SIRT1 knockdown promotes neural differentiation and attenuates the heat shock response.

Neurons have a limited capacity for heat shock protein (HSP) induction and are vulnerable to the pathogenic consequence of protein misfolding and aggregation as seen in age-related neurodegenerative diseases. Sirtuin 1 (SIRT1), an NAD(+) -dependent lysine deacetylase with important biological functions, has been shown to sustain the DNA-binding state of HSF1 for HSP induction. Here we show that differentiation and maturation of embryonic cortical neurons and N2a neuroprogenitor cells is associated with decreases in SIRT1 expression and heat shock-dependent induction of HSP70 protein. Tests of a pharmacological activator and an inhibitor of SIRT1 affirm the regulatory role of SIRT1 in HSP70 induction. Protein cross-linking studies show that nuclear SIRT1 and HSF1 form a co-migrating high molecular weight complex upon stress. The use of retroviral vectors to manipulate SIRT1 expression in N2a cells show that shRNA-mediated knock down of SIRT1 causes spontaneous neurite outgrowth coincident with reduced growth rate and decreased induction of hsp70-reporter gene, whereas SIRT1 over-expression blocks the induced neural differentiation of N2a cells. Our results suggest that decreased SIRT1 expression is conducive to neuronal differentiation and this decrease contributes to the attenuated induction of HSPs in neurons.

Examining food insecurity in a regional New Zealand emergency department: A cross-sectional study.

OBJECTIVE: To determine the prevalence of food insecurity (FI) among patients in a regional New Zealand ED, factors associated with FI and feasibility of an ED-based FI screening programme with voluntary social work (SW) follow up. METHODS: Cross-sectional study of patients presenting to the Whangarei Hospital ED, using the validated two-item Hunger Vital Sign screening tool to assess for FI. Participants were offered SW follow up to discuss community food resources. RESULTS: Of the 300 participants who completed the questionnaire, 111 (37.0%, 95% confidence interval [CI] 32.0-43.0) were food insecure. Factors associated with FI include Maori ethnicity (odds ratio [OR] 2.12 [95% CI 1.19-3.80], P = 0.011), household crowding (OR 1.19 [95% CI 1.02-1.39], P = 0.024) and lower socioeconomic status (OR 1.13 [95% CI 1.00-1.27], P = 0.048). There was no statistically significant association between FI and number of comorbidities or the primary reason for ED attendance. Of participants who were food insecure, only half reported being aware of (n = 56/111, 50.5%) or had used (n = 60/111, 54.1%) food resources. Participants who were food insecure were more likely to have utilised resources, either currently or in the past (OR 8.50 [95% CI 4.46-16.18], P < 0.001). Forty (13.3%) participants requested SW follow up and of those, most (n = 31/40, 77.5%) were successfully contacted. FI was associated with interest in SW follow up (OR 16.95 [95% CI 5.81-49.42], P < 0.001). At follow up, the majority (n = 24/31, 77.4%) of participants requested further information regarding food resources. CONCLUSION: FI was prevalent among patients in a regional NZ ED. An ED-based FI screening programme with voluntary SW follow up was feasible and acceptable to ED patients.

Using Embase as a supplement to PubMed in Cochrane reviews differed across fields.

OBJECTIVE: Medline/PubMed is often first choice for health science researchers when doing literature searches. However, Medline/PubMed does not cover the health science research literature equally well across specialties. Embase is often considered an important supplement to Medline/PubMed in health sciences. The present study analyzes the coverage of Embase as a supplement to PubMed, and the aim of the study is to investigate if searching Embase can compensate for low PubMed retrieval. STUDY DESIGN AND SETTING: The population in this study is all the included studies in all Cochrane reviews from 2012 to 2016 across the 53 Cochrane groups. The analyses were performed using two units of analysis (study and publication). We are examining the coverage in Embase of publications and studies not covered by PubMed (25,119 publications and 9,420 studies). RESULTS: The results showed that using Embase as a supplement to PubMed resulted in a coverage of 66,994 publications out of 86,167 and a coverage rate of 77.7, 95% CI [75.05, 80.45] of all the included publications. Embase combined with PubMed covered 48,326 out of 54,901 studies and thus had a coverage rate of 88.0%, 95% CI [86.2, 89.9] of studies. The results also showed that supplementing PubMed with Embase increased coverage of included publications by 6.8 percentage points, and the coverage of studies increased by 5.5 percentage points. Substantial differences were found across and within review groups over time. CONCLUSION: The included publications and studies in some groups are covered considerably better by supplementing with Embase, whereas in other groups, the difference in coverage is negligible. However, due to the variation over time, one should be careful predicting the benefit from supplementing PubMed with Embase to retrieve relevant publications to include in a review.

