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Inertial waves occur naturally in rotating fluids such as the Sun and the Earth's atmosphere. Rossby waves in the Sun have the potential to shed fresh light on interior turbulence and convection that prior seismic methods, reliant on sound waves, have been unable to accomplish. Here, we utilize ∼13 years of observational products taken by the space-based helioseismic and magnetic imager, onboard the solar dynamics observatory, to characterize solar equatorial Rossby waves. By examining maps of motions at the surface using two different methods, we are able to identify Rossby modes up to azimuthal order m = 30, approximately up to twice the spatial wavenumber limit of previous studies. The dispersion relation of these modes departs significantly from the classical two-dimensional Rossby-Haurwitz description. A parameter study of the effect of superadiabaticity and viscous diffusion on these inertial modes indicates that each parameter plays a role in influencing both the frequencies and linewidths of high m modes. Using the Rhines-scale relation, we constrain the root mean square amplitude of turbulent convection more tightly to ∼ 2 m/s, adding more evidence to the paradigm of weakly convective amplitudes at large scales. [ABSTRACT FROM AUTHOR]

Sinusitis is a common condition for which patients often consult the community pharmacist. It is, however, challenging to differentiate between common forms of sinusitis as they have nearly identical clinical representations. This review article provides an overview of sinusitis, classification, differential diagnosis between viral sinusitis, bacterial sinusitis and chronic rhinosinusitis, therapeutic management, patient education and patient referral guidelines. In addition, the recently updated guidelines on sinusitis published by the American Academy of Otolaryngology-Head and Neck Surgery Foundation (2015), the European position paper on rhinosinusitis and nasal polyps, EPOS 2012 and the Canadian guidelines for acute bacterial rhinosinusitis (2014) will be reviewed. [ABSTRACT FROM AUTHOR]

The optimality of the Erdős–Rado theorem for pairs is witnessed by the colouring Δ κ : [ 2 κ ] 2 → κ recording the least point of disagreement between two functions. This colouring has no monochromatic triangles or, more generally, odd cycles. We investigate a number of questions investigating the extent to which Δ κ is an extremal such triangle-free or odd-cycle-free colouring. We begin by introducing the notion of Δ -regressive and almost Δ -regressive colourings and studying the structures that must appear as monochromatic subgraphs for such colourings. We also consider the question as to whether Δ κ has the minimal cardinality of any maximal triangle-free or odd-cycle-free colouring into κ . We resolve the question positively for odd-cycle-free colourings. [ABSTRACT FROM AUTHOR]

Objective: To describe caesarean section rates and neonatal mortality to assess change in access to life-saving interventions in a rural low-resource setting between 2007 and 2013.Design: Population-based cross-sectional study.Setting: Southern Tanzania.Population: A total of 34 063 women from 384 549 households who gave birth in the previous year.Methods: Using data collected in two geo-referenced household surveys conducted in 2007 and 2013 in the context of two cluster-randomized controlled trials, we describe trends in caesarean section and neonatal mortality in obstetric risk groups inspired by the 10-group Robson classification.Main Outcome Measures: Rates of self-reported birth by caesarean section and neonatal mortality.Results: Population-based caesarean section rates increased from 4.0% in 2007 to 6.4% in 2013. In 2013, the lowest caesarean section rate was found in multipara whose labour was not induced or augmented [4.4%, 95% confidence interval (CI) 3.9-4.9], a group that showed a rate increase of over 50% from 2007 [adjusted prevalence ratio 1.57 (95% CI 1.34-1.82)]. Nullipara whose labour was not induced or augmented had rates of 6.2% in 2007 and 8.5% in 2013. Caesarean rates in multiple pregnancies were low at 8.1% (95% CI 5.6-10.5) in 2007, and 14.6% (95% CI 9.4-19.8) in 2013. Overall neonatal mortality was high: 3.5% in 2007 and 3.2% in 2013, with rates being lowest in multiparous women whose labour was not induced or augmented: 2.4% (95% CI 2.2-2.7) and 1.7% (95% CI 1.4-2.0) in 2007 and 2013, respectively.Conclusion: Although use of caesarean section remains insufficient, and higher rates do not necessarily imply better quality of care, our analysis highlights improvements in reaching women with caesarean section. Rates in multiple birth remained low compared with high-income settings.Tweetable Abstract: In Southern Tanzania caesarean section rates increased over time, but the rate in high-risk births remained alarmingly low. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Teaching exodontia to novice undergraduates requires a realistic model. Thiel‐embalmed cadavers retain the flexibility of the soft tissues and could be used to teach exodontia. Objective: The objective was to determine whether Thiel‐embalmed cadavers were perceived to be a more realistic model by undergraduates in comparison with mannequins. Materials and Methods: Over a period of 4 years (2011‐2014), students were randomly assigned into two groups: those taught exodontia on mannequins only (NT) and those who also experienced cadaveric teaching (T). This was followed by an assessment. Results: There were 174 students in the T group and 108 in the NT group. Sixty‐five per cent of the T group and 69% of the NT group provided feedback. Ninety‐eight per cent (98%) felt that they had been advantaged by being included in the group compared with 95% in the NT who felt disadvantaged. The majority (98%) thought that using the cadavers was advantageous and gave a realistic feel for soft tissue management (89%) and that it was similar to managing a patient (81%). Self‐reported confidence in undertaking an extraction was not different between the two groups (P=.078), and performance in the extraction assessment was not significantly different between the two groups over the 4 years (P=.8). Conclusion: The Thiel‐embalmed cadavers were well received by the students who found it a more realistic model for exodontia than a mannequin, even though this did not impact on their performance in a following assessment. Future work on these cadavers may be expanded to include surgical procedures. [ABSTRACT FROM AUTHOR]

