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Michael C Cooper, Geetanjali Srivastava
BACKGROUND: In-hospital trauma team activation criteria are formulated to identify severely injured patients requiring specialized multidisciplinary care. Efficacy of trauma activation (TA) criteria is commonly measured by emergency department (ED) disposition, injury severity score, and mortality. Necessity of critical ED interventions is another measure that has been proposed to evaluate the appropriateness of TA criteria. METHODS: Two-year retrospective cohort study of 1715 patients from our trauma registry at a Level 1 pediatric trauma center...
May 14, 2018: Pediatric Emergency Care
Jeanette L Bertron, Hyekyung P Cho, Pedro M Garcia-Barrantes, Joseph D Panarese, James M Salovich, Kellie D Nance, Darren W Engers, Jerri M Rook, Anna L Blobaum, Colleen M Niswender, Shaun R Stauffer, P Jeffrey Conn, Craig W Lindsley
This letter describes the chemical optimization of a new series of M1 positive allosteric modulators (PAMs) based on a novel benzomorpholine core, developed via iterative parallel synthesis, and culminating in the highly utilized rodent in vivo tool compound, VU0486846 (7), devoid of adverse effect liability. This is the first report of the optimization campaign (SAR and DMPK profiling) that led to the discovery of VU0486846 and details all of the challenges faced in allosteric modulator programs (both steep and flat SAR, as well as subtle structural changes affecting CNS penetration and overall physiochemical and DMPK properties)...
May 5, 2018: Bioorganic & Medicinal Chemistry Letters
Katherine D Vickery, Nathan D Shippee, Jeremiah Menk, Ross Owen, David M Vock, Peter Bodurtha, Dana Soderlund, Rodney A Hayward, Matthew M Davis, John Connett, Mark Linzer
Hennepin Health, a Medicaid accountable care organization, began serving early expansion enrollees (very low-income childless adults) in 2012. It uses an integrated care model to address social and behavioral needs. We compared health care utilization in Hennepin Health with other Medicaid managed care in the same area from 2012 to 2014, controlling for demographics, chronic conditions, and enrollment patterns. Homelessness and substance use were higher in Hennepin Health. Overall adjusted results showed Hennepin Health had 52% more emergency department visits and 11% more primary care visits than comparators...
May 1, 2018: Medical Care Research and Review: MCRR
Zachariah E Hale, Astha Singhal, Renee Y Hsia
BACKGROUND: Dyspnea is a common and ambiguous complaint that results in 3.4 million emergency department visits annually. While learners may encounter lists of differential diagnoses to consider while in training, often these lists are not empirically based. We sought to establish an evidence-based differential diagnosis for dyspnea and to determine whether normal vital signs can rule out a life-threatening diagnosis. METHODS: We analyzed data from the National Hospital Ambulatory Medical Care Survey from 2005-2014 for emergency department visits with a chief complaint of dyspnea and tallied the principal discharge diagnosis...
May 8, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Joyeeta G Dastidar, Min Jiang
BACKGROUND: Patients who are frequently admitted to Medicine inpatient services comprise a distinct subset of readmitted patients about whom not much is known. OBJECTIVE: We sought to characterize this group including mortality rates, with the goal of better understanding this population. DESIGN: Observational study of frequently hospitalized patients defined as 4 or more admissions over a 6-month period, with hospitalization defined as nonelective admission to the hospital...
January 1, 2018: Journal of Palliative Care
Stacy Loeb, Caitlin Curnyn, Dawn Walter, Angela Fagerlin, Uwe Siebert, Nick Mühlberger, R Scott Braithwaite, Mark D Schwartz, Herbert Lepor, Erica Sedlander
Background: Active surveillance (AS) is the most rapidly expanding management option for favorable-risk prostate cancer (PCa). Early studies suggested substantial decrements in utility (quality of life weights) from disease-related anxiety. Our objective was to determine utilities for contemporary AS patients using different instruments. Methods: We performed a systematic review of PubMed, PMC and OVID for utility measurements in modern AS patients. We then examined utilities among 37 men on AS participating in focus groups between 2015-2016 using the generic EurQol five dimensions questionnaire (EQ-5D-3L) and Patient Oriented Prostate Utility Scale (PORPUS), a PCa-specific instrument...
April 2018: Translational Andrology and Urology
W A de Graaf-Ruizendaal, L van der Hoek, D H de Bakker
BACKGROUND: General practice care plays a key role in keeping healthcare effective and cost-efficient. However, variation in the utilization rates of practices may reveal variation in practice performance. Our research goal is to investigate whether the socio-demographic profile of the patients' area of residence and practice organization characteristics influence the low or high utilization of general practice care. METHODS: Data on the utilization of general practice care were derived from the electronic health records of 232 general practices participating in the NIVEL Primary Care Database for the year 2013...