Disparities in Objective Sleep Quality as Assessed Through Wrist Actigraphy in Minority Patients With Inflammatory Bowel Disease.

BACKGROUND: Inflammatory bowel disease (IBD) is associated with a reduced quality of life. Minority patients with IBD specifically report more impairing symptoms compared with nonminority patients. Sleep quality, a key component of quality of life, is significantly compromised in minority patients compared with nonminority patients. Nevertheless, subjective and objective sleep assessments in minority patients with IBD have not explicitly been assessed. The purpose of this prospective cohort study is to assess and compare objective sleep parameters utilizing wrist actigraphy between minority and nonminority IBD patients. METHODS: In this institutional review board approved study, 74 patients with IBD were recruited and stratified into 2 cohorts by self-identification: white nonminority patients and minority patients. Patients in the minority cohort included black and Hispanic individuals (black and nonblack). Exclusion criteria included significant comorbidity, a history of an underlying sleep disorder, or patients who did not self-identify into categorized cohorts. Sleep was measured not only through wrist-based actigraphy but also with sleep surveys. Sleep parameters were compared between minority and nonminority cohorts. Regression analyses were performed to assess for factors independently associated with parameters of poor sleep quality. RESULTS: Sixty-four patients (86.4%) were included in the final analysis. Thirty-one individuals (48.4%) were categorized into the nonminority cohort, and 33 (51.6%) patients were in the minority cohort. A significantly higher number of minority patients had poorer sleep efficiency and fragmented sleep compared with nonminority patients (90.9% vs 67.7%; P = 0.03 and 87.8% vs 61.3%; P = 0.02). In the adjusted analysis, minority status was independently associated with poor sleep efficiency (odds ratio = 6.41; 95% confidence interval, 1.48-28.17; P = 0.0139) and fragmented sleep (odds ratio = 4.98; 95% confidence interval, 1.09-22.89; P = 0.0389). CONCLUSIONS: Minority patients with IBD were shown to have poorer objective measures of sleep as assessed through wrist actigraphy compared to nonminority patients. Cultural competency in the care of minority patients with IBD, specifically focusing on the management of psychosocial issues, is needed to address these disparities in sleep. The inclusion of minority patients with IBD in studies investigating sleep and other psychosocial issues are warranted not only to assess potential disparities in disease course but also to determine the etiologies of poor sleep in minority patients with IBD.

The intended-and unintended-consequences of healthcare reform.

Healthcare reform will affect providers by: Changing employer-sponsored health plans. Cutting Medicare payment. Expanding Medicaid coverage. Penalizing excessive avoidable readmissions. Increasing Medicaid payment to primary care physicians. Increasing payment to community health centers. Changing patient-provider relationships.

Don't panic: how CFOs are facing the new economic reality.

CFOs at hospitals throughout the country are implementing strategic initiatives that can help their organizations succeed in challenging times: Revising strategic plans, Reassessing capital capacity, Leveraging IT to enhance revenue management.

PubMed coverage varied across specialties and over time: a large-scale study of included studies in Cochrane reviews.

