An assessment of prevalence and expenditure associated with discharge brain MRI in preterm infants

To assess national expenditure associated with preterm-infant brain MRI and potential impact of reduction per Choosing Wisely campaign 2015 recommendation to “avoid routine screening term-equivalent or discharge brain MRIs in preterm-infants”. Cross-sectional U.S. trend data from the Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) database (2006, 2009, 2012, 2016) was used to estimate overall national expenditure associated with brain MRI among infants with gestational age (GA) ≤36 weeks, and also when classified as ‘not indicated’ (NI-MRI) i.e., equivalent to routine use without clinical indications and regarded as low-value service (LVS). Associated cost was determined by querying CMS-database for physician-fee-schedules to find the highest global procedure-cost per cycle, then adjusting for inflation. Sensitivity-analyses were conducted to account for additional clinical charges associated with NI-MRI. 3,768 (0.26%) of 1,472,236 preterm-infants had brain MRI across all cycles (inflation-adjusted total $3,690,088). Overall proportion of brain MRIs increased across 2006–2012 from 0.25$1,299,130 (95% CI: $987,505,$1,610,755); 2009, $1,194,208 (95$873,487, $1,516,154); 2012,$931,836 (95% CI: $666,114,$1,197,156); and 2016, $264,648 (95$172,061, $357,280). Prevalence for NI-MRI in 2006, 2009, 2012 and 2016 was 86$1,190,919/$518,343, for 2012/2016 cycles respectively. National MRI prevalence in preterm infants (both overall and LVS) and associated expenditure decreased substantially post recommendation; however, annual savings are modest and unlikely to be \u3e$1.2 million

Multidrug-resistant Mycobacterium tuberculosis in HIV-Infected Persons, Peru

During 1999 to 2000, we identified HIV-infected persons with new episodes of tuberculosis (TB) at 10 hospitals in Lima-Peru and a random sample of other Lima residents with TB. Multidrug-resistant (MDR)-TB was documented in 35 (43%) of 81 HIV-positive patients and 38 (3.9%)of 965 patients who were HIV-negative or of unknown HIV status (p < 0.001). HIV-positive patients with MDR-TB were concentrated at three hospitals that treat the greatest numbers of HIV-infected persons with TB. Of patients with TB, those with HIV infection differed from those without known HIV infection in having more frequent prior exposure to clinical services and more frequent previous TB therapy or prophylaxis. However, MDR-TB in HIV-infected patients was not associated with previous TB therapy or prophylaxis. MDR-TB is an ongoing problem in HIV-infected persons receiving care in public hospitals in Lima and Callao; they represent sentinel cases for a potentially larger epidemic of nosocomial MDR-TB

Risk of Remote Seizures After Perinatal Ischemic Stroke

Investigators from the University of California San Francisco and Kaiser Permanente Medical Centers in Oakland report outcome of perinatal arterial ischemic stroke (PAIS) in a population-based cohort, with particular attention to the incidence of seizures

Structural basis of family-wide Rab GTPase recognition by rabenosyn-5

Rab GTPases regulate all stages of membrane trafficking, including vesicle budding, cargo sorting, transport, tethering and fusion. In the inactive (GDP-bound) conformation, accessory factors facilitate the targeting of Rab GTPases to intracellular compartments. After nucleotide exchange to the active (GTP-bound) conformation, Rab GTPases interact with functionally diverse effectors including lipid kinases, motor proteins and tethering complexes. How effectors distinguish between homologous Rab GTPases represents an unresolved problem with respect to the specificity of vesicular trafficking. Using a structural proteomic approach, we have determined the specificity and structural basis underlying the interaction of the multivalent effector rabenosyn-5 with the Rab family. The results demonstrate that even the structurally similar effector domains in rabenosyn-5 can achieve highly selective recognition of distinct subsets of Rab GTPases exclusively through interactions with the switch and interswitch regions. The observed specificity is determined at a family-wide level by structural diversity in the active conformation, which governs the spatial disposition of critical conserved recognition determinants, and by a small number of both positive and negative sequence determinants that allow further discrimination between Rab GTPases with similar switch conformations

Unveiling the merger dynamics of the most massive madcows cluster at z = 1.2 from a multiwavelength mapping of its intracluster medium properties

The characterization of the Intracluster Medium (ICM) properties of high-redshift galaxy clusters is fundamental to our understanding of large-scale structure formation processes. We present the results of a multiwavelength analysis of the very massive cluster MOO J1142+1527 at a redshift z = 1.2 discovered as part of the Massive and Distant Clusters of WISE Survey. This analysis is based on high angular resolution Chandra X-ray and NIKA2 Sunyaev-Zel'dovich (SZ) data. The cluster thermodynamic radial profiles have been obtained with unprecedented precision at this redshift and up to 0.7R , thanks to the combination of high-resolution X-ray and SZ data. The comparison between the galaxy distribution mapped in infrared by Spitzer and the morphological properties of the ICM derived from the combined analysis of the Chandra and NIKA2 data leads us to the conclusion that the cluster is an ongoing merger. We have estimated a systematic uncertainty on the cluster total mass that characterizes both the impact of the observed deviations from spherical symmetry and of the core dynamics on the mass profile. We further combine the X-ray and SZ data at the pixel level to obtain maps of the temperature and entropy distributions. We find a relatively low-entropy core at the position of the X-ray peak and high-temperature regions located on its south and west sides. This work demonstrates that the addition of spatially resolved SZ observations to low signal-to-noise X-ray data brings a high information gain on the characterization of the evolution of ICM thermodynamic properties at z > 1.With funding from the Spanish government through the "María de Maeztu Unit of Excellence" accreditation (MDM-2017-0737