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Predicting Sepsis Risk Using the "Sniffer" Algorithm in the Electronic Medical Record. - Journal of nursing care quality
The Sepsis "Sniffer" Algorithm (SSA) has merit as a digital sepsis alert but should be considered an adjunct to versus an alternative for the Nurse Screening Tool (NST), given lower specificity and positive predictive value. The SSA reduced the risk of incorrectly categorizing patients at low risk for sepsis, detected sepsis high risk in half the time, and reduced redundant NST screens by 70% and manual screening hours by 64% to 72%. Preserving nurse hours expended on manual sepsis alerts may translate into time directed toward other patient priorities.
The Emerging Role of Protein Phosphorylation as a Critical Regulatory Mechanism Controlling Cellulose Biosynthesis. - Frontiers in plant science
Plant cell walls are extracellular matrices that surround plant cells and critically influence basic cellular processes, such as cell division and expansion. Cellulose is a major constituent of plant cell walls, and this paracrystalline polysaccharide is synthesized at the plasma membrane by a large protein complex known as the cellulose synthase complex (CSC). Recent efforts have identified numerous protein components of the CSC, but relatively little is known about regulation of cellulose biosynthesis. Numerous phosphoproteomic surveys have identified phosphorylation events in CSC associated proteins, suggesting that protein phosphorylation may represent an important regulatory control of CSC activity. In this review, we discuss the composition and dynamics of the CSC in vivo, the catalog of CSC phosphorylation sites that have been identified, the function of experimentally examined phosphorylation events, and potential kinases responsible for these phosphorylation events. Additionally, we discuss future directions in cellulose synthase kinase identification and functional analyses of CSC phosphorylation sites.
Increased presence of oxidized low-density lipoprotein in the left ventricular blood of subjects with cardiovascular disease. - Physiological reports
OxidizedLDL(Ox-LDL) and oxidative stress have been implicated in both atherosclerosis and congestive heart failure (HF) development. Here, we tested whether Ox-LDLlevels in left ventricular blood (LVB) might differ from those of venous peripheral blood (PB), and whether the level might depend on cardiac function. We also tested whether theLDLmolecule is likely to have a longer residence time in the left ventricle ofHFsubjects with low ejection fraction (EF). The aim of this study was to determine Ox-LDLlevels, paraoxonase 1 (PON1) activity, and cholesterol efflux capacity (CEC) ofPBandLVB, and correlate these values withLVEF Sixty-oneHFpatients underwent preoperative transthoracic echocardiographic assessment of ventricular function.LVEFs were determined using Simpson's biplane technique.LVBandPBlevels of Ox-LDLwere determined, andPON1 activity and plasma cholesterol efflux capacity were measured. A significant increase in the levels of Ox-LDLinLVBwas noted as compared to levels inPB, even whenEFwas near normal. However, as ejection fraction decreased, the level of Ox-LDLinPBapproached that of theLVBPON1 activity and cholesterol efflux studies indicated increased oxidative stress inLVBand a decreased ability to promote cholesterol efflux from lipid-enriched macrophages. The results suggest thatLVBis more oxidatively stressed compared toPB, and thereforeLVtissue might be affected differently than peripheral tissues. We recently reported that brain natriuretic peptide (BNP), a marker forHF, is induced by Ox-LDL, so it is possible localized factors within theLVcould profoundly affect markers ofHF.Â© 2016 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.
Pediatric Orbital Floor Fractures: Outcome Analysis of 72 Children with Orbital Floor Fractures. - Plastic and reconstructive surgery
Orbital floor fractures are uncommon in the pediatric population. The aim of this study was to review the presentation, management, and outcomes for children with these injuries.A retrospective review was performed on 72 consecutive children with orbital floor fractures over a 21-year period.Seventy-two patients with 76 fractures were identified. Mean follow-up time was 14.2 Â± 4 months. The majority (50 percent) of patients suffered minimally displaced fractures, whereas 17 percent (13 of 76) suffered blowout fractures and 5 percent (four of 76) suffered trapdoor fractures. Nineteen percent of children (14 of 72) presented with decreased visual acuity and 8 percent (six of 72) had enophthalmos on presentation. Thirty-three percent (24 of 72) underwent surgery. The most common indications for surgery were size of the fracture, followed by muscle entrapment. Fracture width and the defect width-to-orbital width ratios were significantly greater in the operative cohort versus their conservatively managed counterparts (20.7 mm versus 7.7 mm, p < 0.05, and 0.54 versus 0.32, p < 0.05, respectively). Surgery was not associated with improved visual outcomes (p < 0.05). However, patients who underwent reconstruction had a significantly lower adjusted risk of enophthalmos on follow-up (relative risk, 0.02; 95 percent CI, 0.00 to 0.49; p < 0.05).Operative intervention prevents enophthalmos in pediatric patients with pediatric orbital floor fractures, and patients who present with decreased visual acuity should be cautioned that surgical intervention does not improve visual outcomes.Risk, II.
