Kawasaki disease following Rocky Mountain spotted fever: a case report

<p>Abstract</p> <p>Introduction</p> <p>Kawasaki disease is an idiopathic acute systemic vasculitis of childhood. Although it simulates the clinical features of many infectious diseases, an infectious etiology has not been established. This is the first reported case of Kawasaki disease following Rocky Mountain spotted fever.</p> <p>Case presentation</p> <p>We report the case of a 4-year-old girl who presented with fever and petechial rash. Serology confirmed Rocky Mountain spotted fever. While being treated with intravenous doxycycline, she developed swelling of her hands and feet. She had the clinical features of Kawasaki disease which resolved after therapy with intravenous immune globulin (IVIG) and aspirin.</p> <p>Conclusion</p> <p>This case report suggests that Kawasaki disease can occur concurrently or immediately after a rickettsial illness such as Rocky Mountain spotted fever, hypothesizing an antigen-driven immune response to a rickettsial antigen.</p

The Effective Fragment Molecular Orbital Method for Fragments Connected by Covalent Bonds

We extend the effective fragment molecular orbital method (EFMO) into treating fragments connected by covalent bonds. The accuracy of EFMO is compared to FMO and conventional ab initio electronic structure methods for polypeptides including proteins. Errors in energy for RHF and MP2 are within 2 kcal/mol for neutral polypeptides and 6 kcal/mol for charged polypeptides similar to FMO but obtained two to five times faster. For proteins, the errors are also within a few kcal/mol of the FMO results. We developed both the RHF and MP2 gradient for EFMO. Compared to ab initio, the EFMO optimized structures had an RMSD of 0.40 and 0.44 {\AA} for RHF and MP2, respectively.Comment: Revised manuscrip

Organizational factors and depression management in community-based primary care settings

Abstract Background Evidence-based quality improvement models for depression have not been fully implemented in routine primary care settings. To date, few studies have examined the organizational factors associated with depression management in real-world primary care practice. To successfully implement quality improvement models for depression, there must be a better understanding of the relevant organizational structure and processes of the primary care setting. The objective of this study is to describe these organizational features of routine primary care practice, and the organization of depression care, using survey questions derived from an evidence-based framework. Methods We used this framework to implement a survey of 27 practices comprised of 49 unique offices within a large primary care practice network in western Pennsylvania. Survey questions addressed practice structure (e.g., human resources, leadership, information technology (IT) infrastructure, and external incentives) and process features (e.g., staff performance, degree of integrated depression care, and IT performance). Results The results of our survey demonstrated substantial variation across the practice network of organizational factors pertinent to implementation of evidence-based depression management. Notably, quality improvement capability and IT infrastructure were widespread, but specific application to depression care differed between practices, as did coordination and communication tasks surrounding depression treatment. Conclusions The primary care practices in the network that we surveyed are at differing stages in their organization and implementation of evidence-based depression management. Practical surveys such as this may serve to better direct implementation of these quality improvement strategies for depression by improving understanding of the organizational barriers and facilitators that exist within both practices and practice networks. In addition, survey information can inform efforts of individual primary care practices in customizing intervention strategies to improve depression management.http://deepblue.lib.umich.edu/bitstream/2027.42/78269/1/1748-5908-4-84.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78269/2/1748-5908-4-84-S1.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78269/3/1748-5908-4-84.pdfPeer Reviewe

Structure-Based Discovery of A2A Adenosine Receptor Ligands

The recent determination of X-ray structures of pharmacologically relevant GPCRs has made these targets accessible to structure-based ligand discovery. Here we explore whether novel chemotypes may be discovered for the A(2A) adenosine receptor, based on complementarity to its recently determined structure. The A(2A) adenosine receptor signals in the periphery and the CNS, with agonists explored as anti-inflammatory drugs and antagonists explored for neurodegenerative diseases. We used molecular docking to screen a 1.4 million compound database against the X-ray structure computationally and tested 20 high-ranking, previously unknown molecules experimentally. Of these 35% showed substantial activity with affinities between 200 nM and 9 microM. For the most potent of these new inhibitors, over 50-fold specificity was observed for the A(2A) versus the related A(1) and A(3) subtypes. These high hit rates and affinities at least partly reflect the bias of commercial libraries toward GPCR-like chemotypes, an issue that we attempt to investigate quantitatively. Despite this bias, many of the most potent new ligands were novel, dissimilar from known ligands, providing new lead structures for modulation of this medically important target

