Improving Awareness of Sleep Disorders in Neurology Clinics

Objective Our main goals were to assess the incidence of sleep problems in our patients and to improve the awareness of sleep disorders amongst our neurology clinicians. We hoped that our patients with significant sleep-related symptoms would be referred for further objective testing. Methods We designed a 5-question sleep quality survey to be filled out by each patient seen in our outpatient neurology clinics. The forms were collected for entry and analysis on an Excel spreadsheet program. A response of 2 or 3 (moderate or high chance of having a symptom) for each of the questions 1-4 and a “yes” for question 5 were considered significant symptomology. We compared the incidence of sleep problems between the general clinic and the multiple sclerosis (MS) clinic. Results Surveys from 1008 patients were analyzed. A large majority (78%) of the neurology patients seen in our clinics was found to have at least one significant sleep related symptom. Most of these patients were not referred for further diagnostic testing by polysomnography (PSG) or for formal evaluation by a sleep clinic. Conclusions Our data support a well-known notion that neurological patients have a high prevalence of symptoms related to sleep disorders. As neurologists, we ought to include sleep as one of the functions of the brain, and we need to be more diligent in the diagnosis of sleep disorders in our patients. Our future goals include verification of our data with objective evidence from PSG results or formal sleep evaluations

The role and impact of digital and traditional information and communication pathways in health service access and equity

This review of the literature was conducted by Flinders University (SA Community Health Research Unit and Southgate Institute for Health Society & Equity) to provide an overview of changing communications in health promotion to inform the Falls Prevention Project of Country Health SA’s Local Health Network. The context is that falls health literacy information is being increasingly made available via digital formats, including the Internet. This is in line with healthcare around the world increasingly moving to e-health (the delivery or enhancement of health services through the Internet and related technologies). There are particular expectations that for rural Australians making health services and information available through digital formats will overcome existing problems with access and availability. Despite a large amount of activity in the area of e-health, there is a scarce evidence base on the equity impacts of e-health promotion

Southgate digital equity tool

Made available with permission from author and publisher.The Southgate Digital Equity Tool has been developed to assist policy makers and practitioners in making informed decisions about the way they engage consumers in services and programs in the digital era. Initially developed for use by health organisations, the tool can be adapted for use by any organisation to guide thinking around the impact of traditional and digital communication on different client/consumer/population groups, with a focus on the impact of shifting to, or increasing, digital engagement with them. The basis for the tool is the assumption that digital engagement strategies will impact on client/consumer groups differently, with a differential impact on intended outcomes, especially on accessibililty of services, information and participation. The tool can be used to examine one strategy or a set of communication strategies which address a particular issue, a geographic area, a group or a population. Part 1 is a Workbook and Part 2 is a Guide to assist in completing the Workbook, including descriptions and examples. The digital equity tool can help you and your organisation to examine: (1) The current mix of communication and engagement modes across a certain service or issue; (2) A proposed change in this mix; (3) The impact of a change in mix retrospectively; (4) Mitigation strategies to limit negative impacts

Prevalence of alternative splicing choices in Arabidopsis thaliana

<p>Abstract</p> <p>Background</p> <p>Around 14% of protein-coding genes of <it>Arabidopsis thaliana </it>genes from the TAIR9 genome release are annotated as producing multiple transcript variants through alternative splicing. However, for most alternatively spliced genes in <it>Arabidopsis</it>, the relative expression level of individual splicing variants is unknown.</p> <p>Results</p> <p>We investigated prevalence of alternative splicing (AS) events in <it>Arabidopsis thaliana </it>using ESTs. We found that for most AS events with ample EST coverage, the majority of overlapping ESTs strongly supported one major splicing choice, with less than 10% of ESTs supporting the minor form. Analysis of ESTs also revealed a small but noteworthy subset of genes for which alternative choices appeared with about equal prevalence, suggesting that for these genes the variant splicing forms co-occur in the same cell types. Of the AS events in which both forms were about equally prevalent, more than 80% affected untranslated regions or involved small changes to the encoded protein sequence.</p> <p>Conclusions</p> <p>Currently available evidence from ESTs indicates that alternative splicing in <it>Arabidopsis </it>occurs and affects many genes, but for most genes with documented alternative splicing, one AS choice predominates. To aid investigation of the role AS may play in modulating function of <it>Arabidopsis </it>genes, we provide an on-line resource (ArabiTag) that supports searching AS events by gene, by EST library keyword search, and by relative prevalence of minor and major forms.</p

Evaluation of African-American and White Racial Classification in a Surveillance, Epidemiology, and End Results Cancer Registry

Objectives: This study evaluated the validity of registry-reported race for individuals who participated in research studies conducted since 1980 through the Metropolitan Detroit Cancer Surveillance System (MDCSS), a Surveillance, Epidemiology, and End Results (SEER) Program registry. Methods: 5329 individuals who self-identified as African American or White and were classified in the MDCSS registry as African American or White were included. Self-identified and registry-reported race were compared, and associations between demographics and racial misclassification were examined. Results: Most self-identified African Americans and Whites were correctly classified (sensitivity= 98.5%, specificity=99.7%). Males were two times more likely to be misclassified than females [odds ratio (OR)=2.13, 95% confidence interval (CI): 1.06-4.29]. Individuals diagnosed with cancer after 1990 were two times more likely to be misclassified than those diagnosed before 1990 (OR= 2.17, 95% CI: 1.07--4.42). African Americans were four times more likely to be misclassified than Whites (OR=4.39, 95% CI: 2.24-8.60). Conclusions: Misclassification in the MDCSS registry of African Americans as Whites, and vice versa, is relatively low. Additional studies should evaluate misclassification of African Americans and Whites as other races and/or ethnicities in the SEER registry

