Immature Platelet Dynamics in Immune-Mediated Thrombocytopenic States

A major challenge encountered by clinicians is differentiating presentations characterized by significant thrombocytopenia due to overlapping clinical symptoms and signs in the setting of ambiguous laboratory results. Immature platelets represent the youngest platelets that can be measured in peripheral blood by current hematology analyzers. These young platelets are larger, with higher RNA content recently released from the bone marrow. Thrombocytopenic presentations caused directly or indirectly by immune responses can lead to compensatory bone marrow responses seeking to normalize the platelet count; thus obtaining absolute immature platelet counts may be informative while triaging patients. Over the last decade, their use has expanded beyond being an early biomarker of bone marrow reconstitution post-hematopoietic stem cell transplantation to being used to establish bone marrow responses to infection and thrombocytopenias due to immune etiologies. Its accessibility as part of more detailed platelet indices obtained with routine laboratories makes it a promising option to understand the bone marrow\u27s real-time response to disease states characterized by thrombocytopenia. This review will look at the immature platelet count as a biomarker, while presenting current attempts trying to understand how it could be used in thrombocytopenias occurring secondary to a given immune etiology

Chronic Red Cell Exchange in Sickle Cell Patients with Iron Overload May Not Affect Mortality

Sickle cell disease (SCD) is an inherited blood disorder that affects ~100,000 Americans (1, 2). In SCD, red blood cells (RBC) containing aberrant sickle hemoglobin (HgbS) become sickle-shaped at low oxygen tension and stick together leading to obstructed blood flow. The resulting decrease in tissue oxygenation causes chronic complications such as vasculo-occlusive pain crises among others that require frequent hospitalizations (3). Chronic RBC transfusions play a prominent role in the treatment of this disease by improving oxygenation through addition of normal RBC and dilution of RBC containing HgbS (4, 5). However, the major disadvantage of management with simple transfusion is the introduction of excess iron into the body which outpaces dedicated mechanisms for iron removal. Thus, over the course of the disease, excess iron is deposited into multiple organs causing organ damage leading to eventual organ failure. By contrast, automated red cell exchange (RCE) is an alternative therapeutic approach that exchanges the patient\u27s sickle RBC with normal RBC reducing the sickle cell RBC more efficiently while being iron neutral (6). Despite the apparent advantage of RCE (7) and inclusion in current management recommendations (8), its benefits for patients with iron overload remains controversial. In this study we examined if RCE improved long-term survival for SCD patients with iron overload treated at our institution

The Effect of Anthrax Bioterrorism on Emergency Department Presentation

Study Objective: From September through December 2001, 22 Americans were diagnosed with anthrax, prompting widespread national media attention and public concern over bioterrorism. The purpose of this study was to determine the effect of the threat of anthrax bioterrorism on patient presentation to a West Coast emergency department (ED). Methods: This survey was conducted at an urban county ED in Oakland, CA between December 15, 2001 and February 15, 2002. During random 8-hour blocks, all adult patients presenting for flu or upper respiratory infection (URI) symptoms were surveyed using a structured survey instrument that included standard visual numerical and Likert scales. Results: Eighty-nine patients were interviewed. Eleven patients (12%) reported potential exposure risk factors. Eighty percent of patients watched television, read the newspaper, or listened to the radio daily, and 83% of patients had heard about anthrax bioterrorism. Fifty-five percent received a chest x-ray, 10% received either throat or blood cultures, and 28% received antibiotics. Twenty-one percent of patients surveyed were admitted to the hospital. Most patients were minimally concerned that they may have contracted anthrax (mean=3.3±3.3 where 0=no concern and 10=extremely concerned). Patient concern about anthrax had little influence on their decision to visit the ED (mean=2.8±3.0 where 0=no influence and 10=greatly influenced). Had they experienced their same flu or URI symptoms one year prior to the anthrax outbreak, 91% of patients stated they would have sought medical attention. Conclusions: After considerable exposure to media reports about anthrax, most patients in this urban West Coast ED population were not concerned about anthrax infection. Fear of anthrax had little effect on decisions to come to the ED, and most would have sought medical help prior to the anthrax outbreak

