Lumbar Radiculopathy Post Lumbar Discectomy: A Case Study

Background and Purpose: Low back pain (LBP) is one of the most common and costly musculoskeletal diagnosis in America. Approximately 50% of individuals with LBP have recurrent episodes by 1 year, 60% by 2 years, and 70% by 5 years. Micro-lumbar discectomies are often performed to relieve the radiculopathy and pain associated with nerve root entrapment. The purpose of this case study was to describe the clinical decision process implemented for the post-operative assessment and intervention of a patient with a L4-5, L5-S1 discectomy and to outline the associated outcomes. Case Description: The patient, a 26 year-old male, underwent a L4-5 and L5-S1 micro-discectomy 10 months prior to presenting to physical therapy with a diagnosis of right L4-5, S1 radiculopathy. Co-morbidities included alcohol and tobacco addiction. Prior to this episode of care, the patient attempted a multitude of care options, with no systemic relief. Plan of Care: Multiple interventions were utilized throughout the treatment sessions due to low patient tolerance. The patient reported a decrease in pain, an increase in time for onset of pain, increased work tolerance, and a centralization of radicular symptoms. Clinical Decision Making: Clinical decisions were based on current evidence and the International Classification of Functioning, Health and Disease (ICF) model. Outcomes were evaluated through the use of visual analog pain scale, location of radicular symptoms, and the Oswestry Disability Index. Reflection on Practice: Using a combination of intervention resulted in the best functional outcomes for this patient. The patient\u27s substance abuse contributed to the lack of program adherence

Implementing Behavioral Health Integration in Primary Care

A detailed review of the teaching assistance (TA) and shared learning (SL) in the area of behavioral health integration UMass Medical School provided to participants of the Primary Care Payment Reform program, an alternative payment pilot developed by the Massachusetts Medicaid program, MassHealth. PCPR was designed to improve access, patient experience, quality and efficiency. As a result of TA and SL, practices reported higher rates on behavioral health quality measures and milestones

Water Quality in Maunalua Bay

In 2002, the Hawaii State Department of Health declared Maunalua Bay an impaired water body, indicating that pollution levels do not meet state standards for public safety. Causes of declining water quality in the bay include: increased urban development, the use of pesticides for landscaping, and alterations of natural streams. These human-induced changes have resulted in increased levels of nutrients, chlorophyll, and turbidity in the bay, which decreases native seagrass and coral health and encourages invasive algal presence and sand accumulation. Despite knowledge of these issues, few efforts have been successful in limiting human impacts on water quality. Therefore, our group has taken steps to characterize water quality in Maunalua Bay, to test methods for water quality assessment, and develop recommendations for constructing a Quality Assurance Project Plan to allow for consistent monitoring of water quality in the bay and facilitate the release of information to stakeholders and community members

Development and implementation of take-home naloxone kit for patients admitted to the emergency department of a large tertiary care hospital

Title: Development and implementation of take-home naloxone kit for patients admitted to the emergency department of a large tertiary care hospital Authors: Myung Seon (Amy) Song, PharmD; Pamela Levine, PharmD, BCPS; Katharine F. Marshall, MD; Chelsea Harmon, PharmD Candidate 2020 Background/Purpose: In 2017, the United States Department of Health and Human Services (HHS) declared the opioid epidemic as a public health emergency as more than 70,000 people died from drug overdoses. Approximately 75% percent of unintentional opioid-overdose deaths occurred outside of a medical setting. In order to combat the opioid crisis, the US Surgeon General urged prescribers and pharmacists to increase access to naloxone for individuals who are at risk for opioid overdose. Community overdose education and naloxone distribution (OEND) programs have demonstrated that take-home naloxone kits are associated with reduced opioid-overdose death rates and are cost-effective. From January 2016 – June 2019, about 4,016 emergency department (ED) and urgent care visits in the Portland metropolitan area were identified to be due to opioid overdose. Recent data from the Centers for Disease Control and Prevention (CDC) indicates a continuing upward trend, making the ED a critical intervention point for providers and pharmacists to engage patients with at-risk of opioid overdose and provide evidence-based interventions such as take-home naloxone kit. The primary objective of this study is to develop and implement a pharmacist driven take-home naloxone kit protocol. The secondary objective is to increase access to naloxone by prescribing and dispensing kits to at-risk patients in the emergency department. Methods: A retrospective quasi-experimental, pre- and post-protocol analysis, will be used to compare the number of prescriptions written prior to implementation of protocol (April 1, 2017 to September 1, 2019) to the number of take-home naloxone kit dispensed post implementation of the protocol. Inclusion criteria include patients 18 years or older and admitted to ED for treatment of opioid overdose, or with risk factors of opioid overdose. The primary endpoint is number of naloxone prescription written and take-home naloxone kits dispensed. Results: Key stakeholders were identified and engaged in developing the protocol. Operational and cost consideration were reviewed. Various factors affected development and implementation of the study. Conclusions: Adaptation of parts of the study to take place in two large tertiary care hospitals. IRB status: Pendinghttps://digitalcommons.psjhealth.org/pharmacy_PGY1/1011/thumbnail.jp

Designing Against the Status Quo

Community + Culture features practitioner perspectives on designing technologies for and with communities. We highlight compelling projects and provocative points of view that speak to both community technology practice and the interaction design field as a whole

