Should RAAS blockade therapy be continued in patients with advanced renal disease?

Q: Should RAAS blockade therapy be continued in patients with advanced renal disease? Evidence-based answer: PROBABLY. Renin-angiotensinaldosterone system (RAAS) blockade therapy should be continued in most patients with advanced renal disease and comorbid conditions; however, individualized treatment is warranted as data on the benefits and harms in all-cause mortality, cardiovascular mortality, and risk for renal replacement therapy are inconclusive (strength of recommendation [SOR]: B, based on observational studies, systematic reviews, and meta-analyses of randomized controlled trials [RCTs]). Certain patient populations, such as patients with diabetes or those with cardiovascular risk or history, may benefit most from continued RAAS blockade therapy (SOR: A, based on systematic reviews and meta-analyses of RCTs).Kim Pham, DO; Carli Beyer, DO (Methodist Charlton Family Medicine Residency), Rick Guthmann, MD, (MPH Advocate Health Care Illinois Masonic Medical Center Program)Includes bibliographical reference

Fear extinction across development: The involvement of the medial prefrontal cortex as assessed by temporary inactivation and immunohistochemistry

Extinction in adult animals, including humans, appears to involve the medial prefrontal cortex (mPFC). However, the role of mPFC in extinction across development has not yet been studied. Given several recent demonstrations of developmental differences in extinction of conditioned fear at a behavioral level, different neural circuitries may mediate fear extinction across development. In all experiments, noise conditioned stimulus (CS) and shock unconditioned stimulus (US) were used. In experiment 1A, temporary unilateral inactivation of the mPFC during extinction training impaired long-term extinction the following day in postnatal day 24 (P24) rats but not in P17 rats. In experiment 1B, bilateral inactivation of them PFC again failed to disrupt long-term extinction in P17 rats. In experiment 2, extinction training increased phosphorylated mitogen-activated protein kinase (pMAPK) in the mPFC for P24 rats but not for P17 rats, whereas rats of both ages displayed elevated pMAPK in the amygdala. Across both ages, "not trained," "reactivated, " and "no extinction" control groups expressed very low numbers of pMAPK immunoreactive (IR) neurons across both neural structures. This result indicates that the mere conditioning experience, the exposure to the CS, or the expression of CS-elicited fear in and of itself is not sufficient to explain the observed increase in pMAPK-IR neurons in them PFC and/or the amygdala after extinction. Together, these findings show that extinction in P17 rats does not involve the mPFC, which has important theoretical and clinical implications for the treatment of anxiety disorders in humans

Fear extinction across development: The involvement of the medial prefrontal cortex as assessed by temporary inactivation and immunohistochemistry

Extinction in adult animals, including humans, appears to involve the medial prefrontal cortex (mPFC). However, the role of mPFC in extinction across development has not yet been studied. Given several recent demonstrations of developmental differences in extinction of conditioned fear at a behavioral level, different neural circuitries may mediate fear extinction across development. In all experiments, noise conditioned stimulus (CS) and shock unconditioned stimulus (US) were used. In experiment 1A, temporary unilateral inactivation of the mPFC during extinction training impaired long-term extinction the following day in postnatal day 24 (P24) rats but not in P17 rats. In experiment 1B, bilateral inactivation of them PFC again failed to disrupt long-term extinction in P17 rats. In experiment 2, extinction training increased phosphorylated mitogen-activated protein kinase (pMAPK) in the mPFC for P24 rats but not for P17 rats, whereas rats of both ages displayed elevated pMAPK in the amygdala. Across both ages, "not trained," "reactivated, " and "no extinction" control groups expressed very low numbers of pMAPK immunoreactive (IR) neurons across both neural structures. This result indicates that the mere conditioning experience, the exposure to the CS, or the expression of CS-elicited fear in and of itself is not sufficient to explain the observed increase in pMAPK-IR neurons in them PFC and/or the amygdala after extinction. Together, these findings show that extinction in P17 rats does not involve the mPFC, which has important theoretical and clinical implications for the treatment of anxiety disorders in humans