April 25, 2018: BMC Family Practice
J C Chang, A M Knight, R Xiao, L M Mercer-Rosa, P F Weiss
Objectives There are no guidelines on the use of echocardiography to detect cardiac manifestations of childhood-onset systemic lupus erythematosus (SLE). We quantify the prevalence of acute cardiac disease in youth with SLE, describe echocardiogram utilization at SLE diagnosis, and compare regional echocardiogram use with incident cardiac diagnoses. Methods Using the Clinformatics® DataMart (OptumInsight, Eden Prairie, MN) de-identified United States administrative database from 2000 to 2013, we identified youth ages 5-24 years with new-onset SLE (≥3 ICD-9 SLE codes 710...
January 1, 2018: Lupus
Agnieszka Szopa, Marta Klimek-Szczykutowicz, Adam Kokotkiewicz, Anna Maślanka, Agata Król, Maria Luczkiewicz, Halina Ekiert
In the presented work, raw materials (fruits and leaves) and in vitro biomass of a highly productive Schisandra chinensis Sadova No. 1 cultivar (SchS) were evaluated for the production of therapeutically useful schisandra lignans (SL). In vitro cultures of SchS were initiated, followed by extensive optimization studies focused on maximizing secondary metabolite production, with the aim of establishing a sustainable source of SL. Different cultivation systems (agar, agitated, bioreactor), experiment times (10, 20, 30, 40, 50 and 60 days) and plant growth regulators (6-benzyladenine-BA and 1-naphthaleneacetic acid-NAA, from 0 to 3 mg/l) in Murashige-Skoog (MS) medium were tested...
April 23, 2018: Applied Microbiology and Biotechnology
Bing Xu, Zhan-Ming Zhang, Lujia Zhou, Junliang Zhang
A highly enantioselective copper-catalyzed [3 + 2] cycloaddition reaction of α-isocyanoesters with β,β-disubstituted enones has been developed. Dihydropyrroles were obtained in excellent yields and enantioselectivity by employing an inexpensive copper catalyst. This process provides a scalable and efficient route for the synthesis of highly enantioselective 2,3-dihydropyrroles bearing a trifluoromethylated all-carbon quaternary stereocenter. The salient feautures of this reaction include high efficiency, operational simplicity, high diastereoselectivity and enantioselectivity, a broad substrate scope, outstanding functional group tolerance, and products exhibiting high utility for further transformations...
April 23, 2018: Organic Letters
James Chambers, Elle Pope, Kathy Bungay, Joshua Cohen, Michael Ciarametaro, Robert Dubois, Peter J Neumann
BACKGROUND: Differences in payer evaluation and coverage of pharmaceuticals and medical procedures suggest that coverage may differ for medications and procedures independent of their clinical benefit. We hypothesized that coverage for medications is more restricted than corresponding coverage for nonmedication interventions. METHODS: We included top-selling medications and highly utilized procedures. For each intervention-indication pair, we classified value in terms of cost-effectiveness (incremental cost per quality-adjusted life-year), as reported by the Tufts Medical Center Cost-Effectiveness Analysis Registry...
April 2018: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Yui Yamaoka, Nanako Tamiya, Akimitsu Watanabe, Yayoi Miyazono, Ryuta Tanaka, Akemi Matsuzawa, Ryo Sumazaki
BACKGROUND: Few researches have been reported hospital-based care utilization of children with medical complexity (CMC) in Japan. This study examined frequency and differences of hospital-based care utilization among moderate and severe CMC in Japan. METHODS: This study utilized medical records of three pediatric tertiary hospitals in one prefecture, 2014. We examined the numbers of outpatient visits and admissions to the hospital for CMC during 5 years after medical care at home was introduced...
April 20, 2018: Pediatrics International: Official Journal of the Japan Pediatric Society
Xuan Kong, Shai N Gozani
Objective: The objective of this study was to assess the effectiveness of fixed-site high-frequency transcutaneous electrical nerve stimulation (FS-TENS) in a real-world chronic pain sample. Background: There is a need for nonpharmacological treatment options for chronic pain. FS-TENS improved multisite chronic pain in a previous interventional study. Large observational studies are needed to further characterize its effectiveness. Methods: This retrospective observational cohort study examined changes in chronic pain measures following 60 days of FS-TENS use...
