Utilizing the Boston Syncope Observation Management Pathway to Reduce Hospital Admission and Decrease Adverse Outcomes

Introduction: In an age of increasing scrutiny of each hospital admission, emergency department (ED) observation has been identified as a low-cost alternative. Prior studies have shown admission rates for syncope in the United States to be as high as 70%. However, the safety and utility of substituting ED observation unit (EDOU) syncope management has not been well studied. The objective of this study was to evaluate the safety of EDOU for the management of patients presenting to the ED with syncope and its efficacy in reducing hospital admissions. Methods: This was a prospective before-and-after cohort study of consecutive patients presenting with syncope who were seen in an urban ED and were either admitted to the hospital, discharged, or placed in the EDOU. We first performed an observation study of syncope management and then implemented an ED observation-based management pathway. We identified critical interventions and 30-day outcomes. We compared proportions of admissions and adverse events rates with a chisquared or Fisher’s exact test. Results: In the “before” phase, 570 patients were enrolled, with 334 (59%) admitted and 27 (5%) placed in the EDOU; 3% of patients discharged from the ED had critical interventions within 30 days and 10% returned. After the management pathway was introduced, 489 patients were enrolled; 34% (p\u3c0.001) of pathway patients were admitted while 20% were placed in the EDOU; 3% (p=0.99) of discharged patients had critical interventions at 30 days and 3% returned (p=0.001). Conclusion: A focused syncope management pathway effectively reduces hospital admissions and adverse events following discharge and returns to the ED. [West J Emerg Med. 2019;20(2)250–255.

Thermal Analysis and Design for VISORS CubeSat Formation

VISORS (Virtual Super-resolution Optics with Reconfigurable Swarms) is a space physics mission for solar corona investigation that will help observe and study the heat release regions. The pair of two formation flying CubeSats containing the observatory and detector will capture the extreme ultraviolet features on the Sun with an unprecedented resolution of 0.2 arcseconds. The strict six-month mission challenges include relative orbit requirements during science observations with several advanced technologies for precise formation flying. For a successful mission, one needs to make sure all the components of the CubeSats\u27 payload meet the thermal requirements. This work performs the thermal analysis of the CubeSat swarm for several mission modes using Thermal Desktop software. Several challenges related to the temperature requirements of specific components are addressed, and solutions are demonstrated

Antibacterial activity of cefoperazone metal complexes

Cefoperazone complexes with different metal ions of 1:1 metal to antibiotic stoichiometry have been prepared. The [M(cefopz)CI] complexes (M = Co, Cu and Cd) were characterized by physicochemical and spectroscopic methods. The solubility of the cefoperazone complexes in water and common organic solvents is reduced on complexation. All complexes show higher activity against Salmonella enteritidis. The Co(II) and Cd(II) complexes show better activity in the case of Pseudomonas aeruginosa and Escherichia coli, and Cu(II) and Cd(II) complexes against Shigella sonnei than cefoperazone sodium. The complexes showed to be less active than free cefoperazone against Staphylococcus aureus and Proteus mirabilis.Cefoperazone complexes with different metal ions of 1:1 metal to antibiotic stoichiometry have been prepared. The [M(cefopz)Cl] complexes (M = Co, Cu and Cd) were characterized by physicochemical and spectroscopic methods. The solubility of the cefoperazone complexes in water and common organic solvents is reduced on complexation. All complexes show higher activity against Salmonella enteritidis. The Co(II) and Cd(II) complexes show better activity in the case of Pseudomonas aeruginosa and Escherichia coli, and Cu(II) and Cd(II) complexes against Shigella sonnei than cefoperazone sodium. The complexes showed to be less active than free cefoperazone against Staphylococcus aureus and Proteus mirabilis.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Discovery, TESS Characterization, and Modeling of Pulsations in the Extremely Low-mass White Dwarf GD 278

