Screening for E-cigarette and Tobacco Use in Standardized Patient Encounters

E-cigarette usage has grown significantly in recent years, with over 5 million US middle and high school students reporting recent usage. The long-term health consequences of these devices are still being investigated, but it is known that e-cigarette aerosol could contain harmful substances including nicotine, heavy metals, and carcinogens. Therefore, it is important for physicians to ask patients about e-cigarette usage specifically, as this may contribute to future health problems. The goal of this study was to investigate if and how medical students screen for e-cigarette usage. Screening language was reviewed in standardized patient encounters, which are a type of assessment that medical students undergo in order to observe how they interact with simulated patients. Video-taped patient encounters were coded to examine the specific phrasing of questions related to tobacco usage, including initial and follow-up questions. The majority of students (97%) did not ask about e-cigarettes specifically. Most students (66%) simply asked, “Do you smoke?” Overall, the evidence shows that e-cigarette and vaping device usage is not being addressed specifically in these interactions. These results demonstrate a need for updated patient screening in regards to tobacco use. Because the majority of e-cigarette users report not knowing that the product contains nicotine, physicians must be made aware of their unknown effects on patient outcomes and the need to screen specifically about e-cigarette usage separately from smoking. Continuing medical education may also help address this gap since many cohorts of practicing physicians were training before the popularity of these types of devices.https://ir.library.louisville.edu/uars/1035/thumbnail.jp

Policies for the Treatment of Alcohol and Drug Use Disorders: A Research Agenda for 2010-2015

Provides an agenda for policy research on drug and alcohol addiction treatment, including integrating screening and short-term interventions into primary care and other settings, services in specialty treatment centers, and ongoing support services

Subakuter und chronischer Rückenschmerz in der hausärztlichen Versorgung: Eine systematische Übersichtsarbeit symptomevaluierender Studien

Hintergrund: Subakuter und chronischer Rückenschmerz ist ein häufiges Symptom in der Allgemeinmedizin. Symptome wiederum sind meist der Grund für eine Vorstellung beim Hausarzt. Dementsprechend liefern symptomevaluierende Studien wichtige Daten für dieses Patientenkollektiv. Interessante Zielgrößen sind unter anderem die Prävalenz, die Ätiologie und die Prognose. Ziel: In dieser systematischen Übersichtsarbeit wird die Literatur der letzten 50 Jahre durchsucht und symptomevaluierende Studien zum Thema subakuter und chronischer Rückenschmerzen beim Hausarzt analysiert, um den aktuellen Wissensstand zu diesem Thema zu erarbeiten. Methode: Studien wurden durch eine systematische Literatursuche in Pubmed identifiziert. Die gefundenen Studienzusammenfassungen wurden anhand zuvor definierter Ein- und Ausschlusskriterien von zwei Beurteilen bewertet. Die Volltexte der einschlägigen Studienzusammenfassungen wurde in gleicher Weise bewertet. Die Daten, der schließlich eingeschlossenen Studien/Publikationen wurden strukturiert extrahiert und die Studienqualität bewertet. Um eine Vergleichbarkeit der verschiedenen Ergebnisse zu gewährleisten wurde ein prozentueller Ergebniswert verwendet. Ergebnisse: 885 der 3794 Studienzusammenfassungen waren einschlägig. Von diesen 885 Publikation entsprachen 26 Publikationen von 15 Studien den Ein- und Ausschlusskriterien dieser Arbeit. Da die Daten der Arbeiten sehr inhomogen waren, wurde keine Metaanalyse durchgeführt, sondern eine deskriptive Auswertung durchgeführt. Der überwiegende Teil der Studien erhielt eine gute bis durchschnittliche Qualitätsbewertung. Eine Studien lieferte Daten zur Ätiologie chronischer Rückenschmerz und fand, dass 23.6 % der Patientin axiale Spondyloarthritis hatten, 22 % von diesen wiederum hatten Spondylitis ankylosans. Zwei Studien erbrachten Daten zur Prävalenz. Eine Studie zeigte, dass 1.3 % der Hausarztpatienten sich wegen chronischer Rückenschmerzen vorstellen. Die zweite Studie zeigte, dass 5.95 % der Chronisch-Kranken chronischen Rückenschmerz haben. Der überwiegende Teil der Ergebnisse ergab Prognosedaten. Die wesentlichen Ergebniskategorien waren: Schmerz, Lebensqualität, funktionelle Beeinträchtigung, arbeitsbezogene Ergebnisse und Stimmung. Die mittlere prozentuale Veränderung über 6 Monate betrug -2.9 bis +23.6 % im Bereich Lebensqualität, mit einer großen Spannweite innerhalb der einzelnen Subskalen. Im Bereich Schmerz war die mittlere prozentuale Veränderung -2.1 bis +11 % nach 6 Monaten. Nur eine Studie zeigte eine Verschlechterung der Schmerzsymptomatik. Die funktionelle Beeinträchtigung verbesserte sich im Mittel um +5.8 bis +6.8 % nach 6 Monaten. 48 bis 58 % der initial krankgeschriebenen Patientin waren auch noch nach 12 Monaten krank geschriebenen. Fazit: Diese systematische Übersichtsarbeit symptomevaluierender Studien zeigt eine Verbesserung der verschiedenen Ergebniskategorien über die Zeit. Es gibt wenig Literatur über Prävalenz und Ätiologie im Bezug auf das Symptom subakuter und chronischer Rückenschmerz in der Hausarztpraxis