Learning End-to-End Channel Coding with Diffusion Models

It is a known problem that deep-learning-based end-to-end (E2E) channel coding systems depend on a known and differentiable channel model, due to the learning process and based on the gradient-descent optimization methods. This places the challenge to approximate or generate the channel or its derivative from samples generated by pilot signaling in real-world scenarios. Currently, there are two prevalent methods to solve this problem. One is to generate the channel via a generative adversarial network (GAN), and the other is to, in essence, approximate the gradient via reinforcement learning methods. Other methods include using score-based methods, variational autoencoders, or mutual-information-based methods. In this paper, we focus on generative models and, in particular, on a new promising method called diffusion models, which have shown a higher quality of generation in image-based tasks. We will show that diffusion models can be used in wireless E2E scenarios and that they work as good as Wasserstein GANs while having a more stable training procedure and a better generalization ability in testing.Comment: 6 pages, WSA/SCC 202

Medication Management Program Among Elderly at a Residential Facility

Abstract This quality improvement project aimed to address medication management-related issues at a residential facility. The project\u27s population was elderly residents who self- administered their medications. A root cause analysis and SWOT analysis identified multiple factors contributing to medication management errors, including lack of resident education, resident competency, and technology limitations. An intervention plan was developed and implemented in two phases. Phase 1 involved conducting medication reconciliation, assessing resident competency, and 1:1 educational sessions with the residents. Educational retention was assessed by using a pre-test and a post-test. Phase 2, to be implemented in the future, will address technology limitations, incorporate an electronic medical records (EMR) system, and provide ongoing staff education. Results from Phase 1 include 80% recalled new information while 20% showed no change after completion of the educational session and the pre/post-test; from those residents assessed with the Medi-Cog, 55% scored above 8 out of 10 while 45% scored below the cutoff score of 8, and last 100% of the Medication Administration Records (MAR) were reviewed. Although time constraints prevented Phase 2 interventions from being implemented, implementing an EMR system and a professional development plan for staff education are expected to contribute to further improvements in medication management at the residential facility. Continued monitoring and collaboration with the residents and staff are vital for sustained success

How accurate is transcutaneous bilirubin testing in newborns with darker skin tones?

Q: How accurate is transcutaneous bilirubin testing in newborns with darker skin tones? Evidence-based answer: Fairly accurate. Photometric transcutaneous bilirubin (TcB) testing may overestimate total serum bilirubin (TSB) in neonates with darker skin tones by a mean of 0.68 to > 2 mg/dL (strength of recommendation [SOR]: C, diagnostic cohort studies with differing reference standards). Overall, TcB meters retain acceptable accuracy in infants of all skin tones across a range of bilirubin levels, despite being more likely to underestimate lighter skin tones and overestimate darker ones (SOR: C, diagnostic cohort studies with differing reference standards). It is unclear if the higher readings prompt an increase in blood draws or otherwise alter care.Brandi Boden, DO; Brittany Buescher, MD; Amanda Kim, MD; Jon O. Neher, MD (Valley Family Medicine Residency, University of Washington), Sarah Safranek (MLIS Librarian Emeritus, University of Washington, Seattle), Rick Guthmann (MD, MPH Advocate Health Care Illinois Masonic Medical Center Program)Includes bibliographical reference

Mysteries of the Underground River

Have you ever heard of a river that that flows backwards? Mammoth Cave, the longest cave system in the world, has an underground river exhibiting reverse fl ow patterns since at least the 1960’s and most likely earlier. Beginning in 2009, 7th graders from T.K. Stone Middle School in Elizabethtown, Kentucky have been teaming with WKU researchers to study and conduct research about this phenomenon

Data-Driven Selection of Security Application Frameworks During Architectural Design

The selection of application frameworks is an important aspect of architectural design. Selection often requires satisficing, that is, searching a potentially large space of design alternatives until an acceptable solution is found. There is, however, little help for architects in selecting software frameworks. In this paper we investigate the criteria used by practicing software architects in selecting security frameworks. We also propose how information associated with some of the criteria that are important to architects can be obtained manually or in an automated way from online sources such as GitHub. Our ultimate goal is to identify measures associated with these criteria that can be helpful in providing support for architects to select software frameworks

Crossover between ionic/covalent and pure ionic bonding in magnesium oxyde clusters

An empirical potential with fluctuating charges is proposed for modelling (MgO)_n clusters in both the molecular (small n) and bulk (n->infty) regimes. Vectorial polarization forces are explicitely taken into account in the self-consistent determination of the charges. Our model predicts cuboid cluster structures, in agreement with previous experimental and theoretical results. The effective charge transferred between magnesium and oxygen smoothly increases from 1 to 2, with an estimated crossover size above 300 MgO molecules