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E Scott Sills,1,2 Liubomir Chiriac,3 Denis Vaughan,4 Christopher A Jones,5 Shala A Salem11Division of Reproductive Endocrinology, Pacific Reproductive Center, Irvine, CA, USA; 2Graduate School of Life Sciences, University of Westminster, London, UK; 3Department of Mathematics, California Institute of Technology, Pasadena, CA, USA; 4Department of Obstetrics and Gynaecology, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; 5Global Health Economics Unit and Department of Surgery, Center for Clinical and Translational Science, University of Vermont College of Medicine, Burlington, VT, USABackground: This investigation evaluated standardized process of care data collected on selected hospitals serving a remote rural section of westernmost North Carolina.Methods: Centers for Medicare and Medicaid Services data were analyzed retrospectively for multiple clinical parameters at Fannin Regional Hospital, Murphy Medical Center, and Union General Hospital. Data were analyzed by paired t-test for individual comparisons among the three study hospitals to compare the three facilities with each other, as well as with state and national average for each parameter.Results: Centers for Medicare and Medicaid Services “Hospital Compare” data from 2011 showed Fannin Regional Hospital to have significantly higher composite scores on standardized clinical process of care measures relative to the national average, compared with Murphy Medical Center (P = 0.01) and Union General Hospital (P = 0.01). This difference was noted to persist when Fannin Regional Hospital was compared with Union General Hospital using common state reference data (P = 0.02). When compared with national averages, mean process of care scores reported from Murphy Medical Center and Union General Hospital were both lower but not significantly different (−3.44 versus −6.07, respectively, P = 0.54).Conclusion: The range of process of care scores submitted by acute care hospitals in western North Carolina is considerable. Centers for Medicare and Medicaid Services “Hospital Compare” information suggests that process of care measurements at Fannin Regional Hospital are significantly higher than at either Murphy Medical Center or Union General Hospital, relative to state and national benchmarks. Further investigation is needed to determine what impact these differences in process of care may have on hospital volume and/or market share in this region. Additional research is planned to identify process of care trends in this demographic and geographically rural area.Keywords: process of care, hospital quality, North Carolina, rural

The previously reported Mn0–MgII bonded heterobimetallic compound [L†Mn–Mg(MesNacnac)] (L† = −N(Ar†)(SiPri3), Ar† = C6H2{C(H)Ph2}2Pri-2,6,4; MesNacnac = [(MesNCMe)2CH]−; Mes = mesityl) forms an adduct complex, [L†Mn–Mg(THF)(MesNacnac)], when dissolved in THF. Adventitious water is shown to be reduced by [L†Mn–Mg(MesNacnac)] to give the hydroxide bridged heterobimetallic, [L†Mn(μ-OH)2Mg(MesNacnac)]. The Mn0–MgII bonded heterobimtallic reductively disproportionates CO2, affording the carbonate bridged species, [{L†Mn(μ-CO3)Mg(THF) (MesNacnac)}2], in the presence of THF. The three new compounds have been crystallographically characterized.

Quantum-enhanced sensing and metrology pave the way for promising routes to fulfil the present day fundamental and technological demands for integrated chips which surpass the classical functional and measurement limits. The most precise measurements of optical properties such as phase or intensity require quantum optical measurement schemes. These non-classical measurements exploit phenomena such as entanglement and squeezing of optical probe states. They are also subject to lower detection limits as compared to classical photodetection schemes. Biosensing with non-classical light sources of entangled photons or squeezed light holds the key for realizing quantum optical bioscience laboratories which could be integrated on chip. Single-molecule sensing with such non-classical sources of light would be a forerunner to attaining the smallest uncertainty and the highest information per photon number. This demands an integrated non-classical sensing approach which would combine the subtle non-deterministic measurement techniques of quantum optics with the device-level integration capabilities attained through nanophotonics as well as nanoplasmonics. In this back drop, we review the underlining principles in quantum sensing, the quantum optical probes and protocols as well as state-of-the-art building blocks in quantum optical sensing. We further explore the recent developments in quantum photonic/plasmonic sensing and imaging together with the potential of combining them with burgeoning field of coupled cavity integrated optoplasmonic biosensing platforms.

β-diketiminate coordinated magnesium(I) compounds, [{(ArNacnac)Mg}2] (ArNacnac = [(ArNCMe)2CH]– (Ar = 2,6-diisopropylphenyl (Dip) or mesityl (Mes)), have been utilized as reducing agents in reactions with the redox active 1,4-diazabutadiene, (ButNCH)2 (ButDAB), and 2,2’-bipyrine (bipy). These reactions led to one-electron reductions of the unsaturated substrate, and formation of the highly colored radical complexes, [(ArNacnac) Mg(ButDAB•)] and [(MesNacnac)Mg(bipy•)(bipy)]. The X-ray crystal structures of the compounds reveal each to possess one singly reduced ButDAB or bipy ligand.