Background: Whether women should be able to decide on mode of birth in healthcare settings has been a topic of debate in the last few decades. In the context of a marked increase in global caesarean section rates, a central dilemma is whether pregnant women should be able to request this procedure without medical indication. Since 2015, Law 25,929 of Humanised Birth is in place in Argentina. This study aims at understanding the power relations between healthcare providers, pregnant women, and labour companions regarding decision-making on mode of birth in this new legal context. To do so, central concepts of power theory are used. Methods: This study uses a qualitative design. Twenty-six semi-structured interviews with healthcare providers were conducted in five maternity wards in different regions of Argentina. Participants were purposively selected using heterogeneity sampling and included obstetrician/gynaecologists (heads of department, specialists working in 24-h shifts, and residents) and midwives where available. Reflexive thematic analysis was used to inductively develop themes and categories. Results: Three themes were developed: (1) Healthcare providers reconceptualize decision-making processes of mode of birth to make women's voices matter; (2) Healthcare providers feel powerless against women's request to choose mode of birth; (3) Healthcare providers struggle to redirect women's decision regarding mode of birth. An overarching theme was built to explain the power relations between healthcare providers, women and labour companions: Healthcare providers' loss of beneficial power in decision-making on mode of birth. Conclusions: Our analysis highlights the complexity of the healthcare provider-woman interaction in a context in which women are, in practice, allowed to choose mode of birth. Even though healthcare providers claim to welcome women being an active part of the decision-making processes, they feel powerless when women make autonomous decisions regarding mode of birth. They perceive themselves to be losing beneficial power in the eyes of patients and consider fruitful communication on risks and benefits of each mode of birth to not always be possible. At the same time, providers perform an increasing number of CSs without medical indication when it is convenient for them, which suggests that paternalistic practices are still in place. Plain Language Summary: In the last few decades, there has been a debate on whether women should be able to choose if they haver a vaginal birth or a caesarean section. This debate has been framed by the fact that an increasing number of caesarean sections are being performed. Since 2015, Argentina has a Law of Humanised Birth. We conducted a study to understand the power relations between healthcare providers, pregnant women and labour companions in decision making on mode of birth in this new legal context. To do so, we used central concepts of power theory. We conducted 26 semi-structured interviews with healthcare providers in five maternity wards of Argentina. The interviewees were obstetrician/gynaecologists (heads of department, specialists working in 24-h shifts, and residents) and midwives where available. We used thematic analysis to build themes from the data. We discovered that healthcare providers perceive themselves to be losing beneficial power in decision-making on mode of birth. Even though they claim to want women to make autonomous decisions, they feel frustrated when this happens. They also perceive it to be more difficult to communicate with patients regarding the risks and benefits of vaginal birth and caesarean section. At the same time, providers carry out an increasing number of CSs without medical indication when it is convenient for them, which suggests that paternalistic practices are still in place. [ABSTRACT FROM AUTHOR]

