The aim of this study was to describe the effectiveness of an electronic health record best practice alert (BPA) in decreasing gynecologic post-discharge opioid prescribing following benign minimally ...invasive hysterectomy.
The BPA triggered for opioid orders >15 tablets. Prescribers' options included (1) decrease to 15 ≤ tablets; (2) remove the order/utilize a defaulted order set; or (3) override the alert.
332 patients were included. The BPA triggered 29 times. The following actions were taken among 16 patients for whom the BPA triggered: "override the alert" (n=13); "cancel the alert" (n=2); and 'remove the opioid order set' (n=1). 12/16 patients had discharge prescriptions: one patient received 20 tablets; two received 10 tablets; and nine received 15 tablets. Top reasons for over prescribing included concerns for pain control and lack of alternatives.
Implementing a post-discharge opioid prescribing BPA aligned opioid prescribing following benign minimally invasive hysterectomy with guideline recommendations.
Abstract
Aims
Autoantibodies against apolipoprotein A-1 (anti-apoA-1 IgGs) have emerged as an independent biomarker for cardiovascular disease and mortality in humans, promote death in ApoE−/− mice, ...and seem to be preferentially oriented against the c-terminal part of apoA-1 (cterA1). Corresponding specific mimetic peptides were shown to reverse anti-apoA-1 IgG pro-inflammatory effects in vitro. We evaluated the association of IgG against c-terminus apoA-1 (anti-cterA1 IgGs) with all-cause mortality in the community and tested the ability of two cterA1 mimetic peptides to reverse the anti-apoA-1 IgG-induced inflammation in vitro and mortality in ApoE−/− mice.
Methods
Anti-cterA1 IgGs were measured on serum samples of 5220 consecutive participants included in the CoLaus study with median follow-up duration of 5.6 years. The primary study outcome was all-cause mortality. Two chemically engineered optimized cterA1 mimetic peptides were tested i) on HEK cells to modulate interleukin-8 (IL-8) and tumor necrosis-alpha (TNF-α) production, and ii) in apoE−/− mice exposed to 16 weeks of anti-apoA-1 IgG passive immunisation.
Results
Anti-cterA1 IgG independently predicted all-cause mortality, each standard deviation of anti-cterA1 IgG being associated with a 18% increase in mortality risk (Hazard Ratio:1.18, 95%confidence intervals:1.04–1.33; p=0.009). Both cterA1 mimetic peptides reduced the anti-apoA-1 IgG-induced inflammation in a dose-dependent manner in vitro, but did not rescue the anti-apoA-1 IgG-associated mortality in mice.
Conclusions
Anti-cterA1 IgG independently predict all-cause mortality in the general population. By failing to reverse the anti-apoA-1 IgG-induced mortality in mice, our data do not support the hypothesis that these autoantibodies could be actionable through cognate peptides immunomodulation.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by a grant from the Leenaards Foundation (grant number 3698 to N.V.) by the Swiss National Science Foundation (grant number 310030-163335 to N.V.) and by the De Reuter Foundation (grant number 315112 to N.V.).
Renal transplant recipients (RTRs) are known to have a high cardio-vascular disease (CVD) burden only partly explained by traditional CVD risk factors. The aim of this paper was therefore to ...determine: i) the prognostic value of autoantibodies against apoA-1 (anti-apoA-1 IgG) for incidence of CVD mortality, all-cause mortality and graft failure in RTR. Four hundred and sixty two (462) prospectively included RTRs were followed for 7.0 years. Baseline anti-apoA-1 IgG were determined and associations with incidence of CVD mortality (
= 48), all-cause mortality (
= 92) and graft failure (
= 39) were tested. Kaplan-Meier analyses demonstrated significant associations between tertiles of anti-apoA-1 IgG and CVD mortality (log rank test:
= 0.048). Adjusted Cox regression analysis showed a 54% increase in risk for CVD mortality for each anti-apoA-1 IgG levels standard deviation increase (hazard ratio HR: 1.54, 95% Confidence Interval 95%CI: 1.14-2.05,
= 0.005), and a 33% increase for all-cause mortality (HR: 1.33; 95%CI: 1.06-1.67,
= 0.01), independent of CVD risk factors, renal function and HDL function. The association with all-cause mortality disappeared after excluding cases of CVD specific mortality. The sensitivity, specificity, positive predictive value, and negative predictive value of anti-apoA-1 positivity for CVD mortality were 18.0%, 89.3%, 17.0%, and 90.0%, respectively. HDL functionality was not associated with anti-apoA-1 IgG levels. This prospective study demonstrates that in RTR, anti-apoA-1 IgG are independent predictors of CVD mortality and are not associated with HDL functionality.
Top Jets at the LHC Almeida, L.G.; Lee, S.J.; Perez, G. ...
Physical review letters,
10/2008
Journal Article
Recenzirano
Odprti dostop
We investigatethe reconstruction of high pT hadronically-decaying top quarksat the Large Hadron Collider. One of the main challenges in identifying energetictop quarks is that the decay products ...become increasingly collimated. This reducesthe efficacy of conventional reconstruction methods that exploit the topology of thetop quark decay chain. We focus on the cases where the decay products of the topquark are reconstructed as a single jet, a"top-jet." The most basic"top-tag" methodbased on jet mass measurement is considered in detail. To analyze the feasibility ofthe top-tagging method, both theoretical and experimental aspects of the large QCDjet background contribution are examined. Based on a factorization approach, wederive a simple analytic approximation for the shape of the QCD jet mass spectrum.We observe very good agreement with the Monte Carlo simulation. We consider high pT tt bar production in the Standard Model as an example, and show that our theoretical QCD jet mass distributions can efficiently characterize the background via sideband analyses. We show that with 25 fb-1 of data, our approach allows us to resolve top-jets with pT _> 1 TeV, from the QCD background, and about 1.5 TeV top-jets with 100 fb-1, without relying on b-tagging. To further improve the significancewe consider jet shapes (recently analyzed in 0807.0234 hep-ph), which resolve thesubstructure of energy flow inside cone jets. A method of measuring the top quarkpolarization by using the transverse momentum of the bottom quark is also presented.The main advantages of our approach are: (i) the mass distributions are driven byfirst principle calculations, instead of relying solely on Monte Carlo simulation; (ii) for high pT jets (pT _> 1 TeV), IR-safe jet shape variables are robust against detectorresolution effects. Our analysis can be applied to other boosted massive particlessuch as the electroweak gauge bosons and the Higgs.
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