Effect of daptomycin and vancomycin on Staphylococcus epidermidis biofilms: An in vitro assessment using fluorescence in situ hybridization

Colonization of in-dwelling catheters by microbial biofilms is a major concern in patient health eventually leading to catheter-related blood stream infections. Biofilms are less susceptible to standard antibiotic therapies that are effective against planktonic bacteria. Standard procedure for the detection of microorganisms on the catheter tip is culture. However, viable but non-culturable cells (VBNCs) may be missed. The aim of this study was to evaluate the use of fluorescence in situ hybridization (FISH) as an indicator to visualize and quantify the effect of the antibiotics daptomycin and vancomycin on biofilms in situ. We established an in vitro catheter biofilm model of Staphylococcus epidermidis biofilms on polyurethane catheters. Biofilm activity was measured by FISH and correlated to colony forming units (CFU) data. Digital image analysis was used for quantification of total biofilm mass and the area of the FISH positive biofilm cells. FISH showed a pronounced effect of both antibiotics on the biofilms, with daptomycin having a significantly stronger effect in terms of both reduction of biofilm mass and number of FISH-positive cells. This supports the anti-biofilm capacity of daptomycin. Interestingly, neither antibiotic was able to eradicate all of the FISH-positive cells. In summary, FISH succeeded in visualization, quantification, and localization of antibiotic activity on biofilms. This technique adds a new tool to the arsenal of test systems for anti-biofilm compounds. FISH is a valuable complementary technique to CFU since it can be highly standardized and provides information on biofilm architecture and quantity and localization of survivor cells

Inferences on the Timeline of Reionization at z~8 From the KMOS Lens-Amplified Spectroscopic Survey

Detections and non-detections of Lyman alpha (Ly$\alpha$) emission from $z>6$ galaxies ($<1$ Gyr after the Big Bang) can be used to measure the timeline of cosmic reionization. Of key interest to measuring reionization's mid-stages, but also increasing observational challenge, are observations at z > 7, where Ly$\alpha$ redshifts to near infra-red wavelengths. Here we present a search for z > 7.2 Ly$\alpha$ emission in 53 intrinsically faint Lyman Break Galaxy candidates, gravitationally lensed by massive galaxy clusters, in the KMOS Lens-Amplified Spectroscopic Survey (KLASS). With integration times of ~7-10 hours, we detect no Ly$\alpha$ emission with S/N>5 in our sample. We determine our observations to be 80% complete for 5$\sigma$ spatially and spectrally unresolved emission lines with integrated line flux $>5.7\times10^{-18}$ erg s$^{-1}$ cm$^{-2}$. We define a photometrically selected sub-sample of 29 targets at $z=7.9\pm0.6$, with a median 5$\sigma$ Ly$\alpha$ EW limit of 58A. We perform a Bayesian inference of the average intergalactic medium (IGM) neutral hydrogen fraction using their spectra. Our inference accounts for the wavelength sensitivity and incomplete redshift coverage of our observations, and the photometric redshift probability distribution of each target. These observations, combined with samples from the literature, enable us to place a lower limit on the average IGM neutral hydrogen fraction of $> 0.76 \; (68\%), \; > 0.46 \; (95\%)$ at z ~ 8, providing further evidence of rapid reionization at z~6-8. We show that this is consistent with reionization history models extending the galaxy luminosity function to $M_\textrm{UV} \lesssim -12$, with low ionizing photon escape fractions, $f_\textrm{esc} \lesssim 15\%$.Comment: Accepted for publication in MNRA

A Composite Seyfert 2 X-ray Spectrum: Implications for the Origin of the Cosmic X-ray Background

We present a composite 1-10 keV Seyfert 2 X-ray spectrum, derived from ASCA observations of a distance-limited sample of nearby galaxies. All 29 observed objects were detected. Above ~3 keV, the composite spectrum is inverted, confirming that Seyfert 2 galaxies as a class have the spectral properties necessary to explain the flat shape of the cosmic X-ray background spectrum. Integrating the composite spectrum over redshift, we find that the total emission from Seyfert 2 galaxies, combined with the expected contribution from unabsorbed type 1 objects, provides an excellent match to the spectrum and intensity of the hard X-ray background. The principal uncertainty in this procedure is the cosmic evolution of the Seyfert 2 X-ray luminosity function. Separate composite spectra for objects in our sample with and without polarized broad optical emission lines are also presented.Comment: 11 pages (AASTeX), including 3 figures. Accepted for publication in ApJ Letter