Measurements of the vertical profile, diurnal variation, and secular change of ClO in the stratosphere over Thule, Greenland, February-March, 1992

We report observations of stratospheric chlorine monoxide over the altitude range approx. 16 to 50 km at Thule, Greenland from Feb. 8 to Mar. 24, 1992. A new, more sensitive ground-based mm-wave spectrometer was employed for these measurements, similar in principle to that used earlier for the discovery of low altitude ClO in the Antarctic springtime. In this report, we discuss different aspects of vertical distribution, secular trends, and diurnal variation of ClO in the Arctic stratosphere, based on a preliminary analysis of our Thule data. We see no evidence for large (approx. 1.2-1.5 ppb) amounts of ClO in the lower stratosphere at any time during February or March, in agreement with UARS-MLS findings for this period, and in marked contrast to findings reported for the Arctic in January. We have some evidence for small enhancements (approx. 0.2-0.5 ppb) in the 18-30 km range in late February-early March, which might be associated with volcanic aerosol, rather than PSC, processing

Observed changes in the vertical profile of stratopheric nitrous oxide at Thule, Greenland, February - March 1992

Using a ground-based mm-wave spectrometer, we have observed stratospheric N2O over Thule, Greenland (76.3 N, 68.4 W) during late February and March, 1992. Vertical profiles of mixing ratio ranging from 16 to 50 km were recovered from molecular emission spectra. The profiles of early March show an abrupt increase in the lower-stratosphere N2O mixing ratio similar to the spring-to-summer change associated with the break up of the Antarctic polar vortex. This increase is correlated with changes in potential vorticity, air temperature, and ozone mixing ratio

Adoption of Conservation-Tillage Practices in Cotton Production

Replaced with revised version of paper 10/23/07.conservation tillage, cotton, genetically modified seed, herbicide-resistant cotton, stacked-gene cotton, simultaneous logit model, single-equation logit model, technology adoption, Crop Production/Industries,

Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial: Design and rationale.

BACKGROUND: Acute decompensated heart failure (ADHF) is a leading cause of hospitalization in older persons in the United States. Reduced physical function and frailty are major determinants of adverse outcomes in older patients with hospitalized ADHF. However, these are not addressed by current heart failure (HF) management strategies and there has been little study of exercise training in older, frail HF patients with recent ADHF. HYPOTHESIS: Targeting physical frailty with a multi-domain structured physical rehabilitation intervention will improve physical function and reduce adverse outcomes among older patients experiencing a HF hospitalization. STUDY DESIGN: REHAB-HF is a multi-center clinical trial in which 360 patients ≥60 years hospitalized with ADHF will be randomized either to a novel 12-week multi-domain physical rehabilitation intervention or to attention control. The goal of the intervention is to improve balance, mobility, strength and endurance utilizing reproducible, targeted exercises administered by a multi-disciplinary team with specific milestones for progression. The primary study aim is to assess the efficacy of the REHAB-HF intervention on physical function measured by total Short Physical Performance Battery score. The secondary outcome is 6-month all-cause rehospitalization. Additional outcome measures include quality of life and costs. CONCLUSIONS: REHAB-HF is the first randomized trial of a physical function intervention in older patients with hospitalized ADHF designed to determine if addressing deficits in balance, mobility, strength and endurance improves physical function and reduces rehospitalizations. It will address key evidence gaps concerning the role of physical rehabilitation in the care of older patients, those with ADHF, frailty, and multiple comorbidities

Precision Farming by Cotton Producers in Eleven Southern States: Results from the 2005 Southern Precision Farming Survey

Precision Farming by Cotton Producers in Eleven Southern States: Results from the 2005 Southern Precision Farming Surveycotton, precision farming, survey, Agribusiness, Farm Management, Production Economics, Research and Development/Tech Change/Emerging Technologies,