We report the discovery of pulsations in the extremely low-mass (ELM), likely helium-core white dwarf GD 278 via ground- and space-based photometry. GD 278 was observed by the Transiting Exoplanet Survey Satellite (TESS) in Sector 18 at a 2 minute cadence for roughly 24 days. The TESS data reveal at least 19 significant periodicities between 2447 and 6729 s, one of which is the longest pulsation period ever detected in a white dwarf. Previous spectroscopy found that this white dwarf is in a 4.61 hr orbit with an unseen >0.4 M ⊙ companion and has T eff = 9230 ± 100 K and logg=6.627±0.056" role="presentation">logg=6.627±0.056 , which corresponds to a mass of 0.191 ± 0.013 M ⊙. Patterns in the TESS pulsation frequencies from rotational splittings appear to reveal a stellar rotation period of roughly 10 hr, making GD 278 the first ELM white dwarf with a measured rotation rate. The patterns inform our mode identification for asteroseismic fits, which, unfortunately, do not reveal a global best-fit solution. Asteroseismology reveals two main solutions roughly consistent with the spectroscopic parameters of this ELM white dwarf, but with vastly different hydrogen-layer masses; future seismic fits could be further improved by using the stellar parallax. GD 278 is now the tenth known pulsating ELM white dwarf; it is only the fifth known to be in a short-period binary, but is the first with extended, space-based photometry.Fil: Lopez, Isaac D.. North Carolina State University; Estados UnidosFil: Hermes, J. J.. University Of Boston. Departament Astronomy; Estados UnidosFil: Calcaferro, Leila Magdalena. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Astrofísica La Plata. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas. Instituto de Astrofísica La Plata; ArgentinaFil: Bell, Keaton. University of Washington; Estados UnidosFil: Samuels, Adam. University Of Boston. Departament Astronomy. Center For Space Physics; Estados UnidosFil: Vanderbosch, Zachary P.. University of Texas at Austin; Estados UnidosFil: Corsico, Alejandro Hugo. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Astrofísica La Plata. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas. Instituto de Astrofísica La Plata; ArgentinaFil: Istrate, Alina G.. University of Utrecht; Países Bajo

Regulation of copper homeostasis by members of the COMMD protein family

Copper is an essential transition metal for all eukaryotes. In mammals, intestinal copper absorption is mediated by the ATP7A copper transporter, whereas copper excretion occurs predominatly through the biliary route and is mediated by the paralog ATP7B. Both transporters have been shown to be actively recycled between the endosomal network and the plasma membrane by a molecular machinery known as the COMMD/CCDC22/CCDC93 or CCC complex. In fact, mutations in COMMD1 can lead to impaired biliary copper excretion and liver pathology in dogs and mice with liver-specific Commd1 deficiency recapitulating aspects of this phenotype as well. Nonetheless, the role of the CCC complex in intestinal copper absorption in vivo has not been studied, and the potential redundancy of various COMMD family members has not been tested. In this study, we examined copper homeostasis in enterocyte-specific and hepatocyte-specific Commd-deficient mice. We find that in contrast to effects in cell lines in culture, COMMD protein deficiency induces minimal changes in ATP7A in enterocytes and does not lead to altered copper levels under low or high copper diets, suggesting that regulation of ATP7A in enterocytes is not of physiologic consequence. In contrast, deficiency of any of 3 Commd genes (Commd1, 6, and 9) all result in hepatic copper accumulation under high copper diets. We find that each of these deficiencies cause destabilization of the entire CCC complex, and suggest that this might explain their shared phenotype. Overall, we conclude that the CCC complex plays an important role in ATP7B endosomal recycling and function

