Optimal Implementation of Prescription Drug Monitoring Programs in the Emergency Department

The opioid epidemic is the most significant modern-day, public health crisis. Physicians and lawmakers have developed methods and practices to curb opioid use. This article describes one method, prescription drug monitoring programs (PDMP), through the lens of how to optimize use for emergency departments (ED). EDs have rapidly become a central location to combat opioid abuse and drug diversion. PDMPs can provide emergency physicians with comprehensive prescribing information to improve clinical decisions around opioids. However, PDMPs vary tremendously in their accessibility and usability in the ED, which limits their effectiveness at the point of care. Problems are complicated by varying state-to-state requirements for data availability and accessibility. Several potential solutions to improving the utility of PDMPs in EDs include integrating PDMPs with electronic health records, implementing unsolicited reporting and prescription context, improving PDMP accessibility, data analytics, and expanding the scope of PDMPs. These improvements may help improve clinical decision-making for emergency physicians through better data, data presentation, and accessibility

B cell acute lymphoblastic leukemia associated with t(8;22)(p11.2q11.2): Role of additional cytogenic anomalies

B lymphoblastic leukemia (B-ALL) may be associated with recurrent cytogenetic and molecular abnormalities. We describe the fourth-known case of B-ALL associated with the t(8;22)(p11.2q11.2) – a translocation seen more frequently in T lymphoblastic leukemia and acute myelogenous leukemia. This patient’s leukemia involves a combination of additional cytogenetic anomalies not yet described in the literature, including del(11)(q13q23), add(9)(p22), and monosomy 7. Given the role in B cell differentiation of genes in the affected regions, including MEN1 (11q13), ATM (11q22), ETS1(11q23), MLL (11q23), AF9 (9p22), and IKZ-F1 (7p12), this case may provide further insight into B cell leukemogenesis associated with the t(8;22). Deletion or mutation of these genes may be critical in targeting the B cell population, and this cytogenetic profile of a B-ALL suggests additional gene targets for diagnostic and therapeutic consideration

Operationalizing the Roles of Experiential Learning: Bringing the Partnership to Life

This article focuses on the partnership between Discovery Charter School of Rochester, New York, founded in 2011, and Nazareth College Partners for Learning. The Partners for Learning program engages Nazareth College students in partnerships with the children, teachers, and staff of eight urban sites. The authors examine the four critical roles that work to foster program success: (1) Associate Director for the Center for Civic Engagement, (2) Student Site Coordinator, (3) Site Representative, and (4) Classroom Teacher. We describe each of the four roles, how the roles support experiential learning, and, most importantly, how we consistently collaborate to ensure success for all parties. We have gathered multiple forms of reflection, and we share data focusing on the impact of student learning for both personal and professional growth. Finally, Discovery Charter School students describe what having a Partner in their classroom means to them, how the Partners have improved their learning, and how the relationships that have formed over the semester/ year(s) have had an impact on them

Primer registro de parasitismo del federal (Amblyramphus holosericeus) por parte del especialista Tordo pico corto (Molothrus rufoaxillaris)

Screaming Cowbird (Molothrus rufoaxillaris) is highly specialized parasitizing only three species, making records of new hosts very informative. During 2017 we studied nesting success on roadsides in Argentine Pampas. Fifty-seven nests (46%) belonged to the known host Brown-and-yellow Marshbirds (Pseudoleistes virescens). Four nests belonged to Scarlet-headed Blackbird (Amblyramphus holosericeus); one contained a Screaming Cowbird nestling that fledged with two of the host. We discuss similarities and differences among the Scarlet-headed Blackbird and old hosts. More studies are needed to confirm the regular parasitism of Scarlet-headed Blackbird by Screaming Cowbird, and to better understand their high specificity in host selection.El Tordo Pico Corto (Molothrus rufoaxillaris) es altamente especialista parasitando solo a tres especies de aves, lo que hace que registros de nuevos hospedadores sean muy informativos. Durante 2017 estudiamos el éxito de nidificación en bordes de camino en la región Pampeana de Argentina. Cincuenta y siete nidos (46%) pertenecieron al hospedador ya conocido Pecho Amarillo (Pseudoleistes virescens). Cuatro nidos pertenecieron al Federal (Amblyramphus holosericeus); uno contenía un pichón de Tordo Pico Corto que abandonó el nido como volantón junto con dos pichones del hospedador. Discutimos similitudes y diferencias entre el Federal y viejos hospedadores. Mayores estudios son necesarios para confirmar el parasitismo regular del Federal por parte del Tordo Pico Corto, y para comprender mejor su alta especificidad en la selección de hospedadores.Fil: Mermoz, Myriam Emilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Ecología, Genética y Evolución de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Ecología, Genética y Evolución de Buenos Aires; ArgentinaFil: Depalma, Daniela María. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Ecología, Genética y Evolución de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Ecología, Genética y Evolución de Buenos Aires; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Ecología, Genética y Evolución; ArgentinaFil: Charnelli, Emilio M.. Museo de Ciencias Naturales Tuyu Mapu; ArgentinaFil: Zilli, Carla Giannina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Ecología, Genética y Evolución de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Ecología, Genética y Evolución de Buenos Aires; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Ecología, Genética y Evolución; Argentin