Unlike the case with acute myeloid leukemia, there is limited information on the prognostic impact of isocitrate dehydrogenase (IDH) mutations in myelodysplastic syndromes (MDS). In the current study of 277 patients with MDS, IDH mutations were detected in 34 (12%) cases: 26 IDH2 (all R140Q) and 8 IDH1 (6 R132S and 2 R132C). Mutational frequency was 4% (2 of 56) in refractory anemia with ring sideroblasts, 12% (16 of 130) in refractory cytopenia with multilineage dysplasia, 14% (2 of 14) in MDS-unclassifiable, 14% (6 of 42) in refractory anemia with excess blasts (RAEB)-1 and 23% (8 of 35) in RAEB-2. Normal karyotype was noted in all but one IDH1-mutated cases and 13 IDH2-mutated cases. Multivariable analysis identified presence of mutant IDH1 (P=0.0004; hazard ration 4.0, 95% confidence interval 1.9-8.8), revised International Prognostic Scoring System risk category (P<0.0001), and red cell transfusion need (P=0.002) as independent predictors of inferior survival. In a similar multivariable analysis, mutant IDH1 was the only variable associated with shortened leukemia-free survival (P=0.001; hazard ration 7.0, 95% confidence interval 2.3-20.8). The presence of IDH2R140Q did not affect the overall (P=0.54) or leukemia-free (P=0.81) survival. The current study suggests a powerful adverse prognostic effect for mutant IDH1 in MDS. [ABSTRACT FROM AUTHOR]

The ability to place sutures is an essential skill in dentistry. In our institution, the introduction of a video teaching aid and a checklist-based assessment has improved the standardisation of teaching as well as the transparency and objectivity of the assessment of suture skills. The aim of this study was to determine whether this skill once acquired is retained in the short term. The same cohort of 67 fourth-year students performed the same assessment at two different time points 2 months apart. The first was a formative assessment and the second was a summative assessment. Feedback was collected on both occasions. On the first sitting of the assessment, 93% of the students were successful compared with 79% on the second occasion. Student feedback was similar on both occasions with 77% and 75% reporting that they thought it was an easy exam. On the first occasion, 27% thought that it was a stressful examination compared with 43% on the second occasion, which may have affected their performance. These findings suggest that regular reinforcement is required to avoid deterioration of suturing skills even in the short term. This might involve exposing the students to surgery earlier in the course and introducing regular formative assessments which the students appear to associate with less stress. [ABSTRACT FROM AUTHOR]

Monosomal karyotype (MK) refers to the presence of two or more distinct autosomal monosomies or a single monosomy associated with a structural abnormality. In acute myeloid leukemia, MK has been shown to be prognostically worse than an otherwise complex karyotype. The current study examines whether the same holds true for myelodysplastic syndromes (MDS). A total of 127 MDS patients (median age 70 years) with a complex karyotype were considered; 106 (83%) met the above-stipulated criteria for MK and 21 (17%) had a complex karyotype without monosomies. Survival was significantly inferior in patients with MK compared with those with a complex karyotype without monosomies (P=0.01; HR 1.9, 95% confidence interval (95% CI), 1.1-3.3). Multivariable analysis identified MK (P=0.002), advanced age (P=0.0004) and bone marrow blast percentage (0.04) as independent risk factors for survival. There was no difference in survival among MK patients further substratified by the presence or absence of monosomy 7 and/or monosomy 5. Although not statistically significant, leukemia-free survival was also worse with MK compared with complex karyotype without monosomies (P=0.09; HR 2.7, 95% CI 0.8-9.0). MK in MDS identifies a prognostically worse subgroup of patients with a complex karyotype, regardless of whether monosomy 7 or 5 is part of the MK component. [ABSTRACT FROM AUTHOR]

