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Ebinger JE, Lan R, Driver M, Sun N, Botting P, Park E, Davis T, Minissian MB, Coleman B, Riggs R, Roberts P, Cheng S. Seasonal COVID-19 surge related hospital volumes and case fatality rates. BMC Infect Dis 2022; 22:178. [PMID: 35197000 PMCID: PMC8864601 DOI: 10.1186/s12879-022-07139-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/09/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Seasonal and regional surges in COVID-19 have imposed substantial strain on healthcare systems. Whereas sharp inclines in hospital volume were accompanied by overt increases in case fatality rates during the very early phases of the pandemic, the relative impact during later phases of the pandemic are less clear. We sought to characterize how the 2020 winter surge in COVID-19 volumes impacted case fatality in an adequately-resourced health system. METHODS We performed a retrospective cohort study of all adult diagnosed with COVID-19 in a large academic healthcare system between August 25, 2020 to May 8, 2021, using multivariable logistic regression to examine case fatality rates across 3 sequential time periods around the 2020 winter surge: pre-surge, surge, and post-surge. Subgroup analyses of patients admitted to the hospital and those receiving ICU-level care were also performed. Additionally, we used multivariable logistic regression to examine risk factors for mortality during the surge period. RESULTS We studied 7388 patients (aged 52.8 ± 19.6 years, 48% male) who received outpatient or inpatient care for COVID-19 during the study period. Patients treated during surge (N = 6372) compared to the pre-surge (N = 536) period had 2.64 greater odds (95% CI 1.46-5.27) of mortality after adjusting for sociodemographic and clinical factors. Adjusted mortality risk returned to pre-surge levels during the post-surge period. Notably, first-encounter patient-level measures of illness severity appeared higher during surge compared to non-surge periods. CONCLUSIONS We observed excess mortality risk during a recent winter COVID-19 surge that was not explained by conventional risk factors or easily measurable variables, although recovered rapidly in the setting of targeted facility resources. These findings point to how complex interrelations of population- and patient-level pandemic factors can profoundly augment health system strain and drive dynamic, if short-lived, changes in outcomes.
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Affiliation(s)
- Joseph E. Ebinger
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA USA ,grid.50956.3f0000 0001 2152 9905Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Roy Lan
- grid.267301.10000 0004 0386 9246College of Medicine, University of Tennessee Health Science Center, Memphis, TN USA
| | - Matthew Driver
- grid.50956.3f0000 0001 2152 9905Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Nancy Sun
- grid.50956.3f0000 0001 2152 9905Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Patrick Botting
- grid.50956.3f0000 0001 2152 9905Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Eunice Park
- grid.50956.3f0000 0001 2152 9905Enterprise Data Intelligence, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Tod Davis
- grid.50956.3f0000 0001 2152 9905Enterprise Data Intelligence, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Margo B. Minissian
- grid.50956.3f0000 0001 2152 9905Brawerman Nursing Institute and Nursing Research Department, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Bernice Coleman
- grid.50956.3f0000 0001 2152 9905Brawerman Nursing Institute and Nursing Research Department, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Richard Riggs
- grid.50956.3f0000 0001 2152 9905Department of Medical Affairs, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Pamela Roberts
- grid.50956.3f0000 0001 2152 9905Department of Medical Affairs, Cedars-Sinai Medical Center, Los Angeles, CA USA ,grid.50956.3f0000 0001 2152 9905Department of Biomedical Sciences, Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Susan Cheng
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA USA ,grid.50956.3f0000 0001 2152 9905Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
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Roberts P, Wertheimer J, Park E, Nuño M, Riggs R. Identification of Functional Limitations and Discharge Destination in Patients With COVID-19. Arch Phys Med Rehabil 2021; 102:351-358. [PMID: 33278363 PMCID: PMC7709477 DOI: 10.1016/j.apmr.2020.11.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/15/2020] [Accepted: 11/02/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The objectives of this study were to identify functional limitations in patients with coronavirus 2019 (COVID-19) admitted to acute care hospitals; to evaluate functional limitations by demographic, medical, and encounter characteristics; and to examine functional limitations in relation to discharge destination. DESIGN and Setting:This is a cross-sectional, retrospective study of adult patients with COVID-19 who were discharged from 2 different types of hospitals (academic medical center and a community hospital) within 1 health care system from January 1 to April 30, 2020. PARTICIPANTS Patients were identified from the Cedars-Sinai COVID-19 data registry who had a new-onset positive test for severe acute respiratory syndrome coronavirus 2. A total of 273 patients were identified, which included 230 patients who were discharged alive and 43 patients who died and were excluded from the study sample. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Functional limitations in patients with COVID-19 in acute care hospitals and the predictors for discharge disposition. RESULTS A total of 230 records were analyzed including demographic, encounter, medical, and functional variables. In a propensity score-matched cohort based on age and comorbidity, 88.2% had functional physical health deficits, 72.5% had functional mental health deficits, and 17.6% experienced sensory deficits. In the matched cohort, individuals discharged to an institution experienced greater physical (62.7% vs 25.5%, P<.001) and mental health (49.0% vs 23.5%, P=.006) deficits than patients discharged home. Marital status (odds ratio, 3.17; P=.011) and physical function deficits (odds ratio, 3.63; P=.025) were associated with an increase odds ratio of discharge to an institution. CONCLUSIONS This research highlights that functional status is a strong predictor for discharge destination to an institution for patients with COVID-19. Patients who were older, in the acute care hospital longer, and with comorbidities were more likely to be discharged to an institution. Rehabilitation is a significant aspect of the health care system for these vulnerable patients. The challenges of adjusting the role of rehabilitation providers and systems during the pandemic needs further exploration. Moreover, additional research is needed to look more closely at the many facets and timing of functional status needs, to shed light in use of interdisciplinary rehabilitation services, and to guide providers and health care systems in facilitating optimal recovery and patient outcomes.
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Affiliation(s)
- Pamela Roberts
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai, Los Angeles, California; Department of Enterprise Information Services, Cedars-Sinai, Los Angeles, California; Department of Medical Affairs, Cedars-Sinai, Los Angeles, California.
| | - Jeffrey Wertheimer
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai, Los Angeles, California
| | - Eunice Park
- Department of Enterprise Information Services, Cedars-Sinai, Los Angeles, California
| | - Miriam Nuño
- University of California, Davis, Department of Public Health Sciences, Davis, California
| | - Richard Riggs
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai, Los Angeles, California; Department of Medical Affairs, Cedars-Sinai, Los Angeles, California
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Fiesseler F, Walsh B, Riggs R, Biggs D. 49 Priapism Caused by Erectile Dysfunction Medication Requires Less Aggressive Therapies. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lovett S, Reed T, Riggs R, Lew G, Koch E, Rech M. 256 Intravenous Sub-Dissociative Dose Ketamine for Analgesia in the Emergency Department: A Dosing Comparison. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cavallari J, Bridgeman P, Awad N, Strickland P, Johnston K, Jawaro T, Riggs R. 114 A Survey of Emergency Medicine Resident Education in Prescribing Medications for Pregnant and Breastfeeding Women in the Emergency Department. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sanders C, Liegey-Dougall A, Haggard R, Buschang P, Karbowski S, Riggs R, Gatchel RJ. Temporomandibular Disorder Diagnostic Groups Affect Outcomes Independently of Treatment in Patients at Risk for Developing Chronicity: A 2-Year Follow-Up Study. J Oral Facial Pain Headache 2017; 30:187-202. [PMID: 27472521 DOI: 10.11607/ofph.1613] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To evaluate whether a biobehavioral intervention would be more effective than a self-care intervention or no intervention in reducing psychosocial distress, reducing pain, and improving functioning in patients with an acute myofascial temporomandibular disorder (m-TMD). METHODS Participants (n = 435) were from community dental clinics in the Dallas-Fort Worth Metroplex who were seeking treatment for their acute TMD symptoms and were recruited between 2008 and 2013. The participants were diagnosed using the Research Diagnostic Criteria for TMD (RDC/TMD) and assigned to a biobehavioral intervention, self-care intervention, or no intervention. Three outcomes were assessed: psychosocial distress, pain, and functioning; and treatment effectiveness was assessed according to TMD diagnosis. Outcome evaluations were conducted immediately postintervention as well as at 1 and 2 years postintervention. Analyses were conducted using two-level hierarchical multilevel linear models (MLMs). RESULTS Contrary to expectations, patients did not respond differently to the intervention based on their TMD diagnosis. Acute m-TMD patients, especially those with other comorbid TMD diagnoses, reported the highest levels of pain and pain-related symptoms and disability. They also exhibited poorer jaw functioning, especially if they were at high risk for chronic TMD. CONCLUSION This study indicates that acute m-TMD tends to result in more severe symptom presentations, particularly if diagnosed in combination with other TMD comorbidities. Additionally, patients do not appear to respond better to biobehavioral or self-care intervention on the basis of their TMD diagnosis.