HST Grism Observations of a Gravitationally Lensed Redshift 10 Galaxy

We present deep spectroscopic observations of a Lyman-break galaxy candidate (hereafter MACS1149-JD) at $z\sim9.5$ with the $\textit{Hubble}$ Space Telescope ($\textit{HST}$) WFC3/IR grisms. The grism observations were taken at 4 distinct position angles, totaling 34 orbits with the G141 grism, although only 19 of the orbits are relatively uncontaminated along the trace of MACS1149-JD. We fit a 3-parameter ($z$, F160W mag, and Ly$\alpha$ equivalent width) Lyman-break galaxy template to the three least contaminated grism position angles using an MCMC approach. The grism data alone are best fit with a redshift of $z_{\mathrm{grism}}=9.53^{+0.39}_{-0.60}$ ($68\%$ confidence), in good agreement with our photometric estimate of $z_{\mathrm{phot}}=9.51^{+0.06}_{-0.12}$ ($68\%$ confidence). Our analysis rules out Lyman-alpha emission from MACS1149-JD above a $3\sigma$ equivalent width of 21 \AA{}, consistent with a highly neutral IGM. We explore a scenario where the red $\textit{Spitzer}$/IRAC $[3.6] - [4.5]$ color of the galaxy previously pointed out in the literature is due to strong rest-frame optical emission lines from a very young stellar population rather than a 4000 \AA{} break. We find that while this can provide an explanation for the observed IRAC color, it requires a lower redshift ($z\lesssim9.1$), which is less preferred by the $\textit{HST}$ imaging data. The grism data are consistent with both scenarios, indicating that the red IRAC color can still be explained by a 4000 \AA{} break, characteristic of a relatively evolved stellar population. In this interpretation, the photometry indicate that a $340^{+29}_{-35}$ Myr stellar population is already present in this galaxy only $\sim500~\mathrm{Myr}$ after the Big Bang.Comment: Accepted to ApJ. This is the accepted versio

Spectroscopic confirmation of an ultra-faint galaxy at the epoch of reionization

Within one billion years of the Big Bang, intergalactic hydrogen was ionized by sources emitting ultraviolet and higher energy photons. This was the final phenomenon to globally affect all the baryons (visible matter) in the Universe. It is referred to as cosmic reionization and is an integral component of cosmology. It is broadly expected that intrinsically faint galaxies were the primary ionizing sources due to their abundance in this epoch. However, at the highest redshifts ($z>7.5$; lookback time 13.1 Gyr), all galaxies with spectroscopic confirmations to date are intrinsically bright and, therefore, not necessarily representative of the general population. Here, we report the unequivocal spectroscopic detection of a low luminosity galaxy at $z>7.5$. We detected the Lyman-$\alpha$ emission line at $\sim 10504$ {\AA} in two separate observations with MOSFIRE on the Keck I Telescope and independently with the Hubble Space Telescope's slit-less grism spectrograph, implying a source redshift of $z = 7.640 \pm 0.001$. The galaxy is gravitationally magnified by the massive galaxy cluster MACS J1423.8+2404 ($z = 0.545$), with an estimated intrinsic luminosity of $M_{AB} = -19.6 \pm 0.2$ mag and a stellar mass of $M_{\star} = 3.0^{+1.5}_{-0.8} \times 10^8$ solar masses. Both are an order of magnitude lower than the four other Lyman-$\alpha$ emitters currently known at $z > 7.5$, making it probably the most distant representative source of reionization found to date

A Stellar Population Gradient in VII Zw 403 - Implications for the Formation of Blue Compact Dwarf Galaxies

We present evidence for the existence of an old stellar halo in the Blue Compact Dwarf galaxy VII Zw 403. VII Zw 403 is the first Blue Compact Dwarf galaxy for which a clear spatial segregation of the resolved stellar content into a "core-halo" structure is detected. Multicolor HST/WFPC2 observations indicate that active star formation occurs in the central region, but is strikingly absent at large radii. Instead, a globular-cluster-like red giant branch suggests the presence of an old (> 10 Gyr) and metal poor (=-1.92) stellar population in the halo. While the vast majority of Blue Compact Dwarf galaxies has been recognized to possess halos of red color in ground-based surface photometry, our observations of VII Zw 403 establish for the first time a direct correspondence between a red halo color and the presence of old, red giant stars. If the halos of Blue Compact Dwarf galaxies are all home to such ancient stellar populations, then the fossil record conflicts with delayed-formation scenarios for dwarfs.Comment: Accepted for publication in the Ap