Virologic testing in bronchiolitis: does it change management decisions and predict outcomes?

The aim of this study was to evaluate the clinical, therapeutic, laboratory, and radiological differences between respiratory syncytial virus (RSV) and non-RSV bronchiolitis in order to assess if the prior knowledge of viral etiology changed management decisions and would be able to predict outcomes. Medical charts of children <1 year admitted to the emergency department with bronchiolitis during two RSV seasons (2010–2012) were reviewed. We analyzed 221 episodes of bronchiolitis. The percentage of exams performed (95 % confidence interval (CI) 0.74–2.52), abnormal laboratory and radiological findings (95 % CI 0.53–16.89) did not differ between groups. RSV bronchiolitis had a more severe clinical course. However, virologic testing for RSV had low specificity in identifying at-risk patients for hospitalization, longer hospital length of stay, and need of oxygen therapy and nasogastric tube (44, 40, 42, and 35 %, respectively), and while statistically significant, the positive likelihood ratios were only slightly greater than 1. Conclusion: Although RSV bronchiolitis has a more severe clinical course, virologic testing does not help in management decisions, and at an individual level, as a performance test, it seems insufficient to precisely predict outcomes.     

A technique for detecting GABA in the human brain with PRESS localization and optimized refocusing spectral editing radiofrequency pulses

A proton magnetic resonance spectral editing technique is presented that uses PRESS excitation to achieve spatially localized measurements of brain gamma-aminobutyric acid (GABA). The homonuclear difference spectroscopy technique employs a frequency selective inversion pulse to suppress the creatine resonance at 3.0 ppm. The timing of this pulse is optimized to maximize the suppression of creatine by minimizing the effect of the editing pulse on the 3.0 ppm resonances. The PRESS excitation achieves three dimensional spatial localization in a single acquisition making it less sensitive to patient motion than multiple acquisition techniques. The performance and utility of this technique were evaluated by phantom experiments and by in vivo measurements of brain GABA concentration in 10 normal subjects.     

Collagenase production by synovial fibroblasts treated with phorbol myristate acetate

A series of intracellular events occurring after treatment of rabbit synovial fibroblasts with 0.01 μg/ml phorbol myristate acetate (PMA) were measured. Ten minutes after addition of PMA, there was a temporary increase in intracellular cyclic AMP levels, followed by a transient decrease in incorporation of ³H-thymidine into DNA. Approximately 500 ng/mg cell protein of PGE₂ were found in culture medium from the 12- to 24- hour incubation period, but significant collagenase was not detectable until 24 to 36 hours. Treatment with aspirin or indomethacin abolished PGE₂ production but did not affect collagenase levels. Production of enzyme was associated with a cessation of cell proliferation, measured by protein content/culture and cell number. No enzyme was detectable in untreated cultures. Synovial fibroblasts treated with phorbol myristate acetate may provide a good model for studies on the mechanism of induction of collagenase production.     

Teachers as Learners: Developing Professionalism Feedback Skills via Observed Structured Teaching Encounters

This Conversations Starter article presents a selected research abstract from the 2017 Association of American Medical Colleges Southern Region Group on Educational Affairs annual spring meeting. The abstract is paired with the integrative commentary of 4 experts who shared their thoughts stimulated by the study. These thoughts explore the value of the Observed Structured Teaching Encounter in providing structured opportunities for medical students to engage with the complexities of providing peer feedback on professionalism.     

Cigarettes and social differentiation in France: is tobacco use increasingly concentrated among the poor?

Aims   This paper aimed to assess whether the increase of social differentiation of smoking is observed in France.
Design and setting   Five cross-sectional telephone surveys conducted in France between 2000 and 2007.
Participants   The surveys were conducted among national representative samples of French subjects aged 18–75 years ( n  = 12 256, n  = 2906, n  = 27 499, n  = 2887, n  = 6007 in 2000, 2003, 2005, 2006 and 2007, respectively). We focused on three groups: executives, manual workers and the unemployed.
Measurements   Time trends of smoking prevalence were assessed, and socio-economic factors (especially occupation and job status) associated with smoking were identified and compared in 2000 and 2005. We also computed respondents' equivalized household consumption (EHI) and their cigarette budget to assess the financial burden of smoking.
Findings   Between 2000 and 2007, smoking prevalence decreased by 22% among executive managers and professionals and by 11% among manual workers, and did not decrease among the unemployed. Indicators of an underprivileged social situation were associated more markedly with smoking in 2005 than in 2000. In addition, the falling-off of smoking initiation occurred later and was less marked among manual workers than it was among executive managers and professionals. Finally, in 2005 15% of French smokers devoted at least 20% of their EHI to the purchase of cigarettes, versus only 5% in 2000, and smoking weighted increasingly heavily on the poorest smokers' budgets.
Conclusions   While these results point out an increased social differentiation in tobacco use, they underline the need to design and implement other forms of action to encourage people to quit, in particular targeting individuals belonging to underprivileged groups.