The utility of pulse volume waveforms in the identification of lower limb arterial insufficiency

Background: The ankle brachial index is widely used for non-invasive assessment of lower limb arterial status, but has recognised limitations. The most significant limitation involves arterial calcification, which results in artefactually raised occlusion pressures and uninformative ankle brachial indices. Hypothesis: Analysis of the pulse volume waveform is useful for identification of lower limb arterial insufficiency in the presence of arterial calcification. Method: Individuals (n = 1101) registered at a Welsh general practice were invited to undergo cardiovascular risk assessment. The ankle brachial index was measured using an automated device utilising volume plethysmography and the traditional Doppler ultrasound method. Results: Eight percent of participants (30/368) had an ankle brachial index *1.3, suggesting possible arterial calcification; consideration of the pulse volume waveform in these cases identified possible mild peripheral arterial disease in three cases (10%). Furthermore, in one case, the ankle brachial indices were within the normal range, but the pulse volume waveforms suggested a moderate degree of arterial insufficiency; this participant was subsequently diagnosed with bilateral superficial femoral artery stenoses and treated accordingly. Conclusion: Pulse volume waveforms can be easily utilised as an adjunct to ankle brachial index measurement to identify patients who may benefit from further vascular assessment and interventio

Food Preference Predicts Speed of Approach on a Runway Task by Dogs

The effective and quick assessment of food preference is important when attempting to identify foods that might function as effective reinforcers in dogs. In the current experiment, more highly preferred foods were expected to be associated with faster approaches in a subsequent runway task. Eight dogs experienced combinations of two of six types of raw food in a paired preference assessment. These included the dog’s staple diet, to identify a rank order of preference for the foods. A different raw food was offered as the staple in two preference tests. In the runway task, the dogs were required to walk five metres to obtain a small amount of their most preferred, least preferred or staple foods and latency of approach to the foods was recorded. The results showed that the staple foods were not preferred as highly as the other foods and that each dog displayed unique and stable preferences for the different foods. The approach latencies were faster for their most-preferred food compared to their least preferred and the staple foods. The use of a runway to assess reinforcer effectiveness combined an effortful behaviour to obtain food while also requiring the dogs to make a choice, thus precluding the need for more complicated and time-consuming methods of preference assessment. The application of this method for fast and effective identification of preferred reinforcers is currently being investigating further to inform pet owners and behavioural scientists better about simple methods that they might use to identify highly preferred foods for use as reinforcers in training and behavioural testing

The utility of pulse volume waveforms in the identification of lower limb arterial insufficiency

Background: The ankle brachial index is widely used for non-invasive assessment of lower limb arterial status, but has recognised limitations. The most significant limitation involves arterial calcification, which results in artefactually raised occlusion pressures and uninformative ankle brachial indices. Hypothesis: Analysis of the pulse volume waveform is useful for identification of lower limb arterial insufficiency in the presence of arterial calcification. Method: Individuals (n = 1101) registered at a Welsh general practice were invited to undergo cardiovascular risk assessment. The ankle brachial index was measured using an automated device utilising volume plethysmography and the traditional Doppler ultrasound method. Results: Eight percent of participants (30/368) had an ankle brachial index *1.3, suggesting possible arterial calcification; consideration of the pulse volume waveform in these cases identified possible mild peripheral arterial disease in three cases (10%). Furthermore, in one case, the ankle brachial indices were within the normal range, but the pulse volume waveforms suggested a moderate degree of arterial insufficiency; this participant was subsequently diagnosed with bilateral superficial femoral artery stenoses and treated accordingly. Conclusion: Pulse volume waveforms can be easily utilised as an adjunct to ankle brachial index measurement to identify patients who may benefit from further vascular assessment and interventio

Implementing educational and systems-level changes to improve cancer screening rates among state employees in Missouri

