Background Due to significant medical improvements, persons with Down syndrome now live well into adulthood. Consequently, primary care for adults with Down syndrome needs to incorporate routine ...care with screening for condition‐specific comorbidities. This study seeks to evaluate the adherence of primary care physicians to age‐ and condition‐specific preventive care in a cohort of adults with Down syndrome.
Methods In this retrospective observational cohort study, preventive screening was evaluated in patients with Down syndrome aged 18–45 years who received primary care in an academic medical centre from 2000 to 2008. Comparisons were made based on the field of patients' primary care providers (Family or Internal Medicine).
Results This cohort included 62 patients, median index age = 33 years. Forty per cent of patients received primary care by Family Physicians, with 60% seen by Internal Medicine practices. Patient demographics, comorbidities and overall screening patterns were similar between provider groups. Despite near universal screening for obesity and hypothyroidism, adherence to preventive care recommendations was otherwise inconsistent. Screening was ‘moderate’ (50–80%) for cardiac anomalies, reproductive health, dentition, and the combined measure of behaviour, psychological, or memory abnormalities. Less than 50% of patients were evaluated for obstructive sleep apnea, atlanto‐axial instability, hearing loss or vision loss.
Conclusions We observed inconsistent preventive care in adults with Down syndrome over this 8.5‐year study. This is concerning, given that the adverse effects of many of these conditions can be ameliorated if discovered in a timely fashion. Further studies must evaluate the implications of screening practices and more timely identification of comorbidities on clinical outcomes.
Background
Serum folate is considered a biomarker of chronic enteropathy (CE) in dogs, but few studies have examined associations with markers of CE.
Hypothesis/Objectives
To evaluate serum folate ...concentrations in dogs with and without CE and associations with sample hemolysis and selected markers of CE. We hypothesized that hypofolatemia would be more common in dogs with CE and associated with hypocobalaminemia, higher CIBDAI, and hypoalbuminemia.
Animals
Six hundred seventy‐three dogs with available serum folate measurements performed at an academic veterinary hospital between January 2016 and December 2019.
Methods
Medical records were retrospectively reviewed to categorize cases as CE or non‐CE and record clinical details and laboratory markers. Relationships between serum folate, cobalamin, and CE variables were assessed using chi‐square, Kruskal‐Wallis, or Spearman's correlation tests.
Results
Of the 673 dogs, 99 CE were compared to 95 non‐CE. In the overall cohort, serum folate concentration did not correlate with sample hemolysis (P = .75). In the CE subset, serum folate and cobalamin concentrations were positively associated (rho = 0.34, FDR = 0.02). However, serum folate concentrations (median 25th, 75th percentiles) were higher (CE: 12.1 (8.9, 16.1), non‐CE: 10.4 (7.2, 15.5); P = .04) and cobalamin concentrations were lower (CE: 343 (240, 597), non‐CE: 550 (329, 749); P = .001) in the CE vs non‐CE group. Serum folate was not associated with markers of CE, but serum cobalamin was associated with albumin (P = .04) and cholesterol (P = .03).
Conclusions and Clinical Importance
Hypofolatemia is an inferior biomarker of CE compared to hypocobalaminemia.
Abstract
Objective
Medication list discrepancies between outpatient clinics and pharmacies can lead to medication errors. Within the last decade, a new health information technology (IT), CancelRx, ...emerged to send a medication cancellation message from the clinic’s electronic health record (EHR) to the outpatient pharmacy’s software. The objective of this study was to measure the impact of CancelRx on reducing medication discrepancies between the EHR and pharmacy dispensing software.
Materials and Methods
CancelRx was implemented in October 2017 at an academic health system. For 12 months prior, and 12 months after CancelRx implementation, data were collected on discontinued medications in the health system’s EHR and whether those prescriptions were successfully discontinued in the pharmacy’s dispensing software. An interrupted time series analysis was conducted to model the occurrence of prescriptions successfully discontinued over time.
Results
There was an immediate (lag = 0), significant (P < 0.001), and sustained (post-implementation slope 0.02) increase in the proportion of successful medication discontinuations after CancelRx implementation (from 34% to 93%). CancelRx had variable impact based on whether the clinic was primary care (71.4% change prepost) or specialty care (53.9% change prepost). CancelRx reduced the time between when a medication was discontinued in the clinic EHR and pharmacy dispensing software.
Conclusion
CancelRx automated a manual process and illustrated the role for health IT in communicating medication discontinuations between clinics and pharmacies. Overall, CancelRx had a marked benefit on medication list discrepancies and illustrated how health IT can be used across different settings to improve patient care.
Biosecurity Dobson, Andrew; Barker, Kezia; Taylor, Sarah L
2013, 20130815, 2013-08-15
eBook
Biosecurity is the assessment and management of potentially dangerous infectious diseases, quarantined pests, invasive (alien) species, living modified organisms, and biological weapons. It is a ...holistic concept of direct relevance to the sustainability of agriculture, food safety, and the protection of human populations (including bio-terrorism), the environment, and biodiversity. Biosecurity is a relatively new concept that has become increasingly prevalent in academic, policy and media circles, and needs a more comprehensive and inter-disciplinary approach to take into account mobility, globalisation and climate change.
