Who Needs Inpatient Detox? Development and Implementation of a Hospitalist Protocol for the Evaluation of Patients for Alcohol Detoxification

BACKGROUND: Clinicians caring for patients seeking alcohol detoxification face many challenges, including lack of evidence-based guidelines for treatment and high recidivism rates. OBJECTIVES: To develop a standardized protocol for determining which alcohol dependent patients seeking detoxification need inpatient versus outpatient treatment, and to study the protocol's implementation. DESIGN: Review of best evidence by ad hoc task force and subsequent creation of standardized protocol. Prospective observational evaluation of initial protocol implementation. PARTICIPANTS: Patients presenting for alcohol detoxification. INTERVENTION: Development and implementation of a protocol for evaluation and treatment of patients requesting alcohol detoxification. MAIN MEASURES: Number of admissions per month with primary alcohol related diagnosis (DRG), 30-day readmission rate, and length of stay, all measured before and after protocol implementation. RESULTS: We identified one randomized clinical trial and three cohort studies to inform the choice of inpatient versus outpatient detoxification, along with one prior protocol in this population, and combined that data with clinical experience to create an institutional protocol. After implementation, the average number of alcohol related admissions was 15.9 per month, compared with 18.9 per month before implementation (p = 0.037). There was no difference in readmission rate or length of stay. CONCLUSIONS: Creation and utilization of a protocol led to standardization of care for patients requesting detoxification from alcohol. Initial evaluation of protocol implementation showed a decrease in number of admissions

Comparative and Functional Genomics of Rhodococcus opacus PD630 for Biofuels Development

The Actinomycetales bacteria Rhodococcus opacus PD630 and Rhodococcus jostii RHA1 bioconvert a diverse range of organic substrates through lipid biosynthesis into large quantities of energy-rich triacylglycerols (TAGs). To describe the genetic basis of the Rhodococcus oleaginous metabolism, we sequenced and performed comparative analysis of the 9.27 Mb R. opacus PD630 genome. Metabolic-reconstruction assigned 2017 enzymatic reactions to the 8632 R. opacus PD630 genes we identified. Of these, 261 genes were implicated in the R. opacus PD630 TAGs cycle by metabolic reconstruction and gene family analysis. Rhodococcus synthesizes uncommon straight-chain odd-carbon fatty acids in high abundance and stores them as TAGs. We have identified these to be pentadecanoic, heptadecanoic, and cis-heptadecenoic acids. To identify bioconversion pathways, we screened R. opacus PD630, R. jostii RHA1, Ralstonia eutropha H16, and C. glutamicum 13032 for growth on 190 compounds. The results of the catabolic screen, phylogenetic analysis of the TAGs cycle enzymes, and metabolic product characterizations were integrated into a working model of prokaryotic oleaginy.Cambridge-MIT InstituteMassachusetts Institute of Technology. (Seed Grant program)Shell Oil CompanyNational Institute of Allergy and Infectious Diseases (U.S.)United States. National Institutes of HealthNational Institutes of Health. Department of Health and Human Services (Contract No. HHSN272200900006C

Track E Implementation Science, Health Systems and Economics

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138412/1/jia218443.pd

Accumulation of lignin residues in organic matter fractions of lowland rice soils: a pyrolysis-GC-MS study