Impacto de la Formación Humanística en el Futuro Profesional del Turismo

En el contexto de la universidad cubana, un objetivo es garantizar una educación que propicie el desarrollo del conocimiento, habilidades, capacidades y valores que contribuyan a la implementación de los resultados científicos tecnológicos, a escala social. Este desarrollo humano no es solo objetivo de la universidad, responde a uno de la Agenda 2030, donde la equidad y la justicia social deben ser potenciadas. Se hace necesario fomentar un desarrollo sostenible garantizando un equilibrio económico, medioambiental y sociocultural, una adecuada autonomía territorial, en ello el turismo juega un rol fundamental.  Se declara como objetivo de la investigación científica: demostrar el impacto de la formación humanística en el graduado de la carrera de turismo para el logro del desarrollo económico y social sostenible. Se emplearon de los métodos teóricos el analítico-sintético, inducción-deducción; histórico-lógico y de los métodos empíricos el análisis y revisión documental, la búsqueda, selección de información, y la observación. Se obtiene como resultado acciones de preparación metodológica a egresados que se desempeñan como profesores de la carrera de Turismo para que garanticen un egresado capaz de aplicar una gestión sostenible.In the Cuban university context, an essential goal is to guarantee an education, which propitiates the development of the knowledge, abilities, capacities and values that contribute to the technological scientific achievements ‘implementation, in order to apply them at social scale. This human development is not just an objective from university, it also responds to one of the 2030 Agenda, where the equity and the social justice should be enhanced. It´s necessary to foment the sustainable development guaranteeing an economic, ecological and sociocultural balance achieving the territorial autonomy, where the tourism plays a main role. That’s why, the main goal of the scientific research is to demonstrate the impact of humanistic training in the development of the tourism career for the achievement of sustainable economic and social development. It was used theoretical methods such as: the analytic-synthetic one, induction-deduction and historical-logical one. It was also used empiric methods such as: the analysis and documental revision, the search, selection of information and the observation. As result, it is obtained methodological preparation actions for Tourism career ‘professors, in order they can guarantee a graduate able to apply sustainable management

Best Nursing Intervention Practices to Prevent Non-Communicable Disease: A Systematic Review.

Objectives: To explore nursing health education interventions for non-communicable disease patients. Methods: The design was a systematic review of research work published between 2008 and 2018. The data sources included the Web of Science, PubMed, Scopus, COCHRANE, and LILACS. The studies that met the inclusion were assessed, and the analysis for methodological quality through the recommended tools CASPe, and JADAD. Results: Fifteen original studies from eight counties were included in the review; Findings revealed 13 studies with randomized samples and six used power analysis. Nurses’ interventions included house calls, home care, and individual and group health education. Conclusion: Nursing interventions showed 76.4% the effectiveness of results in patient outcomes to promote and improve healthier lifestyles and quality of life of noncommunicable disease patients. This review discloses the significant impact of nursing health education interventions. Nursing leadership and political decision-makers should consider providing programs to enhance health education knowledge and abilities. All of this can favor the sustainability of the global economy by changing the life style of thousands of people worldwide.post-print970 K

Gait Characterization in Duchenne Muscular Dystrophy (DMD) Using a Single-Sensor Accelerometer: Classical Machine Learning and Deep Learning Approaches

Differences in gait patterns of children with Duchenne muscular dystrophy (DMD) and typically-developing (TD) peers are visible to the eye, but quantifications of those differences outside of the gait laboratory have been elusive. In this work, we measured vertical, mediolateral, and anteroposterior acceleration using a waist-worn iPhone accelerometer during ambulation across a typical range of velocities. Fifteen TD and fifteen DMD children from 3-16 years of age underwent eight walking/running activities, including five 25 meters walk/run speed-calibration tests at a slow walk to running speeds (SC-L1 to SC-L5), a 6-minute walk test (6MWT), a 100 meters fast-walk/jog/run (100MRW), and a free walk (FW). For clinical anchoring purposes, participants completed a Northstar Ambulatory Assessment (NSAA). We extracted temporospatial gait clinical features (CFs) and applied multiple machine learning (ML) approaches to differentiate between DMD and TD children using extracted temporospatial gait CFs and raw data. Extracted temporospatial gait CFs showed reduced step length and a greater mediolateral component of total power (TP) consistent with shorter strides and Trendelenberg-like gait commonly observed in DMD. ML approaches using temporospatial gait CFs and raw data varied in effectiveness at differentiating between DMD and TD controls at different speeds, with an accuracy of up to 100%. We demonstrate that by using ML with accelerometer data from a consumer-grade smartphone, we can capture DMD-associated gait characteristics in toddlers to teens

Validación de la Escala Breve de Optimismo Interactivo-G en México antes de la COVID-19

