Characteristics of ambulatory anticoagulant adverse drug events: a descriptive study

<p>Abstract</p> <p>Background</p> <p>Despite the high frequency with which adverse drug events (ADEs) occur in outpatient settings, detailed information regarding these events remains limited. Anticoagulant drugs are associated with increased safety concerns and are commonly involved in outpatient ADEs. We therefore sought to evaluate ambulatory anticoagulation ADEs and the patient population in which they occurred within the Duke University Health System (Durham, NC, USA).</p> <p>Methods</p> <p>A retrospective chart review of ambulatory warfarin-related ADEs was conducted. An automated trigger surveillance system identified eligible events in ambulatory patients admitted with an International Normalized Ratio (INR) >3 and administration of vitamin K. Event and patient characteristics were evaluated, and quality/process improvement strategies for ambulatory anticoagulation management are described.</p> <p>Results</p> <p>A total of 169 events in 167 patients were identified from December 1, 2006-June 30, 2008 and included in the study. A median supratherapeutic INR of 6.1 was noted, and roughly half of all events (52.1%) were associated with a bleed. Nearly 74% of events resulted in a need for fresh frozen plasma; 64.8% of bleeds were classified as major. A total of 59.2% of events were at least partially responsible for hospital admission. Median patient age was 68 y (range 36-95 y) with 24.9% initiating therapy within 3 months prior to the event. Of events with a prior documented patient visit (n = 157), 73.2% were seen at a Duke clinic or hospital within the previous month. Almost 80% of these patients had anticoagulation therapy addressed, but only 60.0% had a follow-up plan documented in the electronic note.</p> <p>Conclusions</p> <p>Ambulatory warfarin-related ADEs have significant patient and healthcare utilization consequences in the form of bleeding events and associated hospital admissions. Recommendations for improvement in anticoagulation management include use of information technology to assist monitoring and follow-up documentation, avoid drug interactions, and engage patients in their care.</p

Abundance and Distribution of Transposable Elements in Two Drosophila QTL Mapping Resources

Here we present computational machinery to efficiently and accurately identify transposable element (TE) insertions in 146 next-generation sequenced inbred strains of Drosophila melanogaster. The panel of lines we use in our study is composed of strains from a pair of genetic mapping resources: the Drosophila Genetic Reference Panel (DGRP) and the Drosophila Synthetic Population Resource (DSPR). We identified 23,087 TE insertions in these lines, of which 83.3% are found in only one line. There are marked differences in the distribution of elements over the genome, with TEs found at higher densities on the X chromosome, and in regions of low recombination. We also identified many more TEs per base pair of intronic sequence and fewer TEs per base pair of exonic sequence than expected if TEs are located at random locations in the euchromatic genome. There was substantial variation in TE load across genes. For example, the paralogs derailed and derailed-2 show a significant difference in the number of TE insertions, potentially reflecting differences in the selection acting on these loci. When considering TE families, we find a very weak effect of gene family size on TE insertions per gene, indicating that as gene family size increases the number of TE insertions in a given gene within that family also increases. TEs are known to be associated with certain phenotypes, and our data will allow investigators using the DGRP and DSPR to assess the functional role of TE insertions in complex trait variation more generally. Notably, because most TEs are very rare and often private to a single line, causative TEs resulting in phenotypic differences among individuals may typically fail to replicate across mapping panels since individual elements are unlikely to segregate in both panels. Our data suggest that “burden tests” that test for the effect of TEs as a class may be more fruitful

Meeting Students Where They Are: Educating Students with Varying Life Experiences About the Health Care Needs of Persons with Disabilities