Calcium-Dependent Protein Kinases from Arabidopsis Show Substrate Specificity Differences in an Analysis of 103 Substrates

The identification of substrates represents a critical challenge for understanding any protein kinase-based signal transduction pathway. In Arabidopsis, there are more than 1000 different protein kinases, 34 of which belong to a family of Ca2+-dependent protein kinases (CPKs). While CPKs are implicated in regulating diverse aspects of plant biology, from ion transport to transcription, relatively little is known about isoform-specific differences in substrate specificity, or the number of phosphorylation targets. Here, in vitro kinase assays were used to compare phosphorylation targets of four CPKs from Arabidopsis (CPK1, 10, 16, and 34). Significant differences in substrate specificity for each kinase were revealed by assays using 103 different substrates. For example CPK16 phosphorylated Serine 109 in a peptide from the stress-regulated protein, Di19-2 with KM ∼70 μM, but this site was not phosphorylated significantly by CPKs 1, 10, or 34. In contrast, CPKs 1, 10, and 34 phosphorylated 93 other peptide substrates not recognized by CPK16. Examples of substrate specificity differences among all four CPKs were verified by kinetic analyses. To test the correlation between in vivo phosphorylation events and in vitro kinase activities, assays were performed with 274 synthetic peptides that contained phosphorylation sites previously mapped in proteins isolated from plants (in vivo-mapped sites). Of these, 74 (27%) were found to be phosphorylated by at least one of the four CPKs tested. This 27% success rate validates a robust strategy for linking the activities of specific kinases, such as CPKs, to the thousands of in planta phosphorylation sites that are being uncovered by emerging technologies

Behavioral Influences on Preterm Birth: Integrated Analysis of the Pregnancy, Infection, and Nutrition Study

Most previous studies of preterm birth have considered risk factors in isolation rather than examining the collective impact of multiple candidate determinants. In order to examine the combined impact of a set of behavioral risk factors on the risk of preterm birth, we analyzed data collected for the Pregnancy, Infection, and Nutrition Study on a range of sociodemographic, behavioral, and related factors. Women who received prenatal care at selected clinics in central North Carolina and gave birth in the period 1995–2005 were recruited into a prospective cohort study, with 4,251 women providing the required information on risk factors and pregnancy outcome. A number of demographic and behavioral attributes were modestly associated with preterm birth, with odds ratios of 1.3–1.5, including age >35, African-American ethnicity, height of 63 inches or less, parity 2+, and delivery at the academic medical center. Despite weak associations for individual risk factors, changes in a constellation of behaviors during pregnancy predict substantial shifts in the risk of preterm birth, suggesting a reduction from 8 to 3% preterm among those with a low-risk baseline profile, and a reduction from 18 to 7% pre-term among those with a high-risk baseline profile. While inferences are limited by the incomplete range of available predictors, uncertainty regarding whether observed associations are causal, and substantial challenges in changing component behaviors, the possibility of substantial reduction in risk merits more serious consideration of whether behavioral interventions could markedly reduce the risk of preterm birth

Epidermolytic Ichthyosis Sine Epidermolysis

Epidermolytic ichthyosis (EI) is a rare disorder of cornification caused by mutations in KRT1 and KRT10, encoding two suprabasal epidermal keratins. Because of the variable clinical features and severity of the disease, histopathology is often required to correctly direct the molecular analysis. EI is characterized by hyperkeratosis and vacuolar degeneration of the upper epidermis, also known as epidermolytic hyperkeratosis, hence the name of the disease. In the current report, the authors describe members of 2 families presenting with clinical features consistent with EI. The patients were shown to carry classical mutations in KRT1 or KRT10, but did not display epidermolytic changes on histology. These observations underscore the need to remain aware of the limitations of pathological features when considering a diagnosis of EI

Ring test evaluation of the detection of influenza A virus in swine oral fluids by real-time reverse-transcription polymerase chain reaction and virus isolation

The probability of detecting influenza A virus (IAV) in oral fluid (OF) specimens was calculated for each of 13 assays based on real-time reverse-transcription polymerase chain reaction (rRT-PCR) and 7 assays based on virus isolation (VI). The OF specimens were inoculated with H1N1 or H3N2 IAV and serially diluted 10-fold (10(-1) to 10(-8)). Eight participating laboratories received 180 randomized OF samples (10 replicates × 8 dilutions × 2 IAV subtypes plus 20 IAV-negative samples) and performed the rRT-PCR and VI procedure(s) of their choice. Analysis of the results with a mixed-effect logistic-regression model identified dilution and assay as variables significant (P \u3c 0.0001) for IAV detection in OF by rRT-PCR or VI. Virus subtype was not significant for IAV detection by either rRT-PCR (P = 0.457) or VI (P = 0.101). For rRT-PCR the cycle threshold (Ct) values increased consistently with dilution but varied widely. Therefore, it was not possible to predict VI success on the basis of Ct values. The success of VI was inversely related to the dilution of the sample; the assay was generally unsuccessful at lower virus concentrations. Successful swine health monitoring and disease surveillance require assays with consistent performance, but significant differences in reproducibility were observed among the assays evaluated