Parent Satisfaction with Outpatient Pediatric Endoscopy Procedures at University of New Mexico Children\u27s Hospital

As a part of endoscopy quality improvement (EQI) project, we decided to measure parent satisfaction about pediatric endoscopy service at University of New Mexico Children\u27s Hospital

Differential modulation of the cellular and humoral immune responses in Drosophila is mediated by the endosomal ARF1-Asrij axis

How multicellular organisms maintain immune homeostasis across various organs and cell types is an outstanding question in immune biology and cell signaling. In Drosophila, blood cells (hemocytes) respond to local and systemic cues to mount an immune response. While endosomal regulation of Drosophila hematopoiesis is reported, the role of endosomal proteins in cellular and humoral immunity is not well-studied. Here we demonstrate a functional role for endosomal proteins in immune homeostasis. We show that the ubiquitous trafficking protein ADP Ribosylation Factor 1 (ARF1) and the hemocyte-specific endosomal regulator Asrij differentially regulate humoral immunity. Asrij and ARF1 play an important role in regulating the cellular immune response by controlling the crystal cell melanization and phenoloxidase activity. ARF1 and Asrij mutants show reduced survival and lifespan upon infection, indicating perturbed immune homeostasis. The ARF1-Asrij axis suppresses the Toll pathway anti-microbial peptides (AMPs) by regulating ubiquitination of the inhibitor Cactus. The Imd pathway is inversely regulated- while ARF1 suppresses AMPs, Asrij is essential for AMP production. Several immune mutants have reduced Asrij expression, suggesting that Asrij co-ordinates with these pathways to regulate the immune response. Our study highlights the role of endosomal proteins in modulating the immune response by maintaining the balance of AMP production. Similar mechanisms can now be tested in mammalian hematopoiesis and immunity

What moves Indian stock markets: A Study on the linkage with real economy in post-reform era

This paper is a fresh attempt to unravel the relationship between the real economic variables and the capital market in Indian context. The paper considers the monthly data of several economic variables like the national output, fiscal deficit, interest rate, inflation, exchange rate, money supply, foreign institutional investment in Indian markets between 1994 and 2003, and tries to reveal the relative influence of these variables on the sensitive index of the Bombay stock exchange. Compared to the earlier similar attempts, this paper applies the modern non-linear technique like VAR and Artificial Neural Network and compares the results. The finding shows that certain variables like the interest rate, output, money supply, inflation rate and the exchange rate has considerable influence in the stock market movement in the considered period, while the other variables have very negligible impact on the stock market. Keywords: Indian Stock Market, Economic Variables, Artificial Neural Network, VA

A decade of early intervention for psychiatric patients in hospital emergency departments by a behavioral health intake team

Background: In the changing face of health care and the introduction of the Affordable Care Act, collaborative interventions are essential to compassionate and dynamic care. There is an increasing volume of patients with complex mental health and substance abuse treatment needs in emergency departments taking time away from medical teams. There is increasing recidivism among patients with complex mental illness, substance abuse and medical comorbidities. There has been increasing volume of uninsured patients needing interventions and resources from the expert Behavioral Health Intake Team (BHIT). Purpose: Evaluate the role of a BHIT in six emergency departments (ED) in an integrated health care system in Wisconsin. Methods: Six hospitals in the Milwaukee area integrated this novel model of early access to care. Each BHIT has psychotherapists or nurses, who triage patients with behavioral health needs in collaboration with a psychiatrist. For all category variables, frequency count and percentages were computed, and chi-square test was used for testing the association between category variables such as age, disposition, types of insurance, time needed and the diagnoses. For statistical tests, an alpha level of 0.05 was used, and all statistical analysis was done using SAS 9.2 software (SAS Institute Inc., Cary, NC). Data was collected for patients assessed every year in ED since 2002. A 10-question survey was sent to emergency room staff to evaluate the role and the effectiveness of the BHIT. Results:The BHIT in ED evaluated 45,161 patients from 2002 through 2013. Per survey results (N=96), 90% rated the effectiveness of the BHIT from very good to excellent; showed BHIT reduced their time spent with patients, provided expertise; reduced inappropriate admissions and established care plans to reduce recidivism in admissions. Majority of patients across all ages were mentally ill without comorbid substance use (P Conclusion: The availability of a dedicated BHIT proved to be effective in improving the timely behavioral health access in emergency departments. Further research and exploration of available data will provide direction for improved patient care

Addiction management in hospitalized patients with intravenous drug use-associated infective endocarditis

BACKGROUND: Infections related to intravenous drug use and opioid use disorders (OUDs) are increasing nationwide. Endocarditis is a recognized complication of intravenous drug use, and inpatient treatment typically focuses on infection management without attention to underlying addiction. OBJECTIVE: A comprehensive intervention for inpatients with infective endocarditis and intravenous drug use was implemented by a multidisciplinary team at a large midwestern hospital. The team included behavioral health/addiction medicine, infectious disease, pain medicine, cardiothoracic surgery, pharmacy, and nursing to address the OUD while managing the infection. The intervention was assessed by measuring the initiation of medication-assisted treatment and endocarditis-related readmissions. METHODS: Patients were identified from the medical records using discharge diagnosis codes for OUDs and infective endocarditis. In addition to medical management of infective endocarditis, the multidisciplinary intervention included early involvement of addiction medicine and the pain management at the time of admission. Patient interventions included education, motivational interviewing, behavioral health engagement, collaborative pain management, individual/family therapy, medication evaluation, and initiation of medication-assisted treatment. Caregivers were also educated on OUDs and ways to support patients undergoing interventions. RESULTS: Both the historical control group (N = 37) and the intervention group (N = 33) were comparable in age, gender, race, marital status, psychiatric history, and smoking but differed by employment status, religious affiliation, and use of psychiatric medications. At discharge, 18.9% of the control group and 54.5% in the intervention group were initiated on medication-assisted treatment for OUDs. No differences in readmission rates were found. CONCLUSION: Multidisciplinary teams for treating inpatients with intravenous drug use and infective endocarditis are feasible and can increase the uptake of OUD-specific treatment

