ECG monitoring after cardiac surgery: postoperative atrial fibrillation and the atrial electrogram.

Atrial fibrillation is one of the most common complications after cardiac surgery and is associated with adverse outcomes such as increased mortality, neurological problems, longer hospitalizations, and increased cost of care. Major risk factors for the development of postoperative atrial fibrillation include older age and a history of atrial fibrillation. beta-Blockers are the most effective preventive therapy, although sotalol and amiodarone can also be used for prophylaxis.

Loss of E-cadherin-mediated cell contacts reduces estrogen receptor alpha (ER alpha) transcriptional efficiency by affecting the respective contribution exerted by AF1 and AF2 transactivation functions.

The estrogen receptor alpha (ER alpha) is key in regulating normal breast development and function and is closely involved in the onset and progress of cancers. ER alpha transcriptional activity is mediated through two activation functions, AF1 and AF2, whose activity is tightly regulated in a cell-specific manner through yet unknown processes. Here, we demonstrate that cell-cell junctions generate cell permissiveness to AF1 through an up-regulation of the activity of an AF1 sub-region termed box 1.

Health information technology and health information exchange in New York State: new initiatives in implementation and evaluation.

More research is needed to understand the effects of health information technology (HIT) and health information exchange (HIE) on quality, safety, efficiency, finances, consumers and providers in community-based settings. New York State is investing heavily in HIT and HIE adoption through the HEAL NY program. It has already provided $53 million in seed money and requires that grantee organizations match the funds.

The United Hospital Fund meeting on evaluating health information exchange.

Health information exchange (HIE) projects are sweeping the nation, with hopes that they will lead to high quality, efficient care, yet the literature on their measured benefits remains sparse. To the degree that the field adopts a common set of evaluation strategies, duplicate work can be reduced and meta-analysis will be easier. The United Hospital Fund sponsored a meeting to address HIE evaluation.

Retinol binding protein 4 expression in humans: relationship to insulin resistance, inflammation, and response to pioglitazone.

Context: Retinol binding protein 4 (RBP4) was recently found to be expressed and secreted by adipose tissue, and was strongly associated with insulin resistance.

Objective: The aim was to determine the relationship between RBP4 and obesity, insulin resistance, and other markers of insulin resistance in humans.

Design And Patients: RBP4 mRNA levels in adipose tissue and muscle of nondiabetic human subjects with either normal or impaired glucose tolerance (IGT) were studied, along with plasma RBP4.

Alcohol consumption, bone density, and hip fracture among older adults: the cardiovascular health study.

Introduction: Previous studies have found inconsistent relationships of alcohol consumption with risk of hip fracture, and the importance of bone mineral density and risk of falls in mediating such a relationship has not been determined.

Methods: As part of the Cardiovascular Health Study, a population-based cohort study of adults aged 65 years and older from four U.S.

Human visfatin expression: relationship to insulin sensitivity, intramyocellular lipids, and inflammation.

Context: Visfatin (VF) is a recently described adipokine preferentially secreted by visceral adipose tissue (VAT) with insulin mimetic properties.

Objective: The aim of this study was to examine the association of VF with insulin sensitivity, intramyocellular lipids (IMCL), and inflammation in humans.

Design And Patients: VF mRNA was examined in paired samples of VAT and abdominal sc adipose tissue (SAT) obtained from subjects undergoing surgery.

Glucose testing and insufficient follow-up of abnormal results: a cohort study.

Background: More than 6 million Americans have undiagnosed diabetes. Several national organizations endorse screening for diabetes by physicians, but actual practice is poorly understood. Our objectives were to measure the rate, the predictors and the results of glucose testing in primary care, including rates of follow-up for abnormal values.

Streptococcal pyomyositis of the psoas: case reports and review.

We present two unusual cases of pyomyositis of the psoas muscle caused by Group A beta-hemolytic streptococcus (GABHS) in children presenting with fever, emesis and leg pain. Pyomyositis secondary to GABHS is rare in children and cases involving the psoas muscle have not been previously reported. In our discussion, we review the epidemiology, presentation, diagnosis and treatment of GABHS psoas myositis in comparison with staphylococcal pyomyositis.

