Variation in early life maternal care predicts later long range frontal cortex synapse development in mice.

Empirical and theoretical work suggests that early postnatal experience may inform later developing synaptic connectivity to adapt the brain to its environment. We hypothesized that early maternal experience may program the development of synaptic density on long range frontal cortex projections. To test this idea, we used maternal separation (MS) to generate environmental variability and examined how MS affected 1) maternal care and 2) synapse density on virally-labeled long range axons of offspring reared in MS or control conditions. We found that MS and variation in maternal care predicted bouton density on dorsal frontal cortex axons that terminated in the basolateral amygdala (BLA) and dorsomedial striatum (DMS) with more, fragmented care associated with higher density. The effects of maternal care on these distinct axonal projections of the frontal cortex were manifest at different ages. Maternal care measures were correlated with frontal cortex → BLA bouton density at mid-adolescence postnatal (P) day 35 and frontal cortex → DMS bouton density in adulthood (P85). Meanwhile, we found no evidence that MS or maternal care affected bouton density on ascending orbitofrontal cortex (OFC) or BLA axons that terminated in the dorsal frontal cortices. Our data show that variation in early experience can alter development in a circuit-specific and age-dependent manner that may be relevant to understanding the effects of early life adversity

Necessity of Analytics in Today’s Healthcare Revenue Cycle

Because of the recently growing pressures to improve quality and reduce costs, healthcare organizations are rapidly adopting IT in order to improve their operations and clinical care. As a result, an accumulation of vast amounts of data are becoming available for use. It is important for healthcare to use this data. Strome (2010) states that healthcare analytics is the application of statistical tools and techniques to healthcare-related data in order to study past situations (i.e., operational performance or clinical outcomes) to improve the quality and efficiency of clinical and business processes and performance. With the introduction of healthcare analytical tools, can the healthcare industry take its huge and exponentially growing amounts of data and learn from it? The purpose of this paper is to review the available literature on the use of analytical tools in the healthcare industry with a focus on the revenue cycle. Most literature available to be reviewed is centered around discussions and theories on the use of analytical tools in the industry. A survey of revenue cycle leaders was conducted to determine the prevalence and importance of analytical tools in conjunction with the revenue cycle. This information will be valuable to revenue cycle leaders in determining if others in the industry are adopting these tools and the potential benefits of using analytical tools in their own departments

Optimizing Guideline-Recommended Antibiotic Doses for Pediatric Infective Endocarditis

The American Heart Association recently published an updated scientific statement on the management of infective endocarditis in childhood. The recommendations included for vancomycin, aminoglycoside, and β-lactam dosing and monitoring are based primarily on expert opinion and do not consider available evidence for dose optimization based on pharmacokinetic and pharmacodynamic principles in pediatric patients. This is concerning because even when clinically necessary, some practitioners may be hesitant to deviate from guideline-recommended doses. In this perspective, we highlight potential areas for improvement in the statement-recommended doses and summarize evidence supporting antibiotic dosing optimization. The addition of a pediatric clinical pharmacist with expertise in antibiotic dosing to the panel would be beneficial for future updates