Identification and Risk-Stratification of Problem Alcohol Drinkers with Minor Trauma in the Emergency Department

BACKGROUND: Brief alcohol intervention may improve outcomes for injury patients with hazardous drinking but is less effective with increased severity of alcohol involvement. This study evaluated a brief method for detecting problem drinking in minor trauma patients and differentiating hazardous drinkers from those with more severe alcohol problems.METHODS: Subjects included 60 minor trauma patients in an academic urban emergency department (ED) who had consumed any amount of alcohol in the prior month. Screening and risk stratification involved the use of a heavy-drinking-day screening item and the Rapid Alcohol Problems Screen (RAPS). We compared the heavy-drinking-day item to past-month alcohol use, as obtained by validated self-reporting methods, and measured the percentage of carbohydrate-deficient transferrin (%CDT) to assess the accuracy of self-reporting. The Alcohol Dependence Scale (ADS) was administered to gauge the severity of alcohol involvement and compared to the RAPS.RESULTS: Eighty percent of the subjects endorsed at least one heavy drinking day in the past year, and all patients who exceeded recommended weekly drinking limits endorsed at least one heavy drinking day. Among those with at least one heavy drinking day, 58% had a positive RAPS result. Persons with no heavy drinking days (n=12) had a median ADS of 0.5 (range 0 to 3). RAPS-negative persons with heavy drinking days (n=20) had a median ADS of 2 (range 0 to 8). RAPS-positive persons with heavy drinking days (n=28) had a median ADS of 8 (range 1 to 43).CONCLUSION: A heavy-drinking-day item is useful for detecting hazardous drinking patterns, and the RAPS is useful for differentiating more problematic drinkers who may benefit from referral from those more likely to respond to a brief intervention. This represents a time-sensitive approach for risk-stratifying non-abstinent injury patients prior to ED discharge. [West J Emerg Med. 2010 May;11(2):133-7.

Reducing in-stent restenosis therapeutic manipulation of miRNA in vascular remodeling and inflammation

Background: Drug-eluting stents reduce the incidence of in-stent restenosis, but they result in delayed arterial healing and are associated with a chronic inflammatory response and hypersensitivity reactions. Identifying novel interventions to enhance wound healing and reduce the inflammatory response may improve long-term clinical outcomes. Micro–ribonucleic acids (miRNAs) are noncoding small ribonucleic acids that play a prominent role in the initiation and resolution of inflammation after vascular injury.<p></p> Objectives: This study sought to identify miRNA regulation and function after implantation of bare-metal and drug-eluting stents.<p></p> Methods: Pig, mouse, and in vitro models were used to investigate the role of miRNA in in-stent restenosis.<p></p> Results: We documented a subset of inflammatory miRNAs activated after stenting in pigs, including the miR-21 stem loop miRNAs. Genetic ablation of the miR-21 stem loop attenuated neointimal formation in mice post-stenting. This occurred via enhanced levels of anti-inflammatory M2 macrophages coupled with an impaired sensitivity of smooth muscle cells to respond to vascular activation.<p></p> Conclusions: MiR-21 plays a prominent role in promoting vascular inflammation and remodeling after stent injury. MiRNA-mediated modulation of the inflammatory response post-stenting may have therapeutic potential to accelerate wound healing and enhance the clinical efficacy of stenting

Design, Optimization and Evaluation of Integrally Stiffened Al 7050 Panel with Curved Stiffeners

A curvilinear stiffened panel was designed, manufactured, and tested in the Combined Load Test Fixture at NASA Langley Research Center. The panel was optimized for minimum mass subjected to constraints on buckling load, yielding, and crippling or local stiffener failure using a new analysis tool named EBF3PanelOpt. The panel was designed for a combined compression-shear loading configuration that is a realistic load case for a typical aircraft wing panel. The panel was loaded beyond buckling and strains and out-of-plane displacements were measured. The experimental data were compared with the strains and out-of-plane deflections from a high fidelity nonlinear finite element analysis and linear elastic finite element analysis of the panel/test-fixture assembly. The numerical results indicated that the panel buckled at the linearly elastic buckling eigenvalue predicted for the panel/test-fixture assembly. The experimental strains prior to buckling compared well with both the linear and nonlinear finite element model

Comparison of different approaches to manage multi-site magnetic resonance spectroscopy clinical data analysis

