4,791 research outputs found
Screening for E-cigarette and Tobacco Use in Standardized Patient Encounters
E-cigarette usage has grown significantly in recent years, with over 5 million US middle and high school students reporting recent usage. The long-term health consequences of these devices are still being investigated, but it is known that e-cigarette aerosol could contain harmful substances including nicotine, heavy metals, and carcinogens. Therefore, it is important for physicians to ask patients about e-cigarette usage specifically, as this may contribute to future health problems. The goal of this study was to investigate if and how medical students screen for e-cigarette usage. Screening language was reviewed in standardized patient encounters, which are a type of assessment that medical students undergo in order to observe how they interact with simulated patients. Video-taped patient encounters were coded to examine the specific phrasing of questions related to tobacco usage, including initial and follow-up questions. The majority of students (97%) did not ask about e-cigarettes specifically. Most students (66%) simply asked, “Do you smoke?” Overall, the evidence shows that e-cigarette and vaping device usage is not being addressed specifically in these interactions. These results demonstrate a need for updated patient screening in regards to tobacco use. Because the majority of e-cigarette users report not knowing that the product contains nicotine, physicians must be made aware of their unknown effects on patient outcomes and the need to screen specifically about e-cigarette usage separately from smoking. Continuing medical education may also help address this gap since many cohorts of practicing physicians were training before the popularity of these types of devices.https://ir.library.louisville.edu/uars/1035/thumbnail.jp
Policies for the Treatment of Alcohol and Drug Use Disorders: A Research Agenda for 2010-2015
Provides an agenda for policy research on drug and alcohol addiction treatment, including integrating screening and short-term interventions into primary care and other settings, services in specialty treatment centers, and ongoing support services
Subakuter und chronischer Rückenschmerz in der hausärztlichen Versorgung: Eine systematische Übersichtsarbeit symptomevaluierender Studien
Hintergrund: Subakuter und chronischer Rückenschmerz ist ein häufiges Symptom in der
Allgemeinmedizin. Symptome wiederum sind meist der Grund für eine Vorstellung beim Hausarzt.
Dementsprechend liefern symptomevaluierende Studien wichtige Daten für dieses
Patientenkollektiv. Interessante Zielgrößen sind unter anderem die Prävalenz, die Ätiologie und die
Prognose.
Ziel: In dieser systematischen Übersichtsarbeit wird die Literatur der letzten 50 Jahre durchsucht
und symptomevaluierende Studien zum Thema subakuter und chronischer Rückenschmerzen beim
Hausarzt analysiert, um den aktuellen Wissensstand zu diesem Thema zu erarbeiten.
Methode: Studien wurden durch eine systematische Literatursuche in Pubmed identifiziert. Die
gefundenen Studienzusammenfassungen wurden anhand zuvor definierter Ein- und
Ausschlusskriterien von zwei Beurteilen bewertet. Die Volltexte der einschlägigen
Studienzusammenfassungen wurde in gleicher Weise bewertet. Die Daten, der schließlich
eingeschlossenen Studien/Publikationen wurden strukturiert extrahiert und die Studienqualität
bewertet. Um eine Vergleichbarkeit der verschiedenen Ergebnisse zu gewährleisten wurde ein
prozentueller Ergebniswert verwendet.
Ergebnisse: 885 der 3794 Studienzusammenfassungen waren einschlägig. Von diesen 885
Publikation entsprachen 26 Publikationen von 15 Studien den Ein- und Ausschlusskriterien dieser
Arbeit. Da die Daten der Arbeiten sehr inhomogen waren, wurde keine Metaanalyse durchgeführt,
sondern eine deskriptive Auswertung durchgeführt. Der überwiegende Teil der Studien erhielt eine
gute bis durchschnittliche Qualitätsbewertung.
Eine Studien lieferte Daten zur Ätiologie chronischer Rückenschmerz und fand, dass 23.6 % der
Patientin axiale Spondyloarthritis hatten, 22 % von diesen wiederum hatten Spondylitis ankylosans.
