Evaluation and nonsurgical management of rotator cuff calcific tendinopathy.

Rotator cuff calcific tendinopathy is a common finding that accounts for about 7% of patients with shoulder pain. There are numerous theories on the pathogenesis of rotator cuff calcific tendinopathy. The diagnosis is confirmed with radiography, MRI or ultrasound. There are numerous conservative treatment options available and most patients can be managed successfully without surgical intervention. Nonsteroidal anti-inflammatory drugs and multiple modalities are often used to manage pain and inflammation; physical therapy can help improve scapular mechanics and decrease dynamic impingement; ultrasound-guided needle aspiration and lavage techniques can provide long-term improvement in pain and function in these patients

Mid-infrared optical sensing using sub-wavelength gratings

Optical sensing has shown great potential for both quantitative and qualitative analysis of compounds. In particular sensors which are capable of detecting changes in refractive index at a surface as well as in bulk material have received much attention. Much of the recent research has focused on developing technologies that enable such sensors to be deployed in an integrated photonic device. In this work we demonstrate experimentally, using a sub-wavelength grating the detection of ethanol in aqueous solution by interrogating its large absorption band at 9.54 μm. Theoretical investigation of the operating principle of our grating sensor shows that in general, as the total field interacting with the analyte is increased, the corresponding absorption is also increased. We also theoretically demonstrate how sub-wavelength gratings can detect changes in the real part of the refractive index, similar to conventional refractive index (RI) sensors

Dynamic somite cell rearrangements lead to distinct waves of myotome growth

The myogenic precursors responsible for muscle growth in amniotes develop from thedermomyotome, an epithelium at the external surface of the somite. In teleosts, themyogenic precursors responsible for growth have not been identified. We have usedsingle cell lineage labeling in zebrafish to show that anterior border cells of epithelialsomites are myogenic precursors responsible for zebrafish myotome growth. These cellsmove to the external surface of the embryonic myotome and express the transcriptionfactor Pax7. Some remain on the external surface and some incorporate into the fastmyotome, apparently by moving between differentiated slow fibres. The posterior cellsof the somite, in contrast, elongate into medial muscle fibres. The surprising movementof the anterior somite cells to the external somite surface transforms a segmentallyrepeated arrangement of myogenic precursors into a medio-lateral arrangement similar tothat seen in amniotes.Fil: Stellabotte, Frank. Ohio Wesleyan University.; Estados UnidosFil: Dobbs McAuliffe, Betsy. Ohio Wesleyan University.; Estados UnidosFil: Fernandez, Daniel Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Austral de Investigaciones Científicas; Argentina. Universidad Nacional de Tierra del Fuego; ArgentinaFil: Feng, Xuesong. Ohio Wesleyan University.; Estados UnidosFil: Devoto, Stephen Henry. Ohio Wesleyan University.; Estados Unido

Cardiomyopathy in Offspring of Pregestational Diabetic Mouse Pregnancy

Purpose. To investigate cardiomyopathy in offspring in a mouse model of pregestational type 1 diabetic pregnancy. Methods. Pregestational diabetes was induced with STZ administration in female C57BL6/J mice that were subsequently mated with healthy C57BL6/J males. Offspring were sacrificed at embryonic day 18.5 and 6-week adolescent and 12-week adult stages. The size and number of cardiomyocyte nuclei and also the extent of collagen deposition within the hearts of diabetic and control offspring were assessed following cardiac tissue staining with either haematoxylin and eosin or Picrosirius red and subsequently quantified using automated digital image analysis. Results. Offspring from diabetic mice at embryonic day 18.5 had a significantly higher number of cardiomyocyte nuclei present compared to controls. These nuclei were also significantly smaller than controls. Collagen deposition was shown to be significantly increased in the hearts of diabetic offspring at the same age. No significant differences were found between the groups at 6 and 12 weeks. Conclusions. Our results from offspring of type 1 diabetic mice show increased myocardial collagen deposition in late gestation and have increased myocardial nuclear counts (hyperplasia) as opposed to increased myocardial nuclear size (hypertrophy) in late gestation. These changes normalize postpartum after removal from the maternal intrauterine environment

Treating Substance Use Disorders: Enhancing Attendance at the Weekly Inpatient Medication Assisted Treatment Group

At a large academic tertiary medical center, an Integrated Medication Assisted Treatment (IMAT) program has been established for those medically stable inpatients with an addiction diagnosis. Over a four month period, this program had experienced a decline in attendance and a quality improvement project was initiated is to better understand the barriers to attendance and institute a process that would reverse the decline. A goal was established to improve attendance by medically stable patients that have consented to participate to a minimum of 50%. A root cause analysis outlined numerous causes for low attendance and several countermeasures were established to address these. Among them were the initiation of a KPI to collect patient attendance data and the creation of an IMAT order in EPIC. Since the IMAT order went “live” in EPIC and other countermeasures were started, the goal of 50% has been surpassed. Next steps include ongoing nurse, physician and care management education, and work with nursing informatics to develop an appointment feature for the IMAT order in EPIC