Isomeric states of the neutron-rich isotope 18973Ta116 were populated via fragmentation of a primary beam of 208Pb ions at 1 GeV/u impinging on a 9Be target at GSI, Darmstadt, Germany. The isotopes of interest were separated, identified and delivered to the DESPEC setup. Two isomers were deduced in 189Ta116 and their lifetimes were measured based on the γ-ray time distributions.

Thermal rearrangement of the 1,2-bis(silylene), [{(4-ButPh)C(NDip)2}Si−]2 (Dip = 2,6-diisopropylphenyl, leads to the silyl-silylene, {(4-ButPh)C(NDip)2}Si−Si(H) {N(Dip)C(=NDip)(4-ButPh-H)}, via an intramolecular C−H activation reaction. The X-ray crystal structure, and limited spectroscopic data, for the compound are reported. The structure of the silyl-silylene incorporates an exocyclic imine fragment, which is unprecedented for this compound class.

A higher proportion of patients with juvenile-onset systemic lupus erythematosus (JSLE) will have renal involvement compared with adult-onset disease, some progressing to renal failure in adulthood. Histological examination is the gold standard for diagnosing lupus nephritis (LN), but its invasive nature limits routine use. Using cross-sectional cohort analysis, we aimed to determine whether urinary concentrations of monocyte chemoattractant protein-1 (MCP1), alpha-1-acid glycoprotein (AGP) and interferon-inducible protein 10 (IP10) are biomarkers of active LN. Sixty JSLE patients recruited to the UK JSLE Cohort Study were categorized according to the British Isles Lupus Assessment Group (BILAG) activity index. Patients with active renal JSLE (n = 8; renal BILAG score A, B) had significantly higher urinary MCP1 concentrations than patients with inactive renal disease (n = 52; renal BILAG score C, D, E; 582 pg/mg creatinine [Cr], 207 pg/mg Cr; p = 0.018) or healthy controls (n = 23; 117 pg/mg Cr; p = 0.005). Urinary AGP concentration was significantly elevated in patients with active renal disease compared with inactive renal disease (1517 ng/mg Cr, 485 ng/mg Cr; p = 0.027) or healthy controls (313 ng/mg Cr; p = 0.013). Urinary IP10 concentration was not significantly different between groups, but did strongly correlate with uMCP and uAGP levels (rho = 0.38, p = 0.009; rho = 0.33, p = 0.021). Urinary MCP1 and AGP are biomarkers of LN, providing insight into its pathophysiology. Longitudinal studies are warranted. [ABSTRACT FROM PUBLISHER]

OBJECTIVE: To assess the impact of intraoperative dexmedetomidine infusion on postoperative analgesia in women undergoing major open and laparoscopic gynecologic surgery under general anesthesia. RESEARCH DESIGN AND METHODS: A retrospective analysis of patients who underwent major open and laparoscopic gynecologic surgery under general anesthesia from January 2007 to October 2008. Patients who received intraoperative opioids with a dexmedetomidine infusion were compared to those who received opioids alone. Patients who received regional anesthesia, remifentanil, or other analgesic adjuncts were excluded. Data were collected in the postanesthesia care unit (PACU) for all patients, and for 24 hours in the open group. RESULTS: A total of 580 women were included in the analysis (293 open surgery [103 dexmedetomidine, 190 controls] and 287 laparoscopic surgery [101 dexmedetomidine, 186 controls]). In the open group, patients who received dexmedetomidine required less opioids intraoperatively and in PACU. However, there was no difference in the duration of PACU stay, opioid consumption from PACU discharge to 24 h or in the need for rescue antiemetics. Pain scores were not different in PACU. In the laparoscopic group, there was no difference between the groups in intraoperative or PACU opioids, pain scores, or need for rescue antiemetics. Patients in the dexmedetomidine laparoscopic group needed less inhaled agents intraoperatively, but stayed longer in PACU. CONCLUSIONS: Intraoperative dexmedetomidine infusion provided an opioid sparing effect intraoperatively and in PACU in women undergoing open gynecologic surgery but did not reduce the need for rescue antiemetics or the duration of PACU stay and did not provide any benefit beyond PACU discharge. For laparoscopic surgery, dexmedetomidine infusion did not provide any analgesic benefit. Limitations of the study include its retrospective non-randomized nature, absence of strict protocol for dexmedetomidine administration and lack of data beyond PACU discharge in patients having laparoscopic surgery. [ABSTRACT FROM AUTHOR]

