Self-reported comfort with tracheostomy tube care. cross-sectional survey of non-ear, nose and throat health care professionals

OBJECTIVE: To assess self-reported comfort of non-ear, nose and throat (ENT) health professionals in tracheostomy care and identify its associated factors. METHODS: This was a cross-sectional survey of non-ENT health care professionals, carried out from December 2011 to February 2013 at the Prince Sultan Military Medical City, and King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia. A self-administered questionnaire was used to collect data on self-rated comfort levels in performing tracheostomy tube change and factors, such as speciality, duration of dedicated ENT rotation in medical school, and years of experience as a practicing consultant. RESULTS: A total of 71 non-ENT health professionals participated in the survey. The response rate was 100%. Overall, one out of every 4 participants (26.8%) rated their comfort level in tracheostomy tube change as \u27fair or poor\u27, 38% as good, and only 35.2% as excellent. Comfort level was the highest among anesthesiologists (94.1%), and intensivists (78.9%). In the multivariate analysis, physicians who reported ever performing tracheostomy tube change as a resident were significantly more likely to report comfort than their counterparts without such exposure (adjusted odds ratio: 7.09; 95% confidence interval: 1.90-26.40; p=0.003). When asked if there should be a mandatory course on tracheostomy care in tertiary care hospitals, most of the participants (60-72%), irrespective of their speciality, training and experience, replied in the affirmative. CONCLUSION: Non-ENT health professionals involved in airway care had a low level of self-rated comfort with tracheostomy tube care suggesting the need for periodic refresher training to address this gap

Cloud Computing Adoption: A Mapping Of Service Delivery And Deployment Models

The recent upward trend in adopting cloud computing by businesses worldwide reflects the captivating opportunity of cost effective computing brought by cloud computing to replace the traditional IT computing services model. However, the decision to adopt cloud computing is somewhat complex. This paper will review the literature of cloud computing service and deployment models with the aim to determine the relevant characteristics of both service delivery and deployment models. Then, the authors will develop a mapping between the two sets of characteristics of cloud computing models. The mapping will lead to the development of a decision-making framework for managing cloud-computing adoption

MicroRNA-203 predicts human survival after resection of colorectal liver metastasis.

BackgroundResection of colorectal liver metastasis (CRLM) can be curative. Predicting which patients may benefit from resection, however, remains challenging. Some microRNAs (miRNAs) become deregulated in cancers and contribute to cancer progression. We hypothesized that miRNA expression can serve as a prognostic marker of survival after CRLM resection.ResultsMiR-203 was significantly overexpressed in tumors of short-term survivors compared to long-term survivors. R1/R2 margin status and high clinical risk score (CRS) were also significantly associated with short-term survival (both p = 0.001). After adjusting for these variables, higher miR-203 expression remained an independent predictor of shorter survival (p = 0.010). In the serum cohort, high CRS and KRAS mutation were significantly associated with short-term survival (p = 0.005 and p = 0.026, respectively). After adjusting for CRS and KRAS status, short-term survivors were found to have significantly higher miR-203 levels (p = 0.016 and p = 0.033, respectively).Materials and methodsWe employed next-generation sequencing of small-RNAs to profile miRNAs in solid tumors obtained from 38 patients who underwent hepatectomy for CRLM. To validate, quantitative reverse-transcription polymerase chain reaction (qRT-PCR) was performed on 91 tumor samples and 46 preoperative serum samples.ConclusionsAfter CRLM resection, short-term survivors exhibited significantly higher miR-203 levels relative to long-term survivors. MiR-203 may serve as a prognostic biomarker and its prognostic capacity warrants further investigation

The crystal structure of human microsomal triglyceride transfer protein

This is the final version. Available from National Academy of Sciences via the DOI in this record.Data deposition: The data have been deposited in the Protein Data Bank, www.wwpdb.org (PDB ID code 6I7S).Microsomal triglyceride transfer protein (MTP) plays an essential role in lipid metabolism, especially in the biogenesis of very low-density lipoproteins and chylomicrons via the transfer of neutral lipids and the assembly of apoB-containing lipoproteins. Our understanding of the molecular mechanisms of MTP has been hindered by a lack of structural information of this heterodimeric complex comprising an MTPα subunit and a protein disulfide isomerase (PDI) β-subunit. The structure of MTP presented here gives important insights into the potential mechanisms of action of this essential lipid transfer molecule, structure-based rationale for previously reported disease-causing mutations, and a means for rational drug design against cardiovascular disease and obesity. In contrast to the previously reported structure of lipovitellin, which has a funnel-like lipid-binding cavity, the lipid-binding site is encompassed in a β-sandwich formed by 2 β-sheets from the C-terminal domain of MTPα. The lipid-binding cavity of MTPα is large enough to accommodate a single lipid. PDI independently has a major role in oxidative protein folding in the endoplasmic reticulum. Comparison of the mechanism of MTPα binding by PDI with previously published structures gives insights into large protein substrate binding by PDI and suggests that the previous structures of human PDI represent the "substrate-bound" and "free" states rather than differences arising from redox state.Academy of FinlandAcademy of FinlandSigrid Juselius FoundationBiocenter Oul

Effects of a Commercial Insurance Policy Restriction on Lumbar Fusion in North Carolina and the Implications for National Adoption

Analysis of the State Inpatient Database of North Carolina, 2005–2012, and the Nationwide Inpatient Sample, including all inpatient lumbar fusion admissions from non-federal hospitals

Assessing the Effects of Cytoprotectants on Selective Neuronal Loss, Sensorimotor Deficit and Microglial Activation after Temporary Middle Cerebral Occlusion.

Although early reperfusion after stroke salvages the still-viable ischemic tissue, peri-infarct selective neuronal loss (SNL) can cause sensorimotor deficits (SMD). We designed a longitudinal protocol to assess the effects of cytoprotectants on SMD, microglial activation (MA) and SNL, and specifically tested whether the KCa3.1-blocker TRAM-34 would prevent SNL. Spontaneously hypertensive rats underwent 15 min middle-cerebral artery occlusion and were randomized into control or treatment group, which received TRAM-34 intraperitoneally for 4 weeks starting 12 h after reperfusion. SMD was assessed longitudinally using the sticky-label test. MA was quantified at day 14 using in vivo [11C]-PK111195 positron emission tomography (PET), and again across the same regions-of-interest template by immunofluorescence together with SNL at day 28. SMD recovered significantly faster in the treated group (p = 0.004). On PET, MA was present in 5/6 rats in each group, with no significant between-group difference. On immunofluorescence, both SNL and MA were present in 5/6 control rats and 4/6 TRAM-34 rats, with a non-significantly lower degree of MA but a significantly (p = 0.009) lower degree of SNL in the treated group. These findings document the utility of our longitudinal protocol and suggest that TRAM-34 reduces SNL and hastens behavioural recovery without marked MA blocking at the assessed time-points