Aim: This functional magnetic resonance imaging (fMRI) study examined reactivity to alcohol, polydrug, marijuana and emotional picture cues in students who were referred to a college alcohol and drug assistance program. Methods: The fMRI data of 10 participants (5 females; 5 males) were collected while they viewed standardized emotional and appetitive cues. Results: Positive and negative emotional cues produced greater activity than neutral cues in the expected brain areas. Compared with neutral cues, alcohol cues produced greater brain activation in the right insula, left anterior cingulate, left caudate and left prefrontal cortex (Z = 2.01, 1.86, 1.82, 1.81, respectively; P < 0.05). Drug cues produced significantly greater left prefrontal activity compared with neutral cues, with polydrug cues activating the right insula and marijuana cues activating left anterior cingulate. Conclusions: Students at-risk for alcohol abuse showed neural reactivity to alcohol cues in four brain regions, which is consistent with their greater use of alcohol. Insula activation to appetitive cues may be an early marker of risk for progression to alcohol/drug abuse. [ABSTRACT FROM AUTHOR]

Introduction: To improve the assessment of suturing skills, we firstly developed a checklist based assessment. As an aid to the teaching of suturing skills a video was subsequently developed. Materials and methods: To validate the checklist a cohort of 57 final year students were videoed performing the formative suturing assessment which was assessed by two examiners independently. Two cohorts of third year students took part in the formal assessment but only the second cohort of students would have access to the video. Results: The first cohort of 58 third year students’ success rate was 93% and 1 year later 94% of 53 third year students were successful. One hundred per cent of the first cohort and 98% of the second cohort thought that the exam was a fair assessment of suturing skills. The majority of students thought that the checklist was helpful (94% and 93%). However, 62% and 55% thought that the assessment was a stressful experience. However, only 80% of the first cohort compared with 98% of the second cohort thought that they could now place sutures in intra-oral wounds. Conclusion: Our findings suggest that checklist based assessments of suturing skills were well received by the students and improved the objectivity and transparency of the assessment process. Further work is required to determine if teaching initially on a tabletop model can be transferred to the dental clinical situation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the effects of a multifaceted paediatric rapid response system on the duration of predefined clinical instability and the subsequent rate of cardiac arrests. METHODS: An interrupted time series study coupled with a retrospective chart review to evaluate the effects of implementing a four component paediatric rapid response system. All patients in a 136-bed university-affiliated paediatric hospital from August 2003 to May 2007 were considered. The main outcome measures included rate of cardiac arrests as indicated by the number of patient days between ward paediatric cardiac arrests and duration of predefined clinical instability before evaluation by critical care personnel. RESULTS: The mean time interval between cardiac arrests increased significantly with the establishment of the rapid response system from a baseline of 2512 to 9418 patient days. The median duration of clinical instability decreased from 9 h 55 min to 4 h 15 min post intervention (p=0.028). CONCLUSIONS: The implementation of a paediatric rapid response system is associated with a significant reduction in the rate of cardiac arrests and duration of clinical instability before evaluation by critical care personnel. This study provides evidence that implementation of a rapid response system brings emergency personnel to deteriorating patients earlier, thus preventing cardiac arrests. [ABSTRACT FROM AUTHOR]

BACKGROUND: In a randomized controlled study aiming to test the effectiveness of preimplantation genetic screening (PGS) in women of advanced maternal age, embryos diagnosed as chromosomally abnormal and those with no diagnosis were fixed for reanalysis. The aim of this study was to determine how well the chromosomal constitution of one biopsied blastomere reflects the status of the entire embryo. [ABSTRACT FROM PUBLISHER]

Numerous agencies, programs, and national networks are focused on improving understanding of water and energy fluxes across temporal and spatial scales and on enhancing confidence to synthesize data across multiple sites. Enhancing the accuracy and precision in the surface energy balance and the latent energy (λE) flux lies, in part, with being able to uniformly calibrate water vapor measurements at and among sites to traceable standards. This paper examines (i) the traceable physical controls on field applications of chilled-mirror hygrometers and (ii) an automated means to accurately and precisely calibrate infrared gas analyzers for water vapor concentrations and eddy covariance (λE) data. The environmental physics and gas handling were examined in a theoretical and applied manner that found that chilled-mirror technologies can be a robust measure of dewpoint temperatures and ambient water vapor only if the unit conversions are accounted for between inlet and body temperatures. Psychrometers were also examined and a functional relationship (exponential) was developed for the psychrometric constant against the wet-bulb temperature depression (Tdb - Twb), across a wider range of temperature depressions than previously reported. These empirical estimates of the psychrometer constant for small temperature depressions are much lower than other reported values—that is, ∼0.000 52 K-1 for a wet-bulb temperature depression (Tdb - Twb) of 4.3 K. [ABSTRACT FROM AUTHOR]