Herpes simplex virus (HSV) transmitted from mother to child around the time of delivery can cause potentially fatal disease in the newborn. Women who experience their first genital HSV infection in pregnancy are at the highest risk of transmitting the virus to their newborn. Efforts to prevent vertically transmitted HSV disease can be directed in the following three ways: (i) prevent maternal genital HSV infection; (ii) prevent transmission during pregnancy and delivery; or (iii) postnatally prevent disease in an exposed newborn. Oral aciclovir and valaciclovir given prophylactically in late pregnancy have been shown to limit clinical recurrence of genital herpes, shedding of HSV at delivery and the rate of caesarean delivery for past HSV disease. However, there are insufficient data to determine the effect of oral antiviral prophylaxis in pregnancy on neonatal HSV disease. Neonatal HSV disease should always be treated with systemic antiviral therapy. There is currently no vaccine licensed to prevent genital herpes, although a number show promise in clinical trials. The role of intrapartum antiviral therapy and postnatal strategies to prevent neonatal HSV disease require further evaluation. [ABSTRACT FROM AUTHOR]

Background: Human immunodeficiency virus (HIV)-infected persons have an increased risk of chronic kidney disease (CKD). Serum creatinine level may underestimate the prevalence of CKD in subjects with decreased lean body mass or liver disease. Level of serum cystatin C, an alternative kidney function marker, is independent of lean body mass.Study Design: Cross-sectional.Setting& Participants: 250 HIV-infected subjects on highly active antiretroviral therapy in the Nutrition for Healthy Living (NFHL) cohort; 2,628 National Health and Nutrition Examination Survey (NHANES) 2001-2002 subjects.Predictors& Outcomes: Comparison of serum creatinine levels in NFHL to those in NHANES subjects; comparison of CKD in NFHL subjects ascertained using serum creatinine versus cystatin C levels.Measurements: Standardized serum creatinine, serum cystatin C, glomerular filtration rate (GFR) estimated from serum creatinine and cystatin C levels.Results: Creatinine levels were lower in NFHL than NHANES subjects despite greater rates of hepatitis, diabetes, and drug use (mean difference, -0.18 mg/dL; P < 0.001 adjusted for age, sex, and race). Of NFHL subjects, only 2.4% had a creatinine-based estimated GFR less than 60 mL/min/1.73 m(2), but 15.2% had a cystatin-based estimated GFR less than 60 mL/min/1.73 m(2).Limitations: GFR was estimated rather than measured. Other factors in addition to GFR may affect creatinine and cystatin C levels. Measurements of proteinuria were not available.Conclusions: Serum creatinine levels may overestimate GFRs in HIV-infected subjects. Kidney disease prevalence may be greater than previously appreciated. [ABSTRACT FROM AUTHOR]

Falling is a significant cause of disability and death among older adults, and assessing awareness of risk factors is the first step to developing falls intervention programs. Older adults who had fallen in the past were more aware of risk factors for falls, and may be receptive to fall risk information following a fall. This may be an opportune time for health care professionals to provide education on risks for falls to prevent further injury. The Falls Risk Awareness Questionnaire (FRAQ) was validated in a range of patients and practice settings, and after further testing, the FRAQ may play an important role in identifying specific differences in the knowledge of risk factors. [ABSTRACT FROM AUTHOR]

Despite more than a decade of education and research-oriented intervention programs, inner city children with asthma continue to engage in episodic 'rescue' patterns of healthcare and experience a disproportionate level of morbidity. The aim of this study was to establish and evaluate a sustainable community-wide pediatric asthma disease management program designed to shift inner city children in Los Angeles from acute episodic care to regular preventive care in accordance with national standards. In 1995 the Southern California Chapter of the Asthma and Allergy Foundation of America (AAFA), the Los Angeles County Department of Health Services (LAC DHS), and the Los Angeles Unified School District (LAUSD) established an agreement to initiate and sustain the Breathmobile Program. This program includes automated case identification, mobile school-based clinics, and highly structured clinical encounters supported by an advanced information technology solution. Interdisciplinary teams of asthma care specialists provide regular and ongoing care to children at school and county clinic sites over a wide geographic area of urban Los Angeles. Each team operates in a specially equipped mobile clinic (Breathmobile), efficiently moving a structured healthcare process to school and county clinic sites with large numbers of children. Demographic, clinical, and participation data is tracked carefully in an electronic medical record system. Program operations, clinical oversight, and patient tracking are centralized at a care coordination center. Clinical operations and methods have been replicated in fixed specialty clinic sites at the Los Angeles County + University of Southern California Medical Center. Clinical and process measures are regularly evaluated to assure quality, plan iterative improvement, and support evidence-based care. Four Breathmobiles deliver ongoing care at more than 90 school sites. The program has engaged over five thousand patients and their families in a continuity care model that has demonstrated efficacy over usual episodic care. More than 90% of patients in all asthma severity categories achieved clinical control of asthma with significant reductions in inpatient (IP) and emergency department (ED) use. On February 14, 2002, the program became the first program in the United States to receive the award of disease-specific care certification by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Proper design and resource allocation can sustain a school-based community-wide pediatric asthma disease management program and shift a population of inner city children from acute episodic care to routine preventive care in accordance with national standards. An evidence-based approach to evaluating and maintaining quality, coupled with stratified care delivery, can assure the efficient use of safety net healthcare resources. [ABSTRACT FROM AUTHOR]

