Delays in Coccidioidomycosis Diagnosis and Relationship to Healthcare Utilization, Phoenix, Arizona, USA1.

We developed an electronic records methodology to programmatically estimate the date of first appearance of coccidioidomycosis symptoms in patients. We compared the diagnostic delay with overall healthcare utilization charges. Many patients (46%) had delays in diagnosis of >1 month. Billed healthcare charges before diagnosis increased with length of delay.

Differential expression of microRNAs as predictors of glioblastoma phenotypes.

BACKGROUND: Glioblastoma is the most aggressive primary central nervous tumor and carries a very poor prognosis. Invasion precludes effective treatment and virtually assures tumor recurrence. In the current study, we applied analytical and bioinformatics approaches to identify a set of microRNAs (miRs) from several different human glioblastoma cell lines that exhibit significant differential expression between migratory (edge) and migration-restricted (core) cell populations. The hypothesis of the study is that differential expression of miRs provides an epigenetic mechanism to drive cell migration and invasion. RESULTS: Our research data comprise gene expression values for a set of 805 human miRs collected from matched pairs of migratory and migration-restricted cell populations from seven different glioblastoma cell lines. We identified 62 down-regulated and 2 up-regulated miRs that exhibit significant differential expression in the migratory (edge) cell population compared to matched migration-restricted (core) cells. We then conducted target prediction and pathway enrichment analysis with these miRs to investigate potential associated gene and pathway targets. Several miRs in the list appear to directly target apoptosis related genes. The analysis identifies a set of genes that are predicted by 3 different algorithms, further emphasizing the potential validity of these miRs to promote glioblastoma. CONCLUSIONS: The results of this study identify a set of miRs with potential for decreased expression in invasive glioblastoma cells. The verification of these miRs and their associated targeted proteins provides new insights for further investigation into therapeutic interventions. The methodological approaches employed here could be applied to the study of other diseases to provide biomedical researchers and clinicians with increased opportunities for therapeutic interventions.

Community knowledge, risk perception, and preparedness for the 2009 influenza A/H1N1 pandemic.

OBJECTIVE: To examine public knowledge, perceptions, and preparedness for the 2009 influenza A/H1N1 pandemic. DESIGN: We conducted a telephone survey of selected households in Arizona during the month of October 2009. RESULTS: Among the 727 households interviewed, one-third (34%) were not aware that the terms swine flu and H1N1 refer to the same virus. Many believed that it is more difficult to contract 2009 H1N1 (27%) than seasonal influenza (14%). About three-quarters of respondents perceived the H1N1 situation as urgent (76%), but only about one-third of those surveyed believed a family member would get sick with H1N1 within a year (35%). Approximately half (53%) of those surveyed intended to get the H1N1 influenza vaccine. Family doctors, television news, and local public health officials were the most trusted sources for H1N1 information. CONCLUSIONS: The survey highlighted a number of important misconceptions about H1N1 knowledge, treatment options and transmissibility. Increased efforts should be made to understand how messages are transmitted and received in the community during a pandemic to improve risk communication plans moving forward.

The Halo Effect: An Unintended Benefit of Care Pathways.

The objective of this study was to determine if implementation of a simplified care pathway for total knee arthroplasty (TKA) would affect outcomes of total hip arthroplasty (THA) patients in the same health care system. Data were collected from a total of 5,095 consecutive THA patients in the year before and 2 years after implementation of the care pathway for TKA patients. Postimplementation increases were observed in both early activity (p < 0.0001) and continuous urinary catheter avoidance (p < 0.0001) among THA patients. These improvements in protocol adherence were associated with decreased complications (p < 0.0001), fewer 30-day readmissions (p < 0.0019), and decreased hospital length of stay (p < 0.0001). Based on these results, the implementation of a simplified care pathway for TKA patients can also improve outcomes for THA patients in the same health care system.