As of 2022, only 51% of active eligible state employees in Missouri have been screened for colorectal cancer and 67% for breast cancer, despite having state-sponsored health insurance. In fall 2020, the Missouri Department of Health and Senior Services Comprehensive Cancer Program partnered with the Missouri Cancer Consortium to create a strategy to improve cancer screening rates among state employees. The project was designed to include 3 phases: 1) a colorectal cancer education phase, 2) an expanded education phase that included additional cancers, and 3) a proposed intervention phase that will include screening events. In the first phase, in 2020, colorectal cancer educational materials were sent to all state employees. In the second phase, in 2022, educational resources were expanded to include additional cancers and screening tools. In both initiatives, educational materials and information on current screening recommendations were distributed to approximately 40,000 state employees. A database of screening rates was developed to monitor screening rates and challenge state employees to complete screenings. Evidence-informed interventions were implemented with a focus on health equity. We used a regional approach to identify geographic areas with the greatest need. These efforts will support the next phase of the project, which involves planning breast and colorectal cancer screening events. Policy changes will be encouraged to remove systems-level barriers that discourage employees from being screened for cancer. Recommended tools and strategies can be adopted by similar organizations with complex, multitier employee structures

Nystagmus Assessments Documented by Emergency Physicians in Acute Dizziness Presentations: A Target for Decision Support?

Objectives:  Dizziness is a common presenting complaint to the emergency department (ED), and emergency physicians (EPs) consider these presentations a priority for decision support. Assessing for nystagmus and defining its features are important steps for any acute dizziness decision algorithm. The authors sought to describe nystagmus documentation in routine ED care to determine if nystagmus assessments might be an important target in decision support efforts. Methods:  Medical records from ED visits for dizziness were captured as part of a surveillance study embedded within an ongoing population‐based cohort study. Visits with documentation of a nystagmus assessment were reviewed and coded for presence or absence of nystagmus, ability to draw a meaningful inference from the description, and coherence with the final EP diagnosis when a peripheral vestibular diagnosis was made. Results:  Of 1,091 visits for dizziness, 887 (81.3%) documented a nystagmus assessment. Nystagmus was present in 185 of 887 (20.9%) visits. When nystagmus was present, no further characteristics were recorded in 48 of the 185 visits (26%). The documentation of nystagmus (including all descriptors recorded) enabled a meaningful inference about the localization or cause in only 10 of the 185 (5.4%) visits. The nystagmus description conflicted with the EP diagnosis in 113 (80.7%) of the 140 visits that received a peripheral vestibular diagnosis. Conclusions:  Nystagmus assessments are frequently documented in acute dizziness presentations, but details do not generally enable a meaningful inference. Recorded descriptions usually conflict with the diagnosis when a peripheral vestibular diagnosis is rendered. Nystagmus assessments might be an important target in developing decision support for dizziness presentations.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86927/1/j.1553-2712.2011.01093.x.pd

Enantioselective Intramolecular C-H Amination Catalyzed by Engineered Cytochrome P450 Enzymes In Vitro and In Vivo

Nitrogen activation: Though P450 enzymes are masters of oxygen activation and insertion into C-H bonds, their ability to use nitrogen for the same purpose has so far not been explored. Engineered variants of cytochrome P450_(BM3) have now been found to catalyze intramolecular C-H aminations in azide substrates. Mutations to two highly conserved residues significantly increased this activity

Food Preference Predicts Speed of Approach on a Runway Task by Dogs

The effective and quick assessment of food preference is important when attempting to identify foods that might function as effective reinforcers in dogs. In the current experiment a food preference assessment was conducted where more highly preferred foods were expected to be associated with faster approaches in a subsequent runway task. Eight dogs were tested in a paired preference assessment offering combinations of two of six types of raw food, including the dog's staple diet, to identify a rank order of preference for the foods. A different raw food was offered as the staple in two preference tests. The results showed that the staple foods were not preferred as highly as the other foods and that each dog displayed unique and stable preferences for the different foods. In the runway task the dogs were required to walk five metres to obtain a small amount of their most preferred, least preferred or staple foods and latency of approach to the foods was recorded. The approach latencies were faster for their most preferred food compared to their least preferred and the staple foods. The use of a runway to assess reinforcer effectiveness combined an effortful behaviour to obtain food while also requiring the dogs to make a choice, thus precluding the need for more complicated and time-consuming methods of preference assessment. The application of this method for fast and effective identification of preferred reinforcers is currently being investigating further to inform pet owners of simple methods to increase their training successes. Owners of raw food fed dogs are advised to conduct a preference assessment to identify their dogs most preferred food for use as a reinforcer during training