Triage and Ongoing Care for Critically Ill Patients in the Emergency Department: Results from a National Survey of Emergency Physicians

Introduction: We conducted a cross-sectional study at the Icahn School of Medicine at Mount Sinai to elicit emergency physician (EP) perceptions regarding intensive care unit (ICU) triage decisions and ongoing management for boarding of ICU patients in the emergency department (ED). We assessed factors influencing the disposition decision for critically ill patients in the ED to characterize EPs’ perceptions about ongoing critical care delivery in the ED while awaiting ICU admission.Methods: Through content expert review and pilot testing, we iteratively developed a 25-item written survey targeted to EPs, eliciting current ICU triage structure, opinions on factors influencing ICU admission decisions, and views on caring for critically ill patients “boarding” in the ED for >4-6 hours.Results: We approached 732 EPs at a large, national emergency medicine conference, achieving 93.6% response and completion rate, with 54% academic and 46% community participants. One-fifth reported having formal ICU admission criteria, although only 36.6% reported adherence. Common factors influencing EPs’ ICU triage decisions were illness severity (91.1%), ICU interventions needed (87.6%), and diagnosis (68.2%), while ICU bed availability (13.5%) and presence of other critically ill patients in ED (10.2%) were less or not important. While 72.1% reported frequently caring for ICU boarders, respondents identified high patient volume (61.3%) and inadequate support staffing (48.6%) as the most common challenges in caring for boarding ICU patients.Conclusion: Patient factors (eg, diagnosis, illness severity) were seen as more important than system factors (eg, bed availability) in triaging ED patients to the ICU. Boarding ICU patients is a common challenge for more than two-thirds of EPs, exacerbated by ED volume and staffing constraints

Urinary neurotransmitter metabolites in drug‐free chronic schizophrenic patients measured by gas chromatography selected positive ion monitoring

The free urinary metabolites, homovanillic, indoleacetic and 5‐hydroxyindoleacetic acid were measured in 24 h urines obtained from seven highly selected drug‐free chronic schizophrenic patients and seven mentally normal control subjects on a low amine diet. Gas chromatography selected ion monitoring of silylated extracts was used to assay each metabolite using its own deuterated form as an internal standard. In the electron impact mode the positive ion fragments used to quantitate the amount of each metabolite in the urine were, respectively, m/z209/211 for homovanillic acid, 319/321 for indoleacetic acid and 290/292 for 5‐hydroxyindoleacetic acid. It was found essential that each compound be assayed using its own deuterated derivative as the internal standard. When expressed per mg creatinine, the homovanillic and 5‐hydroxyindoleacetic acid levels of the chronic schizophrenic patients were in the normal range, but indoleacetic acid was slightly and statistically significantly higher, p = 0.01.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144614/1/bms1200060804.pd

Living Waters Inquiry

What would it be like to live in a world of sentient beings rather than inert objects? How would we relate to such a world? And if we invoke such a world of sentient presence, calling to more than human beings as persons, might we elicit a response?’ These key questions inform the ‘Living Waters’ inquiry, in which co-inquirers participate in communicative ways with their rivers or wetlands. In this presentation, we provide ‘tasters’ of the ‘Living Waters Inquiry’. We sample panpsychism as a philosophical approach to living places; overview Cooperative Inquiry, meet Gaia thinking and practice; and offer examples of co-researchers hearing places. Please be ready with your questions after the presentation

Fatores protetores e de risco associados ao uso de álcool em adolescentes filhos de pais alcoólicos no Perú

O presente estudo teve como objetivo identificar e analisar os fatores protetores e de riscos relacionados ao uso de álcool entre adolescentes na faixa etária de 12 a 18 anos de idade, filhos de pais alcoolistas. O desenho do estudo é de natureza quantitativa, de caráter exploratório. Para a coleta de dados utilizou-se o questionário Drug Use Screening Inventory (DUSI), o qual tem como objetivo quantificar e categorizar os indicadores de uso de drogas em relação ao estado físico, psicossocial, laboral, familiar, relacionamento com os pares e academico. Os adolescentes filhos de pais alcoolistas, apresentaram uso experimental de álcool, alguns casos até embriaguez, porém não com padrão de uso freqüente. Os fatores de riscos e de proteção para o uso de álcool entre os jovens estão em maior ou menor grau associado aos comportamentos familiares, grupos de amigos, parentes e o contexto social em que estão inseridos.La presente investigación tuvo como objetivo el de identificar y analizar los factores protectores y de riesgo relacionados con el uso de alcohol en Adolescentes ente 12 y 18 años de edad, hijos de padre alcohólico. El presente estudio es de tipo cuantitativo, de carácter exploratorio. Para la recolección de datos se utilizo el Drug Use Screening Inventory (DUSI) que está diseñado para cuantificar y categorizar los indicadores de consumo de drogas en relación al estado físico, psicosocial, laboral, familiar, relación con pares y académico. Los adolescentes hijos de padre alcohólico, presentan un uso experimental de alcohol, algunos casos hasta la embriaguez, pero no teniendo este consumo como habitual. Los factores de riesgo y de protección para o uso de alcohol entre os jóvenes están en mayor o menor grado asociados a los comportamientos familiares, de los grupos de amigos, parientes y al contexto social en que están insertados.This research aimed to identify and analyze the protection factors and risks associated with alcohol use in adolescents between 12 and 18 years old, whose parents are addicted to alcohol. This is a quantitative and exploratory study. Data were collected by means of the Drug Use Screening Inventory (DUSI), which to quantify and categorize substance abuse indices with respect to physical, work and family conditions; peer relations and relation with the academician. Adolescents whose parents are addicted to alcohol demonstrated and in some cases even intoxication, but without a frequent use pattern. The risks and protection factors with respect to alcohol use among adolescents are associated, to a lesser or greater extent, with the behavior of family members and friends, as well as with the social context the youngsters are inserted in