Zwei Studien erbrachten Daten zur Prävalenz. Eine Studie zeigte, dass 1.3 % der Hausarztpatienten
sich wegen chronischer Rückenschmerzen vorstellen. Die zweite Studie zeigte, dass 5.95 % der
Chronisch-Kranken chronischen Rückenschmerz haben. Der überwiegende Teil der Ergebnisse
ergab Prognosedaten. Die wesentlichen Ergebniskategorien waren: Schmerz, Lebensqualität,
funktionelle Beeinträchtigung, arbeitsbezogene Ergebnisse und Stimmung. Die mittlere prozentuale
Veränderung über 6 Monate betrug -2.9 bis +23.6 % im Bereich Lebensqualität, mit einer großen
Spannweite innerhalb der einzelnen Subskalen. Im Bereich Schmerz war die mittlere prozentuale
Veränderung -2.1 bis +11 % nach 6 Monaten. Nur eine Studie zeigte eine Verschlechterung der
Schmerzsymptomatik. Die funktionelle Beeinträchtigung verbesserte sich im Mittel um +5.8 bis
+6.8 % nach 6 Monaten. 48 bis 58 % der initial krankgeschriebenen Patientin waren auch noch
nach 12 Monaten krank geschriebenen.
Fazit: Diese systematische Übersichtsarbeit symptomevaluierender Studien zeigt eine Verbesserung
der verschiedenen Ergebniskategorien über die Zeit. Es gibt wenig Literatur über Prävalenz und
Ätiologie im Bezug auf das Symptom subakuter und chronischer Rückenschmerz in der
Hausarztpraxis
Effect of daptomycin and vancomycin on Staphylococcus epidermidis biofilms: An in vitro assessment using fluorescence in situ hybridization
Colonization of in-dwelling catheters by microbial biofilms is a major concern in patient health eventually leading to catheter-related blood stream infections. Biofilms are less susceptible to standard antibiotic therapies that are effective against planktonic bacteria. Standard procedure for the detection of microorganisms on the catheter tip is culture. However, viable but non-culturable cells (VBNCs) may be missed. The aim of this study was to evaluate the use of fluorescence in situ hybridization (FISH) as an indicator to visualize and quantify the effect of the antibiotics daptomycin and vancomycin on biofilms in situ. We established an in vitro catheter biofilm model of Staphylococcus epidermidis biofilms on polyurethane catheters. Biofilm activity was measured by FISH and correlated to colony forming units (CFU) data. Digital image analysis was used for quantification of total biofilm mass and the area of the FISH positive biofilm cells. FISH showed a pronounced effect of both antibiotics on the biofilms, with daptomycin having a significantly stronger effect in terms of both reduction of biofilm mass and number of FISH-positive cells. This supports the anti-biofilm capacity of daptomycin. Interestingly, neither antibiotic was able to eradicate all of the FISH-positive cells. In summary, FISH succeeded in visualization, quantification, and localization of antibiotic activity on biofilms. This technique adds a new tool to the arsenal of test systems for anti-biofilm compounds. FISH is a valuable complementary technique to CFU since it can be highly standardized and provides information on biofilm architecture and quantity and localization of survivor cells
Inferences on the Timeline of Reionization at z~8 From the KMOS Lens-Amplified Spectroscopic Survey
Detections and non-detections of Lyman alpha (Ly) emission from
galaxies ( Gyr after the Big Bang) can be used to measure the timeline of
cosmic reionization. Of key interest to measuring reionization's mid-stages,
but also increasing observational challenge, are observations at z > 7, where
Ly redshifts to near infra-red wavelengths. Here we present a search
for z > 7.2 Ly emission in 53 intrinsically faint Lyman Break Galaxy
candidates, gravitationally lensed by massive galaxy clusters, in the KMOS
Lens-Amplified Spectroscopic Survey (KLASS). With integration times of ~7-10
hours, we detect no Ly emission with S/N>5 in our sample. We determine
our observations to be 80% complete for 5 spatially and spectrally
unresolved emission lines with integrated line flux erg
s cm. We define a photometrically selected sub-sample of 29
targets at , with a median 5 Ly EW limit of 58A.
We perform a Bayesian inference of the average intergalactic medium (IGM)
neutral hydrogen fraction using their spectra. Our inference accounts for the
wavelength sensitivity and incomplete redshift coverage of our observations,
and the photometric redshift probability distribution of each target. These
observations, combined with samples from the literature, enable us to place a
lower limit on the average IGM neutral hydrogen fraction of at z ~ 8, providing further evidence of rapid reionization
at z~6-8. We show that this is consistent with reionization history models
extending the galaxy luminosity function to , with
low ionizing photon escape fractions, .Comment: Accepted for publication in MNRA
A Composite Seyfert 2 X-ray Spectrum: Implications for the Origin of the Cosmic X-ray Background
We present a composite 1-10 keV Seyfert 2 X-ray spectrum, derived from ASCA
observations of a distance-limited sample of nearby galaxies. All 29 observed
objects were detected. Above ~3 keV, the composite spectrum is inverted,
confirming that Seyfert 2 galaxies as a class have the spectral properties
necessary to explain the flat shape of the cosmic X-ray background spectrum.
