Evaluating the non-evidence based practice of rounding serum creatinine in the elderly and the impact on medication dosing

Background: The Cockcroft and Gault equation is widely accepted in practice as the most appropriate way to calculate an estimated creatinine clearance. Geriatric patients often present with reduced muscle mass, and therefore lower creatinine production, due to normal changes in body composition associated with aging. Because serum creatinine and creatinine clearance are inversely proportional using the Cockcroft and Gault equation, a lower serum creatinine may falsely overestimate renal function in the elderly population. Rounding to a normal serum creatinine is believed by some practitioners to prevent over estimation of creatinine clearance and renal function. Objective: The objective of this study is to identify and compare medications that require renal dose adjustment when using the patient\u27s measured serum creatinine, if less than 1 mg/dL, versus a rounded serum creatinine of 1 mg/dL in the Cockcroft and Gault equation. Methods: Each patient\u27s estimated creatinine clearance was calculated using the patient\u27s measured serum creatinine and a rounded value of 1 mg/dl, in the Cockcroft and Gault equation. Once both creatinine clearances had been calculated, an evaluation was completed to determine how many of the patient\u27s medications required renal dose adjustment based on either the measured or rounded creatinine clearance. The number of dosing discrepancies was then assessed, in addition to creatinine clearance values, to look for trends or patterns regarding the amount of dosing discrepancies and the effects of rounding to a serum creatinine of 1 mg/dL. Results: A total of 32 patients (6 male, 26 female) were evaluated for renal dose adjustments based on the measured and rounded creatinine clearance. Seven patients were identified as having discrepancies, all of which were female patients. The average difference between the measured and rounded creatinine clearance in female patients was 16 mL/min. A total of 12 discrepancies were found affecting 9 different medications. The average number of discrepancies per patient that presented with a discrepancy was 1.71 discrepancies. Five of the 12 discrepancies affected both the measured creatinine clearance and the rounded creatinine clearance, while 7 of the 12 discrepancies affected only the rounded creatinine clearance. Conclusion: Results of the study show that patients in CKD Stage 3, or in CKD Stage 2 but within approximately 16 mL/min of CKD Stage 3, are more likely to present with renal dosing discrepancies, and that the discrepancies identified were not localized to particular medications or therapeutic areas

Family factors associated with anxiety sensitivity in youth

The purpose of this study was to examine the relationship between various family variables and anxiety sensitivity (AS) in a community sample of 159 youth ages 7--18 years and their parents. Youth completed self-report measures of anxiety and AS and parents completed measures of AS, attachment, psychopathology, family environment, and parenting practices. The primary purpose was to examine the extent to which these family variables predicted child AS. Results indicated that a combination of family factors including parenting style, parental psychopathology, and family environment significantly predicted child AS. Specifically, parent\u27s perceptions of their child\u27s anxiety sensitivity and a secure attachment contributed the most to the prediction equation. These results are discussed in the context of their implications for both assessment and treatment of youth with AS

Expression and Emotion in Music: How Expression and Emotion Affect the Audience’s Perception of a Performance

Expression and emotion in a musical performance affects how the music is perceived by the audience. A study of a song’s composer and the background of the music aids in improving the expression and understanding of vocal music. A study of theatre brings an extra dynamic to a musical performance. Maria Callas, for example, was a pioneer in combining these many factors into her performances. Her application of music and drama in opera makes her an ideal example of a complete and dynamic vocalist. The expression and emotion she poured into each performance transformed how people saw opera and music in general. This concept of expression and emotion in music and how it may affect an audience’s perception of a performance is further studied in depth through various surveys, and an extensive study of Maria Callas and what she has to say about her art and what others have observed from Callas’s performances and work ethic

T zone lymphoma: cellular origin and function

2018 Fall.Includes bibliographical references.The lymphoid system is exceedingly complex with specialized subsets of lymphocytes involved in both the innate and adaptive immune response. Lymphocytes are subdivided into T cells and B cells with lymphoproliferative disorders comprising a heterogeneous group of diseases arising from various lymphocyte subsets. Dogs are a natural model for studying cancer in humans with overlapping subtypes of lymphoproliferative disease seen in both species. We were particularly interested in characterizing lymphoma subtypes in dogs as a model for studying human disease progression. We believe characterization of lymphoma subtypes in dogs will contribute to enhanced understanding of the pathogenic mechanisms leading to the development of malignancy in both humans and dogs. T zone lymphoma (TZL) is a subtype of peripheral T cell lymphoma (PTCL) occurring in both humans and dogs. Determination of the cell-of-origin of PTCLs in humans has pointed to a subset of the larger disease, but up to half of these lymphomas cannot be further classified and are referred to as PTCL – not otherwise specified (PTCL-NOS). TZL has unique phenotypic characteristics including absence of the pan-leukocyte transmembrane protein, CD45, allowing for reliable identification by flow cytometry. CD45 has been found to be critical for T cell signaling through the T cell receptor (TCR). We hypothesized TZL has been derived from an activated, mature T cell. We used gene expression in an attempt to classify the cell-of-origin in TZL. Then we used in vitro systems to identify proliferative mechanisms, cytokine production, and immunosuppression at play in this disease. We determined TZL cells express genes associated with T helper 2 (Th2) and T regulatory (Treg) cells. We further confirmed that TZL cells do not proliferate through the TCR, likely due to their lack of CD45. We identified IL-2 may be involved in TZL signaling mechanisms. There are reports of TZL occurring with an opportunistic follicular mite infection, suggesting a component of immunosuppression with this disease. We thus anticipated TZL cells would have an immunosuppressive phenotype and inhibit normal T cells. Using in vitro methods, we were unable to confirm immunosuppression through production of TGF-β, inhibition of proliferation and inhibition of IFN-γ production. Finally, we observed older Golden retrievers having a higher frequency of cells with the same aberrant phenotype as TZL, but without evidence or suspicion of lymphoproliferative disease. We believe this finding resembles clonopathies of unknown significance in older human individuals, also with rare progression to disease. We now believe TZL is derived from a Th2 or Treg-like mature T cell which may be responsible for the indolent nature of this disease due to the tolerant behavior of those T cell subsets. Furthermore, inducing proliferation in this disease was challenging, which is consistent with slowly progressive biologic behavior. Expression of immunosuppressive molecules may also contribute to the indolent nature of this disease. While we were not able to observe immunosuppression in vitro, it is reasonable to assume there may be in vivo mechanisms of immunosuppression resulting in clinical manifestations seen in TZL. Characterization of cell-of-origin of this disease, neoplastic cell function, along with recognition of a pre-neoplastic state, contributes to enhanced understanding of the pathogenesis of lymphoproliferative diseases in both humans and dogs