Lack of clinically significant improvement of patients with tardive dyskinesia following phosphatidylcholine therapy

A double-blind controlled study was undertaken to examine the value of phosphatidylcholine as a treatment for tardive dyskinesia (TD) in 19 psychiatric patients. All patients were maintained on their usual psychotropic medication throughout the entire study. In addition, they were given either phosphatidylcholine (30 g/day) or placebo for 6 weeks. Thirteen of the patients received the crossover treatment for 6 weeks, after which 10 of the 13 were continued on the crossover medication for an additional 6 weeks. At the end of the study, 5 patients had received phosphatidylcholine for 12 weeks and another 12 patients had received the drug for only 6 weeks. Plasma and red blood cell choline levels were monitored every 3 weeks as a measure of compliance. Although some patients showed clinical improvement of their TD, the results did not differ significantly between active drug and placebo. This was in spite of a marked elevation of plasma and red blood cell choline (up to 300% for the Lafayette Clinic patients and up to 400% for the patients from the Ypsilanti Regional Psychiatric Hospital) during treatment with phosphatidylcholine. Side effects of the drug included occasional gastrointestinal upsets and diarrhea but, in general, the medication was tolerated very well. The results indicate that large doses of phosphatidylcholine of soya origin are of no clinical value in treating symptoms of TD in spite of very large increases in blood choline.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25523/1/0000064.pd

A guide to naming human non-coding RNA genes.

Research on non-coding RNA (ncRNA) is a rapidly expanding field. Providing an official gene symbol and name to ncRNA genes brings order to otherwise potential chaos as it allows unambiguous communication about each gene. The HUGO Gene Nomenclature Committee (HGNC, www.genenames.org) is the only group with the authority to approve symbols for human genes. The HGNC works with specialist advisors for different classes of ncRNA to ensure that ncRNA nomenclature is accurate and informative, where possible. Here, we review each major class of ncRNA that is currently annotated in the human genome and describe how each class is assigned a standardised nomenclature

An evaluation of Minor Groove Binders as anti- Trypanosoma brucei brucei therapeutics

A series of 32 structurally diverse MGBs, derived from the natural product distamycin, was evaluated for activity against Trypanosoma brucei brucei. Four compounds have been found to possess significant activity, in the nanomolar range, and represent hits for further optimisation towards novel treatments for Human and Animal African Trypanosomiases. Moreover, SAR indicates that the head group linking moiety is a significant modulator of biological activit

Deletions in VANGL1 are a risk factor for antibody-mediated kidney disease

We identify an intronic deletion in VANGL1 that predisposes to renal injury in high risk populations through a kidney-intrinsic process. Half of all SLE patients develop nephritis, yet the predisposing mechanisms to kidney damage remain poorly understood. There is limited evidence of genetic contribution to specific organ involvement in SLE.(1,2) We identify a large deletion in intron 7 of Van Gogh Like 1 (VANGL1), which associates with nephritis in SLE patients. The same deletion occurs at increased frequency in an indigenous population (Tiwi Islanders) with 10-fold higher rates of kidney disease compared with non-indigenous populations. Vangl1 hemizygosity in mice results in spontaneous IgA and IgG deposition within the glomerular mesangium in the absence of autoimmune nephritis. Serum transfer into B cell-deficient Vangl1(+/-) mice results in mesangial IgG deposition indicating that Ig deposits occur in a kidney-intrinsic fashion in the absence of Vangl1. These results suggest that Vangl1 acts in the kidney to prevent Ig deposits and its deficiency may trigger nephritis in individuals with SLE

The Promoter of the Cereal VERNALIZATION1 Gene Is Sufficient for Transcriptional Induction by Prolonged Cold

The VERNALIZATION1 (VRN1) gene of temperate cereals is transcriptionally activated by prolonged cold during winter (vernalization) to promote flowering. To investigate the mechanisms controlling induction of VRN1 by prolonged cold, different regions of the VRN1 gene were fused to the GREEN FLUORESCENT PROTEIN (GFP) reporter and expression of the resulting gene constructs was assayed in transgenic barley (Hordeum vulgare). A 2 kb segment of the promoter of VRN1 was sufficient for GFP expression in the leaves and shoot apex of transgenic barley plants. Fluorescence increased at the shoot apex prior to inflorescence initiation and was subsequently maintained in the developing inflorescence. The promoter was also sufficient for low-temperature induction of GFP expression. A naturally occurring insertion in the proximal promoter, which is associated with elevated VRN1 expression and early flowering in some spring wheats, did not abolish induction of VRN1 transcription by prolonged cold, however. A translational fusion of the promoter and transcribed regions of VRN1 to GFP, VRN1::GFP, was localised to nuclei of cells at the shoot apex of transgenic barley plants. The distribution of VRN1::GFP at the shoot apex was similar to the expression pattern of the VRN1 promoter-GFP reporter gene. Fluorescence from the VRN1::GFP fusion protein increased in the developing leaves after prolonged cold treatment. These observations suggest that the promoter of VRN1 is targeted by mechanisms that trigger vernalization-induced flowering in economically important temperate cereal crops