Grazing of dairy cows on pasture versus indoor feeding on total mixed ration: Effects on low-moisture part-skim Mozzarella cheese yield and quality characteristics in mid and late lactation

peer-reviewedThis study investigated the effects of 3 dairy cow feeding systems on the composition, yield, and biochemical and physical properties of low-moisture part-skim Mozzarella cheese in mid (ML; May–June) and late (LL; October–November) lactation. Sixty spring-calving cows were assigned to 3 herds, each consisting of 20 cows, and balanced on parity, calving date, and pre-experimental milk yield and milk solids yield. Each herd was allocated to 1 of the following feeding systems: grazing on perennial ryegrass (Lolium perenne L.) pasture (GRO), grazing on perennial ryegrass and white clover (Trifolium repens L.) pasture (GRC), or housed indoors and offered total mixed ration (TMR). Mozzarella cheese was manufactured on 3 separate occasions in ML and 4 in LL in 2016. Feeding system had significant effects on milk composition, cheese yield, the elemental composition of cheese, cheese color (green to red and blue to yellow color coordinates), the extent of flow on heating, and the fluidity of the melted cheese. Compared with TMR milk, GRO and GRC milks had higher concentrations of protein and casein and lower concentrations of I, Cu, and Se, higher cheese-yielding capacity, and produced cheese with lower concentrations of the trace elements I, Cu, and Se and higher yellowness value. Cheese from GRO milk had higher heat-induced flow and fluidity than cheese from TMR milk. These effects were observed over the entire lactation period (ML + LL), but varied somewhat in ML and LL. Feeding system had little, or no, effect on gross composition of the cheese, the proportions of milk protein or fat lost to cheese whey, the texture of the unheated cheese, or the energy required to extend the molten cheese. The differences in color and melt characteristics of cheeses obtained from milks with the different feeding systems may provide a basis for creating points of differentiation suited to different markets.This study was funded by the Department of Agriculture, Food and the Marine (Dublin, Ireland) Stimulus fund (11/sf/309), and additionally supported by funding from the Dairy Levy Trust Co-Operative Society Limited (Dublin, Ireland)

Effect of different forage types on the volatile and sensory properties of bovine milk

peer-reviewedThe effect of 3 diets (grass, grass/clover, and total mixed ration) on the volatile and sensory properties of bovine milk was assessed over an entire lactation season. Little evidence was found of direct transfer of terpenes into raw milk from the different diets, and it is likely that the monocultures of ryegrass used with and without white clover were factors as these contained very few terpenes. Evidence of direct transfer of nonterpene volatiles from forage to the subsequent raw milks was probable; however, differences in the protein carbohydrate availability and digestion in the rumen appeared to have a greater contribution to volatile profiles. Pasteurization significantly altered the volatile profiles of all milks. A direct link between the milk fatty acid content, forage, and volatile products of lipid oxidation was also evident and differences in fatty acid content of milk due to forage may also have influenced the viscosity perception of milk. Irish sensory assessors preferred pasteurized milk produced from grass-fed cows, with least preference from milk produced from total mixed ration diets. β-Carotene content was significantly higher in milks derived from grass or grass/clover and appears to have directly influenced color perception. Toluene and p-cresol are both degradation products of β-carotene and along with β-carotene were identified as potential biomarkers for milk derived from pasture. The only correlation that appeared to influence the flavor of milk as determined using ranked descriptive analysis was p-cresol. P-Cresol appears to be responsible for the barnyard aroma of milk and is also likely derived from the deamination and decarboxylation of tryptophan and tyrosine due to the higher levels of available protein in the grass and grass/clover diets. The highest levels of p-cresol were in the grass/clover diets and are likely due to the degradation of the isoflavone formononetin in the rumen, which is present in white clover swards.This work was funded by the Department of Agriculture, Fisheries and Food, under the Food Institutional Research Measure; Sensory Network Ireland Reference 13SN401

