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https://www.readbyqxmd.com/read/28322509/teaching-medical-students-about-cost-effectiveness
#1
Mark Iscoe, Robert Lord, John Schulz, David Lee, Danelle Cayea, Amit Pahwa
BACKGROUND: Rising and burdensome health care costs have driven interest in the practice of high-value care (HVC) and have inspired calls for increased HVC training across all levels of medical education, including among undergraduate medical students. CONTEXT: Classroom-based HVC curricula targeted to medical students have not been previously described in the medical literature. INNOVATION: We developed and evaluated a workshop comprising a lecture, a small-group exercise and a group discussion to instruct medical students on interpreting cost-effectiveness analyses (CEA), applying CEA to patient care and discussing the cost of care with patients...
March 21, 2017: Clinical Teacher
https://www.readbyqxmd.com/read/28288467/tattoo-infections-personal-resistance-and-contagious-exposure-through-tattooing
#2
Jørgen Serup
Bacterial infection of tattoos remains a common complication. Pyogenic bacteria can cause infections shortly after the tattoo is made. Severity of infection varies from minor to major, ultimately with life-threatening septicemia. Viral infections may be introduced, i.e. HVB, HVC, and HIV. The risk of infection depends on the following triad: microbial pathogen and its aggressiveness, individual resistance of the tattooed, and inoculation and exposures by the tattoo needle and in the tattoo parlor. Some infectious risks can be controlled...
2017: Current Problems in Dermatology
https://www.readbyqxmd.com/read/28245938/hcv-core-antigen-assay-as-an-alternative-to-hcv-rna-quantification-a-correlation-study-for-the-assessment-of-hcv-viremia
#3
Roberto Alonso, Felipe Pérez-García, Paula López-Roa, Luis Alcalá, Pilar Rodeño, Emilio Bouza
INTRODUCTION: Detection of hepatitis C virus (HCV) RNA and the HCV core antigen assay (HCV-Ag) are reliable techniques for the diagnosis of active and chronic HCV infection. Our aim was to evaluate the HCV-Ag assay as an alternative to quantification of HVC RNA. METHODS: A comparison was made of the sensitivity and specificity of an HCV-Ag assay (204 serum samples) with those of a PCR assay, and the correlation between the two techniques was determined. RESULTS: The sensitivity and specificity of HCV-Ag was 76...
February 25, 2017: Enfermedades Infecciosas y Microbiología Clínica
https://www.readbyqxmd.com/read/28214021/arfi-elastography-changes-after-direct-acting-antiviral-treatment-in-transplanted-livers-with-relapse-of-hepatitis-c-virus-infection
#4
M Alfageme Zubillaga, T Fontanilla Echeveste, I Pérez González, A Royuela Vicente, A M Duca, R M Ruiz Peralbo, C González Hernando
OBJECTIVE: To evaluate the changes in the values obtained in acoustic radiation force impulse (ARFI) elastography of the liver after antiviral treatment in patients with liver transplants and hepatitis C virus (HVC) infection recurring after transplantation. MATERIAL AND METHODS: We studied 15 patients infected with HVC who had received liver transplants where an HVC infection recurring in the graft within one year after the transplant was treated with direct-acting antivirals...
February 14, 2017: Radiología
https://www.readbyqxmd.com/read/28188629/orthogonal-topography-in-the-parallel-input-architecture-of-songbird-hvc
#5
Kevin C Elliott, Wei Wu, Richard Bertram, Richard L Hyson, Frank Johnson
Neural activity within the cortical premotor nucleus HVC (acronym is name) encodes the learned songs of adult male zebra finches (Taeniopygia guttata). HVC activity is driven and/or modulated by a group of five afferent nuclei (the Medial Magnocellular nucleus of the Anterior Nidopallium, MMAN; Nucleus Interface, NIf; nucleus Avalanche, Av; the Robust nucleus of the Arcopallium, RA; the Uvaeform nucleus, Uva). While earlier evidence suggested that HVC receives a uniformly distributed and non-topographic pattern of afferent input, recent evidence suggests this view is incorrect (Basista et al...
