of focus in biology of aging are lifespan, healthspan, and rejuvenation. Areas covered: Aging research has produced several validated pharmacological interventions currently in clinical trials. Herein, the authors consider two representative case studies: 1) rapamycin analogs and their effect on the mTORC1 pathway, and 2) small molecules that target and kill senescent cells. The authors also provide their expert current and future perspectives on aging targeting drug discovery. Expert opinion: Aging-related therapeutic interventions will continue to emerge at an accelerating pace, both from research in biology of aging, as well as from coordinated biomedical research in aging-related chronic conditions.
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Exploratory analysis of the association of depth of response and survival in patients with metastatic non-small-cell lung cancer treated with a targeted therapy or immunotherapy. Ann Oncol 2019. [PMID: 29529128 DOI: 10.1093/annonc/mdy045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Biomarker-integrated study of single agent targeting molecular alterations of PI3KCA, MET, ALK, ROS1, KRAS, NRAS or BRAF in advanced NSCLC: Phase 2 umbrella trial in China (CTONG1505). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy441.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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JCSE01.09 Cluster Trial: Ph2 Biomarker-Integrated Study of Single Agent Alpelisib, Capmatinib, Ceritinib and Binimetinib in advNSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
ZusammenfassungDie Prognose der spontanen intrazerebralen Massenblutungen gleich welcher Ätiologie ist nach wie vor ungünstig. Weder die konservative Therapie noch das konventionelle neurochirurgische Vorgehen konnten die hohen Mortalitäts-und Morbiditätsraten wesentlich senken.Die CT-stereotaktische Hämatomteilentleerung mit anschließender Fibrinolyse des Resthämatoms stellt hierzu eine effektive therapeutische Alternative dar.Von Oktober 1985 bis August 1988 wurden in der Abt. Stereotaxie und Neuronuklearmedizin der Neurochirurgischen Universitätsklinik Freiburg insgesamt 60 Patienten mit dieser Methode behandelt. Während des Beobachtungszeitraums von durchschnittlich 27 Monaten verstarben insgesamt 15 Patienten, 10 davon innerhalb der ersten 60 Tage unmittelbar an den Blutungsfolgen. Die aktuelle Lebensqualität der 45 überlebenden Patienten wurde nach der Karnofsky-Skala beurteilt. Sie war zum Nachuntersuchungszeitpunkt in 64,4% der Fälle sehr gut bis gut und in 28,9% mäßig. Nur 6,7% der Patienten waren schwer krank und benötigten spezielle Betreuung.Die Langzeitergebnisse der stereotaktischen Behandlungsmethode bei intrazerebralen Blutungen sind somit, verglichen mit den Angaben in der Literatur, deutlich günstiger und daher ermutigend. Durch frühzeitiges Einleiten einer intensiven neurologischen Rehabilitationsbehandlung mit optimaler Hilfsmittelversorgung lassen sich die Resultate wahrscheinlich noch verbessern.
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Exploratory analysis of the association of depth of response and survival in patients with metastatic non-small-cell lung cancer treated with a targeted therapy or immunotherapy. Ann Oncol 2017; 28:2707-2714. [PMID: 29045514 PMCID: PMC6137816 DOI: 10.1093/annonc/mdx414] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Response Evaluation Criteria in Solid Tumors (RECIST) permits rapid evaluation of new therapeutic strategies in cancer. However, RECIST does not capture the heterogeneity of response in highly active therapies. Depth of tumor response may provide a more granular view of response. We explored the association between, depth of response (DepOR), with overall survival (OS) and progression-free survival (PFS) for patients with NSCLC being treated with an ALK inhibitor (ALKi) or an anti-PD-1 antibody (Ab). METHODS Experimental arms from two randomized controlled trials (RCTs) of an ALKi and two RCTs of an anti-PD-1 Ab were separately pooled. Patient responses were grouped into DepOR 'quartiles' by percentage of maximal tumor shrinkage (Q1 = 1%-25%, Q2 = 26%-50%, Q3 = 51%-75%, and Q4 = 76%-100%), Q0 had no shrinkage. We carried out a retrospective exploratory responder analysis to evaluate the association between DepOR and OS or PFS using hazard ratios (HR) generated by the Cox proportional hazards model. RESULTS In the pooled ALK analysis there were 12, 39, 70, 144, and 40 patients in quartiles 0-4, respectively. The DepOR versus PFS/OS analyses HR were: 0.19/0.94 for Q1 0.11/0.56 for Q2, 0.05/0.28 for Q3, and 0.03/0.05 for Q4. In the PD-1 trials within quartiles 0-4 there were 168, 70, 44, 45, and 28 patients, respectively. The DepOR versus PFS/OS analyses HR were 0.3/0.52 for Q1, 0.22/0.47 for Q2, 0.09/0.07 for Q3, and 0.07/0.14 for Q4. CONCLUSIONS Our analysis suggests a greater DepOR is associated with longer PFS and OS for patients receiving ALKi or anti-PD1 Ab. Overall, this suggests that DepOR may provide an additional outcome measure for clinical trials, and may allow better comparisons of treatment activity.