IntroductionThe effects caused by differences in data acquisition can be substantial and may impact data interpretation in multi-site/scanner studies using magnetic resonance spectroscopy (MRS). Given the increasing use of multi-site studies, a better understanding of how to account for different scanners is needed. Using data from a concussion population, we compare ComBat harmonization with different statistical methods in controlling for site, vendor, and scanner as covariates to determine how to best control for multi-site data.MethodsThe data for the current study included 545 MRS datasets to measure tNAA, tCr, tCho, Glx, and mI to study the pediatric concussion acquired across five sites, six scanners, and two different MRI vendors. For each metabolite, the site and vendor were accounted for in seven different models of general linear models (GLM) or mixed-effects models while testing for group differences between the concussion and orthopedic injury. Models 1 and 2 controlled for vendor and site. Models 3 and 4 controlled for scanner. Models 5 and 6 controlled for site applied to data harmonized by vendor using ComBat. Model 7 controlled for scanner applied to data harmonized by scanner using ComBat. All the models controlled for age and sex as covariates.ResultsModels 1 and 2, controlling for site and vendor, showed no significant group effect in any metabolites, but the vendor and site were significant factors in the GLM. Model 3, which included a scanner, showed a significant group effect for tNAA and tCho, and the scanner was a significant factor. Model 4, controlling for the scanner, did not show a group effect in the mixed model. The data harmonized by the vendor using ComBat (Models 5 and 6) had no significant group effect in both the GLM and mixed models. Lastly, the data harmonized by the scanner using ComBat (Model 7) showed no significant group effect. The individual site data suggest there were no group differences.ConclusionUsing data from a large clinical concussion population, different analysis techniques to control for site, vendor, and scanner in MRS data yielded different results. The findings support the use of ComBat harmonization for clinical MRS data, as it removes the site and vendor effects

Exploring the Bone Proteome to Help Explain Altered Bone Remodeling and Preservation of Bone Architecture and Strength in Hibernating Marmots

Periods of physical inactivity increase bone resorption and cause bone loss and increased fracture risk. However, hibernating bears, marmots, and woodchucks maintain bone structure and strength, despite being physically inactive for prolonged periods annually. We tested the hypothesis that bone turnover rates would decrease and bone structural and mechanical properties would be preserved in hibernating marmots (Marmota flaviventris). Femurs and tibias were collected from marmots during hibernation and in the summer following hibernation. Bone remodeling was significantly altered in cortical and trabecular bone during hibernation with suppressed formation and no change in resorption, unlike the increased bone resorption that occurs during disuse in humans and other animals. Trabecular bone architecture and cortical bone geometrical and mechanical properties were not different between hibernating and active marmots, but bone marrow adiposity was significantly greater in hibernators. Of the 506 proteins identified in marmot bone, 40 were significantly different in abundance between active and hibernating marmots. Monoaglycerol lipase, which plays an important role in fatty acid metabolism and the endocannabinoid system, was 98-fold higher in hibernating marmots compared with summer marmots and may play a role in regulating the changes in bone and fat metabolism that occur during hibernation

The inflammatory microenvironment in colorectal neoplasia

Peer reviewedPublisher PD

Modeling population effects of the Deepwater Horizon oil spill on a long-lived species

This research was enabled partly by a grant from The Gulf of Mexico Research Initiative (GOMRI).The 2010 Deepwater Horizon (DWH) oil spill exposed common bottlenose dolphins (Tursiops truncatus) in Barataria Bay, Louisiana to heavy oiling that caused increased mortality and chronic disease and impaired reproduction in surviving dolphins. We conducted photographic surveys and veterinary assessments in the decade following the spill. We assigned a prognostic score (good, fair, guarded, poor, or grave) for each dolphin to provide a single integrated indicator of overall health, and we examined temporal trends in prognostic scores. We used expert elicitation to quantify the implications of trends for the proportion of the dolphins that would recover within their lifetime. We integrated expert elicitation, along with other new information, in a population dynamics model to predict the effects of observed health trends on demography. We compared the resulting population trajectory with that predicted under baseline (no spill) conditions. Disease conditions persisted and have recently worsened in dolphins that were presumably exposed to DWH oil: 78% of those assessed in 2018 had a guarded, poor, or grave prognosis. Dolphins born after the spill were in better health. We estimated that the population declined by 45% (95% CI 14–74) relative to baseline and will take 35 years (95% CI 18–67) to recover to 95% of baseline numbers. The sum of annual differences between baseline and injured population sizes (i.e., the lost cetacean years) was 30,993 (95% CI 6607–94,148). The population is currently at a minimum point in its recovery trajectory and is vulnerable to emerging threats, including planned ecosystem restoration efforts that are likely to be detrimental to the dolphins’ survival. Our modeling framework demonstrates an approach for integrating different sources and types of data, highlights the utility of expert elicitation for indeterminable input parameters, and emphasizes the importance of considering and monitoring long-term health of long-lived species subject to environmental disasters. Article impact statement: Oil spills can have long-term consequences for the health of long-lived species; thus, effective restoration and monitoring are needed.Publisher PDFPeer reviewe