February 11, 2017: Journal of Comparative Neurology
https://www.readbyqxmd.com/read/28170164/perineuronal-nets-and-vocal-plasticity-in-songbirds-a-proposed-mechanism-to-explain-the-difference-between-closed-ended-and-open-ended-learning
#6
Gilles Cornez, Farrah N Madison, Annemie Van der Linden, Charlotte Cornil, Kathleen M Yoder, Gregory F Ball, Jacques Balthazart
Perineuronal nets (PNN) are aggregations of chondroitin sulfate proteoglycans surrounding the soma and proximal processes of neurons, mostly GABAergic interneurons expressing parvalbumin. They limit the plasticity of their afferent synaptic connections. In zebra finches PNN develop in an experience-dependent manner in the song control nuclei HVC and RA (nucleus robustus arcopallialis) when young birds crystallize their song. Because songbird species that are open-ended learners tend to recapitulate each year the different phases of song learning until their song crystallizes at the beginning of the breeding season, we tested whether seasonal changes in PNN expression would be found in the song control nuclei of a seasonally breeding species such as the European starling...
February 7, 2017: Developmental Neurobiology
https://www.readbyqxmd.com/read/28159910/temperature-manipulation-in-songbird-brain-implicates-the-premotor-nucleus-hvc-in-birdsong-syntax
#7
Yisi S Zhang, Jason D Wittenbach, Dezhe Z Jin, Alexay A Kozhevnikov
Variable motor sequences of animals are often structured and can be described by probabilistic transition rules between action elements. Examples include the songs of many songbird species such as the Bengalese finch, which consist of stereotypical syllables sequenced according to probabilistic rules (song syntax). The neural mechanisms behind such rules are poorly understood. Here we investigate where the song syntax is encoded in the brain of the Bengalese finch by rapidly and reversibly manipulating the temperature in the song production pathway...
February 3, 2017: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
https://www.readbyqxmd.com/read/28141859/studies-of-hvc-plasticity-in-adult-canaries-reveal-social-effects-and-sex-differences-as-well-as-limitations-of-multiple-markers-available-to-assess-adult-neurogenesis
#8
Olesya T Shevchouk, Gregory F Ball, Charlotte A Cornil, Jacques Balthazart
In songbirds, neurogenesis in the song control nucleus HVC is sensitive to the hormonal and social environment but the dynamics of this process is difficult to assess with a single exogenous marker of new neurons. We simultaneously used three independent markers to investigate HVC neurogenesis in male and female canaries. Males were castrated, implanted with testosterone and housed either alone (M), with a female (M-F) or with another male (M-M) while females were implanted with 17β-estradiol and housed with a male (F-M)...
2017: PloS One
https://www.readbyqxmd.com/read/28135770/testosterone-induced-neuroendocrine-changes-in-the-medial-preoptic-area-precede-song-activation-and-plasticity-in-song-control-nuclei-of-female-canaries
#9
Olesya T Shevchouk, Samar Ghorbanpoor, Gregory F Ball, Charlotte A Cornil, Jacques Balthazart
Testosterone plays a key role in the control of seasonal changes in singing behavior and its underlying neural circuitry. After administration of exogenous testosterone, song quality and song control nuclei volumes change over the course of weeks, but song rate increases within days. The medial preoptic nucleus (POM) controls sexual motivation and testosterone action in POM increases sexually motivated singing. In this study, we investigated the time course of testosterone action in the song control nuclei and POM, at the gross anatomical and cellular level...
January 30, 2017: European Journal of Neuroscience
https://www.readbyqxmd.com/read/28130386/ethics-and-high-value-care
#10
Matthew DeCamp, Jon C Tilburt
High-value care (HVC) is en vogue, but the ethics of physicians' roles in the growing number of HVC recommendations demands further attention. In this brief report, we argue that, from the standpoint of individual physicians' primary commitments and duties to individual patients, not all HVC is ethically equal. Our analysis suggests that the ethical case for HVC may be both stronger and weaker than is ordinarily supposed. In some cases, HVC is not merely a 'good thing to do' but is actually ethically obligatory...