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AGING AND THE FREQUENCY OF NSAID-RELEVANT COEXISTING MEDICAL CONDITIONS IN THE PRIMARY CARE SETTING. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Are older drivers' on-road driving error rates related to functional performance and/or self-reported driving experiences? ACCIDENT; ANALYSIS AND PREVENTION 2017; 103:1-9. [PMID: 28365398 DOI: 10.1016/j.aap.2017.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/14/2017] [Accepted: 03/06/2017] [Indexed: 06/07/2023]
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Fludarabine with pharmacokinetically guided IV busulfan is superior to fixed-dose delivery in pretransplant conditioning of AML/MDS patients. Bone Marrow Transplant 2016; 52:580-587. [PMID: 27991894 PMCID: PMC5382042 DOI: 10.1038/bmt.2016.322] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 09/28/2016] [Accepted: 09/30/2016] [Indexed: 11/25/2022]
Abstract
We hypothesized that IV Busulfan (Bu) dosing could be safely intensified through pharmacokinetic (PK-) dose guidance to minimize the inter-patient variability in systemic exposure (SE) associated with body-sized dosing, and this should improve outcome of AML/MDS patients undergoing allogeneic stem cell transplantation (allo-HSCT). To test this hypothesis, we treated 218 patients (median age 50.7 years, male/female 50/50%) with fludarabine (Flu) 40 mg/m2 once daily ×4, each dose followed by IV Bu, randomized to 130 mg/m2 (N=107) or PK-guided to average daily SE, AUC of 6,000 µM-min (N=111), stratified for remission-status, and allo-grafting from HLA-matched donors. Toxicity and graft vs. host disease (GvHD) rates in the groups were similar; the risk of relapse or treatment-related mortality remained higher in the fixed-dose group throughout the 80-month observation period. Further, PK-guidance yielded safer disease-control, leading to improved overall and progression-free survival, most prominently in MDS-patients and in AML-patients not in remission at allo-HSCT. We conclude that AML/MDS patients receiving pretransplant conditioning treatment with our 4-day regimen may benefit significantly from PK-guided Bu-dosing. This could be considered an alternative to fixed dose delivery since it provides the benefit of precise dose delivery to a predetermined SE without increasing risk(s) of serious toxicity and/or GvHD.
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Corrigendum: Status of Competency-Based Medical Education in Endoscopy Training: A Nationwide Survey of US ACGME-Accredited Gastroenterology Training Programs. Am J Gastroenterol 2016; 111:585. [PMID: 27125721 DOI: 10.1038/ajg.2016.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Review of antimicrobial administration in cases of proven bacteraemia in adult patients at one London teaching hospital. Intensive Care Med Exp 2015. [PMCID: PMC4797406 DOI: 10.1186/2197-425x-3-s1-a406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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A bodybuilder with an unusual problem; massive transvaginal small bowel evisceration. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mutations in the AMPA receptor complex protein FRRS1L cause an inherited Huntington-like chorea-dementia syndrome. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
An 82-year-old woman with longstanding medial thigh pain presented with a 5-day history of constipation, vomiting, abdominal pain and distension. She was unable to pass flatus for the preceding 24 hours and had a past history of laparoscopic abdominal surgery. Computed tomography of the abdomen and pelvis revealed a right-sided obturator hernia containing a dilated loop of small bowel. She underwent emergency surgery for a right obturator hernia repair by limited laparotomy and was discharged after an extended stay complicated by postoperative atrial fibrillation.
