3,595 research outputs found

    Differentiation of Cardiac from Noncardiac Pleural Effusions in Cats using Second-Generation Quantitative and Point-of-Care NT-proBNP Measurements

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    BACKGROUND: Pleural effusion is a common cause of dyspnea in cats. N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) measurement, using a first‐generation quantitative ELISA, in plasma and pleural fluid differentiates cardiac from noncardiac causes of pleural effusion. HYPOTHESIS/OBJECTIVES: To determine whether NT‐proBNP measurements using second‐generation quantitative ELISA and point‐of‐care (POC) tests in plasma and pleural fluid distinguish cardiac from noncardiac pleural effusions and how results compare to the first‐generation ELISA. ANIMALS: Thirty‐eight cats (US cohort) and 40 cats (UK cohort) presenting with cardiogenic or noncardiogenic pleural effusion. METHODS: Prospective cohort study. Twenty‐one and 17 cats in the US cohort, and 22 and 18 cats in the UK cohort were classified as having cardiac or noncardiac pleural effusion, respectively. NT‐proBNP concentrations in paired plasma and pleural fluid samples were measured using second‐generation ELISA and POC assays. RESULTS: The second‐generation ELISA differentiated cardiac from noncardiac pleural effusion with good diagnostic accuracy (plasma: sensitivity, 95.2%, specificity, 82.4%; pleural fluid: sensitivity, 100%, specificity, 76.5%). NT‐proBNP concentrations were greater in pleural fluid (719 pmol/L (134–1500)) than plasma (678 pmol/L (61–1500), P = 0.003), resulting in different cut‐off values depending on the sample type. The POC test had good sensitivity (95.2%) and specificity (87.5%) when using plasma samples. In pleural fluid samples, the POC test had good sensitivity (100%) but low specificity (64.7%). Diagnostic accuracy was similar between first‐ and second‐generation ELISA assays. CONCLUSIONS AND CLINICAL IMPORTANCE: Measurement of NT‐proBNP using a quantitative ELISA in plasma and pleural fluid or POC test in plasma, but not pleural fluid, distinguishes cardiac from noncardiac causes of pleural effusion in cats

    Development of a post-fall multidisciplinary checklist to evaluate the in-patient fall

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    Background: Falls suffered by hospitalized patients are an important reportable event. Approximately 4 - 6 % of inpatient falls result in serious injury. Recurrent falls or delayed recognition of injury can harm patients and represents a medico-legal risk. In 2010, our tertiary-care academic medical center reviewed current practice regarding falls prevention and assessment to develop a comprehensive falls prevention program. The committee found that there was no consistent practice in the assessment by nurses or physicians of inpatients who had fallen, either for injury or for conditions which might have led to the fall. A new systematic checklist for evaluation of the hospital faller was developed by a team consisting of nursing, hospitalists, and a medical unit director. Purpose: To develop an evidence-based multi-disciplinary checklist to facilitate evaluation, implementation of secondary prevention interventions and documentation following a hospital fall. Description: The hospitalist and the general medical unit director reviewed relevant literature, consulted national experts, and drafted a multidisciplinary checklist, the UNMH Post-Fall/Huddle Tool, to be used by nurses and physicians in post-fall patient evaluation. The checklist was reviewed and revised with further input from key stakeholders including hospitalists, housestaff, and the adult Medical/Surgical Shared Governance Committee. It was implemented as part of a comprehensive falls prevention program 3 month pilot. The checklist prompts a three step process: (1) an initial 7-item assessment by nursing staff to determine factors which would necessitate immediate evaluation by cross-covering physicians versus deferring evaluation to the primary team; (2) a 5-item focused physical examination to be performed by a physician to assess the likelihood of injury and suggested diagnostic tests based on this examination; and (3) an interdisciplinary face-to-face meeting between the evaluating physician and nurse to review 7 specific possible precipitating events and implement potential interventions. The UNMH Post-Fall/Huddle Tool will be adapted into the electronic health record after pilot completion and evaluation. An educational presentation about falls and how to use the checklist was developed for residents and hospitalists. Use of the checklist was implemented in November, 2010. To date, nurses and residents report that the checklist is easy to use and that it facilitates a timely, multidisciplinary evaluation of patients who have fallen in the hospital. Conclusion: A multi-disciplinary post-fall checklist facilitates a consistent and evidence-based evaluation and treatment of patients who have fallen in the hospital

    Junior faculty exchange program assists mid-career clinician-educators increase scholarly activity and meet promotion requirements

