Intervention during wait time: identification and referral of individuals non-adherent for colorectal cancer screening.

Background: Despite unanimous recommendations from numerous specialty societies on regular colorectal cancer screening, a substantial proportion of eligible adults are non-adherent with screening. The current study investigated whether research associates (RAs) in the emergency department (ED) can adequately assess patients' adherence with colorectal cancer screening recommendations, outlined by the US Preventive Services Task Force (USPSTF), and provide referrals to individuals who are found to be non-adherent. Methods: RAs at seven heterogeneous hospitals in the USA queried non-emergent adult patients and visitors between the ages of 50 and 75. After obtaining verbal consent, the participant's adherence with USPSTF guidelines for colorectal cancer screening was assessed. Participants found due for screening were provided with referrals to obtain these recommended screenings. Results: A total of 8258 participants were surveyed on their colorectal cancer screening status, with RAs identifying 2063 participants who were not adherent with USPSTF guidelines for colorectal cancer screening and 67 for whom adherence could not be determined (total 27%). Conclusions: Our study demonstrates that RAs can identify a large volume of eligible adults who would benefit from colorectal cancer screening across a variety of emergency department settings.

Identifying Cancer Screening Adherence in the Emergency Department Utilizing Research Associates.

BACKGROUND: Despite the demonstrated benefits of regular screening, a large proportion of the adult female population are out of compliance with recommendations from specialty societies regarding breast and cervical cancer. OBJECTIVE: The current study investigated whether research associates (RAs) in the emergency department (ED) can usefully assess patients' recent compliance with breast and cervical cancer screening (BCCS) recommendations and provide information regarding how patients may access any recommended screening when it is overdue. METHODS: RAs at 5 heterogeneous hospitals in the United States approached willing nonemergent female patients and visitors between the ages of 21 and 74 years. After obtaining verbal consent, the participant's compliance with U.S. Preventive Service Task Force recommendations for BCCS was assessed. Participants found overdue for screening were provided information on how to obtain these recommended screenings. RESULTS: A total of 5419 participants were between 50 and 74 years old and would be recommended to have breast cancer screening, and 11,667 participants were between 21 and 65 years old and would be recommended to have cervical cancer screening. Among women of age for either of these screenings, 3169 reported that they did not have a women's primary health care provider (i.e., doctor, nurse practitioner, or physician assistant who manages women's primary health care issues). A total of 786 women (15% of women 50-74 years old) were found to be out of compliance with breast cancer screening guidelines and 1208 women (12% of women 21 to 65 years with intact uteruses) were found to be out of compliance with cervical cancer screening guidelines. CONCLUSIONS: Our results indicate that RAs can identify large numbers of women who should undergo BCCS screening across a variety of emergency department settings.

Promoting tobacco cessation utilizing pre-health professional students as research associates in the emergency department.

OBJECTIVE: The objective of this study was to investigate the extent to which volunteer research associates (RAs) can be utilized to screen emergency department patients and their visitors for tobacco use and effectively refer tobacco users requesting help to state Tobacco Quitlines. METHODS: A sample of 19,149 individuals in 10 emergency departments around the country was enrolled into a prospective, interventional study on tobacco cessation by pre-health professional RAs. Participants who screened positive for tobacco use were provided a brief description of Tobacco Quitline programs and then offered a faxed referral to their respective state Quitline. RESULTS: A total of 10,303 (54%) participants reported tobacco use for more than one month during their lives, with 3861 (20%) currently using every day and an additional 1340 using on some days (7%). Most importantly, 2151 participants requested a faxed Tobacco Quitline referral (36% of individuals who used tobacco in the past month). DISCUSSION: Pre-health professional RAs were shown to be an effective and cost-efficient resource for providing a strongly recommended service in the emergency department. Patient care (and the care of their visitors) was supplemented, emergency department personnel were not provided with additional burden, and RAs were provided with valuable experience for their futures in the health professions.

Integration of cell membranes and nanotube transistors.

We report the integration of a complex biological system and a nanoelectronic device, demonstrating that both components retain their functionality while interacting with each other. As the biological system, we use the cell membrane of Halobacterium salinarum. As the nanoelectronic device, we use a nanotube network transistor, which incorporates many individual nanotubes in such a way that entire patches of cell membrane are contacted by nanotubes. We demonstrate that the biophysical properties of the membrane are preserved, that the nanoelectronic devices still function as transistors, and that the two systems interact. Further, we use the interaction to study the charge distribution in the biological system, finding that the electric dipole of the membrane protein bacteriorhodopsin is located 2/3 of the way from the extracellular to the cytoplasmic side.

Minor elevations in troponin T values enhance risk assessment in emergency department patients with suspected myocardial ischemia: analysis of novel troponin T cut-off values.

