Redefining Mild Traumatic Brain Injury (mTBI) delineates cost effective triage.

OBJECTIVES: Mild traumatic brain injury (mTBI) is defined as Glasgow Coma Score (GCS) of 14 or 15. Despite good outcomes, patients are commonly transferred to trauma centers for observation and/or neurosurgical consultation. The aim of this study is to assess the value of redefining mTBI with novel radiographic criteria to determine the appropriateness of interhospital transfer for neurosurgical evaluation. METHODS: A retrospective study of patients with blunt head injury with GCS 13-15 and CT head from Jan 2014-Dec 2016 was performed. A novel criteria of head CT findings was created at our institution to classify mTBI. Outcomes included neurosurgical intervention and transfer cost. RESULTS: A total of 2120 patients were identified with 1442 (68.0%) meeting CT criteria for mTBI and 678 (32.0%) classified high risk. Two (0.14%) patients with mTBI required neurosurgical intervention compared with 143 (21.28%) high risk TBI (p < 0.0001). Mean age (55.8 years), and anticoagulation (2.6% vs 2.8%) or antiplatelet use (2.1% vs 3.0%) was similar between groups (p > 0.05). Of patients with mTBI, 689 were transferred without receiving neurosurgical intervention. Given an average EMS transfer cost of $700 for ground and $5800 for air, we estimate an unnecessary transfer cost of $733,600. CONCLUSION: Defining mTBI with the described novel criteria clearly identifies patients who can be safely managed without transfer for neurosurgical consultation. These unnecessary transfers represent a substantial financial and resource burden to the trauma system and inconvenience to patients.

HFD-induced energy states-dependent bidirectional control of anxiety levels in mice.

BACKGROUND: The association between the development of obesity and its metabolic comorbidities, and chronic consumption of high-fat diet (HFD) has been well-demonstrated. Interestingly, emerging evidence indicates that obesity is also associated with an increased risk for psychiatric disorders including anxiety and depression. Although HFD feeding is associated with anxiety-related behaviors, previous studies have reported inconsistent findings on the direction of this relationship. Therefore, in this study we sought to investigate the link between HFD feeding, body weight, energy states and anxiety levels in mice and specifically to determine if the duration of HFD exposure has distinct effects on anxiety-related behaviors. METHODS: To disentangle the temporal dynamic effects of HFD feeding on anxiety-related behaviors, mice were fed a HFD or regular chow (RC) diet and were assayed periodically for anxiety-related behaviors by using behavioral tests (open field test; OFT) and the elevated plus maze. To determine if obesity phenotypes correlate with anxiety-related behaviors, changes in anxiety-related behaviors in OFTs were correlated with changes in both body weight and glucose sensitivity following various levels of HFD and RC exposure. RESULTS: Our results demonstrate a time-dependent biphasic effect of HFD feeding on anxiety-related behaviors. At 5 weeks, mice fed HFD show a reduction in anxiety-related behaviors when compared to pair-fed RC mice. At 8 weeks of HFD or RC feeding, anxiety levels were the same in both groups. Following 15 weeks of HFD and RC feeding, however, mice displaying metabolic symptoms of obesity showed increased anxiety-related behaviors relative to mice resilient to obesity phenotypes, independent of feeding conditions. CONCLUSIONS: Taken together our findings suggest that HFD bi-directionally effects anxiety-related behaviors such that short-term exposure to a HFD reduces anxiety levels, while longer exposure to a HFD promotes anxiety levels selectively in mice that display metabolic symptoms of obesity. Regardless of diet (HFD or RC), heavier animals display increased anxiety-like behaviors. These findings indicate diverse overlapping roles for HFD and body weight in modulating anxiety-related behaviors, and may partly resolve previous inconsistencies in studies examining the relationship between HFD feeding and anxiety.

A call for early, effective, and scalable parent education programs for high-conflict separated/divorcing parents: A synthesized perspective from prevention science and family law.

Conflict between parents is stressful and disruptive to children living in the midst of parental separation or divorce. Although some level of post-separation/divorce conflict is understandable in an emotionally-charged separation/divorce, it undermines the extent to which parents protect their children from short- and long-term problems. In this article, we weave together a synthesized perspective informed by our respective training and experience in prevention science and family law on the role of parent education programs for high-conflict separating/divorcing parents. To do so, we first describe the research on the effects of high interparental conflict on children's outcomes and then discuss current approaches and challenges to reducing these negative effects by offering parent education programs for high-conflict separating/divorcing parents. Then, we propose and describe a new model for early, effective, and scalable parent education programs with the ultimate goal of protecting children after separation/divorce.