OBJECTIVE: PubMed is one of the most commonly used search tools in biomedical and life sciences. Existing studies of database coverage generally conclude that searching PubMed may not be sufficient although some find that the contributions from other databases are modest at best. However, generalizability of the studies of the coverage of PubMed is typically restricted. The objective of this study is to analyze the coverage of PubMed across specialties and over time. STUDY DESIGN AND SETTING: We use the more than 50,000 included studies in all Cochrane reviews published from 2012 to 2016 as our population and examine if the studies and resulting publications can be identified in PubMed. RESULTS: The results show that PubMed has a coverage of 70.9, 95% confidence interval (CI) (68.40, 73.30) of all the included publications and 82.8%, 95% CI (80.9, 84.7) of the included studies. There are huge differences in coverage across and within specialties. In addition, coverage varies within groups over time. CONCLUSION: Databases used for searching topics within the groups with highly varying or low coverage should be chosen with care as PubMed may have a relatively low coverage.

The burden of Legionnaires' disease in New Zealand (LegiNZ): a national surveillance study.

BACKGROUND: Legionnaires' disease is under-diagnosed because of inconsistent use of diagnostic tests and uncertainty about whom to test. We assessed the increase in case detection following large-scale introduction of routine PCR testing of respiratory specimens in New Zealand. METHODS: LegiNZ was a national surveillance study done over 1-year in which active case-finding was used to maximise the identification of cases of Legionnaires' disease in hospitals. Respiratory specimens from patients of any age with pneumonia, who could provide an eligible lower respiratory specimen, admitted to one of 20 participating hospitals, covering a catchment area of 96% of New Zealand's population, were routinely tested for legionella by PCR. Additional cases of Legionnaires' disease in hospital were identified through mandatory notification. FINDINGS: Between May 21, 2015, and May 20, 2016, 5622 eligible specimens from 4862 patients were tested by PCR. From these, 197 cases of Legionnaires' disease were detected. An additional 41 cases were identified from notification data, giving 238 cases requiring hospitalisation. The overall incidence of Legionnaires' disease cases in hospital in the study area was 5·4 per 100 000 people per year, and Legionella longbeachae was the predominant cause, found in 150 (63%) of 238 cases. INTERPRETATION: The rate of notified disease during the study period was three-times the average over the preceding 3 years. Active case-finding through systematic PCR testing better clarified the regional epidemiology of Legionnaires' disease and uncovered an otherwise hidden burden of disease. These data inform local Legionnaires' disease testing strategies, allow targeted antibiotic therapy, and help identify outbreaks and effective prevention strategies. The same approach might have similar benefits if applied elsewhere in the world. FUNDING: Health Research Council of New Zealand.

Murine typhus and febrile illness, Nepal.

Murine typhus was diagnosed by PCR in 50 (7%) of 756 adults with febrile illness seeking treatment at Patan Hospital in Kathmandu, Nepal. Of patients with murine typhus, 64% were women, 86% were residents of Kathmandu, and 90% were unwell during the winter. No characteristics clearly distinguished typhus patients from those with blood culture-positive enteric fever.

Beyond bolt-ons breakthroughs in revenue cycle information systems.

To help healthcare providers surmount today's payment challenges, next-generation revenue cycle information systems will need to include: Built-in "bolt-on" capability. Adaptability and flexibility. Workflow rules-driven capability. Powerful analytics. Consumer-focused features. Single-database structures. Lower total cost of ownership.

Teaching Assistant Attention and Responsiveness to Student Reasoning in Written Work.

Instructors communicate what they value about students' written work through their comments and feedback, and this feedback has the potential to direct how students approach writing assignments. In this study, we examined how graduate student teaching assistants (TAs) attended and responded to students' written lab reports in an introductory biology course. We collected and analyzed marked lab reports from five TAs and interviewed them about their marking decisions. The results show that TAs attended mainly to writing style and form in their markings and comments on lab reports. However, there were occasions when they attended to students' scientific reasoning in their markings and during interviews. We provide evidence that TAs' understanding of the purpose of the laboratory course and assessment structure influenced their attention. We also provide evidence that TAs could shift their attention from style and form to reasoning in response to moment-to-moment contextual cues. Building on these results, we discuss course design and professional development that reframes labs and reports to focus on students' biological reasoning.

Time-resolved and multiple-angle Thomson scattering on gas-puff Z-Pinch plasmas at pinch time.