January 26, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28065731/mechanisms-that-determine-nanocarrier-targeting-to-healthy-versus-inflamed-lung-regions
#11
Jacob S Brenner, Kartik Bhamidipati, Patrick Glassman, N Ramakrishnan, Depeng Jiang, Andrew J Paris, Jacob W Myerson, Daniel C Pan, Vladimir V Shuvaev, Carlos Villa, Elizabeth D Hood, Raisa Kiseleva, Colin F Greineder, Ravi Radhakrishnan, Vladimir R Muzykantov
Inflamed organs display marked spatial heterogeneity of inflammation, with patches of inflamed tissue adjacent to healthy tissue. To investigate how nanocarriers (NCs) distribute between such patches, we created a mouse model that recapitulates the spatial heterogeneity of the inflammatory lung disease ARDS. NCs targeting the epitope PECAM strongly accumulated in the lungs, but were shunted away from inflamed lung regions due to hypoxic vasoconstriction (HVC). In contrast, ICAM-targeted NCs, which had lower whole-lung uptake than PECAM/NCs in inflamed lungs, displayed markedly higher NC levels in inflamed regions than PECAM/NCs, due to increased regional ICAM...
January 5, 2017: Nanomedicine: Nanotechnology, Biology, and Medicine
https://www.readbyqxmd.com/read/28056038/comparison-of-primary-care-experiences-in-village-clinics-with-different-ownership-models-in-guangdong-province-china
#12
Shanshan Feng, Leiyu Shi, Jiazhi Zeng, Wen Chen, Li Ling
OBJECTIVES: In order to improve the quality of services at village clinics (VCs), which are important primary care service providers in rural China, the Chinese government has encouraged the township hospitals to own and manage VCs. There are currently three models of ownership and management of VCs: township hospital-owned and -managed (HVC), village committee-owned and -managed (VVC), and private-owned and -managed (PVC). This study aims to examine the association between these ownership models of VCs and patients' primary care experiences...
2017: PloS One
https://www.readbyqxmd.com/read/28031398/principles-of-auditory-processing-differ-between-sensory-and-premotor-structures-of-the-songbird-forebrain
#13
Efe Soyman, David S Vicario
Sensory and motor brain structures work in collaboration during perception. To evaluate their respective contributions, the present study recorded neural responses to auditory stimulation at multiple sites simultaneously in both the higher-order auditory area NCM and the premotor area HVC of the songbird brain in awake zebra finches (Taeniopygia guttata). Bird's own song (BOS) and various conspecific songs (CON) were presented in both blocked and shuffled sequences. Neural responses showed plasticity in the form of stimulus-specific adaptation, with markedly different dynamics between the two structures...
March 1, 2017: Journal of Neurophysiology
https://www.readbyqxmd.com/read/28028087/floral-visitors-of-three-asteraceae-species-in-a-xeric-environment-in-central-mexico
#14
Dulce María Figueroa-Castro, Guadalupe González-Tochihuitl, Sombra Patricia Rivas-Arancibia, Gabriela Castaño-Meneses
We describe the spatial variation in the structure and composition of the communities of insects visiting the inflorescences of Flaveria ramosissima Klatt, Florestina pedata (Cav.) Cass., and Parthenium bipinnatifidum (Ort.) Rollins (Asteraceae) in a xeric environment in Central Mexico. Inflorescences of the three Asteraceae were visited by a total of 96 species of Hymenoptera, Diptera, Lepidoptera, Coleoptera, and Hemiptera. Total species richness of floral visitors to the three Asteraceae and total abundance of insects of Fl...
December 2016: Environmental Entomology
https://www.readbyqxmd.com/read/27965132/low-volume-vs-high-volume-centers-and-management-of-fournier-s-gangrene-in-washington-state
#15
Nathan Osbun, Lindsay A Hampson, Sarah K Holt, John L Gore, Hunter Wessells, Bryan B Voelzke
BACKGROUND: Fournier's gangrene (FG) is a life-threatening infection affecting the perineum and genitals. Complex patient management often necessitates transfer to tertiary centers. We aimed to characterize hospital transfer patterns and assess morbidity among patients with FG in Washington State. STUDY DESIGN: The Washington State Comprehensive Hospital Abstract Reporting System includes claims from all hospital discharges in Washington. We identified patients with FG between 2007 and 2013, based on diagnosis and treatment codes...