Experiences of intimate-partner violence and contraception use among ever-married women in Jordan.

This study explored the relationship between intimate partner violence (IPV) and current contraception use among ever-married women in Jordan. Analysing a sample (n = 3434) from the 2007 Jordan demographic and health survey, women who reported ever experiencing severe physical violence from their husband were significantly less likely to use contraception than women who did not report severe physical violence (OR = 0.34). Conversely, women who reported ever experiencing sexual IPV were significantly more likely to use contraception (OR = 1.50). Emotional and less severe physical IPV were not significantly related to contraception use. Education, wealth, age, number of children, and fertility preferences were positively associated with contraception use, while residence in the Badia area and consanguineous marriages were negatively associated with contraception use. The findings have implications for the provision of IPV screening and contraception services in Jordan, as well as the specification of services for women most vulnerable to IPV.

Enhancing the Focus: How Does Parental Incarceration Fit into the Overall Picture of Adverse Childhood Experiences (ACEs) and Positive Childhood Experiences (PCEs)?

Despite the five million children in the U.S. with an incarcerated parent, there is limited research on risk and protective factors for this population. We analyzed data from the National Survey for Children's Health (2018) to: (1) examine associations among parental incarceration and other adverse childhood experiences (ACEs), (2) characterize the association between parental incarceration and youth mental health outcomes, (3) examine differences in positive childhood experiences (PCEs; collective socialization, community engagement, neighborhood amenities, and family problem solving) by parental incarceration status, (4) examine whether PCEs were protective against mental health problems and if there was an interaction with parental incarceration status, and (5) examine the interaction between PCEs, parental incarceration, and ACEs on mental health problems. Results revealed that children with incarcerated parents had higher odds of experiencing other ACEs, higher odds of having mental health problems, and experienced fewer PCEs compared to children without incarcerated parents. Further, although PCEs were associated with a lower odds of mental health problems for both children with and without incarcerated parents, they did not mitigate the negative impact of parental incarceration on mental health outcomes. While PCEs attenuated the association between ACEs and mental health, parental incarceration status did not significantly moderate the interaction. These results highlight vulnerabilities and potential protective factors for children with incarcerated parents and have important implications for the development of multilevel intervention strategies that seek to promote resilience and reduce risk for this population.

Realization of a resonant Fermi gas with a large effective range.

We have measured the interaction energy and three-body recombination rate for a two-component Fermi gas near a narrow Feshbach resonance and found both to be strongly energy dependent. Even for de Broglie wavelengths greatly exceeding the van der Waals length scale, the behavior of the interaction energy as a function of temperature cannot be described by atoms interacting via a contact potential. Rather, energy-dependent corrections beyond the scattering length approximation are required, indicating a resonance with an anomalously large effective range. For fields where the molecular state is above threshold, the rate of three-body recombination is enhanced by a sharp, two-body resonance arising from the closed-channel molecular state which can be magnetically tuned through the continuum. This narrow resonance can be used to study strongly correlated Fermi gases that simultaneously have a sizable effective range and a large scattering length.

Nucleotide sequence of the chromosomal gene coding for the aminoglycoside 6-adenylyltransferase from Bacillus subtilis Marburg 168.

Gene aadK of Bacillus subtilis is 855 bp long and codes for aminoglycoside 6-adenylyltransferase.

Volume increase in growth plate chondrocytes during hypertrophy: the contribution of organic osmolytes.

During the differentiation cascade of growth plate chondrocytes, cells undergo as much as a 10-15-fold increase in volume. This volume increase, which occurs to different extents in growth plates growing at different rates, has been demonstrated to be the single most significant variable in understanding the quantitative aspects of the cellular kinetics of long bone growth. Our hypothesis is that this volume increase, which occurs through cell swelling by water imbibition, requires intracellular accumulation of osmolytes through activation or upregulation of membrane transport mechanisms. Significant intracellular accumulation of inorganic osmolytes, such as Na+, K+, and Cl-, is potentially disruptive to normal cellular metabolism, whereas intracellular accumulation of organic osmolytes is considered to be more compatible with metabolic function. Thus, we concentrated on determining the contributions of organic osmolytes--betaine, amino acids, inositol, and sorbitol--to volume increase. Pooled cryostat sections of young bovine growth plates were extracted followed by automated analysis for their content of amino acids. Analysis for betaine and the sugar alcohols was done by extraction and derivatization, followed by high-performance liquid chromatography (HPLC). Parallel stereological analyses correlated osmolyte changes to stages of chondrocytic differentiation, specifically comparing intracellular concentration and amount in proliferative vs. hypertrophic chondrocytes. Calculations demonstrated that, maximally, these organic osmolytes, in total, account for 6%-7% of the intracellular osmolytes required to sustain the volume increase, and that the most significant contribution is from betaine. This suggests that intracellular accumulation of organic osmolytes is not a primary strategy used by growth plate chondrocytes during volume increase of their terminal differentiation. The data also suggest that there is a differential regulation of transporters of these osmolytes such that intracellular concentrations are constantly modified as cells proceed through the differentiation cascade.