A Data-Driven Computational Model for Engineered Cardiac Microtissues

Engineered heart tissues (EHTs) present a potential solution to some of the current challenges in the treatment of heart disease; however, the development of mature, adult-like cardiac tissues remains elusive. Mechanical stimuli have been observed to improve whole-tissue function and cardiomyocyte (CM) maturation, although our ability to fully utilize these mechanisms is hampered, in part, by our incomplete understanding of the mechanobiology of EHTs. In this work, we leverage the experimental data produced by a mechanically tunable experimental setup to generate tissue-specific computational models of EHTs. Using imaging and functional data, our modeling pipeline generates models with tissue-specific ECM and myofibril structure, allowing us to estimate CM active stress. We use this experimental and modeling pipeline to study different mechanical environments, where we contrast the force output of the tissue with the computed active stress of CMs. We show that the significant differences in measured experimental forces can largely be explained by the levels of myofibril formation achieved by the CMs in the distinct mechanical environments, with active stress showing more muted variations across conditions. The presented model also enables us to dissect the relative contributions of myofibrils and extracellular matrix to tissue force output, a task difficult to address experimentally. These results highlight the importance of tissue-specific modeling to augment EHT experiments, providing deeper insights into the mechanobiology driving EHT function.Comment: 19 pages, 7 figure

Identification and quantification of particle growth channels during new particle formation

Atmospheric new particle formation (NPF) is a key source of ambient ultrafine particles that may contribute substantially to the global production of cloud condensation nuclei (CCN). While NPF is driven by atmospheric nucleation, its impact on CCN concentration depends strongly on atmospheric growth mechanisms since the growth rate must exceed the loss rate due to scavenging in order for the particles to reach the CCN size range. In this work, chemical composition measurements of 20 nm diameter particles during NPF in Hyytiälä, Finland, in March–April 2011 permit identification and quantitative assessment of important growth channels. In this work we show the following: (A) sulfuric acid, a key species associated with atmospheric nucleation, accounts for less than half of particle mass growth during this time period; (B) the sulfate content of a growing particle during NPF is quantitatively explained by condensation of gas-phase sulfuric acid molecules (i.e., sulfuric acid uptake is collision-limited); (C) sulfuric acid condensation substantially impacts the chemical composition of preexisting nanoparticles before new particles have grown to a size sufficient to be measured; (D) ammonium and sulfate concentrations are highly correlated, indicating that ammonia uptake is driven by sulfuric acid uptake; (E) sulfate neutralization by ammonium does not reach the predicted thermodynamic end point, suggesting that a barrier exists for ammonia uptake; (F) carbonaceous matter accounts for more than half of the particle mass growth, and its oxygen-to-carbon ratio (~ 0.5) is characteristic of freshly formed secondary organic aerosol; and (G) differences in the overall growth rate from one formation event to another are caused by variations in the growth rates of all major chemical species, not just one individual species

National Athletic Trainers\u27 Association Position Statement: Safe Weight Loss and Maintenance Practices in Sport and Exercise

Objective: To present athletic trainers with recommendations for safe weight loss and weight maintenance practices for athletes and active clients and to provide athletes, clients, coaches, and parents with safe guidelines that will allow athletes and clients to achieve and maintain weight and body composition goals. Background: Unsafe weight management practices can compromise athletic performance and negatively affect health. Athletes and clients often attempt to lose weight by not eating, limiting caloric or specific nutrients from the diet, engaging in pathogenic weight control behaviors, and restricting fluids. These people often respond to pressures of the sport or activity, coaches, peers, or parents by adopting negative body images and unsafe practices to maintain an ideal body composition for the activity. We provide athletic trainers with recommendations for safe weight loss and weight maintenance in sport and exercise. Although safe weight gain is also a concern for athletic trainers and their athletes and clients, that topic is outside the scope of this position statement. Recommendations: Athletic trainers are often the source of nutrition information for athletes and clients; therefore, they practices, and methods to change body composition. Body composition assessments should be done in the most scientifically appropriate manner possible. Reasonable and individualized weight and body composition goals should be identified by appropriately trained health care personnel (eg, athletic trainers, registered dietitians, physicians). In keeping with the American Dietetics Association (ADA) preferred nomenclature, this document uses the terms registered dietitian or dietician when referring to a food and nutrition expert who has met the academic and professional requirements specified by the ADA\u27s Commission on Accreditation for Dietetics Education. In some cases, a registered nutritionist may have equivalent credentials and be the commonly used term. All weight management and exercise protocols used to achieve these goals should be safe and based on the most current evidence. Athletes, clients, parents, and coaches should be educated on how to determine safe weight and body composition so that athletes and clients more safely achieve competitive weights that will meet sport and activity requirements while also allowing them to meet their energy and nutritional needs for optimal health and performance

EM-mosaic detects mosaic point mutations that contribute to congenital heart disease.