How can the components of visual comprehension be characterized as brain activity? Making sense of a dynamic visual world involves perceiving streams of activity as discrete units such as eating breakfast or walking the dog. In order to parse activity into distinct events, the brain relies on both the perceptual (bottom-up) data available in the stimulus as well as on expectations about the course of the activity based on previous experience with, or knowledge about, similar types of activity (top-down data). Using fMRI, we examined the contribution of bottom-up and top-down processing to the comprehension of action streams by contrasting familiar action sequences with those having exactly the same perceptual detection and motor responses (yoked control), but no visual action familiarity. New methods incorporating structural equation modeling of the data yielded distinct patterns of interactivity among brain areas as a function of the degree to which bottom-up and top-down data were available. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which offers a study on the effectiveness of flow cytometry in detecting abnormal plasma cells.

Presents a letter to the editor about chronic neutrophilic leukemia, as defined by the WHO.

Simple and easily reproducible techniques have been used to construct two objective cyclone climatologies of the North Atlantic-European sector. The goal of this study is to increase understanding of cyclones with the potential to cause damage, in particular, those reaching Beaufort category 7 and above. The two climatologies constructed here span the period 1979–2000 and have been developed from reanalysis mean sea level pressure data from the ECMWF (European Centre for Medium Range Weather Forecasts) and NCEP (National Centres for Environmental Prediction). The ECMWF reanalysis data are only available for 15 years, and have been extended from 1994 using operational analyses. The major temporal and spatial characteristics of North Atlantic cyclones are examined and a comparison between the climatologies developed from the two data sets is carried out. The well-known cyclogenesis regions along the east coast of the United States and to the southeast of Greenland are replicated by both reanalyses, as is the characteristic southwest/northeast orientation of the dominant cyclone track across the Atlantic basin. However, only weak correlations are found between the time series of cyclone frequency produced from the two reanalyses, and this is particularly true for the lower intensity Beaufort Scale category 0–6 cyclones. This result, together with the large differences in the spatial distribution of cyclones over Greenland for Beaufort Scale 0–6 cyclones, indicates the NCEP reanalyses generates fewer systems than the ECMWF reanalyses. The overall conclusion is that the ECMWF mean sea level pressure data produce a more comprehensive climatology of North Atlantic cyclones at all scales. [ABSTRACT FROM AUTHOR]

Competence in undergraduate oral surgery involves assessment of the students' knowledge, practical skill and attitude. The assessment of practical skills can be achieved using a formative assessment method such as the structured clinical operative test (SCOT) which uses a checklist for the assessment of a clinical task. The aim of this study was primarily to determine whether SCOTs could be integrated into the oral surgery undergraduate course, and secondarily to collect feedback from both the students and the staff on this assessment. A validated checklist was used by trained examiners to assess the performance of 49 students in their second clinical year undertaking simple exodontia. Feedback was collected from the students by questionnaire and from the staff by interview. The SCOT was well received by both students and staff. The main problem highlighted by the students was the perceived inter-examiner variability and by the staff, the disruptive effect on the clinics. The checklist must be objective enough to prevent misinterpretation. Despite these limitations, the SCOT provides a more objective assessment and serves to highlight weaker students, allowing them to be targeted for closer supervision and instruction as well as providing the students with a tool to measure their progress in oral surgery. The use of peer assessment by students may alleviate the burden on the staff. [ABSTRACT FROM AUTHOR]

The lack of information about future changes in extreme weather is a major constraint of Integrated Assessment Models (IAMs) of climate change. The generation of descriptions of future climate in current IAMs is assessed. We also review recent work on scenario development methods for weather extremes, focusing on those issues which are most relevant to the needs of IAMs. Finally, some options for implementing scenarios of weather extremes in IAMs are considered. [ABSTRACT FROM AUTHOR]