Purpose: Medical students enter preclinical years with varying levels of experience with individuals with disabilities. Previous experience has been shown to have a significant impact on attitudes toward this population and, hence, has the potential to impact patient care (Tervo et. al, 2002). This study examined the impact of a one-day Interclerkship on students’ self-reports regarding specific components of their attitudes, by level and type of previous disability experience. Methodology: Students met with individuals with physical or cognitive disabilities and their families in small groups to discuss their health care needs and experiences. Students also viewed a short film regarding effective methods of communication with and modifications to the clinical encounter for individuals with physical disabilities. Afternoon workshops covered a wide array of topics including assistive technology, sexuality/childbirth, mental health, community resources and bladder management. Students reported levels of experience cognitive/physical: friends, relatives, schoolmates k-12 and college. 153 (77%) students over two years completed pre-and post-Interclerkship self-assessments that rated attitudes about medical care for patients with disabilities, using a 14-item 5-point Likert scale; means were compared by paired t-test. Students also provided course feedback. Results: There was a highly significant (pConclusions: A single-day Interclerkship improved the attitudes of students’ reporting all levels and types of disability experience

Meeting Challenges in Caring for Patients with Disabilities: An Interclerkship Course

Purpose: People with disabilities use healthcare services more than those without disabilities, yet healthcare systems often fail these individuals. Understanding the needs of those with physical and cognitive disabilities is crucial in providing them with appropriate healthcare. A one-day Interclerkship introduced third-year medical students to key challenges for physicians who care for disabled patients: (1) building trust and confidence, (2) communication, (3) anticipating secondary medical conditions, (4) appropriately modifying clinical encounters, and (5) identifying appropriate community resources. Methodology: Essential elements of patient-centered care for disabled individuals were presented in plenary sessions. In small groups, students met with individuals with physical or development disabilities, their families and their community advocates, discussing healthcare and access concerns. Other workshops, taught by clinical and community experts, addressed assistive technology, parenting challenges, mental health, community resources, sexuality, and end-of-life care. Sixty-seven (69%) students completed pre-and post-Interclerkship self-assessments that rated knowledge, skills, and attitudes about medical care for disabled patients, using a 14-item 5-point Likert scale; means were compared by paired t-test. Students also provided course feedback. Results: There was a highly significant (p80% of the students agreed or strongly agreed that the Interclerkship addressed a topic essential to physician training, providing knowledge and skills not obtained elsewhere. Conclusions: A single-day Interclerkship successfully improved third year medical students self-assessed knowledge, attitudes and skills on providing appropriate medical care for disabled patient. Presented at the AAMC (Association of American Colleges) Annual Meeting, RIME (Research in Medical Education) Program, November 2006

Recurrent Chromosomal Copy Number Alterations in Sporadic Chordomas

The molecular events in chordoma pathogenesis have not been fully delineated, particularly with respect to copy number changes. Understanding copy number alterations in chordoma may reveal critical disease mechanisms that could be exploited for tumor classification and therapy. We report the copy number analysis of 21 sporadic chordomas using array comparative genomic hybridization (CGH). Recurrent copy changes were further evaluated with immunohistochemistry, methylation specific PCR, and quantitative real-time PCR. Similar to previous findings, large copy number losses, involving chromosomes 1p, 3, 4, 9, 10, 13, 14, and 18, were more common than copy number gains. Loss of CDKN2A with or without loss of CDKN2B on 9p21.3 was observed in 16/20 (80%) unique cases of which six (30%) showed homozygous deletions ranging from 76 kilobases to 4.7 megabases. One copy loss of the 10q23.31 region which encodes PTEN was found in 16/20 (80%) cases. Loss of CDKN2A and PTEN expression in the majority of cases was not attributed to promoter methylation. Our sporadic chordoma cases did not show hotspot point mutations in some common cancer gene targets. Moreover, most of these sporadic tumors are not associated with T (brachyury) duplication or amplification. Deficiency of CDKN2A and PTEN expression, although shared across many other different types of tumors, likely represents a key aspect of chordoma pathogenesis. Sporadic chordomas may rely on mechanisms other than copy number gain if they indeed exploit T/ brachyury for proliferation