A 526.5 nm Thomson scattering diagnostic laser enables probing of the plasma conditions of neon gas-puff z-pinch implosions with temporal resolution. Splitting the laser into two 2.5 J pulses, both 2.3 ns in duration and separated by 4 ns, allows observation of sub-nanosecond time-resolved spectra for a total time of 7 ns. Collection optics were set at 90° and 30° to the laser, observing the same on-axis scattering volume with a radial extent of 0.4 mm. The spectra from both angles were collected by using the same streak camera, using a coupling system that allowed us to obtain temporal, spectral, and angular resolution in the same image. By comparing the ion-acoustic spectra from the two angles, we determined electron temperature and a range of possible electron densities. Measurements made in the 1-3 ns period before pinch time show best fit (determined by a least-squares method) electron densities of around 2 × 1019 cm-3, increasing to 1.5 × 1020 cm-3 in the 3 ns following the start of the x-ray burst (t = 0 ns) from the pinch. The electron temperature increases from 300 eV to 500 eV at t = 0 ns before decreasing to below 300 eV after pinch time. With the present parameters (probe beam, collection angles, and electron temperature and density), this diagnostic method is too insensitive to electron density to provide more than a constraint on that parameter. Plasma regimes in which this technique could determine electron density with some precision are calculated.

Data and dollars: how CDHC is driving the convergence of banking and health care.

The new world of consumer-directed health care is arriving faster than many thought possible, and new trends are taking shape: Consumers in large numbers are adopting health savings accounts paired with high-deductible insurance policies. Banks, credit unions, and even insurance companies are offering HSAs and making them increasingly attractive by letting holders invest their unused deposits in mutual funds. Employers-including giants such as Wal-Mart--are pushing their employees in large numbers into these consumer-directed plans.

The next generation of revenue cycle management.

The revenue cycle management environment is dynamic. Revenue cycle leaders are now responsible for additional functional areas and have to deal with new financing arrangements that expose the organization to greater financial risk. Financial managers can use key performance indicators and the suggested practice processes checklist to determine whether their revenue cycle operations are in good shape or need shaping up.

UPMC's metric-driven revenue cycle.

The University of Pittsburgh Medical Center's revenue cycle reengineering effort has consisted of eight steps: 1. Identify responsibility. 2. Identify metrics. 3. Capture performance data. 4. Analyze performance data. 5. Share performance information. 6. Take improvement action. 7. Monitor improvement. 8. Celebrate results.

Black space versus white space: the new revenue cycle battleground.

To increase revenue from out-of-network claims, there are several things providers can do, including: Identify and track all out-of-network claims. Require all networks to be identified in the contract. Eliminate contracts that include silent PPOs. Limit authorization to negotiate discounts. Establish out-of-network metrics.

Treating preschool children who stutter: description and preliminary evaluation of a family-focused treatment approach.

PURPOSE: The purpose of this article is to present a detailed description of a family-focused treatment for preschool children who stutter that addresses communication behaviors and attitudinal reactions that children and their parents may exhibit in reaction to stuttering, as well as a preliminary evaluation of the outcomes of that treatment. METHOD: The study involved assessment of the children's speech fluency and a client satisfaction questionnaire that sought parents' opinions about which aspects of the treatment were beneficial. Participants were 17 children who stutter, ages 31 to 62 months, and their families. RESULTS: Responses to the questionnaire indicated that treatment helped families learn about stuttering and about strategies that facilitate children's fluency. Evaluation of the children's fluency revealed that all participants achieved improved fluency at the conclusion of treatment and at long-term follow-up. IMPLICATIONS: Findings suggest that this treatment approach may be useful for helping children achieve improved speech fluency, effective communication skills, and healthy communication attitudes.

Adapting customer service to consumer-directed health care.

A growing number of hospitals are implementing new tools that provide convenient, more detailed patient access to billing information. These tools are paying off for hospitals through reduced calls to their billing offices, decreased mailing costs, and increased payments, as well as higher rates of customer satisfaction.

Performance is reality: how is your revenue cycle holding up?

Expanding your organization's revenue cycle performance indicators beyond receivables, cash, and A/R days can help you: Keep a record and tell a story. Benchmark against your goals and industry best practices. Identify and manage trends, not single-period results. Illustrate relationships between key performance indicators.