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    Project: Our institution requires peer-review scholarly products and an extramural reputation for promotion of clinician-educators to Associate Professor. Given a lack of robust research skill training during residency and a paucity of research mentors in our Division of Hospital Medicine, meeting these two promotion requirements has been especially challenging for many of our hospitalist faculty. We established a junior faculty exchange with other institutions in order to assist individual faculty members to gain a reputation outside of their home institutions, to develop external mentorship and career advice relationships with early career faculty, and to enhance networking and project collaborations. Methods: Participants were mid-career faculty who would gain the maximal career benefit from delivering an invited visit to an external institution and who have sufficient track record to deliver effective mentoring advice to early career hospitalists. Faculty at the late Assistant Professor level or recently promoted Associate Professors were selected by their Divisions leadership to spend one day at a hosting institution, deliver an invited grand rounds or similar didactic presentation, meet with senior leadership, and provide career advice to junior faculty. The program was reciprocal with one faculty member visiting an institution in exchange for that institution hosting a faculty member for a similar invited visit. Each institution covered the cost of travel and hotel accommodations. No honoraria were paid. Results: Over the first two years, four junior academic hospitalists were exchanged between three institutions. There was a high degree of satisfaction among surveyed visiting and visited junior faculty. Two on-going collaborative relationships and one jointly authored paper have resulted to date. Conclusion: A junior faculty exchange program assisted mid-career academic hospitalists establish extramural collaborations and meet promotion requirements that have been problematic at our institution. Implication: This relatively inexpensive faculty development program is easily adaptable by other institutions and may help generalist faculty increase scholarly activity, develop extra-institutional relationships, and achieve promotion.\u2

    Predicting Amount of Compensatory Gain

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    In North American beef production systems, the entire spectrum of restriction and compensation is found. The area of compensatory gain is complex and not well understood, but critically important to the economics of cattle feeding. Several compensatory gain studies from the University of Nebraska have been compiled. The range in compensation observed with cattle grazing season-long is 19-88 percent with a mean of 53 percent. From these grazing studies, days of restriction appear to be related to percentage compensation. In the feedlot, even relatively short restrictions trigger compensatory gain; however, feed efficiency response to compensatory gain i

    Peatland initiation and carbon accumulation in the Falkland Islands

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    The Falkland Islands in the South Atlantic Ocean contain extensive peatlands at the edge of their global climatic envelope, but the long-term carbon dynamics of these sites is poorly quantified. We present new data for ten sites, compile previously-published data and produce a new synthesis. Many peatlands in the Falkland Islands developed notably early, with a fifth of basal 14 C dates pre-Holocene. Falkland Islands peats have high ash content, high carbon content and high bulk density compared to global norms. In many sites carbon accumulation rates are extremely low, which may partly relate to low average rainfall, or to carbon loss through burning and aeolian processes. However, in coastal Tussac peatlands carbon accumulation can be extremely rapid. Our re-analysis of published data from Beauchene Island, the southernmost of the Falkland Islands, yields an exceptional long-term apparent carbon accumulation rate of 139 g C m −2 yr −1 , to our knowledge the highest recorded for any global peatland. This high accumulation might relate to the combination of a long growing-season and marine nutrient inputs. Given extensive coverage and carbon-dense peats the carbon stock of Falkland Islands peatlands is clearly considerable but robust quantification will require the development of a reliable peat map. Falkland Island peatlands challenge many standard assumptions and deserve more detailed study

    Antigen depot is not required for alum adjuvanticity

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    Alum adjuvants have been in continuous clinical use for more than 80 yr. While the prevailing theory has been that depot formation and the associated slow release of antigen and/or inflammation are responsible for alum enhancement of antigen presentation and subsequent T- and B-cell responses, this has never been formally proven. To examine antigen persistence, we used the chimeric fluorescent protein EαGFP, which allows assessment of antigen presentation in situ, using the Y-Ae antibody. We demonstrate that alum and/or CpG adjuvants induced similar uptake of antigen, and in all cases, GFP signal did not persist beyond 24 h in draining lymph node antigen-presenting cells. Antigen presentation was first detectable on B cells within 6–12 h of antigen administration, followed by conventional dendritic cells (DCs) at 12–24 h, then finally plasmacytoid DCs at 48 h or later. Again, alum and/or CpG adjuvants did not have an effect on the magnitude or sequence of this response; furthermore, they induced similar antigen-specific T-cell activation in vivo. Notably, removal of the injection site and associated alum depot, as early as 2 h after administration, had no appreciable effect on antigen-specific T- and B-cell responses. This study clearly rules out a role for depot formation in alum adjuvant activity

    A systematic approach to simultaneously evaluate safety, immunogenicity, and efficacy of novel tuberculosis vaccination strategies

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    Tuberculosis (TB) is the deadliest infectious disease worldwide. Bacille-Calmette-Guerin (BCG), the only licensed TB vaccine, affords variable protection against TB but remains the gold standard. BCG improvement is focused around three strategies: recombinant BCG strains, heterologous routes of administration, and booster vaccination. It is currently unknown whether combining these strategies is beneficial. The preclinical evaluation for new TB vaccines is heavily skewed toward immunogenicity and efficacy; however, safety and efficacy are the dominant considerations in human use. To facilitate stage gating of TB vaccines, we developed a simple empirical model to systematically rank vaccination strategies by integrating multiple measurements of safety, immunogenicity, and efficacy. We assessed 24 vaccination regimens, composed of three BCG strains and eight combinations of delivery. The model presented here highlights that mucosal booster vaccination may cause adverse outcomes and provides a much needed strategy to evaluate and rank data obtained from TB vaccine studies using different routes, strains, or animal models
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