Integrating the composite spectrum over redshift, we find that the total
emission from Seyfert 2 galaxies, combined with the expected contribution from
unabsorbed type 1 objects, provides an excellent match to the spectrum and
intensity of the hard X-ray background. The principal uncertainty in this
procedure is the cosmic evolution of the Seyfert 2 X-ray luminosity function.
Separate composite spectra for objects in our sample with and without polarized
broad optical emission lines are also presented.Comment: 11 pages (AASTeX), including 3 figures. Accepted for publication in
ApJ Letter
HST Grism Observations of a Gravitationally Lensed Redshift 10 Galaxy
We present deep spectroscopic observations of a Lyman-break galaxy candidate
(hereafter MACS1149-JD) at with the Space
Telescope () WFC3/IR grisms. The grism observations were taken at
4 distinct position angles, totaling 34 orbits with the G141 grism, although
only 19 of the orbits are relatively uncontaminated along the trace of
MACS1149-JD. We fit a 3-parameter (, F160W mag, and Ly equivalent
width) Lyman-break galaxy template to the three least contaminated grism
position angles using an MCMC approach. The grism data alone are best fit with
a redshift of ( confidence), in
good agreement with our photometric estimate of
( confidence). Our analysis
rules out Lyman-alpha emission from MACS1149-JD above a equivalent
width of 21 \AA{}, consistent with a highly neutral IGM. We explore a scenario
where the red /IRAC color of the galaxy
previously pointed out in the literature is due to strong rest-frame optical
emission lines from a very young stellar population rather than a 4000 \AA{}
break. We find that while this can provide an explanation for the observed IRAC
color, it requires a lower redshift (), which is less preferred
by the imaging data. The grism data are consistent with both
scenarios, indicating that the red IRAC color can still be explained by a 4000
\AA{} break, characteristic of a relatively evolved stellar population. In this
interpretation, the photometry indicate that a Myr stellar
population is already present in this galaxy only after
the Big Bang.Comment: Accepted to ApJ. This is the accepted versio
Spectroscopic confirmation of an ultra-faint galaxy at the epoch of reionization
Within one billion years of the Big Bang, intergalactic hydrogen was ionized
by sources emitting ultraviolet and higher energy photons. This was the final
phenomenon to globally affect all the baryons (visible matter) in the Universe.
It is referred to as cosmic reionization and is an integral component of
cosmology. It is broadly expected that intrinsically faint galaxies were the
primary ionizing sources due to their abundance in this epoch. However, at the
highest redshifts (; lookback time 13.1 Gyr), all galaxies with
spectroscopic confirmations to date are intrinsically bright and, therefore,
not necessarily representative of the general population. Here, we report the
unequivocal spectroscopic detection of a low luminosity galaxy at . We
detected the Lyman- emission line at {\AA} in two separate
observations with MOSFIRE on the Keck I Telescope and independently with the
Hubble Space Telescope's slit-less grism spectrograph, implying a source
redshift of . The galaxy is gravitationally magnified by
the massive galaxy cluster MACS J1423.8+2404 (), with an estimated
intrinsic luminosity of mag and a stellar mass of
solar masses. Both are an order of
magnitude lower than the four other Lyman- emitters currently known at
, making it probably the most distant representative source of
reionization found to date
A Stellar Population Gradient in VII Zw 403 - Implications for the Formation of Blue Compact Dwarf Galaxies
We present evidence for the existence of an old stellar halo in the Blue
Compact Dwarf galaxy VII Zw 403. VII Zw 403 is the first Blue Compact Dwarf
galaxy for which a clear spatial segregation of the resolved stellar content
into a "core-halo" structure is detected. Multicolor HST/WFPC2 observations
indicate that active star formation occurs in the central region, but is
strikingly absent at large radii. Instead, a globular-cluster-like red giant
branch suggests the presence of an old (> 10 Gyr) and metal poor
(=-1.92) stellar population in the halo. While the vast majority of
Blue Compact Dwarf galaxies has been recognized to possess halos of red color
in ground-based surface photometry, our observations of VII Zw 403 establish
for the first time a direct correspondence between a red halo color and the
presence of old, red giant stars. If the halos of Blue Compact Dwarf galaxies
are all home to such ancient stellar populations, then the fossil record
conflicts with delayed-formation scenarios for dwarfs.Comment: Accepted for publication in the Ap
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