Non-Calcified Coronary Artery Plaque Characterization by Dual-Energy Computed Tomography

Background: Inversion of dual-energy computed tomography (DECT) data for obtaining the electron density and effective atomic number of substances has been a work in progress for the past forty years. It has been the practice to characterize the material in terms of Hounsfield Unit (HU) values obtained by two different energies. Objectives: Since HU values are equipment-dependent quantities, it is necessary to develop a method that characterizes the substance in terms of certain physical quantities that are equipment independent. Materials and Methods: The process that we adopt is to find a calibration method by which all equipment-dependent quantities are eliminated and we directly deal with quantities that are representative of the sample, namely its electron density and effective atomic number. We collect the DECT data from 21 samples of non-calcified coronary artery plaques in human cadavers. Results: With our standardized inversion method, we have obtained the electron density and effective atomic number of these samples. With physical models of lipids and proteins, it becomes possible to conclude that non-calcified plaque samples can have calcium dispersed in the lipid part of the plaque in trace amounts that cannot be observed by light based microscopy or by CT images alone. Conclusion: This characterization, may give a new insight in characterization of non-calcified coronary artery plaque and in medical diagnostics

DECT evaluation of noncalc fied coronary artery plaque

Purpose: Composition of the coronary artery plaque is known to have critical role in heart attack. While calcified plaque can easily be diagnosed by conventional CT, it fails to distinguish between fibrous and lipid rich plaques. In the present paper, the authors discuss the experimental techniques and obtain a numerical algorithm by which the electron density (rho(e)) and the effective atomic number (Z(eff)) can be obtained from the dual energy computed tomography (DECT) data. The idea is to use this inversion method to characterize and distinguish between the lipid and fibrous coronary artery plaques. Methods: For the purpose of calibration of the CT machine, the authors prepare aqueous samples whose calculated values of (rho(e), Z(eff)) lie in the range of (2.65 x 10(23) <= rho(e) <= 3.64 x 10(23)/cm(3)) and (6.80 <= Z(eff) <= 8.90). The authors fill the phantom with these known samples and experimentally determine HU(V-1) and HU(V-2), with V-1,V-2 = 100 and 140 kVp, for the same pixels and thus determine the coefficients of inversion that allow us to determine (rho(e), Z(eff)) from the DECT data. The HU(100) and HU(140) for the coronary artery plaque are obtained by filling the channel of the coronary artery with a viscous solution of methyl cellulose in water, containing 2% contrast. These (rho(e), Z(eff)) values of the coronary artery plaque are used for their characterization on the basis of theoretical models of atomic compositions of the plaque materials. These results are compared with histopathological report. Results: The authors find that the calibration gives Pc with an accuracy of 3.5% while Z(eff) is found within 1% of the actual value, the confidence being 95%. The HU(100) and HU(140) are found to be considerably different for the same plaque at the same position and there is a linear trend between these two HU values. It is noted that pure lipid type plaques are practically nonexistent, and microcalcification, as observed in histopathology, has to be taken into account to explain the nature of the observed (rho(e), Z(eff)) data. This also enables us to judge the composition of the plaque in terms of basic model which considers the plaque to be composed of fibres, lipids, and microcalcification. Conclusions: This simple and reliable method has the potential as an effective modality to investigate the composition of noncalcified coronary artery plaques and thus help in their characterization. In this inversion method, (rho(e), Z(eff)) of the scanned sample can be found by eliminating the effects of the CT machine and also by ensuring that the determination of the two unknowns (rho(e), Z(eff)) does not interfere with each other and the nature of the plaque can be identified in terms of a three component model. (C) 2015 American Association of Physicists in Medicine

Hepatoprotective and antioxidant activity of standardized herbal extracts

Background : Phyllanthus emblica, Camellia sinensis, Mangifera indica, Punica granatum, and Acacia catechu have been shown to possess widespread pharmacological application against multitude of diseases namely cancer, diabetes, liver disorders, and oxidative stress. Objective: We evaluated the hepatoprotective activity of the standardized herbal extracts against tert-butyl hydroperoxide (t-BH) induced toxicity and their mechanism of hepatoprotective action in human hepatocarcinoma cells (HepG2 cell line). Materials and Methods: The hepatoprotective activity was studied by observing the effect of these herbal extracts on t-BH induced reduction in cell viability of HepG2 cells. In addition, the reducing power of the extracts and their ability to scavenge free radicals were evaluated using two antioxidant assay systems: cell free [oxygen radical absorbance capacity (ORAC), 2,2-diphenyl-1-picrylhydrazyl (DPPH), and [2,2′-azino-bis(3-ethylbenzothiazoline-6-sulfonicacid)] (ABTS)] and cell based [cellular antioxidant activity (CAA)]. Results and Discussion: The results obtained showed that these extracts possess significant hepatoprotective activity. This may indicate that the plant extracts contain compounds, which can remove toxic metabolites following t-BH induced toxicity. The extracts exhibited significant antioxidant property as evident by the Trolox values and effective scavenging of DPPH and ABTS radicals. The extracts also demonstrated inhibition of AAPH-induced fluorescence in HepG2 cells. These results indicate the ability of the plant extracts to protect the liver cells from chemical-induced damage, which might be correlated to their radical scavenging potential. Conclusion: This study demonstrates that these extracts have potential hepatoprotective activity which is mainly attributed to the antioxidant potential, which might occur by reduction of lipid peroxidation and cellular damage