In this introductory volume, biosecurity is presented as a governance approach to a set of concerns that span the protection of indigenous biological organisms, agricultural systems and human health, from invasive pests and diseases. It describes the ways in which biosecurity is understood and theorized in different subject disciplines, including anthropology, political theory, ecology, geography and environmental management. It examines the different scientific and knowledge practices connected to biosecurity governance, including legal regimes, ecology, risk management and alternative knowledges. The geopolitics of biosecurity is considered in terms of health, biopolitics and trade governance at the global scale. Finally, biosecurity as an approach to actively secure the future is assessed in the context of future risk and uncertainties, such as globalization and climate change.
While metabolomics has tremendous potential for diagnostic biomarker and therapeutic target discovery, its utility may be diminished by the variability that occurs due to environmental exposures ...including diet and the influences of the human circadian rhythm. For successful translation of metabolomics findings into the clinical setting, it is necessary to exhaustively define the sources of metabolome variation. To address these issues and to measure the variability of urinary and plasma metabolomes throughout the day, we have undertaken a comprehensive inpatient study in which we have performed non-targeted metabolomics analysis of blood and urine in 26 volunteers (13 healthy subjects with no known disease and 13 healthy subjects with autosomal dominant polycystic kidney disease not taking medication). These individuals were evaluated in a clinical research facility on two separate occasions, over three days, while on a standardized, weight-based diet. Subjects provided pre- and post-prandial blood and urine samples at the same time of day, and all samples were analyzed by "fast lane" LC-MS-based global metabolomics. The largest source of variability in blood and urine metabolomes was attributable to technical issues such as sample preparation and analysis, and less variability was due to biological variables, meals, and time of day. Higher metabolome variability was observed after the morning as compared to the evening meal, yet day-to-day variability was minimal and urine metabolome variability was greater than that of blood. Thus we suggest that blood and urine are suitable biofluids for metabolomics studies, though nontargeted mass spectrometry alone may not offer sufficient precision to reveal subtle changes in the metabolome. Additional targeted analyses may be needed to support the data from nontargeted mass spectrometric analyses. In light of these findings, future metabolomics studies should consider these sources of variability to allow for appropriate metabolomics testing and reliable clinical translation of metabolomics data.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Brown meets green Price, Taylor L.; Harper, Jennifer; Francoeur, Steven N. ...
Ecology (Durham),
June 2021, Letnik:
102, Številka:
6
Journal Article
Recenzirano
Odprti dostop
In aquatic detrital-based food webs, research suggests that autotroph-heterotroph microbial interactions exert bottom-up controls on energy and nutrient transfer. To address this emerging topic, we ...investigated microbial responses to nutrient and light treatments during Liriodendron tulipifera litter decomposition and fed litter to the caddisfly larvae Pycnopsyche sp. We measured litter-associated algal, fungal, and bacterial biomass and production. Microbes were also labeled with 14C and 33P to trace distinct microbial carbon (C) and phosphorus (P) supporting Pycnopsyche assimilation and incorporation (growth). Litterassociated algal and fungal production rates additively increased with higher nutrient and light availability. Incorporation of microbial P did not differ across diets, except for higher incorporation efficiency of slower-turnover P on low-nutrient, shaded litter. On average, Pycnopsyche assimilated fungal C more efficiently than bacterial or algal C, and Pycnopsyche incorporated bacterial C more efficiently than algal or fungal C. Due to high litter fungal biomass, fungi supported 89.6–93.1% of Pycnopsyche C growth, compared to 0.2% to 3.6% supported by bacteria or algae. Overall, Pycnopsyche incorporated the most C in high nutrient and shaded litter. Our findings affirm others’ regarding autotroph-heterotroph microbial interactions and extend into the trophic transfer of microbial energy and nutrients through detrital food webs.
Exposure to adverse environmental conditions causes oxidative stress in many organisms, leading either to disease and debilitation
or to response and tolerance. Mitochondria are a key site of ...oxidative stress and of cellular response and play important
roles in cell survival. We analyzed the response of mitochondria in pea ( Pisum sativum ) plants to the common stresses associated with drought, cold, and herbicides. These treatments all altered photosynthetic
and respiratory rates of pea leaves to various extents, but only herbicides significantly increased lipid peroxidation product
accumulation. Mitochondria isolated from the stressed pea plants maintained their electron transport chain activity, but changes
were evident in the abundance of uncoupling proteins, non-phosphorylating respiratory pathways, and oxidative modification
of lipoic acid moieties on mitochondrial proteins. These data suggest that herbicide treatment placed a severe oxidative stress
on mitochondria, whereas chilling and particularly drought were milder stresses. Detailed analysis of the soluble proteome
of mitochondria by gel electrophoresis and mass spectrometry revealed differential degradation of key matrix enzymes during
treatments with chilling being significantly more damaging than drought. Differential induction of heat shock proteins and
specific losses of other proteins illustrated the diversity of response to these stresses at the protein level. Cross-species
matching was required for mass spectrometry identification of nine proteins because only a limited number of pea cDNAs have
been sequenced, and the full pea genome is not available. Blue-native separation of intact respiratory chain complexes revealed
little if any change in response to environmental stresses. Together these data suggest that although many of the molecular
events identified by chemical stresses of mitochondria from a range of model eukaryotes are also apparent during environmental
stress of plants, their extent and significance can vary substantially.
