Recovery from coronary artery bypass surgery: age-related outcomes

As people age, their incidence of coronary heart disease increases. The majority of persons undergoing invasive procedures such as coronary artery bypass surgery are 65 and older. Because of population trends related to aging, it is projected that there will be exponential increases in the numbers of people requiring treatment for this health problem in the future. Changes in health care reimbursement have significantly decreased hospital length of stay, resulting in many patients completing their recovery either in a rehabilitation facility or at home. Patients with multiple preoperative comorbidities are at risk for postoperative complications. Older patients usually have more health problems after coronary artery bypass surgery because they have more risk factors prior to the procedure. It is not known whether there are differences in outcomes between comparatively older and younger patients when they are matched by risk classification. Information on the recovery of patients at home will enable nurses to meet their care needs prior to surgery and after discharge from the hospital

Evaluation of glucose tolerance in cystic fibrosis: Comparison of 50-g and 75-g tests

AbstractBackgroundThe recommended tests for evaluation of glucose tolerance in cystic fibrosis are the fasting blood glucose (FBG) and the 75-g, fasting, 2-h oral glucose tolerance test (OGTT). We compared a 50 g, non-fasting, 1-h glucose challenge test (GCT) to the standard OGTT.MethodsDuring their regularly scheduled visit to the cystic fibrosis clinic, patients underwent a 50-g, non-fasting 1-h GCT and were asked to complete a standard 75-g, fasting, 2-h OGTT within one week of their clinic visit.ResultsFifty-seven patients underwent glucose tolerance testing. Of these, 31/57 (54%) completed both tests. Hyperglycemia was detected on both tests in 9/31 (29%) patients, 11/31 (35%) tested positive only on the GCT, while all those with positive OGTTs had positive GCTs (p<0.01).ConclusionsIn this study, the GCT identified all patients who meet the criteria for abnormal glucose tolerance on an OGTT. There was a large subgroup that was positive for glucose intolerance only on the GCT. These individuals represent a distinct biochemical subgroup of uncertain significance that warrants closer evaluation. Although the GCT can be completed in a non-fasting state and in conjunction with regular blood work or clinic visits, the anticipated greater compliance was not seen

A three-dimensional underwater sound propagation model for offshore wind farm noise prediction.

Author Posting. © Acoustical Society of America, 2019. This article is posted here by permission of Acoustical Society of America for personal use, not for redistribution. The definitive version was published in Journal of the Acoustical Society of America 145(5), (2019):EL335-EL340, doi: 10.1121/1.5099560.A three-dimensional underwater sound propagation model with realistic ocean environmental conditions has been created for assessing the impacts of noise from offshore wind farm construction and operation. This model utilizes an existing accurate numerical solution scheme to solve the three-dimensional Helmholtz wave equation, and it is compared and validated with acoustic transmission data between 750 and 1250 Hz collected during the development of the Block Island Wind Farm (BIWF), Rhode Island. The variability of underwater sound propagation conditions has been investigated in the BIWF area on a temporal scale of months and a spatial scale of kilometers. This study suggests that future offshore wind farm developments can exploit the seasonal variability of underwater sound propagation for mitigating noise impact by scheduling wind farm construction during periods of high acoustic transmission loss. Discussions on other applications of soundscape prediction, planning, and management are provided.The authors would like to acknowledge Captain Ken Houlter and First Mate Ian Hanley of the WHOI R/V Tioga. The authors would also like to acknowledge Dr. Steven Crocker from the Naval Undersea Warfare Center in Newport, Rhode Island for the design of the tetrahedral hydrophone array. Study concept, oversight, and funding under the Real-time Opportunity for Development Environmental Operations (RODEO) were provided by the U.S. Department of the Interior, Bureau of Ocean Energy Management, Environmental Studies Program, Washington, DC under Contract No. M16PD00025. The Program Manager at BOEM is Dr. Mary Boatman. The prime contractor for this work is HDR, Inc. (Program Manager Anwar Khan).2019-11-0