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Status of Competency-Based Medical Education in Endoscopy Training: A Nationwide Survey of US ACGME-Accredited Gastroenterology Training Programs. Am J Gastroenterol 2015; 110:956-62. [PMID: 25803401 DOI: 10.1038/ajg.2015.24] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 01/07/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The Accreditation Council for Graduate Medical Education (ACGME) emphasizes the importance of medical trainees meeting specific performance benchmarks and demonstrating readiness for unsupervised practice. The aim of this study was to examine the readiness of Gastroenterology (GI) fellowship programs for competency-based evaluation in endoscopic procedural training. METHODS ACGME-accredited GI program directors (PDs) and GI trainees nationwide completed an online survey of domains relevant to endoscopy training and competency assessment. Participants were queried about current methods and perceived quality of endoscopy training and assessment of competence. Participants were also queried about factors deemed important in endoscopy competence assessment. Five-point Likert items were analyzed as continuous variables by an independent t-test and χ(2)-test was used for comparison of proportions. RESULTS Survey response rate was 64% (94/148) for PDs and 47% (546/1,167) for trainees. Twenty-three percent of surveyed PDs reported that they do not have a formal endoscopy curriculum. PDs placed less importance (1—very important to 5—very unimportant) on endoscopy volume (1.57 vs. 1.18, P<0.001), adenoma detection rate (2.00 vs. 1.53, P<0.001), and withdrawal times (1.96 vs. 1.68, P=0.009) in determining endoscopy competence compared with trainees. A majority of PDs report that competence is assessed by procedure volume (85%) and teaching attending evaluations (96%). Only a minority of programs use skills assessment tools (30%) or specific quality metrics (28%). Specific competencies are mostly assessed by individual teaching attending feedback as opposed to official documentation or feedback from a PD. PDs rate the overall quality of their endoscopy training and assessment of competence as better than overall ratings by trainees. CONCLUSIONS Although the majority of PDs and trainees nationwide believe that measuring specific metrics is important in determining endoscopy competence, most programs still rely on procedure volume and subjective attending evaluations to determine overall competence. As medical training transitions from an apprenticeship model to competency-based education, there is a need for improved endoscopy curricula which are better suited to demonstrate readiness for unsupervised practice.
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Comment on: Effects of selective digestive decontamination (SDD) on the gut resistome. J Antimicrob Chemother 2014; 69:3444-5. [DOI: 10.1093/jac/dku288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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The role of measurement and modelling of machine tools in improving product quality. INTERNATIONAL JOURNAL OF METROLOGY AND QUALITY ENGINEERING 2014. [DOI: 10.1051/ijmqe/2013054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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AB1370 Case mix of new patients seen in northumberland-results from a local survey:. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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511 Analysis of Neural and Vascular Structures across the Airway Anastomosis in Lung Transplant Recipients. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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P09.09 The benefits and barriers to online learning for infection control education. J Hosp Infect 2010. [DOI: 10.1016/s0195-6701(10)60098-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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C-reactive protein as a predictor of outcome after discharge from the intensive care: a prospective observational study. Br J Anaesth 2010; 105:318-25. [PMID: 20630889 DOI: 10.1093/bja/aeq171] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Recent studies have found plasma C-reactive protein (CRP) to be a predictor of outcome after discharge from the intensive care unit (ICU). To assess the generalizability of this finding, we assessed the value of CRP on the day of ICU discharge as a predictor of unplanned ICU readmission and unexpected death within 2 weeks. Plasma albumin and white cell count at discharge were also considered as markers associated with ongoing inflammation. METHODS This was a single-centre observational study involving a medical-surgical ICU in a university teaching hospital. Data were prospectively collected from 1487 admissions involving 1401 patients over a 12 month period. Patients' admission details and APACHE II score were collected in addition to plasma CRP, white cell count, and albumin values from the day of discharge from ICU. We assessed the difference in these variables between patients who were readmitted, who died unexpectedly, and those who did not. RESULTS We found that 9.9% of patients discharged were either readmitted (7.0%) or died unexpectedly (2.9%). Patients who were readmitted had a lower plasma albumin concentration [20 (16, 24) vs 22 (19, 27), P<0.001] and a higher admission APACHE II score [median (inter-quartile range, IQR) 16.5 (13, 21) vs 15 (12, 18), P=0.02]. Patients who died unexpectedly on the ward were older [mean (sd): 76 (12) vs 59 (19), P<0.001] and had a higher APACHE II score [21 (17.25, 26) vs 15 (12, 18), P<0.001]. There was not a statistically significant difference in CRP concentration between patients who either required ICU readmissions or died unexpectedly on the ward and those who did not. CONCLUSIONS In a mixed medical-surgical intensive care, plasma CRP measured at the day of discharge from intensive care is not a predictor of readmissions or deaths.
