Quantification of Periodic Breathing in Premature Infants

Periodic breathing (PB), regular cycles of short apneic pauses and breaths, is common in newborn infants. To characterize normal and potentially pathologic PB, we used our automated apnea detection system and developed a novel method for quantifying PB. We identified a preterm infant who died of sudden infant death syndrome (SIDS) and who, on review of her breathing pattern while in the neonatal intensive care unit (NICU), had exaggerated PB. We analyzed the chest impedance signal for short apneic pauses and developed a wavelet transform method to identify repetitive 10-40 second cycles of apnea/breathing. Clinical validation was performed to distinguish PB from apnea clusters and determine the wavelet coefficient cutoff having optimum diagnostic utility. We applied this method to analyze the chest impedance signals throughout the entire NICU stays of all 70 infants born at 32 weeks\u27 gestation admitted over a two-and-a-half year period. This group includes an infant who died of SIDS and her twin. For infants of 32 weeks\u27 gestation, the fraction of time spent in PB peaks 7-14 d after birth at 6.5%. During that time the infant that died of SIDS spent 40% of each day in PB and her twin spent 15% of each day in PB. This wavelet transform method allows quantification of normal and potentially pathologic PB in NICU patients

Very Long Apnea Events in Preterm Infants

Apnea is nearly universal among very low birth weight (VLBW) infants, and the associated bradycardia and desaturation may have detrimental consequences. We describe here very long ( \u3e 60 s) central apnea events (VLAs) with bradycardia and desaturation, discovered using a computerized detection system applied to our database of over 100 infant years of electronic signals. Eighty-six VLAs occurred in 29 out of 335 VLBW infants. Eighteen of the 29 infants had a clinical event or condition possibly related to the VLA. Most VLAs occurred while infants were on nasal continuous positive airway pressure, supplemental oxygen, and caffeine. Apnea alarms on the bedside monitor activated in 66% of events, on average 28 s after cessation of breathing. Bradycardia alarms activated late, on average 64 s after cessation of breathing. Before VLAs oxygen saturation was unusually high, and during VLAs oxygen saturation and heart rate fell unusually slowly. We give measures of the relative severity of VLAs and theoretical calculations that describe the rate of decrease of oxygen saturation. A clinical conclusion is that very long apnea (VLA) events with bradycardia and desaturation are not rare. Apnea alarms failed to activate for about one-third of VLAs. It appears that neonatal intensive care unit (NICU) personnel respond quickly to bradycardia alarms but not consistently to apnea alarms. We speculate that more reliable apnea detection systems would improve patient safety in the NICU. A physiological conclusion is that the slow decrease of oxygen saturation is consistent with a physiological model based on assumed high values of initial oxygen saturation

The Stroke Data Bank: Design, Methods, and Baseline Characteristics

The National Institute of Neurological and Communicative Disorders and Stroke Initiated the Stroke Data Bank, which is a Multicenter Project to Prospectively Collect Data on the Clinical Course and Sequelae of Stroke. Additional Objectives Were to Provide Information that Would Enable a Standard Diagnostic Clinical Evaluation, to Identify Prognostic Factors, and to Provide Planning Data for Future Studies. a Brief Description of the Structure and Methods Precede the Baseline Characterization of 1,805 Patients Enrolled in the Stroke Data Bank between July 1983 and June 1986. Two Thirds of These Patients Were Admitted within 24 Hours after Stroke Onset. Medical History, Neurologic History, and Hospitalization Summaries Are Presented Separately for the Following Stroke Subtypes: Infarction, Unknown Cause; Embolism from Cardiac Source; Infarction Due to Atherosclerosis; Lacune; Parenchy-Matous or Intracerebral Hemorrhage; Subarachnoid Hemorrhage; and Other. the Utility and Limitations of These Data Are Discussed. © 1988 American Heart Association, Inc

Evaluating Use of Custom Survey Reports by Local Health Departments

This report demonstrates how providing survey feedback, like comparative reports, to survey respondents can result in improvement activities. For each of the past three years (2010-2013), the North Carolina Institute for Public Health (NCIPH) has invited local health departments (LHDs) from 40 states to participate in a preparedness capacities survey. In addition, NCIPH fielded a six-question evaluation survey to a subset of LHDs (n=70) to determine how LHDs use these reports. LHDs that reported using their custom reports compared their preparedness capacities to other LHDs, conducted strategic planning (e.g., benchmarking, setting preparedness goals), planned staff trainings, and disseminated the report both internally and to external preparedness partners. Through evaluation of custom report use, we have found that survey feedback is a valuable part of a participatory research approach that promotes and encourages discussion, motivates improvement, and provides opportunities to identify potential solutions relevant to both researchers and LHDs

MicroRNA Function in Human Diseases

MicroRNAs are emerging as a hot topic in research, and rightfully so. They show great promise as targets of treatment and as markers for common human diseases, such as cancer and metabolic diseases. In this review, we address some of the basic questions regarding micro- RNA function in human disease and the clinical significance of microRNAs. Specifically, micro- RNAs in epigenetics, cancer, and metabolic diseases are discussed, with examples taken from cholangiocarcinoma and nonalcoholic fatty liver disease

Public Response to Cost-Quality Tradeoffs in Clinical Decisions.

