A Pilot Study of Ketamine versus Midazolam/Fentanyl Sedation in Children Undergoing GI Endoscopy

Background. Ketamine sedation has been found superior by physician report to traditional sedation regimens for pediatric endoscopy. Goal. To objectively compare sedation with ketamine versus midazolam/fentanyl for children undergoing gastrointestinal endoscopy. Study. Patients received one of two regimens and were independently monitored using a standardized rating scale. Results. There were 2 episodes of laryngospasm during ketamine sedation. Univariate analyses showed patients sedated with ketamine (n = 17) moved more (median 25% of procedure time versus 8%, P = .03) and required similar low levels of restraint (0.83% versus 0.25%, P = .4) as patients sedated with midazolam/fentanyl (n = 20). Age-adjusted analyses suggested that patients sedated with ketamine were comparably more quiet (P = .002). Conclusions. A pilot trial of ketamine at our institution was associated with episodes of laryngospasm. In addition, children sedated with ketamine moved and required restraint similarly to patients sedated with midazolam/fentanyl. Physician perceptions may be affected by the fact that children who received ketamine were less likely to vocalize distress

Extracting Gene Networks for Low-Dose Radiation Using Graph Theoretical Algorithms

Genes with common functions often exhibit correlated expression levels, which can be used to identify sets of interacting genes from microarray data. Microarrays typically measure expression across genomic space, creating a massive matrix of co-expression that must be mined to extract only the most relevant gene interactions. We describe a graph theoretical approach to extracting co-expressed sets of genes, based on the computation of cliques. Unlike the results of traditional clustering algorithms, cliques are not disjoint and allow genes to be assigned to multiple sets of interacting partners, consistent with biological reality. A graph is created by thresholding the correlation matrix to include only the correlations most likely to signify functional relationships. Cliques computed from the graph correspond to sets of genes for which significant edges are present between all members of the set, representing potential members of common or interacting pathways. Clique membership can be used to infer function about poorly annotated genes, based on the known functions of better-annotated genes with which they share clique membership (i.e., “guilt-by-association”). We illustrate our method by applying it to microarray data collected from the spleens of mice exposed to low-dose ionizing radiation. Differential analysis is used to identify sets of genes whose interactions are impacted by radiation exposure. The correlation graph is also queried independently of clique to extract edges that are impacted by radiation. We present several examples of multiple gene interactions that are altered by radiation exposure and thus represent potential molecular pathways that mediate the radiation response

Seniors, and their food handlers and caregivers, need food safety and nutrition education

Seniors are at greater risk than other adults for foodborne illness, poor nutrition and high rates of nutrition- and lifestyle-related chronic diseases. They also represent a major underserved segment of the UC Cooperative Extension client population. The Make Food Safe for Seniors (MFSFS) initiative assessed food safety and nutrition education needs of fixed-income seniors and food handlers and caregivers serving seniors in 10 California counties. Baseline survey results found unsafe practices by over 50% of the participants in six areas - and by over 65% of participants in three of those areas. After one food safety training, a post-test showed an average knowledge gain of 18.1%; seniors had gained the least knowledge, food handlers had gained some knowledge, and caregivers had gained the most. The unsafe food handling practices of a majority of the study group, as well as poor food behaviors, suggested areas in which education could reinforce or improve food safety, healthy eating and disease prevention practices of seniors, caregivers and food handlers serving seniors

The Role of Minimal- and No-Contact Behavioural Treatments in Migraine: A Review of Efficacy and Cost Effectiveness

The impact of migraine is substantial for both the individual who suffers from it and society in general in terms of lost work hours, medication costs and healthcare usage. Many different forms of treatment are available for migraine, including biobehavioural approaches such as relaxation training and biofeedback. Research regarding the efficacy of these nonpharmacological treatments has been extensive and consistently demonstrates lasting success with the use of the skills taught in treatment. Such treatment approaches have demonstrated effectiveness even when delivered in as few as 2 or 3 sessions with a therapist, thus substantially reducing the cost of treatment. Other treatment formats such as group and no-contact therapies have demonstrated success as well. This article reviews the efficacy and cost efficiency of minimal-contact biobehavioural treatments for migraine as outlined in the research literature. Strictly self-help approaches are also reviewed, and resources for self-help information are discussed. The research indicates that such time-limited and focused treatment approaches are highly effective with select patients; however, there is a lack of research specifying the specific types of patients with migraine who benefit the most from these approaches. Future research needs to address this issue in order to provide the most efficacious and cost-effective treatments for all patients with migraine.Cognitive behavioural therapy, Cost analysis, Migraine, Pharmacoeconomics

Distribution of Clique Sizes in Control and IR

<p>Maximum clique and average clique sizes were larger in IR (red bars) than control (blue bars).</p

The Distributions of Correlations in Control and IR Are Highly Similar

<p>Control (blue dashed) and IR (red solid) lines overlay each other across the entire distribution. The vertical lines in each tail of the distribution delineate the edges that were included in the graph after applying the threshold of |0.875| to the correlation matrix.</p