A Survey Of Americans With High-Deductible Health Plans Identifies Opportunities To Enhance Consumer Behaviors.

Most high-deductible health plan (HDHP) enrollees do not engage in consumer behaviors such as price shopping. Why not? We surveyed 1,637 Americans in HDHPs-which can be linked to health savings accounts (HSAs) but usually are not-about factors that may predict, facilitate, or impede HDHP enrollees' engagement in consumer behaviors. We found that having an HSA was associated with saving for future care, high financial literacy was associated with comparing prices and quality, and high confidence in talking with providers about costs and trying to negotiate prices was associated with engaging in these behaviors.

VHA Practice Guideline Recommendations for Diffuse Gliomas.

Although histology still plays a critical role in diagnosing diffuse gliomas, additional ancillary testing is an essential tool for VA pathology laboratories.

Similarities and differences between the interictal epileptiform discharges of green-spikes and red-spikes zones of human neocortex.

Objective: This study looks for differences in the waveforms of interictal epileptiform discharges (IEDs) between cortices expressing only isolated discharges (green-spikes zones) vs those manifesting seizures (red-spikes zones): these can help to understand ictogenesis mechanisms and improve clinical decision in surgical epilepsy. Typical IEDs are triphasic, exhibiting in sequence: a negative-sharp-wave, a positive-baseline-shift and a negative-slow-wave. Negative-slow-waves are thought to reflect neurophysiological inhibition: their features at a focus' edge may reflect peripheral inhibition, a mechanism characterized in experimental models, curbing seizures' spread.

Phenotypic expansion in - a common cause of intellectual disability in females.

De variants in account for 1-3% of unexplained intellectual disability (ID) cases and are amongst the most common causes of ID especially in females. Forty-seven patients (44 females, 3 males) have been described. We identified 31 additional individuals carrying 29 unique variants, including 30 postnatal individuals with complex clinical presentations of developmental delay or ID, and one fetus with abnormal ultrasound findings.

Platelet-derived TLT-1 is a prognostic indicator in ALI/ARDS and prevents tissue damage in the lungs in a mouse model.

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) affect >200 000 individuals yearly with a 40% mortality rate. Although platelets are implicated in the progression of ALI/ARDS, their exact role remains undefined. Triggering receptor expressed in myeloid cells (TREM)-like transcript 1 (TLT-1) is found on platelets, binds fibrinogen, and mediates clot formation.

A comparison of anticonvulsant efficacy and action mechanism of Mannitol vs Phenytoin in adult rat neocortical slices.

We show that, in adult rat neocortical slices, an anticonvulsant effect comparable to that of Phenytoin can be obtained through a Mannitol-induced increase in extracellular osmolarity of only 30 mOsm/L. The anticonvulsant action of extracellular hyperosmolarity has been known for decades but has not found a feasible therapeutic application, yet. A 30 mOsm/L increase in extracellular osmolarity is already utilized in neurocritical care though not as an anticonvulsant agent: the data suggest a possible effective anticonvulsant use, too, in this setting.

A Preliminary High-Definition Fiber Tracking Study of the Executive Control Network in Blast-Induced Traumatic Brain Injury.

Blast-induced traumatic brain injury (bTBI) is common in veterans of the Iraq- and Afghanistan-era conflicts. However, the typical subtlety of neural alterations and absence of definitive biomarkers impede clinical detection on conventional imaging. This preliminary study examined the structure and functional correlates of executive control network (ECN) white matter in veterans to investigate the clinical utility of using high-definition fiber tracking (HDFT) to detect chronic bTBI.

Attenuated nitric oxide bioavailability in systemic sclerosis: Evidence from the novel assessment of passive leg movement.

New Findings: What is the central question of this study? Do systemic sclerosis patients exhibit impaired nitric oxide-mediated vascular function of the lower limb and are these decrements correlated with plasma biomarkers for inflammation and oxidative stress? What is the main finding and its importance? Findings indicate impaired nitric oxide-mediated vascular function, linked to the incidence of digital ulcers and a milieu of inflammation and oxidative stress. However, the absence of significant correlations between individual biomarkers and blood flow responses suggests that the vasculopathy observed in systemic sclerosis may not be solely the result of derangements in the redox balance or inflammatory signalling.

