Syncopation and the Score

The first and second authors were supported by an EPSRC DTA (www.epsrc.ac.uk) studentship

Genetics in Practice A Template for Interactive Case Studies

Genetics & Your Practice, began in 1994 as a course for primary health care practitioners to get Continuing Medical Education (CME) credits and to help health care providers learn about the importance of genetic counseling and the fundamental difference between genetic counseling and traditional health care. In a collaborative project between the March of Dimes and Idaho State University Departments of Nursing (ISU) and Continuing Education/Special Programs, the course was converted to an online asynchronous course. Since the course was primarily didactic, ISU approached a team of graduate students at Utah State University’s Department of Instructional Technology (USU) to develop an administrative template for interactive case studies and to produce one completed case study. The goals of the template system were: (1) Give students a chance to “practice”, thereby giving them a set of procedural knowledge as opposed to facts devoid of context, (2) Enable the production of any number of case studies with no additional programming costs, (3) Make it easy to update the case studies since research in the field of genetics is in a constant state of flux

Music Cognition in Breast Cancer Survivors

Advances in breast cancer treatment have resulted in improved survival rates and concomitant reports of chemotherapy-related cognitive dysfunction. Music cognition, a form of general cognition, also may be negatively affected by chemotherapy. Moreover, chemotherapy may have general ototoxic effects. The goal of this study was to explore whether breast cancer survivors (BCS) had similar hearing thresholds and music cognition abilities compared with age-matched healthy controls (HC). A total of 56 women (28 BCS and 28 HC) completed the audiometric tests and the Montreal Battery Evaluation of Amusia (MBEA). Results indicate the 2 groups have similar hearing thresholds. A comparison of music cognition variables suggests possible differences in some music cognition tasks, with HC scoring slightly, but not significantly, better in melodic perception. The BCS scored slightly better, though not significantly, on melodic memory. An adequately powered study including cognitive variables is needed for verification of findings and to establish clinical meaningfulness

Severe Hyperkalemia: Can the Electrocardiogram Risk Stratify for Short-term Adverse Events?

Introduction: The electrocardiogram (ECG) is often used to identify which hyperkalemic patients are atrisk for adverse events. However, there is a paucity of evidence to support this practice. This studyanalyzes the association between specific hyperkalemic ECG abnormalities and the development ofshort-term adverse events in patients with severe hyperkalemia.Methods: We collected records of all adult patients with potassium (K+) ≥6.5 mEq/L in the hospitallaboratory database from August 15, 2010, through January 30, 2015. A chart review identified patientdemographics, concurrent laboratory values, ECG within one hour of K+ measurement, treatments andoccurrence of adverse events within six hours of ECG. We defined adverse events as symptomaticbradycardia, ventricular tachycardia, ventricular fibrillation, cardiopulmonary resuscitation (CPR) and/ordeath. Two emergency physicians blinded to study objective independently examined each ECG forrate, rhythm, peaked T wave, PR interval duration and QRS complex duration. Relative risk wascalculated to determine the association between specific hyperkalemic ECG abnormalities and shorttermadverse events.Results: We included a total of 188 patients with severe hyperkalemia in the final study group. Adverseevents occurred within six hours in 28 patients (15%): symptomatic bradycardia (n=22), death (n=4),ventricular tachycardia (n=2) and CPR (n=2). All adverse events occurred prior to treatment with calciumand all but one occurred prior to K+-lowering intervention. All patients who had a short-term adverse eventhad a preceding ECG that demonstrated at least one hyperkalemic abnormality (100%, 95% confidenceinterval [CI] [85.7-100%]). An increased likelihood of short-term adverse event was found forhyperkalemic patients whose ECG demonstrated QRS prolongation (relative risk [RR] 4.74, 95% CI[2.01-11.15]), bradycardia (HR<50) (RR 12.29, 95%CI [6.69-22.57]), and/or junctional rhythm (RR 7.46,95%CI 5.28-11.13). There was no statistically significant correlation between peaked T waves andshort-term adverse events (RR 0.77, 95% CI [0.35-1.70]).Conclusion: Our findings support the use of the ECG to risk stratify patients with severehyperkalemia for short-term adverse events. [West J Emerg Med. 2017;18(5)963-971.

Severe Hyperkalemia: Can the Electrocardiogram Risk Stratify for Short-term Adverse Events?