Background Evidence from recent clinical trials suggests that transcranial direct current stimulation (tDCS) may have potential in treating neuropsychiatric disorders. However, the optimal frequency ...at which tDCS sessions should be administered is unknown. Objective/Hypothesis This study investigated the effects of daily or second daily tDCS sessions on motor cortical excitability, over a 5-day period. Methods Twelve healthy volunteers received daily or second daily sessions of tDCS to the left primary motor cortex over the study period, in a randomized, intraindividual crossover design. Motor cortical excitability was assessed before and after tDCS at each session through responses to transcranial magnetic stimulation. Results Over a fixed 5-day period, tDCS induced greater increases in MEP amplitude when given daily rather than second daily. Analyses showed that this difference reflected greater cumulative effects between sessions rather than a greater response to each individual tDCS session. Conclusions These results demonstrate that in the motor cortex of healthy volunteers, tDCS alters cortical excitability more effectively when given daily rather than second daily over a 5-day period.
Background
Multimorbidity frequently co-occurs with behavioral health concerns and leads to increased healthcare costs and reduced quality and quantity of life. Unplanned readmissions are a primary ...driver of high healthcare costs.
Objective
We tested the effectiveness of a culturally appropriate care transitions program for Latino adults with multiple cardiometabolic conditions and behavioral health concerns in reducing hospital utilization and improving patient-reported outcomes.
Design
Randomized, controlled, single-blind parallel-groups.
Participants
Hispanic/Latino adults (
N
=536; 75% of those screened and eligible;
M
=62.3 years (SD=13.9); 48% women; 73% born in Mexico) with multiple chronic cardiometabolic conditions and at least one behavioral health concern (e.g., depression symptoms, alcohol misuse) hospitalized at a hospital that serves a large, mostly Hispanic/Latino, low-income population.
Interventions
Usual care (UC) involved best-practice discharge processes (e.g., discharge instructions, assistance with appointments). Mi Puente (“My Bridge”; MP) was a culturally appropriate program of UC plus inpatient and telephone encounters with a behavioral health nurse and community mentor team who addressed participants’ social, medical, and behavioral health needs.
Main Measures
The primary outcome was 30- and 180-day readmissions (inpatient, emergency, and observation visits). Patient-reported outcomes (quality of life, patient activation) and healthcare use were also examined.
Key Results
In intention-to-treat models, the MP group evidenced a
higher
rate of recurrent hospitalization (15.9%) versus UC (9.4%) (OR=1.91 (95% CI 1.09, 3.33)), and a greater number of recurrent hospitalizations (
M
=0.20 (SD=0.49) MP versus 0.12 (SD=0.45) UC;
P
=0.02) at 30 days. Similar trends were observed at 180 days. Both groups showed improved patient-reported outcomes, with no advantage in the Mi Puente group. Results were similar in per protocol analyses.
Conclusions
In this at-risk population, the MP group experienced increased hospital utilization and did not demonstrate an advantage in improved patient-reported outcomes, relative to UC. Possible reasons for these unexpected findings are discussed.
Trial Registration
ClinicalTrials.gov
Identifier: NCT02723019. Registered on 30 March 2016.
When the sta6 (starch-null) strain of the green microalga Chlamydomonas reinhardtii is nitrogen starved in acetate and then "boosted" after 2 days with additional acetate, the cells become "obese" ...after 8 days, with triacylglyceride (TAG)-filled lipid bodies filling their cytoplasm and chloroplasts. To assess the transcriptional correlates of this response, the sta6 strain and the starch-forming cw15 strain were subjected to RNA-Seq analysis during the 2 days prior and 2 days after the boost, and the data were compared with published reports using other strains and growth conditions. During the 2 h after the boost, ∼425 genes are upregulated ≥2-fold and ∼875 genes are downregulated ≥2-fold in each strain. Expression of a small subset of "sensitive" genes, encoding enzymes involved in the glyoxylate and Calvin-Benson cycles, gluconeogenesis, and the pentose phosphate pathway, is responsive to culture conditions and genetic background as well as to boosting. Four genes-encoding a diacylglycerol acyltransferase (DGTT2), a glycerol-3-P dehydrogenase (GPD3), and two candidate lipases (Cre03.g155250 and Cre17.g735600)-are selectively upregulated in the sta6 strain. Although the bulk rate of acetate depletion from the medium is not boost enhanced, three candidate acetate permease-encoding genes in the GPR1/FUN34/YaaH superfamily are boost upregulated, and 13 of the "sensitive" genes are strongly responsive to the cell's acetate status. A cohort of 64 autophagy-related genes is downregulated by the boost. Our results indicate that the boost serves both to avert an autophagy program and to prolong the operation of key pathways that shuttle carbon from acetate into storage lipid, the combined outcome being enhanced TAG accumulation, notably in the sta6 strain.
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