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Player Control of 'Brassiness' at Intermediate Dynamic Levels in Brass Instruments. ACTA ACUST UNITED AC 2010. [DOI: 10.3813/aaa.918316] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Overexpression of VEGF from Sinonasal Epithelium is a Biomarker for Chronic Rhinosinusitis with Nasal Polyposis. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2009.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nrf2-regulated glutathione recycling independent of biosynthesis is critical for cell survival during oxidative stress. Free Radic Biol Med 2009; 46:443-53. [PMID: 19028565 PMCID: PMC2634824 DOI: 10.1016/j.freeradbiomed.2008.10.040] [Citation(s) in RCA: 329] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 10/15/2008] [Accepted: 10/16/2008] [Indexed: 12/22/2022]
Abstract
Nuclear factor-erythroid 2 p45-related factor 2 (Nrf2) is the primary transcription factor protecting cells from oxidative stress by regulating cytoprotective genes, including the antioxidant glutathione (GSH) pathway. GSH maintains cellular redox status and affects redox signaling, cell proliferation, and death. GSH homeostasis is regulated by de novo synthesis as well as GSH redox state; previous studies have demonstrated that Nrf2 regulates GSH homeostasis by affecting de novo synthesis. We report that Nrf2 modulates the GSH redox state by regulating glutathione reductase (GSR). In response to oxidants, lungs and embryonic fibroblasts (MEFs) from Nrf2-deficient (Nrf2(-/-)) mice showed lower levels of GSR mRNA, protein, and enzyme activity relative to wild type (Nrf2(+/+)). Nrf2(-/-) MEFs exhibited greater accumulation of glutathione disulfide and cytotoxicity compared to Nrf2(+/+) MEFs in response to t-butylhydroquinone, which was rescued by restoring GSR. Microinjection of glutathione disulfide induced greater apoptosis in Nrf2(-/-) MEFs compared to Nrf2(+/+) MEFs. In silico promoter analysis of the GSR gene revealed three putative antioxidant-response elements (ARE1, -44; ARE2, -813; ARE3, -1041). Reporter analysis, site-directed mutagenesis, and chromatin immunoprecipitation assays demonstrated binding of Nrf2 to two AREs distal to the transcription start site. Overall, Nrf2 is critical for maintaining the GSH redox state via transcriptional regulation of GSR and protecting cells against oxidative stress.
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IL-13 Regulation of Skin Remodeling in a Mouse Model of Atopic Dermatitis. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract No. 101: The Essential Role of the Interventional Radiology Consultation in Day-to-Day Patient Care. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Raised C-reactive protein on ICU discharge is not associated with subsequent poor outcome. Crit Care 2009. [PMCID: PMC4084277 DOI: 10.1186/cc7555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Rolling out male circumcision as a mass HIV/AIDS intervention seems neither justified nor practicable. S Afr Med J 2008; 98:781-782. [PMID: 19115752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
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Independent measurement of the total active 8B solar neutrino flux using an array of 3He proportional counters at the Sudbury Neutrino Observatory. PHYSICAL REVIEW LETTERS 2008; 101:111301. [PMID: 18851271 DOI: 10.1103/physrevlett.101.111301] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Indexed: 05/26/2023]
Abstract
The Sudbury Neutrino Observatory (SNO) used an array of 3He proportional counters to measure the rate of neutral-current interactions in heavy water and precisely determined the total active (nu_x) 8B solar neutrino flux. This technique is independent of previous methods employed by SNO. The total flux is found to be 5.54_-0.31;+0.33(stat)-0.34+0.36(syst)x10(6) cm(-2) s(-1), in agreement with previous measurements and standard solar models. A global analysis of solar and reactor neutrino results yields Deltam2=7.59_-0.21;+0.19x10(-5) eV2 and theta=34.4_-1.2;+1.3 degrees. The uncertainty on the mixing angle has been reduced from SNO's previous results.
