Question prompt lists and caregiver question asking in pediatric specialty appointments: A randomized controlled trial

Objective: Question prompt lists (QPLs) have been effective at increasing patient involvement and question asking in medical appointments, which is critical for shared decision making. We investigated whether pre-visit preparation (PVP), including a QPL, would increase question asking among caregivers of pediatric patients with undiagnosed, suspected genetic conditions. Methods: Caregivers were randomized to receive the PVP before their appointment (n = 59) or not (control, n = 53). Appointments were audio-recorded. Transcripts were analyzed to determine questions asked. Results: Caregivers in the PVP group asked more questions (MeanPVP = 4.36, SDPVP = 4.66 vs. Meancontrol = 2.83, SDcontrol = 3.03, p = 0.045), including QPL questions (MeanPVP = 1.05, SDPVP = 1.39 vs. Meancontrol = 0.36, SDcontrol = 0.81, p = 0.002). Caregivers whose child had insurance other than Medicaid in the PVP group asked more total and QPL questions than their counterparts in the control group (ps = 0.005 and 0.002); there was no intervention effect among caregivers of children with Medicaid or no insurance (ps = 0.775 and 0.166). Conclusion: The PVP increased question asking but worked less effectively among traditionally underserved groups. Additional interventions, including provider-focused efforts, may be needed to promote engagement of underserved patients. Practice implications: Patient/family-focused interventions may not be beneficial for all populations. Providers should be aware of potential implicit and explicit biases and encourage question asking to promote patient/family engagement

Localization of the human homolog of the yeast cell division control 27 gene (CDC27) proximal to ITGB3 on human chromosome 17q21.3

The human homolog of the Saccharomyces cerevisiae cell division control 27 gene (CDC27) was mapped to human chromosome 17q12-q21 using a panel of human/rodent somatic cell hybrids and localized distal to the breast cancer susceptibility gene, BRCA1 , using a panel of radiation hybrids. The radiation hybrid panel indicates that the most likely position of human CDC27 on human chromosome 17 is between the marker D17S409 and the beta 3 subunit of integrin (ITGB3). Further confirmation of this localization comes from the sequence tagged site (STS) mapping of human CDC27 to the same yeast artificial chromosomes (YACs) positive for ITGB3 . The estimated distance between ITGB3 and human CDC27 is less than 600 kb.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45546/1/11188_2005_Article_BF02257470.pd

Planck early results. XVII. Origin of the submillimetre excess dust emission in the Magellanic Clouds

The integrated spectral energy distributions (SED) of the Large Magellanic Cloud (LMC) and SmallMagellanic Cloud (SMC) appear significantly flatter than expected from dust models based on their far-infrared and radio emission. The still unexplained origin of this millimetre excess is investigated here using the Planck data. The integrated SED of the two galaxies before subtraction of the foreground (Milky Way) and background (CMB fluctuations) emission are in good agreement with previous determinations, confirming the presence of the millimetre excess. In the context of this preliminary analysis we do not propose a full multi-component fitting of the data, but instead subtract contributions unrelated to the galaxies and to dust emission. The background CMB contribution is subtracted using an internal linear combination (ILC) method performed locally around the galaxies. The foreground emission from the Milky Way is subtracted as a Galactic Hi template, and the dust emissivity is derived in a region surrounding the two galaxies and dominated by Milky Way emission. After subtraction, the remaining emission of both galaxies correlates closely with the atomic and molecular gas emission of the LMC and SMC. The millimetre excess in the LMC can be explained by CMB fluctuations, but a significant excess is still present in the SMC SED. The Planck and IRAS–IRIS data at 100 μm are combined to produce thermal dust temperature and optical depth maps of the two galaxies. The LMC temperature map shows the presence of a warm inner arm already found with the Spitzer data, but which also shows the existence of a previously unidentified cold outer arm. Several cold regions are found along this arm, some of which are associated with known molecular clouds. The dust optical depth maps are used to constrain the thermal dust emissivity power-law index (β). The average spectral index is found to be consistent with β =1.5 and β =1.2 below 500 μm for the LMC and SMC respectively, significantly flatter than the values observed in the Milky Way. Also, there is evidence in the SMC of a further flattening of the SED in the sub-mm, unlike for the LMC where the SED remains consistent with β =1.5. The spatial distribution of the millimetre dust excess in the SMC follows the gas and thermal dust distribution. Different models are explored in order to fit the dust emission in the SMC. It is concluded that the millimetre excess is unlikely to be caused by very cold dust emission and that it could be due to a combination of spinning dust emission and thermal dust emission by more amorphous dust grains than those present in our Galaxy

Planck early results. XIII. Statistical properties of extragalactic radio sources in the Planck Early Release Compact Source Catalogue

The data reported in Planck’s Early Release Compact Source Catalogue (ERCSC) are exploited to measure the number counts (dN/dS) of extragalactic radio sources at 30, 44, 70, 100, 143 and 217 GHz. Due to the full-sky nature of the catalogue, this measurement extends to the rarest and brightest sources in the sky. At lower frequencies (30, 44, and 70 GHz) our counts are in very good agreement with estimates based on WMAP data, being somewhat deeper at 30 and 70 GHz, and somewhat shallower at 44 GHz. Planck’s source counts at 143 and 217 GHz join smoothly with the fainter ones provided by the SPT and ACT surveys over small fractions of the sky. An analysis of source spectra, exploiting Planck’s uniquely broad spectral coverage, finds clear evidence of a steepening of the mean spectral index above about 70 GHz. This implies that, at these frequencies, the contamination of the CMB power spectrum by radio sources below the detection limit is significantly lower than previously estimated