A Root-Cause Analysis of Mortality Following Major Pancreatectomy

Abstract Introduction Although mortality rates from pancreatectomy have decreased worldwide, death remains an infrequent but profound event at an individual practice level. Root-cause analysis is a retrospective method commonly employed to understand adverse events. We evaluate whether emerging mortality risk assessment tools sufficiently predict and account for actual clinical events that are often identified by root-cause analysis. Methods We assembled a Pancreatic Surgery Mortality Study Group comprised of 36 pancreatic surgeons from 15 institutions in 4 countries. Mortalities after pancreatectomy (30 and 90 days) were accrued from 2000 to 2010. For root-cause analysis, each surgeon "deconstructed" the clinical events preceding a death to determine cause. We next tested whether mortality risk assessment tools (ASA, POSSUM, Charlson, SOAR, and NSQIP) could predict those patients who would die (n=218) and compared their prognostic accuracy against a cohort of resections in which no patient died (n=1,177). Results Two hundred eighteen deaths (184 Whipple's resection, 18 distal pancreatectomies, and 16 total pancreatectomies) were identified from 11,559 pancreatectomies performed by surgeons whose experience averaged 14.5 years. Overall 30-and 90-day mortalities were 0.96% and 1.89%, respectively. Individual surgeon rates ranged from 0% to 4.7%. Only 5 patients died intraoperatively, while the other 213 succumbed at a median of 29 days. Mean patient age was 70 years old (38% were >75 years old). Malignancy was the indication in 90% of cases, mostly pancreatic cancer (57%). Median operative time was 365 min and estimated blood loss was 700 cc (range, 100-16,000 cc). Vascular repair or multivisceral resections were required for 19.7% and 15.1%, respectively. Seventy-seven percent had a variety of major complications before death. Eighty-seven percent required intensive care unit care, 55% were transfused, and 35% were reoperated upon. Fifty percent died during the index admission, while another 11% died after a readmission. Almost half (n=107) expired between 31 and 90 days. Only 11% had autopsies. Operation-related complications contributed to 40% of deaths, with pancreatic fistula being the most evident (14%). Technical errors (21%) and poor patient selection (15%) were cited by surgeons. Of deaths, 5.5% had associated cancer progression-all occurring between 31 and 90 days. Even after root-cause scrutiny, the ultimate cause of death could not be determined for a quarter of the patients-most often between 31 and 90 days. While assorted risk models predicted mortality with variable discrimination from nonmortalities, they consistently underestimated the actual mortality events we report. Conclusion Root-cause analysis suggests that risk prediction should include, if not emphasize, operative factors related to pancreatectomy. While risk models can distinguish between mortalities and nonmortalities in a collective fashion, they vastly miscalculate the actual chance of death on an individual basis. This study reveals the contributions of both comorbidities and aggressive surgical decisions to mortality

Nicotine Replacement Therapies to Decrease Withdrawal Symptoms and Improve Patient Experience

Smoking is one the leading causes of preventable death in the United States. Patient centered care revolves around encouraging patients to reduce their chances of preventable disease and death. To that end, nicotine replacement therapy (NRT) prescribed within 24 hours of hospital admission increases the chance of quitting and decreases the chance of nicotine withdrawal. A pilot performance improvement project was initiated on two cardiac units at an academic tertiary medical center. The goal the project was to have NRT ordered within 24 hours of admission 100% of the time. Baseline metrics demonstrated admission NRT orders were below acceptable levels and subsequent root cause analyses showed barriers to reaching the established goal. Several countermeasures were initiated to include several KPIs. Post rollout, a significant increase in NRT orders was demonstrated. Next steps include educating staff on all hospital units as well as adding tobacco assessment to the yearly competency policy

Effect of pasture versus indoor feeding systems on raw milk composition and quality over an entire lactation

peer-reviewedThe aim of this study was to investigate the effects of different feeding systems on milk quality and composition. Fifty-four multiparous and primiparous Friesian lactating cows were divided into 3 groups (n=18) to study the effects of 3 feeding systems over a full lactation. Group 1 was housed indoors and offered a total mixed ration diet (TMR), group 2 was maintained outdoors on a perennial ryegrass pasture (referred to as grass), and group 3 was also grazed outdoors on a perennial ryegrass/white clover pasture (referred to as clover). Bulk milk samples were collected from each group at morning and afternoon milkings once weekly from March 11 to October 28 in 2015. Milk from pasture-fed cows (grass and clover) had significantly higher concentrations of fat, protein, true protein, and casein. The pasture feeding systems induced significantly higher concentrations of saturated fatty acids C11:0, C13:0, C15:0, C17:0, C23:0, and unsaturated fatty acids C18:2n-6 trans, C18:3n-3, C20:1, and C20:4n-6 and a greater than 2-fold increase in the conjugated linoleic acid C18:2 cis-9,trans-11 content of milk compared with that of the TMR feeding system. The TMR feeding system resulted in milks with increased concentrations of C16:0, C18:2n-6 cis, C18:3n-6 cis, C22:0 C22:1n-9, and C18:2 cis-10,trans-12. Principal component analysis of average fatty acid profiles showed clear separation of milks from the grazed pasture-based diets to that of a TMR system throughout lactation, offering further insight into the ability to verify pasture-derived milk by fatty acid profiling