Electronic health record impact on work burden in small, unaffiliated, community-based primary care practices.

Background: The use of electronic health records (EHR) is widely recommended as a means to improve the quality, safety and efficiency of US healthcare. Relatively little is known, however, about how implementation and use of this technology affects the work of clinicians and support staff who provide primary health care in small, independent practices.

Objective: To study the impact of EHR use on clinician and staff work burden in small, community-based primary care practices.

Experimental analysis of the mechanism of chromatin remodeling by RNA polymerase II.

The vital process of transcription by RNA polymerase II (Pol II) occurs in chromatin environment in eukaryotic cells; in fact, moderately transcribed genes retain nucleosomal structure. Recent studies suggest that chromatin structure presents a strong barrier for transcribing Pol II in vitro, and that DNA-histone interactions are only partially and transiently disrupted during transcript elongation on moderately active genes. Furthermore, elongating Pol II complex is one of the major targets during gene regulation.

Moderate drinking? Alcohol consumption significantly decreases neurogenesis in the adult hippocampus.

Drinking alcohol in moderation is often considered a health-conscious behavior, associated with improved cardiovascular and brain health. However, "moderate" amounts of alcohol include drinking 3-4 alcohol beverages in a day, which is closer to binge drinking and may do more harm than good. Here we examined how daily drinking of moderate-high alcohol alters the production of new neurons in the adult hippocampus.

Quality improvement and cost savings after implementation of the Leapfrog intensive care unit physician staffing standard at a community teaching hospital.

Background: Prior studies have shown that implementation of the Leapfrog intensive care unit physician staffing standard of dedicated intensivists providing 24-hr intensive care unit coverage reduces length of stay and in-hospital mortality. A theoretical model of the cost-effectiveness of intensive care unit physician staffing patterns has also been published, but no study has examined the actual cost vs. cost savings of such a program.

Design and validation of a passive deposition sampler.

A new, passive particle deposition air sampler, called the Einstein-Lioy Deposition Sampler (ELDS), has been developed to fill a gap in passive sampling for near-field particle emissions. The sampler can be configured in several ways: with a protective hood for outdoor sampling, without a protective hood, and as a dust plate. In addition, there is an XRF-ready option that allows for direct sampling onto a filter-mounted XRF cartridge which can be used in conjunction with all configurations.

The polarity protein partitioning-defective 1 (PAR-1) regulates dendritic spine morphogenesis through phosphorylating postsynaptic density protein 95 (PSD-95).

The polarity protein PAR-1 plays an essential role in many cellular contexts, including embryogenesis, asymmetric cell division, directional migration, and epithelial morphogenesis. Despite its known importance in different cellular processes, the role of PAR-1 in neuronal morphogenesis is less well understood. In particular, its role in the morphogenesis of dendritic spines, which are sites of excitatory synaptic inputs, has been unclear.

Continuous enteral and parenteral feeding each reduces heart rate variability but differentially influences monocyte gene expression in humans.

Enteral (EN) or parenteral (PN) nutrition is used to support critically ill patients until oral feeding resumes. Enteral nutrition is assumed preferable to PN, but the differential influence on immune function is not well defined. Autonomic nervous activity is known to influence innate immune responses, and we hypothesized that EN and PN could influence both autonomic signaling and gene activation in peripheral blood monocytes (PBMs).

Red blood cell transfusion: a clinical practice guideline from the AABB*.

Description: Although approximately 85 million units of red blood cells (RBCs) are transfused annually worldwide, transfusion practices vary widely. The AABB (formerly, the American Association of Blood Banks) developed this guideline to provide clinical recommendations about hemoglobin concentration thresholds and other clinical variables that trigger RBC transfusions in hemodynamically stable adults and children.

Methods: These guidelines are based on a systematic review of randomized clinical trials evaluating transfusion thresholds.

Heme oxygenase-1 and chronic hypoxia.

A myriad of changes are necessary to adapt to chronic hypoxemia. Key among these changes increases in arterial oxygen carrying capacity, ventilation and sympathetic activity. This requires the induction of several gene products many of which are regulated by the activity of HIF-1α, including HO-1.

Zonisamide-induced psychosis in a patient with bipolar disorder and narcolepsy.

Zonisamide is an anticonvulsant used as an adjunctive treatment for partial seizures. It has also been used off-label for treatment of mania. Abdoh et al recently reported a very interesting case of psychosis induced by zonisamide.

Paternal age and risk for cesarean delivery.

Objective: To determine whether advanced paternal age is associated with increased risk for cesarean delivery.

Study Design: We used the 1990-2002 US linked live birth and infant death data files restricted to primiparous Caucasian and African-American women that delivered a singleton birth at ≥20 week's gestation (12.5 million).

Readjustment stressors and early mental health treatment seeking by returning National Guard soldiers with PTSD.

Objectives: Readjustment stressors are commonly encountered by veterans returning from combat operations and may help motivate treatment seeking for posttraumatic stress disorder (PTSD). The study examined rates of readjustment stressors (marital, family, and employment) and their relationship to early mental health treatment seeking among returning National Guard soldiers with PTSD.