Draft genome sequence of the blaOXA-436- and blaNDM-1-harboring Shewanella putrefaciens SA70 isolate

ABSTRACT We sequenced a carbapenem-resistant Shewanella putrefaciens isolate cultured from the sink handle of a Pakistan hospital room. Assembly annotation indicates that the isolate has a chromosomal bla OXA-436 carbapenemase and a plasmid-borne bla NDM-1 gene. To our knowledge, this is the first report of a Shewanella species harboring bla NDM . </jats:p

Characteristics and Outcomes of Patients Discharged Directly Home from a Medical Intensive Care Unit

Introduction: Discharging patients directly home from the ICU is becoming increasingly common, largely driven by decreased ward bed availability. We evaluated readmission patterns of ICU patients discharged directly home. Methods: Retrospective review was conducted of direct discharges from the ICU to home between June 2017 and June 2019. The primary outcome of interest was 30-day hospital readmission. Patients were dichotomized by “wait-time” between transfer order and hospital discharge (\u3c24 hours or ≥24 hours). Outcomes were compared using t-test, Fisher exact, and chi-squared. Risk-adjustment was performed using the Mortality Probability Model (MPM0-III). ICU workload was estimated using the nine equivalents of nursing manpower use score (NEMS). Results: 331 patients were identified, with a mean time of 0.72 [0 - 5.84] days between ICU transfer order and discharge to home. 68.3% (226/331) of patients waited \u3c24 hours for discharge. There was no difference in severity-of-illness or admission NEMS between the groups. 10.3% (45/331) of patients presented for evaluation within 30 days of discharge. 10.3% (34/331) of patients were readmitted. There was no significant difference in 30-day readmission between patients who were discharged after waiting \u3c24 hours vs. waiting ≥24 hours (p=0.70). Discussion: Patients returning directly home from the ICU without discharge delay were not readmitted more frequently within 30 days than those discharged after a delay exceeding 24 hours. Further investigation into identifying patients eligible for safe, early discharge may reduce unnecessary critical care resource utilization

Superficieibacter electus gen. nov., sp. nov., an extended-spectrum β-lactamase possessing member of the enterobacteriaceae family, isolated from Intensive Care Unit surfaces

<p>Two Gram-negative bacilli strains, designated BP-1(T) and BP-2, were recovered from two different Intensive Care Unit surfaces during a longitudinal survey in Pakistan. Both strains were unidentified using the bioMerieux VITEK MS IVD v2.3.3 and Bruker BioTyper MALDI-TOF mass spectrometry platforms. To more precisely determine the taxonomic identity of BP-1(T) and BP-2, we employed a biochemical and phylogenomic approach. The 16S rRNA gene sequence of strain BP-1(T) had the highest identity to Citrobacter farmeri CDC 2991-81(T) (98.63%) Citrobacter amalonaticus CECT 863(T) (98.56%), Citrobacter sedlakii NBRC 105722(T) (97.74%) and Citrobacter rodentium NBRC 105723(T) (97.74%). The biochemical utilization scheme of BP-1(T) using the Analytic Profile Index for Enterobacteriaceae (API20E) indicated its enzymatic functions are unique within the Enterobacteriaceae but most closely resemble Kluyvera spp., Enterobacter cloacae and Citrobacter koseri/farmeri. Phylogenomic analysis of the shared genes between BP-1(T), BP-2 and type strains from Kluyvera, Citrobacter, Escherichia, Salmonella, Kosakonia, Siccibacter and Shigella indicate that BP-1(T) and BP-2 isolates form a distinct branch from these genera. Average Nucleotide Identity analysis indicates that BP-1(T) and BP-2 are the same species. The biochemical and phylogenomic analysis indicate strains BP-1(T) and BP-2 represent a novel species from a new genus within the Enterobacteriaceae family, for which the name Superficieibacter electus gen. nov., sp. nov., is proposed. The type strain is BP-1(T) (= ATCC BAA-2937, = NBRC 113412).</p

A strategy to combine pathway-targeted low toxicity drugs in ovarian cancer.

Serous Ovarian Cancers (SOC) are frequently resistant to programmed cell death. However, here we describe that these programmed death-resistant cells are nonetheless sensitive to agents that modulate autophagy. Cytotoxicity is not dependent upon apoptosis, necroptosis, or autophagy resolution. A screen of NCBI yielded more than one dozen FDA-approved agents displaying perturbed autophagy in ovarian cancer. The effects were maximized via combinatorial use of the agents that impinged upon distinct points of autophagy regulation. Autophagosome formation correlated with efficacy in vitro and the most cytotoxic two agents gave similar effects to a pentadrug combination that impinged upon five distinct modulators of autophagy. However, in a complex in vivo SOC system, the pentadrug combination outperformed the best two, leaving trace or no disease and with no evidence of systemic toxicity. Targeting the autophagy pathway in a multi-modal fashion might therefore offer a clinical option for treating recalcitrant SOC