March 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27928663/volume-of-hospital-is-important-for-the-prognosis-of-high-risk-patients-with-nonvariceal-upper-gastrointestinal-bleeding-nvugib
#16
Jin Woo Choi, Seong Woo Jeon, Jung Gu Kwon, Dong Wook Lee, Chang Yoon Ha, Kwang Bum Cho, Byung Ik Jang, Jung Bae Park, Youn Sun Park
BACKGROUND AND AIM: Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a potentially life-threatening hospital emergency requiring hemodynamic stabilization and resuscitation. This study is carried out to determine whether hospital volume can influence outcome in patients with NVUGIB. METHOD: This is a retrospective study with a prospective cohort database (KCT 0000514. cris.nih.go.kr). Eight teaching hospitals were divided into two different groups: high-volume centers (HVC, ≥60 NVUGIB patients/year, four clinics) and low-volume centers (LVC, <60 NVUGIB patients/year, four clinics)...
December 7, 2016: Surgical Endoscopy
https://www.readbyqxmd.com/read/27836364/the-association-between-nephroblastoma-specific-outcomes-and-high-versus-low-volume-treatment-centers
#17
COMPARATIVE STUDY
Morgan K Richards, Adam B Goldin, Alexandra Savinkina, John Doski, Melanie Goldfarb, Jed Nuchtern, Monica Langer, Elizabeth A Beierle, Sanjeev Vasudevan, Kenneth W Gow, Mehul V Raval
BACKGROUND: Though the volume-outcome relationship has been well-established in adults, low mortality rates and small sample sizes have precluded definitive demonstration in children. This study compares treatment-specific factors for children with nephroblastoma at high (HVC) versus low volume centers (LVC). METHODS: We performed a retrospective cohort study comparing patients ≤18years with unilateral nephroblastoma treated at HVCs and LVCs using the National Cancer Data Base (1998-2012)...
January 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27776810/-management-following-sexual-exposure-to-hiv-hvb-and-hvc
#18
F-J Timsit, C Vernay-Vaisse, C Derancourt, R Viraben, C Chartier, N Spenatto
No abstract text is available yet for this article.
November 2016: Annales de Dermatologie et de Vénéréologie
https://www.readbyqxmd.com/read/27723764/a-neural-code-that-is-isometric-to-vocal-output-and-correlates-with-its-sensory-consequences
#19
Alexei L Vyssotski, Anna E Stepien, Georg B Keller, Richard H R Hahnloser
What cortical inputs are provided to motor control areas while they drive complex learned behaviors? We study this question in the nucleus interface of the nidopallium (NIf), which is required for normal birdsong production and provides the main source of auditory input to HVC, the driver of adult song. In juvenile and adult zebra finches, we find that spikes in NIf projection neurons precede vocalizations by several tens of milliseconds and are insensitive to distortions of auditory feedback. We identify a local isometry between NIf output and vocalizations: quasi-identical notes produced in different syllables are preceded by highly similar NIf spike patterns...
October 2016: PLoS Biology
https://www.readbyqxmd.com/read/27723744/unstable-neurons-underlie-a-stable-learned-behavior
#20
William A Liberti, Jeffrey E Markowitz, L Nathan Perkins, Derek C Liberti, Daniel P Leman, Grigori Guitchounts, Tarciso Velho, Darrell N Kotton, Carlos Lois, Timothy J Gardner
Motor skills can be maintained for decades, but the biological basis of this memory persistence remains largely unknown. The zebra finch, for example, sings a highly stereotyped song that is stable for years, but it is not known whether the precise neural patterns underlying song are stable or shift from day to day. Here we demonstrate that the population of projection neurons coding for song in the premotor nucleus, HVC, change from day to day. The most dramatic shifts occur over intervals of sleep. In contrast to the transient participation of excitatory neurons, ensemble measurements dominated by inhibition persist unchanged even after damage to downstream motor nerves...
December 2016: Nature Neuroscience
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