Methods: Participants were 157 soldiers who were surveyed approximately three months after returning from combat operations in Iraq and scored positive on the PTSD Checklist (PCL).

ACL reconstruction using a novel hybrid scaffold composed of polyarylate fibers and collagen fibers.

The objective was to perform an initial in vivo evaluation of a novel braided hybrid polyarylate and collagen fiber scaffold for the reconstruction of the anterior cruciate ligament (ACL). The braided hybrid scaffold is composed of 75% poly(desaminotyrosyl-tyrosine dodecyl dodecanedioate)(12,10), [p(DTD DD)] fibers and 25% type I bovine collagen fibers. The scaffold is designed to temporarily bear mechanical loads and gradually degrade as neoligament tissue is deposited.

In vitro explant culture and related protocols for the study of mouse retinal development.

The mouse retina is composed of many cell types and subtypes with distinct morphology and function; how these cells are differentiated from the multipotent progenitors is still largely unknown. Retinal in vitro explant culture has proven to be a useful tool to study the molecular and cellular mechanisms underlying retinal development. Here, we provide detailed descriptions about how to prepare retroviruses, dissect retinal cups, perform in vitro explant culture, and collect explant samples.

Beliefs and attitudes about lung cancer screening among smokers.

The National Lung Screening Trial (NLST) recently reported that annual computed tomography (CT) screening is associated with decreased lung cancer mortality in high-risk smokers. Beliefs about lung cancer and screening, particularly across race and ethnicity, and their influence on CT screening utilization are largely unexamined. Our study recruited asymptomatic, high-risk smokers, 55-74 years of age from primary care clinics in an academic urban hospital.

Association between pioglitazone and urothelial bladder cancer.

The U.S. Food and Drug Administration and the European Medicines Agency have recently informed the public of a potential impact of pioglitazone (Actos) use on bladder cancer incidence.

Iatrogenic pulmonary artery rupture during Swan-Ganz catheter placement--a novel therapeutic approach.

Pulmonary artery rupture (PAR) is a rare but deadly complication (incidence of 0.03-0.2% of all PA cannulations), with mortality in the region of 70%.

Afrocentric cultural values and beliefs: movement beyond the race and ethnicity proxy to understand views of diabetes.

Purpose: The purpose of this study was to estimate the benefit of using a cultural characteristics scale to help diabetes educators understand how African Americans cope with diabetes. Illness representations are influenced by culture. Race and ethnicity as a proxy for culture provides an incomplete understanding of the mechanism by which cultural values influence representations of diabetes.

A key role for Mg(2+) in TRPM7's control of ROS levels during cell stress.

The TRPM7 (transient receptor potential melastatin 7) channel has been shown to play a pivotal role in cell survival during brain ischaemia as well as in the survival of other cell types challenged with apoptotic stimuli. Ca(2+) is thought to be central to the channel's ability to regulate ROS (reactive oxygen species) production. However, channel-mediated entry of Mg(2+) and Zn(2+) have also been implicated in cell death.

Typical electronic health record use in primary care practices and the quality of diabetes care.

Purpose: Recent efforts to encourage meaningful use of electronic health records (EHRs) assume that widespread adoption will improve the quality of ambulatory care, especially for complex clinical conditions such as diabetes. Cross-sectional studies of typical uses of commercially available ambulatory EHRs provide conflicting evidence for an association between EHR use and improved care, and effects of longer-term EHR use in community-based primary care settings on the quality of care are not well understood.

Methods: We analyzed data from 16 EHR-using and 26 non-EHR-using practices in 2 northeastern states participating in a group-randomized quality improvement trial.

Targeting mTOR as a novel therapeutic strategy for traumatic CNS injuries.

The adult central nervous system (CNS) has a remarkable ability to repair itself. However, severe brain and spinal cord injuries (SCIs) cause lasting disability and there are only a few therapies that can prevent or restore function in such cases. In this review, we provide an overview of traumatic CNS injuries and discuss several emerging pharmacological options that have shown promise in preclinical and early clinical studies.

Clostridium difficile MazF toxin exhibits selective, not global, mRNA cleavage.

Clostridium difficile is an important, emerging nosocomial pathogen. The transition from harmless colonization to disease is typically preceded by antimicrobial therapy, which alters the balance of the intestinal flora, enabling C. difficile to proliferate in the colon.

Surgery for pelvic organ prolapse: a historical perspective.

Surgical treatment of pelvic organ prolapse has evolved from the use of pomegranates as pessary devices to contemporary robot-assisted laparoscopic sacral colpopexy. Symptomatic pelvic organ prolapse requires correction of all the defects to achieve optimal outcomes. Factors to consider in selecting the appropriate repair include patient's age; stage of prolapse; vaginal length; hormonal status; desire for uterine preservation and coitus; symptoms of sexual, urinary, or bowel dysfunction; and any comorbidities that influence her eligibility for anesthesia or chronically increase intra-abdominal pressure.