We present a review of the impact of intensivists and ICU teams on patient outcomes, with specific emphasis on varying hospital environments and study designs. While the demand for critical care services is likely to increase, 50% of ICU patients still receive care from nonintensivists in conjunction with consultants. While no “standard” of critical care practice exists, costs are substantial: there are about 55,000 ICU patients/day in the United States, and organizational structures vary substantially. ICU outcome studies can be divided into three groups: multi-institutional comparisons, before-and-after studies, and side-by-side comparisons. Multi-institutional comparisons have tended to show improved outcomes in well-organized ICUs, with strong medical direction and on-site intensivists. The change from an “open” to a “closed” format for ICU care is associated with decreased low-acuity admissions, resource utilization and mortality rates, and improved efficiency. Side-by-side comparisons have demonstrated improved efficiency, decreased complications, and decreased resource use on ICU services directed by an intensivist. [ABSTRACT FROM AUTHOR]

Investigates the reactions of palladium/silicon carbide and nickel/silicon carbide samples during thermal annealing by X-ray diffraction and megaelectronvolt ion backscattering spectrometry. Reason for the increasing technological interest in the properties of metal-silicon carbide; Phase identifications obtained from X-ray diffraction; Comparison between the interactions of palladium/silicon carbide and nickel/silicon carbide from the interactions of palladium/silicon and nickel/silicon.

The article focuses on a study which examines the features and performance of four differential diagnosis (DDX) generators. The study identifies these generators through a systematic search, compares each tool against a set of consensus criteria. The study tests each tool using diagnostic conundrums from the "New England Journal of Medicine" (NEJM) and the Medical Knowledge Self Assessment Program (MKSAP) of the American College of Physicians.

Objectives: Develop and implement a machine learning algorithm to predict severe sepsis and septic shock and evaluate the impact on clinical practice and patient outcomes.Design: Retrospective cohort for algorithm derivation and validation, pre-post impact evaluation.Setting: Tertiary teaching hospital system in Philadelphia, PA.Patients: All non-ICU admissions; algorithm derivation July 2011 to June 2014 (n = 162,212); algorithm validation October to December 2015 (n = 10,448); silent versus alert comparison January 2016 to February 2017 (silent n = 22,280; alert n = 32,184).Interventions: A random-forest classifier, derived and validated using electronic health record data, was deployed both silently and later with an alert to notify clinical teams of sepsis prediction.Measurement and Main Result: Patients identified for training the algorithm were required to have International Classification of Diseases, 9th Edition codes for severe sepsis or septic shock and a positive blood culture during their hospital encounter with either a lactate greater than 2.2 mmol/L or a systolic blood pressure less than 90 mm Hg. The algorithm demonstrated a sensitivity of 26% and specificity of 98%, with a positive predictive value of 29% and positive likelihood ratio of 13. The alert resulted in a small statistically significant increase in lactate testing and IV fluid administration. There was no significant difference in mortality, discharge disposition, or transfer to ICU, although there was a reduction in time-to-ICU transfer.Conclusions: Our machine learning algorithm can predict, with low sensitivity but high specificity, the impending occurrence of severe sepsis and septic shock. Algorithm-generated predictive alerts modestly impacted clinical measures. Next steps include describing clinical perception of this tool and optimizing algorithm design and delivery. [ABSTRACT FROM AUTHOR]

PURPOSE: Medication nonadherence is a persistent and costly problem across health care. Measures of medication adherence are ineffective. Methods such as self-report, prescription claims data, or smart pill bottles have been used to monitor medication adherence, but these are subject to recall bias, lack real-time feedback, and are often expensive. METHODS: We proposed a method for monitoring medication adherence using a commercially available wearable device. Passively collected motion data were analyzed on the basis of the Movelet algorithm, a dictionary learning framework that builds person-specific chapters of movements from short frames of elemental activities within the movements. We adapted and extended the Movelet method to construct a within-patient prediction model that identifies medication-taking behaviors. RESULTS: Using 15 activity features recorded from wrist-worn wearable devices of 10 patients with breast cancer on endocrine therapy, we demonstrated that medication-taking behavior can be predicted in a controlled clinical environment with a median accuracy of 85%. CONCLUSION: These results in a patient-specific population are exemplar of the potential to measure real-time medication adherence using a wrist-worn commercially available wearable device. Wrist-worn tech can detect when breast cancer patients take medications based on hand motions. [ABSTRACT FROM AUTHOR]

A personal narrative is presented which explores the author's experience of being an atheist who was raised in a family of Mormons.