MicroRNA profiling reveals marker of motor neuron disease in ALS models

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder marked by the loss of motor neurons (MNs) in the brain and spinal cord, leading to fatally debilitating weakness. Because this disease predominantly affects MNs, we aimed to characterize the distinct expression profile of that cell type to elucidate underlying disease mechanisms and to identify novel targets that inform on MN health during ALS disease time course. microRNAs (miRNAs) are short, noncoding RNAs that can shape the expression profile of a cell and thus often exhibit cell-type-enriched expression. To determine MN-enriched miRNA expression, we used Cre recombinase-dependent miRNA tagging and affinity purification in mice. By defining thein vivomiRNA expression of MNs, all neurons, astrocytes, and microglia, we then focused on MN-enriched miRNAs via a comparative analysis and found that they may functionally distinguish MNs postnatally from other spinal neurons. Characterizing the levels of the MN-enriched miRNAs in CSF harvested from ALS models of MN disease demonstrated that one miRNA (miR-218) tracked with MN loss and was responsive to an ALS therapy in rodent models. Therefore, we have used cellular expression profiling tools to define the distinct miRNA expression of MNs, which is likely to enrich future studies of MN disease. This approach enabled the development of a novel, drug-responsive marker of MN disease in ALS rodents.SIGNIFICANCE STATEMENTAmyotrophic lateral sclerosis (ALS) is a neurodegenerative disease in which motor neurons (MNs) in the brain and spinal cord are selectively lost. To develop tools to aid in our understanding of the distinct expression profiles of MNs and, ultimately, to monitor MN disease progression, we identified small regulatory microRNAs (miRNAs) that were highly enriched or exclusive in MNs. The signal for one of these MN-enriched miRNAs is detectable in spinal tap biofluid from an ALS rat model, where its levels change as disease progresses, suggesting that it may be a clinically useful marker of disease status. Furthermore, rats treated with ALS therapy have restored expression of this MN RNA marker, making it an MN-specific and drug-responsive marker for ALS rodents.</jats:p

Variation in White-tailed Deer Antler Size: The Effects of Age, Landscape Composition, and Physiographic Province

Spatial variation in landscape composition can influence phenotypic expression in wildlife species and can improve management efforts to express certain phenotypic traits. We evaluated the influence of age, landscape composition, and physiographic province on white-tailed deer (Odocoileus virginianus) antler characteristics using data from 16,622 male deer (age range: 1.5–3.5+ years old) harvested between 1997–2016 across five physiographic provinces in Georgia. Age and physiographic province influenced antler size index (ASI; P \u3c 0.001). ASI of yearling males was greatest (- x = 53.37; SE = 0.39) in the Upper Coastal Plain and least (- x = 46.23; SE = 0.51) in the Lower Coastal Plain physiographic province. Given the differences in ASI among physiographic provinces, we evaluated how landscape composition within each physiographic province influenced ASI of 7,325 yearling (1.5-year-old) males. Yearling ASI was positively related to increasing coverage of cultivated crops and suburban-urban areas (e.g., parks, small housing developments). Conversely, evergreen and deciduous forested cover consistently had a negative effect on ASI, except in the Ridge and Valley physiographic province where evergreen was positively related to ASI. Wildlife managers and hunters should recognize the effects of age, landscape composition, and physiographic province when setting antler size expectations

Planning for Project ECHO in New Hampshire

Assuring a healthy New Hampshire requires making sure that all of the state’s residents can get the right care in the right place at the right time. Yet, access to timely, effective health care is not always a given in our state, especially for vulnerable populations. Health and community care workforce shortages, long distances to care, and social, economic, and cultural barriers make accessing care challenging for many. The Project ECHO Model™ is an evidence-based method using web-based teleconferencing to link specialist teams with community-based sites to help community providers improve their ability to manage complex conditions. It has been proven to improve health care outcomes for vulnerable populations with limited access to care because of socioeconomic factors or geography. The New Hampshire Project ECHO® (Extension for Community Healthcare Outcomes) Planning for Implementation and Business Sustainability Project (Planning for Project ECHO in NH) undertook a planning process to inform how to best to develop Project ECHO at UNH to serve New Hampshire health and community care providers and ultimately improve access to effective, timely care. Planning for Project ECHO in NH also developed a business and sustainability plan for long-term success of the UNH Project ECHO Hub and an evaluation plan for measuring efficacy. Planning for Project ECHO in NH included: A Project ECHO Needs Assessment and Prioritization Process, including review of existing needs assessments in the field; a stakeholder survey of health and community care providers conducted by the New Hampshire Citizens Health Initiative (Initiative); and analysis of data from the NH Comprehensive Health Information System (NH CHIS), NH’s all-payer claims database (APCD). A business and sustainability plan including Key Informant Interviews, an environmental scan, and a template for business sustainability planning to identify funding sources and structures to sustain Project ECHO in NH. A framework for Project ECHO evaluation

Intelligent Liver Function Testing (iLFT):A trial of automated diagnosis and staging of liver disease in Primary Care

