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 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.

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.

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.

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.

Quantifying patient bacterial exposure risk from reusable phlebotomy tourniquets in a New Zealand secondary level hospital.

AIM: This study aimed to assess for the presence of multi-drug resistant organisms (MDROs) on tourniquets and quantify the number of bacteria to which patients might be exposed with each blood collection episode. METHODS: Tourniquets were randomly sampled in a 246-bed, secondary level, New Zealand hospital, which is currently non-endemic for MDROs. A 6-cm length of each tourniquet sampled was applied to the surface of an agar plate and the colony forming units (CFUs) were enumerated. All colonies were then screened for MDROs using standard methods. CFU counts per linear centimetre were multiplied by a range of patient arm circumference measurements. Comparison was also made between non-disinfected tourniquets left on the wards and phlebotomy service tourniquets after daily decontamination with a proprietary disinfectant. RESULTS: The median exposure risk from non-disinfected tourniquets was 173 CFUs per collect (95% CI, 104-861). None of the general ward tourniquets grew any MDROs but four out of five dedicated, single-patient reusable isolation room tourniquets grew MRSA. Disinfected tourniquets had few if any CFUs and CFU counts were significantly lower than non-disinfected tourniquets (P = 0.0001). CONCLUSION: The quantitative risk from reusable tourniquets appears low in the setting of MDRO non-endemicity, with the application of standard infection control practices.

A doubly curved elliptical crystal spectrometer for the study of localized x-ray absorption in hot plasmas.

X-ray absorption spectroscopy is a powerful tool for the diagnosis of plasmas over a wide range of both temperature and density. However, such a measurement is often limited to probing plasmas with temperatures well below that of the x-ray source in order to avoid object plasma emission lines from obscuring important features of the absorption spectrum. This has excluded many plasmas from being investigated by this technique. We have developed an x-ray spectrometer that provides the ability to record absorption spectra from higher temperature plasmas than the usual approach allows without the risk of data contamination by line radiation emitted by the plasma under study. This is accomplished using a doubly curved mica crystal which is bent both elliptically and cylindrically. We present here the foundational work in the design and development of this spectrometer along with initial results obtained with an aluminum x-pinch as the object plasma.

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.

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.

Study of nanosecond pulsed magnetic fields using temporally resolved Faraday rotation through a magneto-optical waveguide.

We have measured magnetic fields up to 17.7 T with a rise time of 75 ns using temporally resolved Faraday rotation of a single longitudinal mode laser beam through a magneto-optically active bulk waveguide. We believe this to be the first time that such large, rapidly varying magnetic fields have been measured with this class of materials (multicomponent terbium borate glass). As there was no measurable lag between the magnetic field inferred from the angle of rotation of the laser beam and the electromagnetically measured field, our sample of terbium borate glass has a spin-lattice relaxation time of a few tens of nanoseconds at most at approximately room temperature (300 K). The highest peak magnetic fields were measured in wire-array Z-pinch experiments on a 0.5 MA pulsed power machine.

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.

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.