In tropical Asia, multiple annual cropping of lowland rice and the associated submerged soil conditions have been linked to long-term changes in nitrogen (N) cycling and the chemical nature of soil organic matter. To identify changes in organic matter properties, two humic acid fractions and whole soil samples were obtained from field treatments of lowland rice that varied in cropping intensity, fertilizer management, and location. These samples were methylated and analyzed by pyrolysis-gas chromatography-mass spectrometry. With compounds expressed in relative abundance, whole soil was enriched in nonmethoxybenzene compounds and heterocyclic N compounds compared with extracted humic acids. The young mobile humic acid (MHA) fraction had a wide diversity of methoxybenzenes that are associated with lignin residues. The more recalcitrant calcium humate (CaHA) fraction had characteristics intermediate between whole soil and MHA. Under intensified cropping and increased soil submergence, lignin residues increased in relative abundance in all three fractions. Heterocyclic N compounds decreased with intensified cropping, consistent with previous analysis by 15N nuclear magnetic resonance spectroscopy. Their parent compounds may be primarily naturally occurring heterocyclic N compounds. For whole soil, and especially the MHA, submergence effects were accentuated in treatments with high fertilizer rates, trends that may be related to the balance between input rates and degradation rates of crop residues. The ratio of myristic acid: stearic acid varied with soil submergence, fertilizer rate, and type of fraction in patterns following the abundance of methoxybenzenes. In general, responses of the MHA and CaHA to field treatments were representative of whole soil

Ultrasound in the diagnosis and management of pleural effusions

We review the literature on the use of point-of-care ultrasound to evaluate and manage pleural effusions. Point-of-care ultrasound is more sensitive than physical exam and chest radiography to detect pleural effusions, and avoids many negative aspects of computerized tomography. Additionally, point-of-care ultrasound can assess pleural fluid volume and character, revealing possible underlying pathologies and guiding management. Thoracentesis performed with ultrasound guidance has lower risk of pneumothorax and bleeding complications. Future research should focus on the clinical effectiveness of point-of-care ultrasound in the routine management of pleural effusions and how new technologies may expand its clinical utility. Journal of Hospital Medicine 2015. (c) 2015 Society of Hospital Medicine

Structural analysis of carrageenan from farmed varieties of Philippine seaweed

Kappaphycus alvarezii, Eucheuma denticulatum and, more recently, Kappaphycus sp. ‘Sacol’ variety, are the carrageenan-containing red seaweeds currently farmed in the Philippines. The Kappaphycus sp. ‘Sacol’ variety is of particular interest to the Philippine seaweed industry because of its improved resistance to ‘ice-ice’ disease and its fast growing characteristics. Here we report on the detailed chemical analysis of the carrageenan from this species. The native and alkali-modified carrageenans from Kappaphycus sp. ‘Sacol’ variety were characterized by FT-IR, 1H and 13C NMR spectroscopy, and constituent sugar and methylation analyses and were compared to those from K. alvarezii, K. cottonii and Eucheuma denticulatum. The three Kappaphycus species contained predominantly κ-carrageenan with low levels of ι-carrageenan, methylated carrageenan and μ-precursor residues, while Eucheuma denticulatum contained predominantly ι-carrageenan with significant amounts of ν-precursor residues. Taxonomic classification of Kappaphycus species based on morphology has proved to be difficult because of their known plasticity. Molecular analysis using the rbcLsequence revealed that the Kappaphycus sp. ‘Sacol’ variety is most likely a form of K. cottonii

Credentialing of hospitalists in ultrasound-guided bedside procedures: A position statement of the society of hospital medicine

© 2018 Society of Hospital Medicine. Ultrasound guidance is used increasingly to perform the following 6 bedside procedures that are core competencies of hospitalists: abdominal paracentesis, arterial catheter placement, arthrocentesis, central venous catheter placement, lumbar puncture, and thoracentesis. Yet most hospitalists have not been certified to perform these procedures, whether using ultrasound guidance or not, by specialty boards or other institutions extramural to their own hospitals. Instead, hospital privileging committees often ask hospitalist group leaders to make ad hoc intramural certification assessments as part of credentialing. Given variation in training and experience, such assessments are not straightforward “sign offs.” We thus convened a panel of experts to conduct a systematic review to provide recommendations for credentialing hospitalist physicians in ultrasound guidance of these 6 bedside procedures. Pathways for initial and ongoing credentialing are proposed. A guiding principle of both is that certification assessments for basic competence are best made through direct observation of performance on actual patients