Early referral for esophageal pH monitoring is more cost-effective than prolonged empiric trials of proton-pump inhibitors for suspected gastroesophageal reflux disease.

Introduction: The most cost-effective diagnostic algorithm for gastroesophageal reflux disease (GERD) remains controversial. We hypothesized that prompt referral for esophageal pH monitoring is more cost-effective than prolonged empiric courses of proton-pump inhibitors (PPIs).

Discussion: A cost model was created based on a cohort of 100 patients with possible GERD who underwent pH monitoring.

Sympathetic nerve-derived ATP regulates renal medullary vasa recta diameter via pericyte cells: a role for regulating medullary blood flow?

Pericyte cells are now known to be a novel locus of blood flow control, being able to regulate capillary diameter via their unique morphology and expression of contractile proteins. We have previously shown that exogenous ATP causes constriction of vasa recta via renal pericytes, acting at a variety of membrane bound P2 receptors on descending vasa recta (DVR), and therefore may be able to regulate medullary blood flow (MBF). Regulation of MBF is essential for appropriate urine concentration and providing essential oxygen and nutrients to this region of high, and variable, metabolic demand.

Factors Affecting Mental Health of Local Staff Working in the Vanni Region, Sri Lanka.

In the aftermath of the civil war that extended from 1983-2009, humanitarian organizations provided aid to the conflict-affected population of the Vanni region in northern Sri Lanka. In August, 2010, a needs assessment was conducted to determine the mental-health status of Sri Lankan national humanitarian aid staff working in conditions of stress and hardship, and consider contextual and organizational characteristics influencing such status. A total of 398 staff members from nine organizations working in the Vanni area participated in the survey, which assessed stress, work characteristics, social support, coping styles, and symptoms of psychological distress.

A systematic review of biopsychosocial training programs for the self-management of emotional stress: potential applications for the military.

Combat-exposed troops and their family members are at risk for stress reactions and related disorders. Multimodal biopsychosocial training programs incorporating complementary and alternative self-management techniques have the potential to reduce stress-related symptoms and dysfunction. Such training can preempt or attenuate the posttraumatic stress response and may be effectively incorporated into the training cycle for deploying and redeploying troops and their families.

Alternative strategies to constant patient observation and sitters: a proactive approach.

The evidence is inconclusive as to whether better patient outcomes for behavioral issues in acute care are achieved using constant patient observation. Nurse leaders at a northern California hospital designed and implemented proactive strategies to identify patients at risk for behavioral issues, developed evidence-based interventions to reduce the use of sitters and constant observation, and maintained or improved patient safety.

Behavioral effects of dopamine receptor inactivation in the caudate-putamen of preweanling rats: role of the D2 receptor.

Rationale: Inactivating dopamine (DA) receptors in the caudate-putamen (CPu) attenuates basal and DA agonist-induced behaviors of adult rats while paradoxically increasing the locomotor activity of preweanling rats.

Objective: The purpose of this study was to determine (a) whether D1 or D2 receptor inactivation is responsible for the elevated locomotion shown by preweanling rats and (b) whether DA receptor inactivation produces a general state in which any locomotor-activating drug will cause a potentiated behavioral response.

Methods: Dimethyl sulfoxide (DMSO) or N-ethoxycarbonyl-2-ethoxy-1,2-dihydroquinoline (EEDQ) was bilaterally infused into the CPu on postnatal day (PD) 17.

Repeated aripiprazole treatment causes dopamine D2 receptor up-regulation and dopamine supersensitivity in young rats.

Aripiprazole is a second-generation antipsychotic that is increasingly being prescribed to children and adolescents. Despite this trend, little preclinical research has been done on the neural and behavioral actions of aripiprazole during early development. In the present study, young male and female Sprague-Dawley rats were pretreated with vehicle, haloperidol (1 mg/kg), or aripiprazole (10 mg/kg) once daily on postnatal days (PD) 10-20.

Evaluation of false positive responses by mass spectrometry and ion mobility spectrometry for the detection of trace explosives in complex samples.

Secondary electrospray ionization-ion mobility-time of flight mass spectrometry (SESI-IM-TOFMS) was used to evaluate common household products and food ingredients for any mass or mobility responses that produced false positives for explosives. These products contained ingredients which shared the same mass and mobility drift time ranges as the analyte ions for common explosives. The results of this study showed that the vast array of compounds in these products can cause either mass or mobility false positive responses.

Challenges of systematic reviewing integrative health care.

This article is based on an extensive review of integrative medicine (IM) and integrative health care (IHC). Since there is no general agreement of what constitutes IM/IHC, several major problems were identified that make the review of work in this field problematic. In applying the systematic review methodology, we found that many of those captured articles that used the term integrative medicine were in actuality referring to adjunctive, complementary, or supplemental medicine.

Adult Degenerative Scoliosis Surgical Outcomes: A Systematic Review and Meta-analysis.

Introduction: There is increasing awareness of adult degenerative or de novo scoliosis, and its surgical treatment when indicated can be challenging and resource intense. Surgical randomized controlled trials are rare, and observational studies pose limitations because of the heterogeneity of surgical practices, techniques, and patient populations. Pooled analysis of current literature may identify effective treatment strategies and guide future efforts at prospective clinical research.