Application of nanoscale packed capillary liquid chromatography (75 µm id) and capillary zone electrophoresis/electrospray ionization mass spectrometry to the analysis of macrolide antibiotics.

Nanoscale separation techniques, nanoscale packed capillary columns (75 µm id), and capillary zone electrophoresis (CZE), on-line with electrospray mass spectrometry (ESI/MS), were applied to the separation of a series of ten macrolide antibiotics. Both techniques use sub-microliter-per-minute flow rates through the analytical column and therefore require an electrospray probe that incorporates coaxial sheath flow. Positive ion electrospray mass spectra of these compounds yielded mainly protonated molecules. Fragmentation to yield structurally significant fragment ions was achieved by collision-induced dissociation (CID) at increased skimmer voltages. Separations were achieved using both techniques, with CZE/ESI/MS showing improved peak shapes and detection limits combined with faster analysis times. Nanoscale packed capillary columns provided better chromatographic resolution and was less susceptible to peak broadening caused by overloading of the analytes.

Ovarian hilus cell heterotopia.

A systematic pathologic study was done of the paratubal and parametrial tissues, submitted along with distal tubal segments excised for sterilization and with uteri (with or without attached adnexa) removed for common gynecologic conditions. Heterotopic ovarian hilus cell rests were noted in 12 cases, giving an overall incidence of 0.52% (12/2299). These cell rests, confined exclusively to the endosalpinx and perisalpinx, were easily differentiated from pregnancy-related decidual nodules, Walthard rests, foci of paratubal endometriosis, and ectopic adrenal rests.

Two different types of fosfomycin resistance in clinical isolates of Klebsiella pneumoniae.

The fosfomycin susceptibility of 100 clinical isolates of Klebsiella pneumoniae and the resistance mechanisms utilized by resistant strains were examined. Washed cells prepared from the strains demonstrating MICs of more than 8 micrograms ml-1 of fosfomycin inactivated the drug. A crude extract from strain Tf129B, highly resistant to fosfomycin, was used to study the enzymatic properties of the drug-inactivating enzyme. The optimum pH for inactivation was 7.8 and the optimum temperature of the reaction was 37 degrees C. Glutathione was shown to be effective as a cofactor in the inactivation. It was suggested that the inactivating enzyme of Klebsiella pneumoniae was fosfomycin: glutathione-S-transferase, a constitutive enzyme located in the periplasmic space. A good correlation was found between the specific activities of this enzyme and the MIC levels; however, certain strains showed a low level of fosfomycin:glutathione-S-transferase activity which could not account for the increased MIC. Strains Tf129B and Tf408E, both demonstrating MICs of more than 1024 micrograms ml-1 of fosfomycin carried a transferable resistance plasmid. In strain Tf129B, the mechanism of fosfomycin resistance was due to a high level of enzymic activity. In strain Tf408E, it was determined to be mainly due to the reduced permeability of the cell membrane.

Purification and characterization of macrolide 2'-phosphotransferase type II from a strain of Escherichia coli highly resistant to macrolide antibiotics.

The resistance mechanism of Escherichia coli BM2506 to macrolides was found to be due to inactivation. Inactivated oleandomycin was identified as oleandomycin 2'-phosphate by thin-layer chromatography. A new type of macrolide-phosphorylating enzyme, macrolide 2'-phosphotransferase type II (MPH(2')II), was detected, purified 95-fold and its enzymological properties investigated. MPH(2')II was a constitutive intracellular enzyme which showed high levels of activity with both 14-member-ring and 16-member-ring macrolides. The optimum pH for the inactivation of oleandomycin was 8.2 and the optimum temperature of the reaction was 40 degrees C. Enzyme activity was lost by heat treatment at 60 degrees C for 1 min. The isoelectric point and M(r) of the enzyme were 5.3 and 48,000, respectively. Purine nucleotides, such as ITP, GTP and ATP, were effective as cofactors in the inactivation of macrolides. An inhibitory effect of iodine, EDTA, or divalent cations on MPH(2')II activity was observed.

Cloning and nucleotide sequence of the mphB gene for macrolide 2'-phosphotransferase II in Escherichia coli.