Proceedings of the Second Caldwell Conference, St. Catherines Island, Georgia, March 30-April 1, 2007

229 p. : ill. (some col.), maps (some col.) ; 26 cm. "Issued August 26, 2009." Includes bibliographical references (p. [213]-229).Archaeologists have long known that important changes took place in aboriginal ceramic assemblages of the northern Florida, Georgia, and South Carolina coast after the arrival of Europeans. New pottery designs emerged and aboriginal demographics became fluid. Catastrophic population loss occurred in some places, new groups formed in others, and movements of people occurred nearly everywhere. Although culturally and linguistically diverse, the native inhabitants of this region shared the unwelcome encounter with Spanish people and colonial institutions, beginning in the early decades of the 16th century and continuing into the 18th century. Spanish missions and military outposts were established at native communities throughout the area, and these sites have been studied by both archaeologists and historians for decades. As a consequence, the lower southeastern Atlantic coast offers one of the most intensively studied episodes of multicultural colonial engagement in America. The Second Caldwell Conference was organized to bring researchers working in South Carolina, Georgia, and Florida together to address and more precisely define aboriginal ceramic change throughout the region as a baseline for approaching a more broadly based anthropological perspective on the consequences of encounter. The scope of inquiry was restricted to late prehistoric and early historic (A.D. 1400-1700) aboriginal ceramic wares from Santa Elena (South Carolina) to St. Augustine (Florida). The primary objective was to more precisely establish the technology, form, and design of the archaeological ceramic evidence. Without devolving into semantic and/or taxonomic wrangles, we examined how well (or poorly) archaeological labels used throughout the region to identify pottery serve as reliable proxies for the physical examples of those ceramic traditions. We also attempted to define the time-space distribution of the various ceramic traditions and pottery types throughout the south Atlantic coast. Specifically, we asked: (1) Did the indigenous ceramic complexes change fundamentally with the arrival of the Spaniards? (2) Or did indigenous ceramic traditions essentially persist, and merely shifted geographically? The eight contributions of this volume examine, on a case-by-case basis, the most important aboriginal ceramic assemblages from Santa Elena southward to St. Augustine, across the region, contextualizing each assemblage with the relevant physical stratigraphy, radiocarbon dates, associations with Euro-American wares, and documentary evidence. We also attempt to situate the physical ceramic evidence from the northern Florida-Georgia-South Carolina coastline with the contemporary archaeological assemblages in the immediate interior. The volume concludes with an epilogue that summarizes the results and general contributions of the conference, relative to archaeological practice in the lower Atlantic coastal Southeast, and also to the larger cultural and methodological issues raised by these papers

Placental uptake and metabolism of 25(OH)vitamin D determine its activity within the fetoplacental unit

Pregnancy 25-hydroxyvitamin D [25(OH)D] concentrations are associated with maternal and fetal health outcomes. Using physiological human placental perfusion and villous explants, we investigate the role of the placenta in regulating the relationships between maternal 25(OH)D and fetal physiology. We demonstrate active placental uptake of 25(OH)D3 by endocytosis, placental metabolism of 25(OH)D3 into 24,25-dihydroxyvitamin D3 and active 1,25-dihydroxyvitamin D [1,25(OH)2D3], with subsequent release of these metabolites into both the maternal and fetal circulations. Active placental transport of 25(OH)D3 and synthesis of 1,25(OH)2D3 demonstrate that fetal supply is dependent on placental function rather than simply the availability of maternal 25(OH)D3. We demonstrate that 25(OH)D3 exposure induces rapid effects on the placental transcriptome and proteome. These map to multiple pathways central to placental function and thereby fetal development, independent of vitamin D transfer. Our data suggest that the underlying epigenetic landscape helps dictate the transcriptional response to vitamin D treatment. This is the first quantitative study demonstrating vitamin D transfer and metabolism by the human placenta, with widespread effects on the placenta itself. These data demonstrate a complex interplay between vitamin D and the placenta and will inform future interventions using vitamin D to support fetal development and maternal adaptations to pregnancy.</jats:p