The prevalence of cardiac ectopy in elderly patients with echocardiographically normal hearts is not increased by significant coronary artery disease.

Issue: A higher frequency of abnormal heart rhythms has previously been shown in elderly subjects with overtly normal hearts as demonstrated by noninvasive testing. However, no prior study on elderly patients with echocardiographically structurally normal hearts has distinguished cardiac dysrhythmia incidence based on the presence or absence of angiographically documented coronary artery disease (CAD).

Methods: We performed 24-hour ambulatory monitoring on patients with no coronary stenosis of greater than 30% and normal left ventricular (LV) systolic function by angiography.

Rapid titration of carvedilol in patients with congestive heart failure: a randomized trial of automated telemedicine versus frequent outpatient clinic visits.

Background: Because of potential side effects and logistical difficulty of titrating medications, outpatients with congestive heart failure rarely receive appropriate doses of carvedilol or other beta-blockers. To address these obstacles, we studied if an automated telemedicine system named TeleWatch (TW) could facilitate carvedilol titration in outpatients with left ventricular systolic dysfunction.

Methods: Forty-nine patients with New York Heart Association class II and III left ventricular systolic dysfunction, who were tolerating appropriate afterload-reducing therapy and not receiving beta-blockers, were enrolled into a 3-month study.

Reducing pica by teaching children to exchange inedible items for edibles.

Assessment results indicated that pica exhibited by two boys with developmental disabilitieswas not associated with environmental contingencies. Consistent with previous research, an oral stimulation function was hypothesized. A related intervention that taught participants to exchange inedible items for edibles was developed.

The value of diagnostic information to patients with chest pain suggestive of coronary artery disease.

Background: The results of diagnostic tests often have a profound impact on the way patients view their health. Decision analyses and clinical guidelines do not routinely consider this, in part because methods are not well developed for measuring the value of testing to patients.

Objectives: To measure the value of stress testing to patients with chest pain suggestive of coronary artery disease (CAD) and to improve methods for measuring the value of diagnostic information.

Association between screening for osteoporosis and the incidence of hip fracture.

Background: Because direct evidence for the effectiveness of screening is lacking, guidelines disagree on whether people should be screened for osteoporosis.

Objective: To determine whether population-based screening for osteoporosis in older adults is associated with fewer incident hip fractures than usual medical care.

Design: Nonconcurrent cohort study.

Analysis of the estrogen regulation of the zebrafish estrogen receptor (ER) reveals distinct effects of ERalpha, ERbeta1 and ERbeta2.

We have previously cloned and characterized three estrogen receptors (ER) in the zebrafish (zfERalpha, zfERbeta1 and zfERbeta2). We have also shown that they are functional in vitro and exhibit a distinct expression pattern, although partially overlapping, in the brain of zebrafish. In this paper, we have shown that the hepatic expression of these zfER genes responds differently to estradiol (E2).

Postoperative atrial fibrillation: new directions in prevention and treatment.

Postoperative atrial fibrillation (POAF) is the most common and vexing complication of cardiac surgeries in adults. The consequences of this dysrhythmia are numerous and include hemodynamic instability, increased risk for embolic stroke, increased length of hospital stay, increased cost of hospitalization, significant resource utilization, and decreased long-term survival. While some progress has been made in prevention of POAF, the multiple mechanisms involved in its genesis are yet to be elucidated.

Changing eating behavior: a preliminary study to consider broader measures of weight control treatment success.

This study evaluated changes in the self-reported eating behaviors (snacking, binge eating, portion sizes, and meal skipping) of 52 obese adults (33 women and 19 men) attending a residential weight loss facility on two consecutive occasions. For each of the eating patterns studied, subjects reported engaging in the behavior significantly less frequently at the time of their return visit. It is proposed that changes in eating behaviors provide a useful and appropriate nonweight based outcome measure for estimating treatment success in diet-seeking clients.