2018: Journal of Pain Research
Rasheedat T Zakare-Fagbamila, Elizabeth Howell, Ashley Y Choi, Tracy Z Cheng, Mary Clement, Megan Neely, Oren N Gottfried
BACKGROUND: Patient-reported assessments of the clinic experience are increasingly important for improving the delivery of care. The Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey is the current standard for evaluating patients' clinic experience, but its format gives 2-mo delayed feedback on a small proportion of patients in clinic. Furthermore, it fails to give specific actionable results on individual encounters. OBJECTIVE: To develop and assess the impact of a single-page Clinic Satisfaction Tool (CST) to demonstrate real-time feedback, individualized responses, interpretable and actionable feedback, improved patient satisfaction and communication scores, increased physician buy-in, and overall feasibility...
April 14, 2018: Neurosurgery
Y Merid, Y Woldeamanuel, M Abebe, D G Datiko, T Hailu, G Habtamu, G Assefa, R R Kempker, H M Blumberg, A Aseffa
SETTING: Hawassa Prison, Southern Region of Ethiopia. OBJECTIVE: To determine the burden of pulmonary tuberculosis (TB) using active case finding among prisoners. DESIGN: In this cross-sectional study, prisoners were screened for TB using a symptom screen. Those with cough of 2 weeks had spot and morning sputum samples collected for acid-fast bacilli (AFB) smear microscopy and molecular diagnostic testing (Xpert® MTB/RIF). RESULTS: Among 2068 prisoners, 372 (18%) had a positive cough screen...
May 1, 2018: International Journal of Tuberculosis and Lung Disease
Chenguang Wang, Aiko Fukazawa, Yoshiyuki Tanabe, Naoto Inai, Daisuke Yokogawa, Shigehiro Yamaguchi
We have recently reported the fluorescent dye PB430, which consists of a 2-phenyl-substituted benzophosphole P-oxide skeleton that is reinforced with a methylene bridge. PB430 showed pronounced photostability and thus high utility for applications in super-resolution stimulated emission depletion (STED) microscopy. In the present study, we replaced the methylene bridge with another P=O group to (i) investigate the role of the bridging moieties, and (ii) further modulate the fluorescence properties. We synthesized a series of phospholo[3,2-b]phosphole-based dyes, i...
April 16, 2018: Chemistry, An Asian Journal
Emily D Carter, Micky Ndhlovu, Melinda Munos, Emmy Nkhama, Joanne Katz, Thomas P Eisele
Background: Accurate data on care-seeking for child illness are needed to improve public health programs and reduce child mortality. The accuracy of maternal report of care-seeking for child illness as collected through household surveys has not been validated. Methods: A 2016 survey compared reported care-seeking against a gold-standard of health care provider documented care-seeking events among a random sample of mothers of children <5 years in Southern Province, Zambia...
June 2018: Journal of Global Health
Fangmin Ye, Meinan Liu, Xue Yan, Jia Li, Zhenghui Pan, Hongfei Li, Yuegang Zhang
High-capacity Li2 S cathode (1166 mAh g-1 ) is regarded as a promising candidate for the next-generation lithium ion batteries. However, its high potential barrier upon the initial activation process leads to a low utilization of Li2 S. In this work, a Li2 S/graphite full cell with the zero activation potential barrier is achieved through an in situ electrochemical conversion of Li2 S8 catholyte into the amorphous Li2 S. Theoretical calculations indicate that the zero activation potential for amorphous Li2 S can be ascribed to its lower Li extraction energy than that of the crystalline Li2 S...
April 3, 2018: Small
Xin Chen, Lixia Yuan, Zhangxiang Hao, Xiaoxiao Liu, Jingwei Xiang, Zhuoran Zhang, Yunhui Huang, Jia Xie
Freestanding paper cathodes with layer-by-layer structure are synthesized for high-loading lithium-sulfur (Li-S) battery. Sulfur is loaded in a three dimensional (3D) interconnected nitrogen-doped carbonfiber (CNF) framework impregnated with Mn3O4 nanoparticles. The 3D-interconnected CNF framework creates an architecture with outstanding mechanical properties. Synergetic effects generated from physical and chemical entrapment could effectively suppress the dissolution and diffusion of the polysulfides. Electrochemical measurements suggest that the rationally designed structure endows the electrode with high utilization of sulfur and good cycle performance...
April 2, 2018: ACS Applied Materials & Interfaces
Xiao-Xiao Zhang, Gang Zhang, Min Jin, Li-Xin Niu, Yan-Long Zhang
The purpose of this study was to analyze the phenolic profiles of seeds from fifteen Paeonia ostii cultivated populations in China and identify their relationship with antioxidant activities and associated environmental factors. Thirteen individual phenolic compounds were quantitatively determined by HPLC, and (+)-catechin was the most abundant phenolic compound in the seeds. Correlation analysis showed that phenolics were the most effective antioxidant compound class by evaluating DPPH, ABTS, and hydroxyl radical scavenging activities as well as ferric reducing antioxidant power...
March 30, 2018: Chemistry & Biodiversity
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