BACKGROUND: A consensus document developed by a joint committee of the European Society of Cardiology and the American College of Cardiology redefines myocardial infarction (MI) using an increase of troponin I or T as compared to a reference control population (i.e., troponin T (TnT) of 0.01 microg/l). A clinical problem arises when an arbitrary cut-off point is selected for determination of MI (i.e., TnT> or =0.1 microg/l), as minor elevations of troponin are associated with increased cardiovascular risk in selected patients with acute coronary syndromes. METHODS: We prospectively studied 420 unselected patients being evaluated for suspected myocardial ischemia in the emergency department (ED). We compared a 99th percentile MI cut-off limit for TnT, determined by constructing a standard receiver operator curve from our ED population in whom an acute coronary syndrome was excluded, to a standard MI cut-off limit of 0.1 microg/l in assessing cardiovascular risk. We also assessed the prognostic value of detectable TnT concentrations below this 99th percentile MI cut-off, but above the upper reference limit of healthy controls. RESULTS: The diagnosis of acute coronary syndromes (ACS) was more frequent in groups with higher TnT concentrations: 16.8% with a normal TnT (<0.03 microg/l), 29.5% with detectable TnT below the 99th percentile MI limit (0.03-0.066 microg/l), 64.3% with detectable TnT between the 99th percentile and standard MI cut-offs (0.067-0.099 microg/l), and 85.4% with TnT> or =0.1 microg/l (p<0.001 for the trend). Thirty-day cardiovascular event rates increased for any detectable concentration of troponin: 1.3% with normal TnT, 4.8% with detectable TnT below the 99th percentile MI limit, 15.4% with TnT between the 99th percentile and standard MI cut-off limits, and 12.5% with TnT> or =0.1 microg/l (p<0.01 for the trend). CONCLUSION: Using an MI cut-off concentration for TnT from a "non-ACS reference" improves risk stratification, but fails to detect a positive TnT in 11.7% of subjects with an acute coronary syndrome.

Charge transfer from ammonia physisorbed on nanotubes.

We report the use of nanotube field-effect transistor devices for chemical sensing in a conducting liquid environment. Detection of ammonia occurs through the shift of the gate voltage dependence of the source-drain current. We attribute this shift to charge transfer from adsorbed ammonia molecules, with the amount of charge estimated to be as small as 40 electrons for the smallest shift detected. Using the concentration dependence of the response as an adsorption isotherm, we are able to measure the amount of charge transfer to be 0.04 electron per ammonia molecule.

Parental use and misuse of antibiotics: are there differences in urban vs. suburban settings?

OBJECTIVE: To compare the frequencies with which suburban and urban parents give their children antibiotics without first consulting a physician. METHODS: This was a prospective, comparative survey of a suburban emergency department (ED) patient population in New Jersey with an annual patient census of 60,000 visits and an urban ED in Connecticut with 58,000 annual visits. A convenience sample of parents with children <18 years of age were enrolled. Patients who were critically ill and/or not oriented were excluded. Subjects provided written answers to a series of closed questions regarding their knowledge and use of antibiotics for their children over the previous 12 months. Categorical data were analyzed by chi-square and Fisher's exact test; continuous data were analyzed by t-tests. All tests were two-tailed with alpha set at 0.05. The primary endpoint, antibiotic "misuse," was defined as parental administration of antibiotics to a child during the previous 12 months without the consultation of a physician. RESULTS: Eight hundred one parents were enrolled; 424 at the suburban site. Parents in the suburban site were significantly different with regard to mean age (39 +/- 7.2 vs. 32 +/- 9.0, p < 0.001), percentage female sex (63% vs. 81%, p < 0.001), percentage white race (78% vs. 34%, p < 0.001), and percentage with private insurance (89% vs. 56%, p < 0.001). A higher percentage of parents at the suburban site had misused antibiotics (12.1% vs. 4.0%; p < 0.001). Using logistic regression, this significant difference in the rate of antibiotic misuse between the two groups remained after adjustment for demographic variables and insurance status of the parents (p < 0.001). Parents at the suburban site were significantly less likely to have been previously discharged with their child from an office or ED setting without antibiotics only to go soon afterwards to another health facility in order to obtain such medications (5% vs. 48%; p < 0.001). CONCLUSIONS: Parents in the suburban setting were more likely to have misused antibiotics for their children. On the other hand, parents in the urban setting were more likely to have been discharged by a physician at one health facility and gone to another physician's office or ED in order to obtain antibiotics for their children.

GOLDmineR: improving models for classifying patients with chest pain.

The laboratory is dealing with reporting tests as information needed to make clinical decisions. The traditional statistical quality control measures which assigns reference ranges based on 95 percent confidence intervals is insufficient for diagnostic tests that assign risk. We construct a basis for risk assignment by a method that builds on the 2 x 2 contingency table used to calculate the C2 goodness-of-fit and Bayesian estimates. The widely used logistic regression is a subset of the regression method, as it only considers dichotomous outcome choices. We use examples of multivalued predictor(s) and a multivalued as well as dichotomous outcome. Outcomes analyses are quite easy using the ordinal logit regression model.