Effects of a topical anesthetic on non-socially maintained self-injurious behavior.

In the present study we hypothesized that the self-injurious behavior (SIB) of a 12-year-old male diagnosed as having autism and severe mental retardation was maintained by automatic reinforcement. Further, we hypothesized SIB served a sensory reinforcement function related to sensation at the skin surface. The participant engaged in high rates of SIB in the form of self-slapping.

Peptide insertion in the DNA-binding domain of fish glucocorticoid receptor is encoded by an additional exon and confers particular functional properties.

The trout glucocorticoid receptor (rtGR) contains an additional sequence of nine amino acids located between the two zinc fingers of the DNA-binding domain (DBD) (Endocrinology 136 (1995) 3774). Polymerase chain reaction on trout genomic DNA and sequencing were performed in the DBD region, demonstrating that this peptide is encoded by an additional exon of 27 nucleotides between the two exons encoding the two zinc fingers of other nuclear receptors. This additional sequence in the rtGR confers a better binding affinity of the receptor to a single GRE, as shown by gel shift experiments with GST-DBDrtGR fusion proteins, deleted or not of the nine amino acids (Delta9).

An analysis of physical guidance as reinforcement for noncompliance.

Physical guidance is a strategy commonly used for noncompliance. In two experiments, we evaluated reinforcing effects of physical guidance. Experiment 1 include three individuals with developmental disabilities who were noncompliant with tasks.

The gender specificity of emotional, situational, and behavioral indicators of binge eating in a diet-seeking obese population.

Objective: This study investigated the unique gender correlates of binge eating severity in a diet-seeking population.

Method: This sample consisted of 288 self-admitted patients enrolled in a residential weight loss program between 1996 and 1997. Subjects were administered several questionnaires including (a) the Binge Eating Scale, (b) the Beck Depression Inventory, (c) the Rosenberg Self-Esteem Scale, (d) 5-point scales of eating related foci, and (e) 7-point scales of subject confidence in controlling their eating under various circumstances.

"Pseudo" twin-to-twin transfusion syndrome and fetal outcome.

Objective: To assess the fetal outcome, in a tertiary center, in pregnancies with suspected twin-to-twin transfusion syndrome (TTTS) not confirmed using ultrasonographic examination, diagnosis of pathology, or both.

Study Design: Forty-four pregnancies with suspected TTTS were followed longitudinally using ultrasonographic examination until delivery. The minimal criteria for the diagnosis of TTTS were: (1) suspicion of monochorionicity gleaned from ultrasound examination (to be confirmed at birth); (2) presence of polyhydramnios in one gestational sac (either assessed subjectively--or, finding that the largest vertical pocket of amniotic fluid was >8 cm in diameter before 20 weeks' gestation and >10 cm in diameter thereafter); and (3) presence of oligohydramnios in the other gestational sac (finding either that there was a "stuck" twin complication or that the largest vertical pocket of amniotic fluid was <1 cm in diameter).

Management of postoperative atrial fibrillation.

Atrial fibrillation is a common complication of heart surgery. Consequences for the patient who develops this dysrhythmia are many. It prolongs hospitalization, may induce hemodynamic compromise, and carries the risks of thromboembolism and stroke.

Classroom-based functional and adjunctive assessments: proactive approaches to intervention selection for adolescents with attention deficit hyperactivity disorder.

The present investigation evaluated the utility of classroom-based functional and adjunctive assessments of problem behaviors for 2 adolescents who met diagnostic criteria for attention deficit hyperactivity disorder (ADHD) and comorbid oppositional defiant disorder (ODD). For children with ADHD-ODD, environmental classroom variables, when systematically manipulated by teachers, were related to the occurrence and nonoccurrence of problem behaviors. Classroom interventions derived from information that was obtained during functional and adjunctive assessments and from subsequent analyses resulted in substantial reductions in problem behaviors.