A group randomized trial of a complexity-based organizational intervention to improve risk factors for diabetes complications in primary care settings: study protocol

<p>Abstract</p> <p>Background</p> <p>Most patients with type 2 diabetes have suboptimal control of their glucose, blood pressure (BP), and lipids – three risk factors for diabetes complications. Although the chronic care model (CCM) provides a roadmap for improving these outcomes, developing theoretically sound implementation strategies that will work across diverse primary care settings has been challenging. One explanation for this difficulty may be that most strategies do not account for the complex adaptive system (CAS) characteristics of the primary care setting. A CAS is comprised of individuals who can learn, interconnect, self-organize, and interact with their environment in a way that demonstrates non-linear dynamic behavior. One implementation strategy that may be used to leverage these properties is practice facilitation (PF). PF creates time for learning and reflection by members of the team in each clinic, improves their communication, and promotes an individualized approach to implement a strategy to improve patient outcomes.</p> <p>Specific objectives</p> <p>The specific objectives of this protocol are to: evaluate the effectiveness and sustainability of PF to improve risk factor control in patients with type 2 diabetes across a variety of primary care settings; assess the implementation of the CCM in response to the intervention; examine the relationship between communication within the practice team and the implementation of the CCM; and determine the cost of the intervention both from the perspective of the organization conducting the PF intervention and from the perspective of the primary care practice.</p> <p>Intervention</p> <p>The study will be a group randomized trial conducted in 40 primary care clinics. Data will be collected on all clinics, with 60 patients in each clinic, using a multi-method assessment process at baseline, 12, and 24 months. The intervention, PF, will consist of a series of practice improvement team meetings led by trained facilitators over 12 months. Primary hypotheses will be tested with 12-month outcome data. Sustainability of the intervention will be tested using 24 month data. Insights gained will be included in a delayed intervention conducted in control practices and evaluated in a pre-post design.</p> <p>Primary and secondary outcomes</p> <p>To test hypotheses, the unit of randomization will be the clinic. The unit of analysis will be the repeated measure of each risk factor for each patient, nested within the clinic. The repeated measure of glycosylated hemoglobin A1c will be the primary outcome, with BP and Low Density Lipoprotein (LDL) cholesterol as secondary outcomes. To study change in risk factor level, a hierarchical or random effect model will be used to account for the nesting of repeated measurement of risk factor within patients and patients within clinics.</p> <p>This protocol follows the CONSORT guidelines and is registered per ICMJE guidelines:</p> <p>Clinical Trial Registration Number</p> <p>NCT00482768</p

A high‐resolution view of the coordination environment in a paramagnetic metalloprotein from its magnetic properties

Metalloproteins constitute a significant fraction of the proteome of all organisms and their characterization is critical for both basic sciences and biomedical applications. A large portion of metalloproteins bind paramagnetic metal ions, and paramagnetic NMR spectroscopy has been widely used in their structural characterization. However, the signals of nuclei in the immediate vicinity of the metal center are often broadened beyond detection. In this work, we show that it is possible to determine the coordination environment of the paramagnetic metal in the protein at a resolution inaccessible to other techniques. Taking the structure of a diamagnetic analogue as a starting point, a geometry optimization is carried out by fitting the pseudocontact shifts obtained from first principles quantum chemical calculations to the experimental ones

VILNIAUS MIESTO ŠEŠKINĖS POLIKLINIKOS PACIENTŲ APKLAUSA APIE SVEIKATOS PRIEŽIŪROS PASLAUGŲ PRIEINAMUMĄ – NUOMONĖ PAGAL PACIENTŲ AMŽIŲ IR IŠSILAVINIMĄ