Background: Striking increases in the prevalence and morbidity of asthma among inner city children have been documented.Objective: To establish and evaluate a large-scale, school-based case-detection process designed to efficiently and reliably identify inner city children with asthma.Methods: A bilingual, seven-question, self-administered, parental asthma screening survey was developed. Clinical validation was achieved in a sample of 675 consecutive parents bringing a child to the school-based Breathmobile Program for initial evaluation, using a comprehensive evaluation by a physician specialist (ie, allergist) as the standard. Survey response patterns were used to construct a novel seven-model, tiered scoring algorithm and an abbreviated algorithm that predict the probability of a child being clinically classified as "yes asthma" or "no asthma." A systematic survey distribution process administered by a single coordinator was developed, and the impact of a classroom-oriented incentive offering a 25 dollars school supply gift certificate for survey return rates of >or= 80% was evaluated.Results: A total of 636 parents provided one or more survey responses and information sufficient for clinical classification. The scoring algorithm correctly identified children with asthma (>or= 80% probability) with a sensitivity of 86.5%, a specificity of 83.6%, and a misclassification rate of 14.3% (91 of 636 children). The sensitivity for identifying persistent asthma was 91.3%. Asthma prevalence estimates derived using survey results from a larger sampling of the general population were similar to rates previously reported for comparable populations. The inclusion of an inexpensive incentive increased the median survey return rates from 35.3 to 65% (z= -11.9; p <.001). The screening process has been used to conduct 27,526 surveys at inner city schools.Conclusions: The Breathmobile case-detection process offers a validated, comprehensive, large-scale method with which to identify children with asthma at their school sites. [ABSTRACT FROM AUTHOR]

Background: Increasing availability of urine testing for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) offers expanded opportunities to collaborate with community-based organizations (CBOs) to screen high-risk populations for sexually transmitted diseases (STDs).Goal: To determine the prevalence and correlates of genital tract gonococcal and chlamydial infection among CBO clients, and to assess the feasibility of implementing widespread community-based STD screening programs.Design: Free, voluntary, confidential first-catch urine screening was conducted at 20 CBOs serving disadvantaged populations in St. Louis, MO. Brief demographic, behavioral, and sexual contact data were obtained from all participants. Urine samples were tested by ligase chain reaction (LCR). Persons testing positive were promptly notified and directed to seek treatment.Results: A GC and/or CT infection was identified in 24 of 277 persons (8.7%) screened; 2 persons were infected with GC only, 17 with CT only, and 5 with GC and CT. Treatment was documented for 22 persons (91.7%) testing positive. The highest rates of infection were found at shelters (12.3%) and residence facilities (11.1%). Costs of screening were $38 per sample collected and $453 per case identified.Conclusion: Community-based urine testing successfully identified GC and CT infections, and was well accepted by community members and CBOs. Community-based screening can significantly impact STD epidemiology by facilitating early detection, treatment, and interruption of transmission. [ABSTRACT FROM AUTHOR]

A concern is emerging in Ireland that social care managers and staff are moving too far away from the ‘care’ in social ‘care’ work. In this paper a discussion of the impact of the bureaucratic procedures and regulation within the social work and social care work sectors is presented along with an exploration of leadership approaches. It is argued that certain leadership approaches, in particular pedagogical leadership, could not only help social care managers to negotiate the complex issues they are facing but also facilitate putting the ‘care’ back into social ‘care’ work. Pedagogical leadership is globally supported across a variety of human service disciplines: it facilitates the creation of a learning culture within the workplace where social care managers facilitate conversations with their teams to encourage reflection, critical thinking and contributions to the professional wisdom required for quality service. The purpose of this article is to contribute to the dialogue within leadership practice for social care professionals. This discourse is necessary if lessons are to be learned from past experiences in this country and others about how to balance the need for care, learning and compassion with accountability.

Reaction of an extremely bulky potassium amide complex, KL† (L†=[Ar†(PPh2)N]-, Ar†=C6H2{C(H)Ph2}2Pri-2,6,4), with GeCl2·dioxane afforded low yields of the phosphinoamido and phosphinoamino germanium(II) chloride complexes, [GeCl2(κ1-P-L†GeCl)] and [GeCl2(κ1-P-L†H)], respectively. The X-ray crystal structures, and limited spectroscopic data, for the complexes are reported. Both complexes represent rare examples of phosphine adducts of GeCl2.