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Plasma C-reactive protein and albumin as predictors of readmission to intensive care. Crit Care 2008. [PMCID: PMC4088545 DOI: 10.1186/cc6395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Increased familial risk and genomewide significant linkage for Alzheimer's disease with psychosis. Am J Med Genet B Neuropsychiatr Genet 2007; 144B:841-8. [PMID: 17492769 DOI: 10.1002/ajmg.b.30515] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Psychotic symptoms are common in Alzheimer's disease (AD) and are associated with increased cognitive impairment and earlier institutionalization. One study has suggested that they are genetically modified and two genome screens have been performed to search for susceptibility loci for AD with psychosis (AD + P). The aim of this study was to further investigate the familial aggregation of AD + P and perform a genome screen for AD, conditioning on the presence or absence of psychotic symptoms. Samples from the UK and US were combined, providing data from 374 families in which at least two members met criteria for AD and had complete data regarding psychotic symptoms. Generalized estimating equations (GEE) were used to assess the relationship of psychotic symptoms between siblings. A total of 321 affected relative pairs (ARPs) were genotyped for linkage. There was a significant association between proband psychosis status and the occurrence of AD + P in siblings in the UK (OR = 4.17, P = 0.002) and US (OR = 3.2, P < 0.001) samples. Chromosomewide and genomewide significant linkage peaks were observed on chromosomes 7 (LOD = 2.84) and 15 (LOD = 3.16), respectively, with the strongest evidence coming from pairs concordant for AD without psychosis. A LOD score of 2.98 was observed close to a previously reported AD + P linkage region on chromosome 6, however the increase in LOD attributable to psychosis was not significant. These findings support the hypothesis that psychotic symptoms in AD are genetically modified and that a gene/s implicated in their aetiology may be located on chromosome 7 and 15.
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Delay in access to appropriate care for children presenting with musculoskeletal symptoms and ultimately diagnosed with juvenile idiopathic arthritis. ACTA ACUST UNITED AC 2007; 57:921-7. [PMID: 17665486 DOI: 10.1002/art.22882] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To document pathways of care, management, and interval from onset of symptoms to first pediatric rheumatology multidisciplinary team (PRhMDT) assessment for children with incident juvenile idiopathic arthritis (JIA). METHODS We conducted a retrospective observational study of children with incident JIA over a 3-year period. RESULTS The study included 152 patients with JIA (87 females). The median interval from symptom onset to first PRhMDT assessment was 20 weeks (range 0-416), with significant variation between JIA subtypes (P = 0.0097); children with extended oligoarticular JIA had the longest interval (median 60 weeks, range 12-320). Prior to pediatric rheumatology assessment, many children had referrals to multiple secondary care specialties and had been subjected to multiple and often invasive procedures including arthroscopy/synovial biopsy (18 [11.8%] of 152), but none were referred for ophthalmologic screening, physical therapy, or nursing input and a diagnosis of JIA was rarely made (98%). At first PRhMDT assessment, most patients had untreated active disease with active joint count >or=1 (135 [89%] of 152), restricted joint count >or=1 (135 [89%] of 152), and functional disability by Child Health Assessment Questionnaire score >0 (53 [68%] of 118); 1 child had undetected uveitis. Following PRhMDT assessment, interventions were invariably indicated, including joint injections (69 [45%] of 152), methotrexate (49 [32%] of 152), and physical therapy programs (all patients). CONCLUSION Delay in access to pediatric rheumatology assessment is common with complex pathways of referral. Many children were subjected to inappropriate invasive investigations and many had prolonged untreated active disease at the initial PRhMDT assessment. This delay is likely to affect long-term outcome and warrants further exploration.
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The frequency and impact of restless legs syndrome in primary care. IRISH MEDICAL JOURNAL 2007; 100:539-42. [PMID: 17886530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
This study examined the prevalence and impact of moderate to severe RLS (MS-RLS) in primary care patients in Ireland. Patients completed a screening questionnaire and those with symptoms suggestive of MS-RLS underwent a diagnostic interview. Patients diagnosed with MS-RLS completed quality of life and sleep assessment questionnaires, and their medical records were examined. Of 2628 patients screened for RLS, 74 (2.8%, 95% confidence interval 2.2%-3.5%) were ultimately diagnosed at interview as having MS-RLS. These patients reported significant impact on sleep and quality of life; 24 (32.4%) had consulted a health care professional about their RLS symptoms but only 4 (16.7%) were diagnosed with RLS. Ten (13.5%) MS-RLS patients were taking inappropriate medicines to try to relieve their symptoms. Clinically significant RLS is common in Irish general practice and has a significant effect on sleep and quality of life. Nevertheless, the condition often goes undiagnosed.
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Male circumcision--the new hope? S Afr Med J 2007; 97:338-41. [PMID: 17599212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
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P0094 RLS should be considered in patients presenting with poor sleep in European Primary Care. Sleep Med 2007. [DOI: 10.1016/s1389-9457(07)70350-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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