Tyrimas atliktas 2014.05–2014.06 laikotarpiu. Buvo apklausinėjami 18 metų sulaukę respondentai. Iš pradžių 450 anketų buvo išskirstytos į registratūras, iš jų 442 anketos grįžo (grįžtamumas 98,2 proc.). Anketa buvo duodama kas dešimtam pirmą kartą besikreipiančiam pacientui. Daugiau respondentų (60,7 proc.), turinčių aukštąjį/ nebaigtą aukštąjį išsilavinimą, nei respondentų (4,4 proc.), turinčių nebaigtą vidurinį išsilavinimą, 21–40 m. amžiaus nei 41–60 m. amžiaus respondentų, nurodė, kad buvo patenkinti poliklinikos darbo laiku. Apklausoje dalyvavusių pacientų nuomone, poliklinikos registratūroje, norint užsiregistruoti pas gydytoją sugaištama nuo 5 iki 10 minučių. Dauguma tyrime dalyvavusių 21–40 m. (47,1 proc.) ir 41–60 m. (34,8 proc.) pacientų nurodė, kad pas savo šeimos gydytoją vizito teko laukti apie 1–5 dienas. Daugiausia respondentų (66,7 proc.), nurodžiusių, kad juos šeimos gydytojas priima per 1–5 dienas, buvo respondentai, turintys aukštąjį/nebaigtą aukštąjį išsilavinimą, o mažiausiai taip teigusių buvo respondentai (5,7 proc.), turintys nebaigtą vidurinį išsilavinimą. Daugiau jaunesnio (42,3 proc.) nei vyresnio (15,5 proc.) amžiaus respondentų nurodė, kad pas neurologą jiems teko laukti apie mėnesį, o daugiau vyresnio (44,4 proc.) nei jaunesnio (34,7 proc.) amžiaus respondentų nurodė, kad jiems teko laukti ilgiau kaip mėnesį. Išanalizavus tyrimo duomenis nustatyta, jog 40,6 proc. 21–40 m. respondentų į gydytojo kabinetą buvo pakviesti paskirtu laiku, o 45,2 proc. 41–60 m. amžiaus respondentų teigė, kad jiems teko laukti ilgiau kaip 30 minučių. Daugiau respondentų (53,7 proc.), turinčių aukštąjį/ nebaigtą aukštąjį išsilavinimą, nei respondentų (3,3 proc.), turinčių nebaigtą vidurinį išsilavinimą, nurodė, kad jiems poliklinika priminė apie profilaktines programas.The study was conducted during the 2014.05–2014.06 period. It was questioned respondents 18 years of age. Initially, 450 questionnaires were distributed to the registries of the 442 questionnaires returned (98.2 percent reversibility.). The questionnaire was administered to every tenth referring a patient for the first time. More respondents (60.7 percent), with higher / incomplete higher education than respondents (4.4 percent), with incomplete secondary education 21–40 years than 41–60 years the respondents indicated that they were satisfied with the clinic working hours. The surveyed patients opinion, clinic reception, to register with a doctor wasted 5 to 10 minutes. Many study participants 21–40 years. (47.1 percent) and 41–60 years. (34.8 percent) reported that with your family doctor‘s visit had to wait for about 1–5 days. The majority of respondents (66.7 percent) indicated that they adopt a family doctor within 1–5 days were respondents with higher / incomplete higher education, at least as contention was the respondents (5.7 percent) with incomplete secondary education. Upon analysis of the data showed that 40.6 percent 21–40 years respondents to the doctor‘s office was called at the scheduled time while 45.2 percent. 4 –60 years age of the respondents said that they had to wait longer than 30 minutes. More respondents (53.7 percent), with higher / incomplete higher education than respondents (3.3 percent) with incomplete secondary education, said the surgery is that they are reminded of preventive programs