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Rapp K, Fiesseler F, Salo D, Walsh B, Riggs R. 230 Reduction in Emergency Department Visits After Implementing a Care Plan in Patients With Drug-Seeking Behavior: Five-Year Analysis. Ann Emerg Med 2016. [DOI: 10.1016/j.annemergmed.2016.08.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cuthbert D, Allen J, Fiesseler F, Riggs R, Salo D. 318 Most Emergency Department Patients With Epistaxis are Treated Without Intervention and Bounce Backs are Uncommon. Ann Emerg Med 2016. [DOI: 10.1016/j.annemergmed.2016.08.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Roberts PS, Rizzo JR, Hreha K, Wertheimer J, Kaldenberg J, Hironaka D, Riggs R, Colenbrander A. A conceptual model for vision rehabilitation. J Rehabil Res Dev 2016; 53:693-704. [PMID: 27997671 PMCID: PMC5444332 DOI: 10.1682/jrrd.2015.06.0113] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 12/15/2015] [Indexed: 01/15/2023]
Abstract
Vision impairments are highly prevalent after acquired brain injury (ABI). Conceptual models that focus on constructing intellectual frameworks greatly facilitate comprehension and implementation of practice guidelines in an interprofessional setting. The purpose of this article is to provide a review of the vision literature in ABI, describe a conceptual model for vision rehabilitation, explain its potential clinical inferences, and discuss its translation into rehabilitation across multiple practice settings and disciplines.
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Affiliation(s)
- Pamela S. Roberts
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Health System, Los Angeles, CA
| | - John-Ross Rizzo
- Rehabilitation Medicine, New York University Langone Medical Center, New York, NY
| | - Kimberly Hreha
- Kessler Institute for Rehabilitation and Kessler Foundation, West Orange, NJ, and Teachers College, Columbia University, New York, NY
| | - Jeffrey Wertheimer
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Health System, Los Angeles, CA
| | - Jennifer Kaldenberg
- College of Health and Rehabilitation Sciences, Boston University, Boston, MA
| | - Dawn Hironaka
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Health System, Los Angeles, CA
| | - Richard Riggs
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Health System, Los Angeles, CA
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DiVita MA, Roberts P, Riggs R. Total Therapy Time and Time by Therapy Discipline is Associated with Rehabilitation Outcomes Among Stroke Inpatient Rehabilitation Patients. Arch Phys Med Rehabil 2015. [DOI: 10.1016/j.apmr.2015.08.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dieter M, Fiessler F, Salo D, Patel H, Riggs R. Hematuria is Almost Always Seen in Pediatric Patients Presenting to the Emergency Department With Urolithiasis. Ann Emerg Med 2013. [DOI: 10.1016/j.annemergmed.2013.07.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ekanayake R, Haines E, Fiesseler F, Riggs R, Armstrong L, Salo D. 430 Most Pediatric Patients With Retropharyngeal Abscess Are Afebrile. Ann Emerg Med 2011. [DOI: 10.1016/j.annemergmed.2011.06.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Haines E, Fiesseler F, Riggs R, Reedman L, Salo D. 364: The Prevalence of Afebrile Patients With Retropharyngeal Abscesses. Ann Emerg Med 2010. [DOI: 10.1016/j.annemergmed.2010.06.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Day JA, Beighle A, Riggs R, Hall J, Clasey JL. Body Composition and Physical Activity Levels of Young Rural Children. Med Sci Sports Exerc 2010. [DOI: 10.1249/01.mss.0000385358.40184.d0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Fiesseler F, Kairam N, Salo D, Riggs R, Reedman L, Destefano S, Amato C. 166: Are Carboxyhemoglobin Levels Required in Asymptomatic Patients Whose Carbon Monoxide Detector Alarms? Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.06.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Riggs R, Jennings R, Derstine E, Nguyen T, Trinh T, Riordan J. Synthesis and Evaluation of N-Aryl 2-Aminothiazole-4-Carboxamide Derivatives for Activity Against TB. LETT DRUG DES DISCOV 2008. [DOI: 10.2174/157018008783406615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Gatchel RJ, Stowell AW, Wildenstein L, Riggs R, Ellis E. Efficacy of an early intervention for patients with acute temporomandibular disorder-related pain: a one-year outcome study. J Am Dent Assoc 2006; 137:339-47. [PMID: 16570467 DOI: 10.14219/jada.archive.2006.0183] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The authors conducted a randomized clinical trial to evaluate the efficacy of a biopsychosocial intervention for patients who were at high risk (HR) of progressing from acute to chronic temporomandibular disorder (TMD)-related pain. METHODS The authors classified subjects' risk using a predictive algorithm and randomized them into an early-intervention (EI) or a nonintervention (NI) group. The EI included cognitive behavioral