Introduction: The electrocardiogram (ECG) is often used to identify which hyperkalemic patients are at risk for adverse events. However, there is a paucity of evidence to support this practice. This study analyzes the association between specific hyperkalemic ECG abnormalities and the development of short-term adverse events in patients with severe hyperkalemia. Methods: We collected records of all adult patients with potassium (K+) ≥6.5 mEq/L in the hospital laboratory database from August 15, 2010, through January 30, 2015. A chart review identified patient demographics, concurrent laboratory values, ECG within one hour of K+ measurement, treatments and occurrence of adverse events within six hours of ECG. We defined adverse events as symptomatic bradycardia, ventricular tachycardia, ventricular fibrillation, cardiopulmonary resuscitation (CPR) and/or death. Two emergency physicians blinded to study objective independently examined each ECG for rate, rhythm, peaked T wave, PR interval duration and QRS complex duration. Relative risk was calculated to determine the association between specific hyperkalemic ECG abnormalities and short-term adverse events. Results: We included a total of 188 patients with severe hyperkalemia in the final study group. Adverse events occurred within six hours in 28 patients (15%): symptomatic bradycardia (n=22), death (n=4), ventricular tachycardia (n=2) and CPR (n=2). All adverse events occurred prior to treatment with calcium and all but one occurred prior to K +-lowering intervention. All patients who had a short-term adverse event had a preceding ECG that demonstrated at least one hyperkalemic abnormality (100%, 95% confidence interval [CI] [85.7–100%]). An increased likelihood of short-term adverse event was found for hyperkalemic patients whose ECG demonstrated QRS prolongation (relative risk [RR] 4.74, 95% CI [2.01–11.15]), bradycardia (HR<50) (RR 12.29, 95%CI [6.69–22.57]), and/or junctional rhythm (RR 7.46, 95%CI 5.28–11.13). There was no statistically significant correlation between peaked T waves and short-term adverse events (RR 0.77, 95% CI [0.35–1.70]). Conclusion: Our findings support the use of the ECG to risk stratify patients with severe hyperkalemia for short-term adverse events

Joint data assimilation of satellite reflectance and net ecosystem exchange data constrains ecosystem carbon fluxes at a high-elevation subalpine forest

We utilized an ecosystem process model (SIPNET, simplified photosynthesis and evapotranspiration model) to estimate carbon fluxes of gross primary productivity and total ecosystem respiration of a high-elevation coniferous forest. The data assimilation routine incorporated aggregated twice-daily measurements of the net ecosystem exchange of CO2 (NEE) and satellite-based reflectance measurements of the fraction of absorbed photosynthetically active radiation (fAPAR) on an eight-day timescale. From these data we conducted a data assimilation experiment with fifteen different combinations of available data using twice-daily NEE, aggregated annual NEE, eight-day f AP AR, and average annual fAPAR. Model parameters were conditioned on three years of NEE and fAPAR data and results were evaluated to determine the information content from the different combinations of data streams. Across the data assimilation experiments conducted, model selection metrics such as the Bayesian Information Criterion and Deviance Information Criterion obtained minimum values when assimilating average annual fAPAR and twice-daily NEE data. Application of wavelet coherence analyses showed higher correlations between measured and modeled fAPAR on longer timescales ranging from 9 to 12 months. There were strong correlations between measured and modeled NEE (R2, coefficient of determination, 0.86), but correlations between measured and modeled eight-day fAPAR were quite poor (R2 = −0.94). We conclude that this inability to determine fAPAR on eight-day timescale would improve with the considerations of the radiative transfer through the plant canopy. Modeled fluxes when assimilating average annual fAPAR and annual NEE were comparable to corresponding results when assimilating twice-daily NEE, albeit at a greater uncertainty. Our results support the conclusion that for this coniferous forest twice-daily NEE data are a critical measurement stream for the data assimilation. The results from this modeling exercise indicate that for this coniferous forest, average annuals for satellite-based fAPAR measurements paired with annual NEE estimates may provide spatial detail to components of ecosystem carbon fluxes in proximity of eddy covariance towers. Inclusion of other independent data streams in the assimilation will also reduce uncertainty on modeled values

Sex Differences in the Brain Transcriptome Related to Alcohol Effects and Alcohol Use Disorder.

There is compelling evidence that sex and gender have crucial roles in excessive alcohol (ethanol) consumption. Here, we review some of the data from the perspective of brain transcriptional differences between males and females, focusing on rodent animal models. A key emerging transcriptional feature is the role of neuroimmune processes. Microglia are the resident neuroimmune cells in the brain and exhibit substantial functional differences between males and females. Selective breeding for binge ethanol consumption and the impacts of chronic ethanol consumption and withdrawal from chronic ethanol exposure all demonstrate sex-dependent neuroimmune signatures. A focus is on resolving sex-dependent differences in transcriptional responses to ethanol at the neurocircuitry level. Sex-dependent transcriptional differences are found in the extended amygdala and the nucleus accumbens. Telescoping of ethanol consumption is found in some, but not all, studies to be more prevalent in females. Recent transcriptional studies suggest that some sex differences may be due to female-dependent remodeling of the primary cilium. An interesting theme appears to be developing: at least from the animal model perspective, even when males and females are phenotypically similar, they differ significantly at the level of the transcriptome