Abstract: Systemic sclerosis (SSc) is an autoimmune disease characterized by vasculopathy, which may be the consequence of inflammation and oxidative stress that ultimately leads to a reduced nitric oxide (NO) bioavailability.

Vitamin D levels are associated with epistaxis severity and bleeding duration in hereditary hemorrhagic telangiectasia.

Aim: To explore the association between vitamin D levels and mild versus severe epistaxis, as well as the overall epistaxis severity score (ESS) in patients with hereditary hemorrhagic telangiectasia.

Patients & Methods: A retrospective chart review of 198 patients was performed to explore the relationship between vitamin D levels and the ESS. Vitamin D levels were also compared with those with mild epistaxis to those with severe epistaxis.

Epistaxis in children and adolescents with hereditary hemorrhagic telangiectasia.

Objectives/hypothesis: Our objective was to describe epistaxis onset and severity in pediatric hereditary hemorrhagic telangiectasia (HHT) patients and study the cumulative incidence of epistaxis by age of onset within each genetic subtype.

Study Design: Retrospective cohort chart review.

Methods: Charts were reviewed of patients age 0 to 18 years with a clinical or genetic diagnosis of HHT who were evaluated at a tertiary multidisciplinary HHT clinic from January 2010 to June 2016.

Risk of Pancreatitis Following Treatment of Irritable Bowel Syndrome With Eluxadoline.

Background & Aims: The Food and Drug Administration approved eluxadoline for the treatment of diarrhea-predominant irritable bowel syndrome despite cases of pancreatitis in early stage trials. We investigated the frequency of pancreatitis attributed to eluxadoline in postmarketing surveillance.

Methods: We extracted reports on eluxadoline submitted to the Federal Adverse Event Reporting System from January through September 2016.

A comparison of electronic and manual fracture risk assessment tools in screening elderly male US veterans at risk for osteoporosis.

Unlabelled: This study compares four screening tools in their ability to predict osteoporosis. We found that there was no significant difference between the tools. These results provide support for the use of automated screening tools which work in conjunction with the electronic medical record and help improve screening rates for osteoporosis.

From Harmful Treatment to Secondary Gain: Adverse Event Reporting in Dyspepsia and Gastroparesis.

Introduction: Medical management of gastroparesis and functional dyspepsia remains difficult with several recent trials showing limited or no benefit. If treatment comes with only marginal improvements, concerns about adverse events become more relevant. We therefore examined the type and outcomes of side effects submitted to a public repository.

Multi-complexity measures of heart rate variability and the effect of vasopressor titration: a prospective cohort study of patients with septic shock.

Background: Septic shock is a common and often devastating syndrome marked by severe cardiovascular dysfunction commonly managed with vasopressors. Whether markers of heart rate complexity before vasopressor up-titration could be used to predict success of the up-titration is not known.

Methods: We studied patients with septic shock requiring vasopressor, newly admitted to the intensive care unit.

Checking the lists: A systematic review of electronic checklist use in health care.

Objective: We conducted a literature search to examine the effects and experiences surrounding the transition from paper to electronic checklists in healthcare settings. We explore the types of electronic checklists being used in health care, how and where they were evaluated and seek to identify the successes and failures of using electronic checklists in healthcare, including use of checklists to ensure completeness of documentation in the electronic medical record.

Background: Formalized checklist use as a memory and decision aid in aviation has resulted in significant increases in safety in that domain.

Increased inflammation and disease activity among current cigarette smokers with rheumatoid arthritis: a cross-sectional analysis of US veterans.

Objectives: Cigarette smoking is a major risk factor for RA and has been associated with increased disease severity and lower rates of disease remission. We hypothesized that inflammation and disease activity would be associated with smoking status and this would be related to levels of ACPA.

Methods: RA patients from the Veterans Affairs RA registry were studied (n = 1466): 76.

Has Interprofessional Education Changed Learning Preferences? A National Perspective.

Objective: To assess how changes in curriculum, accreditation standards, and certification and licensure competencies impacted how medical students and physician residents value interprofessional team and patient-centered care.

Primary Data Source: The Department of Veterans Affairs Learners' Perceptions Survey (2003-2013). The nationally administered survey asked a representative sample of 56,569 U.

Neocortical slices from adult chronic epileptic rats exhibit discharges of higher voltages and broader spread.