Soil Microbial Community Succession During Cadaver Decomposition

Microbes play critical roles in nutrient cycling in terrestrial ecosystems. In particular, microbial decomposition of organic matter is a key step in carbon and nutrient cycling, linking above-ground and below-ground pools. It is well known that the microbial community changes in structure and function following the introduction of organic matter into a terrestrial system. The decomposition of plant litter has been extensively investigated but the decomposition of animal-derived organic matter has often been overlooked. The unique characteristics of animal input are hypothesized to dictate a distinct decomposition process. This study examined the microbial community responsible for decomposition of animal-derived organic matter. Our objective was to determine the taxonomic and functional succession of microbial populations in a Cadaver Decomposition Island (CDI) during decomposition. To address our objectives, soils from beneath four cadavers at the UT Anthropological Facility were sampled throughout the decomposition process. Reproducible patterns in the concentration of extractable total nitrogen, ammonia and organic carbon in the soil were observed. The distinct trends in microbial respiration and net N mineralization rates indicated that a major functional shift in the community occurred following the Active Decay stage. Human-associated Bacteroides were detected at high concentrations throughout decomposition, up to 198 days after cadavers were first placed. This study revealed the succession in microbial community function and structure during decomposition of animal-derived organic matter, and has implications in the fields of public health and forensic science

An Investigation of Variables Which Predict Social Skills Functioning in Children With Attention Deficit Hyperactivity Disorder.

The focus of this paper was on defining variables associated with social skills of children diagnosed with Attention-deficit Hyperactivity Disorder, as currently defined in the DSM-III-R. Sixty-six boys aged six through 10 participated in the study. Diagnosis of ADHD was made by a licensed psychologist in a private practice setting. Each student was administered the Wechsler Intelligence Scale for Children-Revised and the Kaufman Test of Educational Achievement. The primary teacher of each student completed the Matson Evaluation of Social Skills with Youngsters (MESSY), the Social Skills Rating System-Teacher Form (SSRS-T), the Revised Conner\u27s Teacher Rating Scale (CTRS-R), the IOWA Conner\u27s Teacher Rating Scale (IOWA), and the Swanson, Nolan, and Pelham (SNAP) Checklist. Correlational analyses supported hypotheses that scores on the social skills measures were related significantly to measures of inattention, impulsivity, inattention, aggression, and academic achievement. Regression analyses were performed in order to determine a parsimonious model which would account for the relationship between symptoms of ADHD, aggression, academic competence and social skills functioning. The results of these analyses are discussed along with the relevancy of the findings in relation to suggestions for future research

The Nets of Style: Shaping Modernist Literary Narrative

Literary modernism is often defined by a stylistic distinctiveness generated by experiments in subject and form. Given that these experiments necessarily break with convention, how are we to make sense of this style without those conventions to guide us? In “The Nets of Style: Shaping Modernist Literary Narrative,” I reveal how critical definitions of modernist style often rely on the individualist poses struck and critical pronouncements made by modernists themselves. My research is situated in a body of work in modernist studies that argue, as Paul Sheehan does in Modernism and the Aesthetics of Violence, that “modernism seeks to transform the world through sheer style, to awaken consciousness to itself through a violent renovation of language and literary form” (6). For these readings, style is the creation of the singular antagonistic artist disrupting the status quo—the artist purportedly maintains autonomy while affecting the world around her. These readings are one valid way of reading the style of modernism as a trace of authorial intent but, I argue, ultimately serve to reinforce modernist self-narratives of cultural authority. In place of this, I offer a social theory of style to imagine new ways of defining this notoriously troublesome textual feature, starting from the theories of Jacques Rancière and Pierre Bourdieu and the observation that what we identify as style and how we understand and use it is determined by a cultural and social value system of which we ourselves, as critics and scholars, are part. I call attention to the primary role style plays in giving shape to that cultural hierarchy, while questioning the role literary criticism plays in describing, and thus granting meaning and value to, that style. Joyce’s style in Ulysses, for example, is often read as a distinctive and unsettling voice, but the voice’s capacity to unsettle is generated from our reliance on style as an indication of the writer in the text, our recognition of Joyce the unsettler; my reading of the social nature of style allows us to bring the reader back into the experience of the modernist text as more than just a passive shock victim. In other words, I consider how the meaning of style is generated when readers respond to texts that are hostile to normative response