skills training and biofeedback. The authors assessed pain and psychosocial measures at intake and at a one-year follow-up. Subjects' self-reported pain levels were measured on an analog scale and as a response to palpation. RESULTS At one year, EI-group subjects had significantly lower levels of self-reported pain and depression. At one year, more NI-group subjects than EI-group subjects had utilized health care for jaw-related pain. NI-group subjects were 12.5 times as likely to have a somatoform disorder, more than seven times as likely to have an anxiety disorder, and 2.7 times more likely to have an affective disorder at one year, compared with EI-group subjects. CONCLUSIONS EI-group subjects had reduced pain levels, improved coping abilities and reduced emotional distress at one year. CLINICAL IMPLICATIONS The TMD-related pain experience is complex and requires early identification with a biopsychosocial EI to achieve maximal, sustainable results.
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Affiliation(s)
- Robert J Gatchel
- Department of Psychology, College of Science, University of Texas at Arlington, 313 Life Science Building, 501 S. Nedderman Drive, Arlington, Texas 76019-0528, USA.
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Wright AR, Gatchel RJ, Wildenstein L, Riggs R, Buschang P, Ellis E. Biopsychosocial differences between high-risk and low-risk patients with acute TMD-related pain. J Am Dent Assoc 2004; 135:474-83. [PMID: 15127871 DOI: 10.14219/jada.archive.2004.0213] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was to use a biopsychosocial perspective to characterize patients who were identified as being at high risk, or HR, of progressing from acute to chronic jaw-related pain. METHODS The authors classified 74 subjects as being at HR or low risk, or LR, according to the predictive algorithm. They used a variety of functional and biopsychosocial measures to evaluate subjects. RESULTS The HR group had significantly higher levels of self-reported pain as measured by the Characteristic Pain Inventory and significantly higher levels of depression as measured by the Beck Depression Inventory-II. They were 11 times more likely to have a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or DSM-IV, Axis I clinical diagnosis, and more than three times as likely to have a DSM-IV Axis II personality disorder. Logistic regression analyses identified variables that differentiated, with 77 percent accuracy, the HR and LR patients. CONCLUSIONS Overall, the HR subjects had more psychopathology than did the LR subjects, used poorer coping styles and had greater self-reported pain. Six psychosocial factors alone enabled the authors to correctly classify 77 percent of the subjects as being in the HR group. CLINICAL IMPLICATIONS Future research, in conjunction with the above findings, may enable the authors to determine, with greater certainty, if patients who are more anxious are at greater risk of developing chronic pain. If so, this provides further evidence of the need for early detection of patients at risk of developing chronic pain and the need to refer them for adjunctive care, such as cognitive-behavioral intervention.
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Affiliation(s)
- Anna R Wright
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas 75390-9044, USA.
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Abstract
Daily rhythms in response output and accuracy were examined when reinforcement for a complex operant was uncoupled from accuracy of performance. Rats housed in operant conditioning chambers earned their daily ration of food under a targeted percentile procedure for responding on two levers. The targeted pattern was a series of consecutive responses on the left lever (a "run"), followed by a single response on the right lever. The targeted run length was either "O" (i.e., undefined, under the nondifferential baseline), 6, 12 or 24. Under baseline, a random third of all trials ended in pellet delivery; under the percentile conditions, trials with runs closer to the target than two-thirds of the runs from the most recent 24 trials ended in pellet delivery. This contingency shaped run lengths while ensuring that approximately one-third of all trials produced pellets. Responding tracked the target value well, with mean obtained run lengths equal to 90% of the target or better. Daily rhythms were clearly evident in measures of overall output, with subjects responding primarily 3-7 h into the dark period. The only substantial light-period responding observed in all subjects occurred during the 2 h after noon, when the chambers were serviced. No systematic variation in this pattern was observed as a function of target. Run length was much less variable across the daily cycle than was response output, with only a suggestion under the longest target that response accuracy was lower during periods removed from the period of peak activity.