Much of the current understanding of epilepsy mechanisms has been built on data recorded with one or a few electrodes from temporal lobe slices of normal young animals stimulated with convulsants. Mechanisms of adult, extratemporal, neocortical chronic epilepsy have not been characterized as much. A more advanced understanding of epilepsy mechanisms can be obtained by recording epileptiform discharges simultaneously from multiple points of an epileptic focus so as to define their sites of initiation and pathways of spreading.

Sensing of latent EBV infection through exosomal transfer of 5'pppRNA.

Complex interactions between DNA herpesviruses and host factors determine the establishment of a life-long asymptomatic latent infection. The lymphotropic Epstein-Barr virus (EBV) seems to avoid recognition by innate sensors despite massive transcription of immunostimulatory small RNAs (EBV-EBERs). Here we demonstrate that in latently infected B cells, EBER1 transcripts interact with the lupus antigen (La) ribonucleoprotein, avoiding cytoplasmic RNA sensors.

Ceramide-Initiated Protein Phosphatase 2A Activation Contributes to Arterial Dysfunction In Vivo.

Prior studies have implicated accumulation of ceramide in blood vessels as a basis for vascular dysfunction in diet-induced obesity via a mechanism involving type 2 protein phosphatase (PP2A) dephosphorylation of endothelial nitric oxide synthase (eNOS). The current study sought to elucidate the mechanisms linking ceramide accumulation with PP2A activation and determine whether pharmacological inhibition of PP2A in vivo normalizes obesity-associated vascular dysfunction and limits the severity of hypertension. We show in endothelial cells that ceramide associates with the inhibitor 2 of PP2A (I2PP2A) in the cytosol, which disrupts the association of I2PP2A with PP2A leading to its translocation to the plasma membrane.

CYP17A1 and CYP2E1 variants associated with high altitude polycythemia in Tibetans at the Qinghai-Tibetan Plateau.

Tibetans adapt to high altitude environments through low blood hemoglobin concentrations. Previous work has identified that CYP17A1 and CYP2E1 genes exhibit evidence of local positive selection for this Tibetan high-altitude adaptation. Nevertheless, despite this apparent genetic advantage, some Tibetans still develop high altitude polycythemia (HAPC) yet the reasons for this remain unknown.

Coalescence of deep and superficial epileptic foci into larger discharge units in adult rat neocortex.

Epilepsy is a disease of neuronal hyper-synchrony that can involve both neocortical and hippocampal brain regions. While much is known about the network properties of the hippocampus little is known of how epileptic neocortical hyper-synchrony develops. We aimed at characterizing the properties of epileptic discharges of a neocortical epileptic focus.

Mortality in American Veterans with the HLA-B27 gene.

Objective: To compare survival in American veterans with and without the HLA-B27 (B27) gene.

Methods: Mortality was evaluated in a national cohort of veterans with clinically available B27 test results between October 1, 1999, and December 31, 2011. The primary outcome was the mortality difference between B27-positive and B27-negative veterans, adjusted for age, sex, race, and diagnoses codes for diseases that may have influenced both B27 testing and mortality, including psoriasis, inflammatory bowel disease, spondyloarthritis (SpA), and other types of inflammatory arthritis.

Teaching Motivational Interviewing Skills to Psychiatry Trainees: Findings of a National Survey.

Objective: The authors report on the current status of motivational interviewing education and training director attitudes about providing it to psychiatry residents.

Methods: Training directors of general, child/adolescent and addiction psychiatry training programs were invited to participate in an anonymous online survey.

Results: Of the 333 training directors who were invited to participate, 66 of 168 (39.

Clinician versus Veteran ratings on the Mayo-Portland Participation Index in veterans with a history of mild traumatic brain injury.

Background: The Department of Veterans Affairs is encouraging administration of the Mayo-Portland Adaptability Inventory-4 Participation Index (M2PI) to identify long-term psychosocial outcomes of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans with a history of traumatic brain injury (TBI).

Objective: To evaluate clinician and Veteran interrater reliability and how response validity influences M2PI item ratings.

Participants: A total of 122 OEF/OIF/OND Veterans who reported a history consistent with mild TBI during deployment and were referred for neuropsychological evaluation following Comprehensive TBI Evaluation.