Towards diagnostic conversational profiles of patients presenting with dementia or functional memory disorders to memory clinics. - Patient education and counseling
This study explores whether the profile of patients' interactional behaviour in memory clinic conversations with a doctor can contribute to the clinical differentiation between functional memory disorders (FMD) and memory problems related to neurodegenerative diseases.Conversation Analysis of video recordings of neurologists' interactions with patients attending a specialist memory clinic. "Gold standard" diagnoses were made independently of CA findings by a multi-disciplinary team based on clinical assessment, neuropsychological testing and brain imaging.Two discrete conversational profiles for patients with memory complaints emerged, including (i) who attends the clinic (i.e., whether or not patients are accompanied), and (ii) patients' responses to neurologists' questions about memory problems, such as difficulties with compound questions and providing specific and elaborated examples and frequent "I don't know" responses.Specific communicative difficulties are characteristic of the interaction patterns of patients with a neurodegenerative pathology. Those difficulties are manifest in memory clinic interactions with neurologists, thereby helping to differentiate patients with dementia from those with FMD.Our findings demonstrate that conversational profiles based on patients' contributions to memory clinic encounters have diagnostic potential to assist the screening and referral process from primary care, and the diagnostic service in secondary care.Copyright Â© 2015 Elsevier Ireland Ltd. All rights reserved.
Conversational assessment in memory clinic encounters: interactional profiling for differentiating dementia from functional memory disorders. - Aging & mental health
In the UK dementia is under-diagnosed, there is limited access to specialist memory clinics, and many of the patients referred to such clinics are ultimately found to have functional (non-progressive) memory disorders (FMD), rather than a neurodegenerative disorder. Government initiatives on 'timely diagnosis' aim to improve the rate and quality of diagnosis for those with dementia. This study seeks to improve the screening and diagnostic process by analysing communication between clinicians and patients during initial specialist clinic visits. Establishing differential conversational profiles could help the timely differential diagnosis of memory complaints.This study is based on video- and audio recordings of 25 initial consultations between neurologists and patients referred to a UK memory clinic. Conversation analysis was used to explore recurrent communicative practices associated with each diagnostic group.Two discrete conversational profiles began to emerge, to help differentiate between patients with dementia and functional memory complaints, based on (1) whether the patient is able to answer questions about personal information; (2) whether they can display working memory in interaction; (3) whether they are able to respond to compound questions; (4) the time taken to respond to questions; and (5) the level of detail they offer when providing an account of their memory failure experiences.The distinctive conversational profiles observed in patients with functional memory complaints on the one hand and neurodegenerative memory conditions on the other suggest that conversational profiling can support the differential diagnosis of functional and neurodegenerative memory disorders.
Treatment of the periocular complex in paralytic lagophthalmos. - The Annals of otology, rhinology, and laryngology
Paralytic lagophthalmos can lead to devastating exposure keratitis. The main surgical intervention consists of upper eyelid loading. However, adjunctive lower eyelid and brow procedures are also available as necessary. We sought to analyze the use of periocular procedures in paralytic lagophthalmos at Johns Hopkins.The method was a retrospective review of patients treated at a single tertiary care center from 2006 to 2012.One hundred one patients met inclusion criteria, and 20 patients were excluded for not meeting the minimum follow-up. Upper eyelid loading was required on 95/101 patients (95%). Adjunctive procedures were necessary in 73% (73/101) of patients. Lower eyelid procedures were used in 47% (47/101) and brow lifts in 47% (47/101). Older patients (>50 years) were more likely to require lower eyelid procedures (P=.04) and more likely to require revision (P=.003). Medial canthopexy and direct brow lift were associated with the need for revision (P=.006, P=.03).Paralytic lagophthalmos management is not one-size-fits-all. Upper eyelid loading is the mainstay of treatment; however, adjunctive procedures to the lower eyelid and brow are indicated in the majority of patients. Our retrospective review has allowed us to continue to refine our strategy for managing these patients.Â© The Author(s) 2014.