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Affiliation(s)
- G Galbicka
- Department of Neurobehavioral Assessment, Walter Reed Army Institute of Research, Washington, DC 20307-5100, USA. Dr. Gregory
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Carvalho P, Thompson WH, Riggs R, Carvalho C, Charan NB. Management of bronchopleural fistula with a variable-resistance valve and a single ventilator. Chest 1997; 111:1452-4. [PMID: 9149613 DOI: 10.1378/chest.111.5.1452] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Independent lung ventilation with two ventilators is sometimes used in the management of bronchopleural fistula (BPF). We describe a patient in whom gas flow through a large BPF was initially reduced, and subsequently eliminated, during differential lung ventilation using a single ventilator and a variable-resistance valve attached to one lumen of a bifurcated endotracheal tube.
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Affiliation(s)
- P Carvalho
- Department of Veterans Affairs Medical Center, Boise, Idaho 83702, USA
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Deutsch SI, Rosse RB, Steinberg K, Morn C, Koetzner L, Riggs R, Mastropaolo J. Evaluation of in vivo interactions in mice between flurazepam and two neuroactive steroids. Pharmacol Biochem Behav 1996; 55:323-6. [PMID: 8951972 DOI: 10.1016/s0091-3057(96)00100-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The development of neuroactive steroids as anticonvulsant medications may be useful both as a primary treatment and as an adjuvant to other anticonvulsants. They may be limited, however, by sedative and ataxic side effects. In the current study, 3 alpha-hydroxy-5 beta-pregnan-20-one and alfaxalone, two prototypic neuroactive steroids, were shown to potentiate the ability of flurazepam to antagonize electrically precipitated tonic hindlimb extension in mice at doses that by themselves had little antiseizure efficacy. While alfaxalone alone lacked motor incoordinating effects at a dose (18.0 mg/kg) that potentiated the antiseizure efficacy of flurazepam, the same dose of 3 alpha-hydroxy-5 beta-pregnan-20-one possessed both the ability to potentiate flurazepam's anticonvulsant effect and disrupt mouse rotorod performance. The data suggest that allosteric interactions that have been described in vitro between neuroactive steroids and other modulators of the GABAA receptor complex may have relevance for the intact animal. Finally, the data also suggest that neuroactive steroids could be developed as short-lived adjuvant antiseizure medications in certain critical situations (e.g., medication-refractory status epilepticus). However, the motor incoordinating effects resulting from the combination of neuroactive steroids and flurazepam suggest that their usefulness as adjuvant medications in the chronic therapy of seizure disorders may be limited.
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Affiliation(s)
- S I Deutsch
- Psychiatry Service (116A), Department of Veterans Affairs Medical Center, Washington, DC 20422, USA
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Cuevas-Trisan RL, Riggs R. Analysis and outcome of orthotopic liver transplantation patients who require inpatient rehabilitation. Arch Phys Med Rehabil 1994. [DOI: 10.1016/0003-9993(94)90690-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
To evaluate the clinical and virologic course of patients with chronic fatigue who had elevated Epstein-Barr virus (EBV) titers, we prospectively followed up 26 patients with serial cultures for EBV in blood and saliva and serial EBV serologic and clinical and psychiatric evaluations, and we compared these results with those for healthy controls. The frequency of isolating EBV in blood or demonstrating EBV infection by in situ hybridization in blood lymphocytes or in saliva was similar in patients and controls. The prevalence and titers of antibody to human herpesvirus type 6 were also similar in the two populations. Patients with chronic fatigue did demonstrate higher in vitro natural killer activity and lower in vitro interleukin 2 production than controls, and patients had a high frequency of DSM-III depressive illness. Over 50% of patients with chronic fatigue improved over the course of follow-up. Improvement was not associated with any discernible change in titers of EBV proteins. No evidence of ongoing EBV infection with either transforming or nontransforming strains was demonstrated in this population of patients with chronic fatigue. Clinically, most patients gradually improve over time.
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Affiliation(s)
- D Gold
- Department of Medicine, University of Washington School of Medicine, Seattle
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