Using an Observational Framework to investigate adult language input to young children in a naturalistic environment

The correlation between the communicative intent of parents, in terms of their expectation of a response and the response patterns of young children aged 23—25 months during parent—child interactions, was investigated. An Observational Framework was used to code these parameters in interactions between 36 children and their mothers. The children were assigned by cluster analysis to `advanced', `typical' and `delayed' language groups and their responses were coded with respect to the degree of correctness or appropriateness within the interaction. Differences in both the parental response expectations and the children's response patterns across the three clusters are discussed

The Lantern Vol. 53, No. 2, Spring 1987

• The One • Homecoming-1946 • Puff • Victory • The Prelude • Playtime • There\u27s a Killer in My Heart • Who is Keats? • Relationships • It\u27s OK • Rasping • Wearers of Underwear • Conjecture • Look Her in the Eye • Counterpoint • When the Air is Biting • A Stream of Consciousness • Bach\u27s Concerto in E • Tomorrow Morn • Ruminations on Bob Dylan • Last Night a Dream • Stephen • A Baseball Story • I Am Sorry • And Baby Makes Two • Next on Mr. Steinbeck\u27s Itinerary • Upon Visiting the Nursing Home • Taps for Ralph • Yes, I Believe • The Morning After • Conversation • Dear Man • Autumn Leaveshttps://digitalcommons.ursinus.edu/lantern/1130/thumbnail.jp

Social Network Evolution during Long-term Migration: A comparison of three case studies in the South Wales region

Ten years after Poland joined the European Union (EU), a sizable number of the once considered short-term migrants that entered the United Kingdom (UK) post-2004 have remained. From the literature, it is known that when initially migrating, social networks, composed of family and friends, are used to facilitate migration. Later, migrants’ social networks may evolve to include local, non-ethnic members of the community. Through these networks, migrants may access new opportunities within the local economy. They also serve to socialise newcomers in the cultural modalities of life in the destination country. However, what if migrants’ social networks do not evolve or evolve in a limited manner? Is cultural integration still possible under these conditions? Using data collected from three case studies in the South Wales region –Cardiff, Merthyr Tydfil & Llanelli- from 2008-2012, the aim of this article is to compare Polish migrants’ social network usage, or lack thereof, over time. This comparison will be used to understand how these social networks can be catalysts and barriers for cultural integration. The findings point to the migrants’ varied use of their local social networks, which is dependent upon their language skill acquisition and their labour market mobility in the destination country

Emergence of an Ultra-Red Ultra-Massive Galaxy Cluster Core at z=4

Recent simulations and observations of massive galaxy cluster evolution predict that the majority of stellar mass buildup happens within cluster members by z = 2, before cluster virialization. Protoclusters rich with dusty, star-forming galaxies (DSFGs) at z > 3 are the favored candidate progenitors for these massive galaxy clusters at z ~ 0. We present here the first study analyzing stellar emission along with cold dust and gas continuum emission in a spectroscopically confirmed z = 4.002 protocluster core rich with DSFGs, the Distant Red Core (DRC). We combine new Hubble Space Telescope and Spitzer data with existing Gemini, Herschel, and Atacama Large Millimeter/submillimeter Array observations to derive individual galaxy-level properties and compare them to coeval field and other protocluster galaxies. All of the protocluster members are massive (>1010 M ⊙), but not significantly more so than their coeval field counterparts. Within uncertainty, all are nearly indistinguishable from galaxies on the star-forming versus stellar mass main-sequence relationship and the star formation efficiency plane. Assuming no future major influx of fresh gas, we estimate that these gaseous DSFGs will deplete their gas reservoirs in ~300 Myr, becoming the massive quiescent ellipticals dominating cluster cores by z ~ 3. Using various methodologies, we derive a total z = 4 halo mass of ~1014 M ⊙ and estimate that the DRC will evolve to become an ultramassive cluster core of mass 1015 M ⊙ by z = 0