The primary objectives of this study were determining the construct, convergent, and discriminant validity of the Brief Interactive Optimism Scale-G (BIOS-G) in participants from six states of Mexico and estimating its internal consistency. In this study 3 289 Mexicans participated (2 028 men and 1 243 women). The average age was = 30.43 years and SD = 10.52. Confirmatory factor analysis (CFA) and multiple regression analysis (MRA) were applied. There were appropriate fit indexes (e. g., CFI = .99; RMSEA = .07.). Convergent validity showed ANR (3 289)=.52(p=<.01;d=medium), with the Satisfaction with Life Scale (SWLS) and the estimation of discriminant validity was r (3 289) r = -.19 with the Brief Scale for Assessing Anger Proneness (APS-G) (p = < .01; d = almost small), Alpha = .70 (3 289); p = < .01; omega = .76. The conclusion is that there is partial national evidence supporting the use of BIOS-G, because Mexico lacks a measure of this kind, being useful, at least, for research purposes.Los objetivos primarios del presente estudio fueron determinar la validez de constructo, convergente y discriminante de la Escala Breve de Optimismo Interactivo-G (EBOI-G), en participantes de seis estados de México y calcular su consistencia interna. Participaron 3289 mexicanos, 2028 hombres y 1243 mujeres (18 casos no contestaron cuál era su género). Su edad promedio = 30.43 años, de = 10.52. Se usó el análisis factorial confirmatorio y análisis de regresión múltiple, y se encontraron buenos indicadores promedio de bondad de ajuste (e. g., CFI = .99; RMSEA = .07.). Se evaluó la validez convergente, r (3 289) = .52 (p = < .01; d = mediano), con la Escala de Satisfacción con la Vida. Se estimó la validez discriminante, r (3 289) r = -.19, con la Escala Breve de Disposición a la IRA (p = < .01; d = casi pequeño). El alfa = .70 (3 289); p = < .01; el omega = .76. Se concluye que hay evidencia parcial nacional que apoya el uso de la EBOI-G, debido a la carencia de una medida de este tipo en México, útil cuando menos para propósitos de investigación.Os objetivos primários do estudo foram determinar a validade convergente e discriminante do construto da Escala Breve de Otimismo Interativo-G (EBOI-G), em participantes de seis estados do México e calcular sua consistência interna. Participaram 3 289 mexicanos, sendo 2 028 homens e 1 243 mulheres. A média de idade foi = 30.43 anos, DP = 10.52. Foram utilizadas análises fatoriais confirmatórias e análises de regressão múltipla. Bons indicadores médios de qualidade de ajuste foram encontrados (por exemplo, CFI = .99; RMSEA = .07.) A validade convergente foi avaliada, r (3 289) = .52 (p = <.01; d = mediana), com a Escala de satisfação com a vida. A validade discriminante, r (3 289) = -.19 foi estimada com a Escala Breve de Disposição à Raiva (p = <.01; d = quase pequeno). O alfa = 0,70 (3 289); p = <0,01; o ômega = 0,76. Conclui-se que há evidências nacionais parciais que apoiam o uso da EBOI-G, devido à falta de uma medida desse tipo no México, sendo útil pelo menos para fins de pesquisa

Data-driven historical characterization of epilepsy-associated genes.

Many epilepsy-associated genes have been identified over the last three decades, revealing a remarkable molecular heterogeneity with the shared outcome of recurrent seizures. Information about the genetic landscape of epilepsies is scattered throughout the literature and answering the simple question of how many genes are associated with epilepsy is not straightforward. Here, we present a computationally driven analytical review of epilepsy-associated genes using the complete scientific literature in PubMed. Based on our search criteria, we identified a total of 738 epilepsy-associated genes. We further classified these genes into two Tiers. A broad gene list of 738 epilepsy-associated genes (Tier 2) and a narrow gene list composed of 143 epilepsy-associated genes (Tier 1). Our search criteria do not reflect the degree of association. The average yearly number of identified epilepsy-associated genes between 1992 and 2021 was 4.8. However, most of these genes were only identified in the last decade (2010–2019). Ion channels represent the largest class of epilepsy-associated genes. For many of these, both gain- and loss-of-function effects have been associated with epilepsy in recent years. We identify 28 genes frequently reported with heterogenous variant effects which should be considered for variant interpretation. Overall, our study provides an updated and manually curated list of epilepsy-related genes together with additional annotations and classifications reflecting the current genetic landscape of epilepsy