Macrolide 2'-phosphotransferase II [MPH(2')II] inactivates macrolide antibiotics. The mphB gene for MPH(2')II was cloned from Escherichia coli and sequenced. Analysis of the nucleotide sequence indicated that mphB encoded a protein of 302 amino acids with a molecular mass of 34483 Da. The carboxy terminal region of the deduced protein contained a sequence that resembled a conserved functional domain in aminoglycoside phosphotransferases.

Identification of Escherichia coli clinical isolates producing macrolide 2'-phosphotransferase by a highly sensitive detection method.

Macrolide is inactivated with ATP plus crude extract of Escherichia coli producing macrolide 2'-phosphotransferase (MPH(2')), but not by living cells. Therefore, a convenient method for detection of MPH(2') using intact cells is needed. In this report, we determine that the modified lysozyme-DNase-RNase (LDR) method (named ELDR method) is at least one hundred times more sensitive for the detection of MPH(2') activity than the LDR method and, in addition, highly sensitive for the detection of aminoglycoside-modifying enzymes. Therefore, three new MPH(2')-producing strains were found in clinically isolated E. coli in Japan in 1997 by this method. It suggests that MPH(2')-producing E. coli have been spread in Japanese clinical fields.

Novel metallo beta-lactamase mediated by a Shigella flexneri plasmid.

Novel carbapenem-hydrolyzing beta-lactamase (newly named MET-1) encoded on a transferable plasmid pMS390 from Shigella flexneri JS19622 was purified. The molecular weight was 28,000 by SDS-PAGE and the isoelectric point was higher than 9.3. This beta-lactamase favorably hydrolyzed classical cephalosporins and oxyimino-cephalosporins rather than penicillins and carbapenems, but did not hydrolyze monobactams. The enzymatic activity was inhibited by EDTA, and the enzyme was found to contain two moles of zinc per mole of enzyme protein by means of atomic absorption spectrophotometry. These results indicated that the enzyme is a zinc beta-lactamase which differs from known metallo beta-lactamases, especially in its cephalosporinase-type substrate profile.

Hypernephroma with perirenal hemorrhage.

Two cases of hypernephroma with rupture of the renal capsule and localized perirenal hemorrhage are reported. This unusual complication of hypernephroma exhibited a subacute clinical presentation with pain as the major presenting symptom.

Methamphetamine-induced striatal dopamine release, behavior changes and neurotoxicity in BALB/c mice.

The behaviors associated with the neurotoxic effects of methamphetamine were evaluated in BALB/c mice. Hyperthermia and behavioral observations were measured 60 min after each subcutaneous injection of methamphetamine (4x4 or 8 mg/kg) or saline, each given 2 h apart. The behavioral observations included stereotyped behaviors, incidence of hemorrhage in breast, salivation and self-injurious behavior (SIB). Repeated administration of methamphetamine produced these behavioral changes and hyperthermia, but resulted in hypothermia by the final injection (8 mg/kg). In addition, the methamphetamine treatment induced a long-lasting dopamine depletion of similar magnitude in the 4 and 8 mg/kg-treated animals. In a time course study striatal monoamine levels were measured 60 min after each injection of these doses. The first and second injections of methamphetamine (8 mg/kg) produced a drastic increase in striatal 3-methoxytyramine; this failed to occur after the third or fourth injection of the same dose. In contrast, 4 mg/kg of methamphetamine also produced an increase in 3-methoxytyramine after the second and third injections of the drug and, in this case, these were maintained for the duration of the treatment. Striatal 3, 4-dihydroxyphenylacetic acid levels also drastically decreased following both doses of methamphetamine, suggesting inhibition of monoamine oxidase in striatum. Moreover, a single injection of methamphetamine increased striatal 2,3-dihydroxybenzoic acid formation. These results suggest that the incidence of hyperthermia, SIB and striatal dopamine neurotoxicity are closely linked to striatal dopamine release and inhibition of monoamine oxidase produced by methamphetamine in BALB/c mice.

Failed tubal sterilization as an etiologic factor in ectopic tubal pregnancy.

An indirect statistical method was used to demonstrate that failed tubal sterilization must be considered as a significant etiologic factor in tubal ectopic pregnancy. Since the exact incidence of poststerilization pregnancies was unknown in our population, a "theoretical" incidence of a 0.71% failure rate was used as the most realistic estimate on the basis of published reports of failed tubal sterilizations. From this figure the "expected" number of poststerilization conceptions, both total and tubal, was computed. The observed incidence of poststerilization ectopic tubal pregnancy was found to be 20 times the "expected" incidence in our population.