Subperiosteal hematoma in multiple settings.

Most reports of orbital hemorrhage do not distinguish among intraconal, extraconal, and subperiosteal hemorrhages, although several reports describe isolated subperiosteal hematomas as a separate entity. We report 3 cases of subperiosteal hematoma with different etiologies but similar progression of signs and symptoms. Each patient presented with spontaneous proptosis, rarely caused by orbital subperiosteal hematoma, measuring approximately 5 mm.

Warm-ups for military fitness testing: rapid evidence assessment of the literature.

Introduction: Warm-up exercises are commonly used before exercise as a method to physiologically prepare for strenuous physical activity. Various warm-up exercises are often implemented but without scientific merit and, at times, may be detrimental to performance.

Purpose/objective: To date, no systematic reviews have examined the effectiveness of warm-up exercises for military physical fitness test (PFT) or combat fitness test (CFT).

Surveillance for certain health behaviors among States and selected local areas - United States, 2010.

Problem: Chronic diseases (e.g., heart disease, stroke, cancer, and diabetes) are the leading causes of morbidity and mortality in the United States.

The evolution of complementary and alternative medicine (CAM) in the USA over the last 20 years.

Medical practices that reside outside the mainstream medical structures have existed for centuries, often waxing and waning in prominence and use for various reasons. Recently, there has been a resurgence in interest and use of such practices in the USA generally referred to under the label of 'complementary and alternative medicine' (CAM). In this article we summarize some of the highlight events that punctuated this resurgence over the last 20 years.

The integration of occupational therapy into primary care: a multiple case study design.

Background: For over two decades occupational therapists have been encouraged to enhance their roles within primary care and focus on health promotion and prevention activities. While there is a clear fit between occupational therapy and primary care, there have been few practice examples, despite a growing body of evidence to support the role. In 2010, the province of Ontario, Canada provided funding to include occupational therapists as members of Family Health Teams, an interprofessional model of primary care.

Selective thoracic fusion in Lenke 1C curves: prevalence and criteria.

Study Design: Multicenter retrospective analysis of prospectively collected data.

Objective: Evaluate radiographical and clinical characteristics of patients undergoing a selective thoracic fusion (STF) for Lenke 1C curves.

Summary Of Background Data: STF of adolescent idiopathic scoliosis has been advocated for the so-called "false double major" curve (Lenke 1C/King type II).

Acute zonal occult outer retinopathy: vision loss in an active duty soldier.

Objective. To describe a case of acute zonal occult outer retinopathy (AZOOR) in an active duty patient. Methods.

Comparison of reactant and analyte ions for ⁶³Nickel, corona discharge, and secondary electrospray ionization sources with ion mobility-mass spectrometry.

(63)Nickel radioactive ionization ((63)Ni) is the most common and widely used ion source for ion mobility spectrometry (IMS). Regulatory, financial, and operational concerns with this source have promoted recent development of non-radioactive sources, such as corona discharge ionization (CD), for stand-alone IMS systems. However, there has been no comparison of the negative ion species produced by all three sources in the literature.

Retinitis pigmentosa and granular dystrophy: a rare and unique combination in one patient.

Objective: To present a case of concurrent diagnoses, Retinitis Pigmentosa and Granular Corneal Dystrophy, discovered in one patient experiencing progressive vision loss.

Methods: In this case report we studied fundus photographs, anterior segment photographs, Goldman visual field, and electroretinography.

Results: Exam findings on presentation: A 58-year-old Korean female with bilateral crumb-like corneal stromal deposits, waxy pallor of the disc, attenuated vessels and bone spicules.

Acupuncture for posttraumatic stress disorder: a systematic review of randomized controlled trials and prospective clinical trials.

To evaluate the current evidence for effectiveness of acupuncture for posttraumatic stress disorder (PTSD) in the form of a systematic review, a systematic literature search was conducted in 23 electronic databases. Grey literature was also searched. The key search terms were "acupuncture" and "PTSD.

Novelty-induced conditioned place preference, sucrose preference, and elevated plus maze behavior in adult rats after repeated exposure to methylphenidate during the preweanling period.

Early treatment with methylphenidate has a persistent effect on the affective (i.e., anxiety- and depressive-like) behaviors of adult rats and mice.

Postnatal manganese exposure does not alter dopamine autoreceptor sensitivity in adult and adolescent male rats.

Administering manganese chloride (Mn) to rats on postnatal day (PD) 1-21 causes long-term reductions in dopamine transporter levels in the dorsal striatum, as well as a persistent increase in D1 and D2 receptor concentrations. Whether dopamine autoreceptors change in number or sensitivity is uncertain, although D2S receptors, which may be presynaptic in origin, are elevated in Mn-exposed rats. The purpose of this study was to determine if early Mn exposure causes long-term changes in dopamine autoreceptor sensitivity that persist into adolescence and adulthood.

Outcomes Following Posterior Fusion for Adolescent Idiopathic Scoliosis With and Without Autogenous Iliac Crest Bone Graft Harvesting.

Study Design: Retrospective.

Summary Of Background Data: There is continued controversy regarding the morbidity associated with harvesting iliac crest bone graft (ICBG). More important, its effect on clinical outcomes is poorly understood.