Maternal antibody levels in XLA neonates may predict when to start replacement IgG. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective of this study was to examine the relationship of obstructive sleep apnea (OSA), body weight (BMI percentage [BMI%]), and monosymptomatic nocturnal enuresis (MNE) in children. METHODS: A case-control study design was used. All children were 5 to 15 years of age; case patients were recruited from a comprehensive sleep disorders center (n = 149), and control subjects were recruited from a general pediatric practice in the same catchment area (n = 139). Case patients were subject to overnight polysomnograms and grouped into apnea severity categories (minimal, mild, moderate, or severe) on the basis of respiratory disturbance index and minimum arterial oxygen saturation levels. Data for all children included age; gender; height; weight; and history of MNE, snoring, diabetes, nasal allergies, and/or enlarged tonsils. BMI% was used to group children into weight categories as suggested by the Centers for Disease Control and Prevention (underweight, normal weight, at risk for overweight, and overweight). Two age groupings were created (5-10 years and 11-15 years). Descriptive statistics provided the prevalence of OSA, weight category, and MNE among case patients and control subjects. Cross-tabulations examined the relationship of severity of OSA with weight categories and MNE, stratified by age and gender. A series of logistic regression models explored the interrelationship of the grouping variables. RESULTS: A large majority (79.9%) of control subjects were at risk for overweight, and a large majority (80.0%) of children with MNE also had some degree of OSA. Logistic regression demonstrated that both MNE (odds ratio: 5.29) and overweight (odds ratio 4.16) were significantly associated with OSA but not with each other. CONCLUSIONS: Overweight and MNE are associated with OSA but not with each other. OSA should be considered in overweight children with MNE, especially when they display other symptoms of OSA or fail to respond to standard MNE treatment programs. [ABSTRACT FROM AUTHOR]

The article focuses on the performance of ballast mats on passenger railroads. It cites the common practice of fitting ballast mats on urban railway systems for the isolation of ground-borne vibrations from trains. It states that there is a variance between the actual performance of the product and the claims of the suppliers of ballast mats.

There is substantial evidence that Ca2+ fluxes occur during most forms of apoptosis, and that inhibiting such fluxes protects cells from death. IP3 receptors – ligand-gated channels that release Ca2+ from intracellular stores – are emerging as key sites for regulation by pro- and anti-apoptotic factors. [Copyright &y& Elsevier]

Background: Changes in the medium of communication from paging to mobile secure text messaging may change clinical care, but the effects of these changes on patient outcomes have not been well examined.Objective: To evaluate the association between inpatient medicine service adoption of mobile secure text messaging and patient length of stay and readmissions.Design: Observational study.Participants: Patients admitted to medicine services at the Hospital of the University of Pennsylvania (intervention site; n = 8995 admissions of 6484 patients) and Penn Presbyterian Medical Center (control site; n = 6799 admissions of 4977 patients) between May 1, 2012, and April 30, 2014.Intervention: Mobile secure text messaging.Main Measures: Change in length of stay and 30-day readmissions, comparing patients at the intervention site to the control site before (May 1, 2012 to April 30, 2013) and after (May 1, 2013 to April 30, 2014) the intervention, adjusting for time trends and patient demographics, comorbidities, insurance, and disposition.Key Results: During the pre-intervention period, the mean length of stay ranged from 4.0 to 5.0 days at the control site and from 5.2 to 6.7 days at the intervention site, but trends were similar. In the first month after the intervention, the mean length of stay was unchanged at the control site (4.7 to 4.7 days) but declined at the intervention site (6.0 to 5.4 days). Trends were mostly similar during the rest of the post-intervention period, ranging from 4.4 to 5.6 days at the control site and from 5.4 to 6.5 days at the intervention site. Readmission rates varied significantly within sites before and after the intervention, but overall trends were similar. In adjusted analyses, there was a significant decrease in length of stay for the intervention site relative to the control site during the post-intervention period compared to the pre-intervention period (-0.77 days ; 95 % CI, -1.14, -0.40; P < 0.001). There was no significant difference in the odds of readmission (OR, 0.97; 95 % CI: 0.81, 1.17; P = 0.77). These findings were supported by multiple sensitivity analyses.Conclusions: Compared to a control group over time, hospitalized medical patients on inpatient services whose care providers and staff were offered mobile secure text messaging showed a relative decrease in length of stay and no change in readmissions. [ABSTRACT FROM AUTHOR]