Planck Early Results XVIII: The power spectrum of cosmic infrared background anisotropies

Using Planck maps of six regions of low Galactic dust emission with a total area of about 140 deg2, we determine the angular power spectra of cosmic infrared background (CIB) anisotropies from multipole ℓ = 200 to ℓ = 2000 at 217, 353, 545 and 857 GHz. We use 21-cm observations of Hi as a tracer of thermal dust emission to reduce the already low level of Galactic dust emission and use the 143 GHz Planck maps in these fields to clean out cosmic microwave background anisotropies. Both of these cleaning processes are necessary to avoid significant contamination of the CIB signal. We measure correlated CIB structure across frequencies. As expected, the correlation decreases with increasing frequency separation, because the contribution of high-redshift galaxies to CIB anisotropies increases with wavelengths. We find no significant difference between the frequency spectrum of the CIB anisotropies and the CIB mean, with ∆I/I=15% from 217 to 857 GHz. In terms of clustering properties, the Planck data alone rule out the linear scale- and redshift-independent bias model. Non-linear corrections are significant. Consequently, we develop an alternative model that couples a dusty galaxy, parametric evolution model with a simple halo-model approach. It provides an excellent fit to the measured anisotropy angular power spectra and suggests that a different halo occupation distribution is required at each frequency, which is consistent with our expectation that each frequency is dominated by contributions from different redshifts. In our best-fit model, half of the anisotropy power at ℓ=2000 comes from redshifts z 2 at 353 and 217 GHz, respectively

Planck early results. XXV. Thermal dust in nearby molecular clouds

Planck allows unbiased mapping of Galactic sub-millimetre and millimetre emission from the most diffuse regions to the densest parts of molecular clouds. We present an early analysis of the Taurus molecular complex, on line-of-sight-averaged data and without component separation. The emission spectrum measured by Planck and IRAS can be fitted pixel by pixel using a single modified blackbody. Some systematic residuals are detected at 353 GHz and 143 GHz, with amplitudes around −7% and +13%, respectively, indicating that the measured spectra are likely more complex than a simple modified blackbody. Significant positive residuals are also detected in the molecular regions and in the 217 GHz and 100 GHz bands, mainly caused by the contribution of the J = 2 → 1 and J = 1 → 0 12CO and 13CO emission lines. We derive maps of the dust temperature T, the dust spectral emissivity index β, and the dust optical depth at 250 μm τ250. The temperature map illustrates the cooling of the dust particles in thermal equilibrium with the incident radiation field, from 16−17 K in the diffuse regions to 13−14 K in the dense parts. The distribution of spectral indices is centred at 1.78, with a standard deviation of 0.08 and a systematic error of 0.07. We detect a significant T − β anti-correlation. The dust optical depth map reveals the spatial distribution of the column density of the molecular complex from the densest molecular regions to the faint diffuse regions.We use near-infrared extinction and Hi data at 21-cm to perform a quantitative analysis of the spatial variations of the measured dust optical depth at 250 μm per hydrogen atom τ250/NH. We report an increase of τ250/NH by a factor of about 2 between the atomic phase and the molecular phase, which has a strong impact on the equilibrium temperature of the dust particles

Distribution of Major Health Risks: Findings from the Global Burden of Disease Study

BACKGROUND: Most analyses of risks to health focus on the total burden of their aggregate effects. The distribution of risk-factor-attributable disease burden, for example by age or exposure level, can inform the selection and targeting of specific interventions and programs, and increase cost-effectiveness. METHODS AND FINDINGS: For 26 selected risk factors, expert working groups conducted comprehensive reviews of data on risk-factor exposure and hazard for 14 epidemiological subregions of the world, by age and sex. Age-sex-subregion-population attributable fractions were estimated and applied to the mortality and burden of disease estimates from the World Health Organization Global Burden of Disease database. Where possible, exposure levels were assessed as continuous measures, or as multiple categories. The proportion of risk-factor-attributable burden in different population subgroups, defined by age, sex, and exposure level, was estimated. For major cardiovascular risk factors (blood pressure, cholesterol, tobacco use, fruit and vegetable intake, body mass index, and physical inactivity) 43%–61% of attributable disease burden occurred between the ages of 15 and 59 y, and 87% of alcohol-attributable burden occurred in this age group. Most of the disease burden for continuous risks occurred in those with only moderately raised levels, not among those with levels above commonly used cut-points, such as those with hypertension or obesity. Of all disease burden attributable to being underweight during childhood, 55% occurred among children 1–3 standard deviations below the reference population median, and the remainder occurred among severely malnourished children, who were three or more standard deviations below median. CONCLUSIONS: Many major global risks are widely spread in a population, rather than restricted to a minority. Population-based strategies that seek to shift the whole distribution of risk factors often have the potential to produce substantial reductions in disease burden

Planck early results III : First assessment of the Low Frequency Instrument in-flight performance

Peer reviewe