PURPOSE: To explore public attitudes toward the incorporation of cost-effectiveness analysis into clinical decisions. METHODS: The authors presented 781 jurors with a survey describing 1 of 6 clinical encounters in which a physician has to choose between cancer screening tests. They provided cost-effectiveness data for all tests, and in each scenario, the most effective test was more expensive. They instructed respondents to imagine that he or she was the physician in the scenario and asked them to choose which test to recommend and then explain their choice in an open-ended manner. The authors then qualitatively analyzed the responses by identifying themes and developed a coding scheme. Two authors separately coded the statements with high overall agreement (kappa = 0.76). Categories were not mutually exclusive. RESULTS: Overall, 410 respondents (55%) chose the most expensive option, and 332 respondents (45%) choose a less expensive option. Explanatory comments were given by 82% respondents. Respondents who chose the most expensive test focused on the increased benefit (without directly acknowledging the additional cost) (39%), a general belief that life is more important than money (22%), the significance of cancer risk for the patient in the scenario (20%), the belief that the benefit of the test was worth the additional cost (8%), and personal anecdotes/preferences (6%). Of the respondents who chose the less expensive test, 40% indicated that they did not believe that the patient in the scenario was at significant risk for cancer, 13% indicated that they thought the less expensive test was adequate or not meaningfully different from the more expensive test, 12% thought the cost of the test was not worth the additional benefit, 9% indicated that the test was too expensive (without mention of additional benefit), and 7% responded that resources were limited. CONCLUSIONS: Public response to cost-quality tradeoffs is mixed. Although some respondents justified their decision based on the cost-effectiveness information provided, many focused instead on specific features of the scenario or on general beliefs about whether cost should be incorporated into clinical decisions

Dementia in Stroke Survivors in the Stroke Data Bank Cohort: Prevalence, Incidence, Risk Factors, and Computed Tomographic Findings

We Determined the Prevalence of Dementia in 927 Patients with Acute Ischemic Stroke Aged ≥60 Years in the Stroke Data Bank Cohort based on the Examining Neurologist\u27s Best Judgment Diagnostic Agreement among Examiners Was 68% (K=0.34). of 726 Testable Patients, 116 (16%) Were Demented. Prevalence of Dementia Was Related to Age But Not to Sex, Race, Handedness, Educational Level, or Employment Status Before the Stroke. Previous Stroke and Previous Myocardial Infarction Were Related to Prevalence of Dementia Although Hypertension, Diabetes Mellitus, Atrial Fibrillation, and Previous Use of Antithrombotic Drugs Were Not Prevalence of Dementia Was Most Frequent in Patients with Infarcts Due to Large-Artery Atherosclerosis and in Those with Infarcts of Unknown Cause. Computed Tomographic Findings Related to Prevalence of Dementia Included Infarct Number, Infarct Site, and Cortical Atrophy. among 610 Patients Who Were Not Demented at Stroke Onset, We Used Methods of Survival Analysis to Determine the Incidence of Dementia Occurring during the 2-Year Follow-Up. Incidence of Dementia Was Related to Age But Not Sex. based on Logistic Regression Analysis, the Probability of New-Onset Dementia at 1 Year Was 5.4% for a Patient Aged 60 Years and 10.4% for a Patient Aged 90 Years. with a Multivariate Proportional Hazards Model, the Most Important Predictors of Incidence of Dementia Were a Previous Stroke and the Presence of Cortical Atrophy at Stroke Onset. © 1990 American Heart Association, Inc

FoxO3 increases miR-34a to cause palmitate-induced cholangiocyte lipoapoptosis.

Nonalcoholic steatohepatitis (NASH) patients have elevated plasma saturated free fatty acid levels. These toxic fatty acids can induce liver cell death and our recent results demonstrated that the biliary epithelium may be susceptible to lipotoxicity. Here, we explored the molecular mechanisms of cholangiocyte lipoapoptosis in cell culture and in an animal model of NASH. Treatment of cholangiocytes with palmitate (PA) showed increased caspase 3/7 activity and increased levels of cleaved poly (ADP-ribose) polymerase and cleaved caspase 3, demonstrating cholangiocyte lipoapoptosis. Interestingly, treatment with PA significantly increased the levels of microRNA miR-34a, a pro-apoptotic microRNA known to be elevated in NASH. PA induction of miR-34a was abolished in cholangiocytes transduced with forkhead family of transcription factor class O (FoxO)3 shRNA, demonstrating that FoxO3 activation is upstream of miR-34a and suggesting that FoxO3 is a novel transcriptional regulator of miR-34a. Further, anti-miR-34a protected cholangiocytes from PA-induced lipoapoptosis. Direct and indirect targets of miR-34a, such as SIRT1, receptor tyrosine kinase (MET), Kruppel-like factor 4, fibroblast growth factor receptor (FGFR)1, and FGFR4, were all decreased in PA-treated cholangiocytes. SIRT1 and MET were partially rescued by a miR-34a antagonist. Cholangiocyte apoptosis and miR-34a were dramatically increased in the liver of mice with early histologic features of NASH. Our study provides evidence for the pro-apoptotic role of miR-34a in PA-induced cholangiocyte lipoapoptosis in culture and in the liver