Defining pediatric orbital roof fractures: patterns, sequelae, and indications for operation. - Plastic and reconstructive surgery
There are few published data addressing pediatric orbital roof fractures, particularly regarding long-term outcomes and indications for operative intervention. To provide evidence-based guidelines for the management of these injuries, the authors examined a large cohort of patients with this injury pattern.Institutional review board approval was obtained to review pediatric patients presenting to Johns Hopkins Hospital from 1991 to 2011. All patients with a diagnosis indicating orbital or skull base fractures were reviewed to determine orbital roof involvement. Patients with roof fractures were assessed for demographics, management, and outcomes.A total of 1484 pediatric patients carried the diagnoses of orbital fracture or anterior skull base fracture. After review, 159 patients (11 percent) were found to have true orbital roof fractures, with 36 percent being comminuted. One hundred five patients returned after discharge (average follow-up, 19 months). One patient developed vertical dystopia 10 months after being lost to follow-up with a large, comminuted fracture. Ten patients underwent surgery to repair the orbital roof. Inferior displacement correlated with need for surgical repair (p < 0.001).In the largest study to date analyzing pediatric orbital roof fractures, the authors found that most can be managed conservatively with good long-term outcomes. Vertical dystopia occurred in less than 1 percent of patients and was associated with large, comminuted fractures. Inferiorly displaced and fractures with a surface area over 2 cm represent higher risk fractures that should be followed closely for possible intervention based on the development of sequelae such as vertical dystopia or encephalocele.Therapeutic, IV.
A family living with Alzheimer's disease: The communicative challenges. - Dementia (London, England)
Alzheimer's disease irrevocably challenges a person's capacity to communicate with others. Earlier research on these challenges focused on the language disorders associated with the condition and situated language deficit solely in the limitations of a person's cognitive and semantic impairments. This research falls short of gaining insight into the actual interactional experiences of a person with Alzheimer's and their family. Drawing on a UK data set of 70 telephone calls recorded over a two-and-a-half year period (2006-2008) between one elderly woman with Alzheimer's disease, and her daughter and son-in-law, this paper explores the role which communication (and its degeneration) plays in family relationships. Investigating these interactions, using a conversation analytic approach, reveals that there are clearly communicative difficulties, but closer inspection suggests that they arise due to the contingencies that are generated by the other's contributions in the interaction. That being so, this paper marks a departure from the traditional focus on language level analysis and the assumption that deficits are intrinsic to the individual with Alzheimer's, and instead focuses on the collaborative communicative challenges that arise in the interaction itself and which have a profound impact on people's lives and relationships.Â© The Author(s) 2013.
Association of the PGC-1Î± rs8192678 variant with microalbuminuria in subjects with type 2 diabetes mellitus. - Disease markers
PPAR-Î³ co-activator-1Î± (PGC-1Î±) is a tissue-specific transcriptional co-activator involved in the regulation of antioxidant enzymes. The A-allele of the rs8192678 PGC-1 Î±} (G>A) gene variant has previously been associated with nephropathy in Korean and Indian-Asian type 2 diabetes mellitus (T2DM) samples. Our aim was to examine the association between this variant and urine albumin exccretion in European subjects with T2DM. Genotyping was performed on 583 European subjects with T2DM and examined in relation to urinary albumin, plasma oxidized-LDL and small dense-LDL percentage. We observed a significant association between genotype (GG/GA/AA) and urinary albumin (normoalbuminuria v micro/macroalbuminuria: 48.6/39.7/11.7% v 38.2/51.2/10.5%, p=0.02; for GG v GA/AA, p=0.01). The odds ratio for micro/macroalbuminuria in GA and AA subjects relative to GG were 1.70 [1.15-2.50], p=0.008 and 1.20 [0.66-2.16], p=0.56 respectively (for GA/AA v GG: 1.58 [95% CI: 1.09-2.27], p=0.02). There was a significant association between the A allele and a higher percentage of small dense-LDL particles (GG v GA v AA: 70.8 [58.01-81.06] % v 72.8 [56.18-81.19] % v 78.9 [67.16-85.33] %, p=0.03). In European subjects with T2DM the GA relative to the GG genotype is associated with a 70% increase in the risk of micro/microalbuminuria. Furthermore, homozygosity for the A-allele is also associated with a preponderance of small dense-LDL particles.
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