Background: Liver function tests (LFTs) are frequently requested blood tests which may indicate liver disease. LFTs are commonly abnormal, the causes of which can be complex and frequently under investigated. This can lead to missed opportunities to diagnose and treat liver disease at an early stage. We developed an automated investigation algorithm, which would maximise early diagnosis of liver related diseases. Our aim was to determine whether this new pathway of care, Intelligent Liver Function testing (iLFT) increased diagnosis of liver disease and was cost-effective. Methods: We developed an automated system that further investigated abnormal LFTs on initial testing samples to generate a probable diagnosis and management plan. We integrated an automated investigation algorithm into the laboratory management system, based on minimal diagnostic criteria, liver fibrosis estimation, and reflex testing for causes of liver disease. This algorithm then generated a diagnosis and/or management plan. A stepped-wedged trial design was utilised to compare LFT outcomes in General Practices in the 6 months before and after introduction of the iLFT system. Diagnostic outcomes were collated and compared. Results: Using iLFT, the diagnosis of liver disease was increased by 43%. It was cost-effective with a low initial incremental cost-effectiveness ratio (ICER) of £284 per correct diagnosis, and a saving to the NHS of £3,216 per patient lifetime. Conclusions: iLFT increases liver diagnosis, improves quality of care, and is highly cost-effective. This can be achieved with minor changes to working practices and exploitation of functionality existing within modern laboratory diagnostics systems. Lay Summary: There is a growing epidemic of advanced liver disease, this could be offset by early detection and management. Checking liver blood tests (LFTs) should be an opportunity diagnose liver problems, but abnormal results are often incompletely investigated. In this study we were able to substantially increase the diagnostic yield of the abnormal LFTs using the automated iLFT system. With the addition of referral recommendations and management plans, this strategy provides optimum investigation and management of LFTs and is cost saving to the NHS

Characterization of impact pile driving signals during installation of offshore wind turbine foundations

Author Posting. © Acoustical Society of America, 2020. This article is posted here by permission of Acoustical Society of America for personal use, not for redistribution. The definitive version was published in Journal of the Acoustical Society of America 147(4), (2020): 2323, doi:10.1121/10.0001035.Impact pile driving creates intense, impulsive sound that radiates into the surrounding environment. Piles driven vertically into the seabed generate an azimuthally symmetric underwater sound field whereas piles driven on an angle will generate an azimuthally dependent sound field. Measurements were made during pile driving of raked piles to secure jacket foundation structures to the seabed in waters off the northeastern coast of the U.S. at ranges between 500 m and 15 km. These measurements were analyzed to investigate variations in rise time, decay time, pulse duration, kurtosis, and sound received levels as a function of range and azimuth. Variations in the radiated sound field along opposing azimuths resulted in differences in measured sound exposure levels of up to 10 dB and greater due to the pile rake as the sound propagated in range. The raked pile configuration was modeled using an equivalent axisymmetric FEM model to describe the azimuthally dependent measured sound fields. Comparable sound level differences in the model results confirmed that the azimuthal discrepancy observed in the measured data was due to the inclination of the pile being driven relative to the receiver.This paper was presented at the fifth International Meeting on The Effects of Noise on Aquatic Life held in Den Haag, July 2019. Study concept, oversight, and funding for the experiment were provided by the U.S. Department of the Interior, Bureau of Ocean Energy Management (BOEM), Environmental Studies Program, Washington, DC, under Contract No. M15PC00002, Task Order M16PD00025. Collaborators in this project include Randy Gallien and Anwar Khan (HDR, Inc.).2020-10-1

Mycobactericidal activity of sutezolid (PNU-100480) in sputum (EBA) and blood (WBA) of patients with pulmonary tuberculosis

Rationale: Sutezolid (PNU-100480) is a linezolid analog with superior bactericidal activity against Mycobacterium tuberculosis in the hollow fiber, whole blood and mouse models. Like linezolid, it is unaffected by mutations conferring resistance to standard TB drugs. This study of sutezolid is its first in tuberculosis patients. METHODS: Sputum smear positive tuberculosis patients were randomly assigned to sutezolid 600 mg BID (N = 25) or 1200 mg QD (N = 25), or standard 4-drug therapy (N = 9) for the first 14 days of treatment. Effects on mycobacterial burden in sputum (early bactericidal activity or EBA) were monitored as colony counts on agar and time to positivity in automated liquid culture. Bactericidal activity was also measured in ex vivo whole blood cultures (whole blood bactericidal activity or WBA) inoculated with M. tuberculosis H37Rv. RESULTS: All patients completed assigned treatments and began subsequent standard TB treatment according to protocol. The 90% confidence intervals (CI) for bactericidal activity in sputum over the 14 day interval excluded zero for all treatments and both monitoring methods, as did those for cumulative WBA. There were no treatment-related serious adverse events, premature discontinuations, or dose reductions due to laboratory abnormalities. There was no effect on the QT interval. Seven sutezolid-treated patients (14%) had transient, asymptomatic ALT elevations to 173±34 U/L on day 14 that subsequently normalized promptly; none met Hy's criteria for serious liver injury. CONCLUSIONS: The mycobactericidal activity of sutezolid 600 mg BID or 1200 mg QD was readily detected in sputum and blood. Both schedules were generally safe and well tolerated. Further studies of sutezolid in tuberculosis treatment are warranted. Trial Registration ClinicalTrials.gov NCT0122564