BackgroundThe contribution of somatic mosaicism, or genetic mutations arising after oocyte fertilization, to congenital heart disease (CHD) is not well understood. Further, the relationship between mosaicism in blood and cardiovascular tissue has not been determined.MethodsWe developed a new computational method, EM-mosaic (Expectation-Maximization-based detection of mosaicism), to analyze mosaicism in exome sequences derived primarily from blood DNA of 2530 CHD proband-parent trios. To optimize this method, we measured mosaic detection power as a function of sequencing depth. In parallel, we analyzed our cohort using MosaicHunter, a Bayesian genotyping algorithm-based mosaic detection tool, and compared the two methods. The accuracy of these mosaic variant detection algorithms was assessed using an independent resequencing method. We then applied both methods to detect mosaicism in cardiac tissue-derived exome sequences of 66 participants for which matched blood and heart tissue was available.ResultsEM-mosaic detected 326 mosaic mutations in blood and/or cardiac tissue DNA. Of the 309 detected in blood DNA, 85/97 (88%) tested were independently confirmed, while 7/17 (41%) candidates of 17 detected in cardiac tissue were confirmed. MosaicHunter detected an additional 64 mosaics, of which 23/46 (50%) among 58 candidates from blood and 4/6 (67%) of 6 candidates from cardiac tissue confirmed. Twenty-five mosaic variants altered CHD-risk genes, affecting 1% of our cohort. Of these 25, 22/22 candidates tested were confirmed. Variants predicted as damaging had higher variant allele fraction than benign variants, suggesting a role in CHD. The estimated true frequency of mosaic variants above 10% mosaicism was 0.14/person in blood and 0.21/person in cardiac tissue. Analysis of 66 individuals with matched cardiac tissue available revealed both tissue-specific and shared mosaicism, with shared mosaics generally having higher allele fraction.ConclusionsWe estimate that ~ 1% of CHD probands have a mosaic variant detectable in blood that could contribute to cardiac malformations, particularly those damaging variants with relatively higher allele fraction. Although blood is a readily available DNA source, cardiac tissues analyzed contributed ~ 5% of somatic mosaic variants identified, indicating the value of tissue mosaicism analyses

Advanced Electrocardiographic Predictors of Sudden Death in Familial Dysautonomia

To identify accurate predictors for the risk of sudden death in patients with familial dysautonomia (FD). Ten-minute resting high-fidelity 12-lead ECGs were obtained from 14 FD patients and 14 age/gender-matched healthy subjects. Multiple conventional and advanced ECG parameters were studied for their ability to predict sudden death in FD over a subsequent 4.5-year period, including multiple indices of linear and non-linear heart rate variability (HRV); QT variability; waveform complexity; high frequency QRS; and derived Frank-lead parameters. Four of the 14 FD patients died suddenly during the follow-up period, usually with concomitant pulmonary disorder. The presence of low vagally-mediated HRV was the ECG finding most predictive of sudden death. Concomitant left ventricular hypertrophy and other ECG abnormalities such as increased QTc and JTc intervals, spatial QRS-T angles, T-wave complexity, and QT variability were also present in FD patients, suggesting that structural heart disease is fairly common in FD. Although excessive or unopposed cardiac vagal (relative to sympathetic) activity has been postulated as a contributor to sudden death in FD, the presence of low vagally-mediated HRV was paradoxically the best predictor of sudden death. However, we suggest that low vagally-mediated HRV be construed not as a direct cause of sudden death in FD, but rather as an effect of concurrent pathological processes, especially hypoxia due to pulmonary disorders and sleep apnea, that themselves increase the risk of sudden death in FD and simultaneously diminish HRV. We speculate that adenosine may play a role in sudden death in FD, possibly independently of vagal activity, and that adenosine inhibitors such as theophylline might therefore be useful as prophylaxis in this disorder

Detecting and Characterizing Young Quasars. III. the Impact of Gravitational Lensing Magnification

We test the impact of gravitational lensing on the lifetime estimates of seven high-redshift quasars at redshift z 3 6. The targeted quasars are identified by their small observed proximity zone sizes, which indicate extremely short quasar lifetimes (t Q 2 105yr). However, these estimates of quasar lifetimes rely on the assumption that the observed luminosities of the quasars are intrinsic and not magnified by gravitational lensing, which would bias the lifetime estimates toward younger ages. In order to test the possible effects of gravitational lensing, we obtain high-resolution images of the seven quasars with the Hubble Space Telescope and look for signs of strong lensing. We do not find any evidence of strong lensing, i.e., all quasars are well described by point sources, and no foreground lensing galaxy is detected. We estimate that the strong-lensing probabilities for these quasars are extremely small ( 1/41.4 × 10-5) and show that weak lensing changes the estimated quasar lifetimes by only 20.2 dex. We thus confirm that the short lifetimes of these quasars are intrinsic. The existence of young quasars indicates a high obscured fraction, radiatively inefficient accretion, and/or flickering lightcurves for high-redshift quasars. We further discuss the impact of lensing magnification on measurements of black hole masses and Eddington ratios of quasars