Occurrence of the specific long spike burst pattern in the ovine proximal gallbladder as an indication of myoelectric regional variability

AbstractThe myoelectrical activity of ovine gallbladder is incompletely recognized. Accordingly, each of five rams was fitted with six small intestinal and three gallbladder electrodes. The strain gauge force transducer was also mounted near the gallbladder fundic electrode. In two series of chronic experiments the electromyographical and mechanical recordings were conducted during 5–7 h in fasted or non-fasted animals, with or without feeding. The occurrence of the slow waves in the small bowel was common, unlike those in the gallbladder. In the small bowel myoelectrical records both the migrating motility complex and minute rhythm pattern were observed regularly. In the gallbladder, both the migrating motility complex-like activity and the minute rhythm were also denoted in the same time as in the small bowel. In gallbladder infundibulum, and often also in the gallbladder corpus, the specific pattern, called the long spike burst pattern (LSBP) was observed. It comprised usually one or two parts of prolonged duration. The first part resembled the classical (short lasting) spike burst in the small bowel and its amplitude was lower than that of the second part. The spike burst frequency of the second part of the pattern was 2–3 times lower than that of the first part. During phase 1 – and phase 2a-like activity, the frequency of the gallbladder LSBP was reduced in fasted rams. The LSBP amplitude was relatively high and not further enhanced after feeding. In fasted rams, the duration of specific pattern, observed in gallbladder infundibulum, was longer than that in non-fasted animals and its amplitude was low. Similar events were recorded in the gallbladder corpus, but the LSBP was shorter and not regular. In the gallbladder fundus, mostly irregular short spike bursts were recorded. It is concluded that in sheep, specific types of the long-lasting groups of spikes occur in the upper gallbladder areas forming the specific pattern that indicates the presence of the regional variability of the gallbladder motor activity. The character of LSBP depends mostly on feeding conditions.

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Indigenous Over-representation in Canada’s Youth Correctional System: An Assessment of Regional Variability

Canadian Journal of Criminology and Criminal Justice/La Revue canadienne de criminologie et de justice pénale ◽

10.3138/cjccj.2019-0049 ◽

2020 ◽

Vol 62 (2) ◽

pp. 22-43

Author(s):

Stephanie A. Wiley ◽

Helene Love ◽

Kelin A. Emmett

Keyword(s):

Regional Variability ◽

Correctional System

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Regional Variability of Michigan Niagaran Reefs and the Impact on CO2 Storage Resources

SSRN Electronic Journal ◽

10.2139/ssrn.3366309 ◽

2019 ◽

Author(s):

Autumn Haagsma ◽

Andrew Burchwell ◽

Amber Conner ◽

Jackie Gerst ◽

Wayne Goodman ◽

...

Keyword(s):

Co2 Storage ◽

Regional Variability ◽

The Impact

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P092 NICE biologics pathways for inflammatory arthritis exhibit regional variability due to modification by CCG’s: results from a national survey of pathways in England

Rheumatology ◽

10.1093/rheumatology/keab247.090 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Jatin Mistry ◽

Diane Hill ◽

Ailsa Bosworth ◽

Arvind Kaul

Keyword(s):

Inflammatory Arthritis ◽

Good Practice ◽

National Study ◽

Freedom Of Information ◽

Inadequate Response ◽

Limited Sample ◽

Regional Variability ◽

Nice Guidance ◽

Information Requests ◽

Individual Funding

Abstract Background/Aims NICE publishes guidance underpinned by act of Parliament and legally enforceable, on the use of biological therapies in the treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) which should allow harmonisation of access independent of region. However, sufficient guidance is not provided on the use of sequential biologics nor is a numerical cap placed on the number of biologics a patient can attempt if they have had an inadequate response. We have previously reported that in a limited sample, Clinical Commissioning Groups (CCGs) interpret NICE guidance variably and restrict access to NICE approved treatments depending on geography, the so-called “postcode lottery”. We determined the variability of biologics pathways in all CCG’s in England to examine whether a potentially unfair postcode lottery exists for sequential biologics use. Methods All 135 England CCGs covering over 55 million people, were sent Freedom of Information requests, for their biologic pathways for RA, PsA and AS. Where CCGs did not have this information, the relevant acute trusts were contacted, with responses recorded under that CCG. For every CCG the local biologics pathways were examined for detail on the number and type of biologics commissioned before an Individual Funding Request was needed. “No Cap” was recorded if CCG’s responded with no restriction on the number of biologics. Results Responses were obtained from 124/135 CCG’s for RA, 122/135 for PsA and AS, all covering an estimated population in excess of 45 million people. For RA, 55% CCG’s had no cap on the number of commissioned RA biologics. 45% had a variable cap from 3 to 6 commissioned biologics. For PsA, the figures were 54% with no cap and 46% with variable capping between 2-5 biologics allowed, for AS the figures were 51% and 49% respectively. In total this represented 41 different local pathways for RA, 29 different pathways for PsA and in AS where fewer biologics choices exist, 25 different pathways depending on CCG and location. Conclusion There is wide regional variation in the interpretation of NICE guidance by CCG’s resulting in many different local pathways depending on geography. Approximately 50% of pathways restricted biologics prescribing by mandating the type and sequence of biologics used, potentially compromising patient care and delaying treatment by requiring an IFR for a NICE approved biologic. Moreover, pathways varied as to which biologics could be used at any point of management by region as well. As exemplars of good practice, approximately 50% of CCG’s had no cap, allowing clinical freedom to prescribe the most appropriate biologic. The results of this national study demonstrate the variability of biologics pathways in many areas of England ensuring a postcode lottery still exists in many regions. Disclosure J. Mistry: None. D. Hill: None. A. Bosworth: None. A. Kaul: None.

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Regional Variability in COVID-19 Case Fatality Rate in Canada, February–December 2020

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041839 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1839

Author(s):

Eunha Shim

Keyword(s):

British Columbia ◽

Case Fatality Rate ◽

Case Reports ◽

Case Fatality ◽

Health Interventions ◽

Fatality Rate ◽

Older Individuals ◽

Regional Variability ◽

Provincial Level ◽

Mortality Burden

A total of 475,214 COVID-19 cases, including 13,659 deaths, had been recorded in Canada as of 15 December 2020. The daily reports of confirmed cases and deaths in Canada prior to 15 December 2020 were obtained from publicly available sources and used to examine regional variations in case fatality rate (CFR). Based on a factor of underestimation and the duration of time from symptom onset to death, the time-delay adjusted CFR for COVID-19 was estimated in the four most affected provinces (Quebec, Ontario, Alberta, and British Columbia) and nationwide. The model-based adjusted CFR was higher than the crude CFR throughout the pandemic, primarily owing to the incorporation in our estimation of the delay between case reports and deaths. The adjusted CFR in Canada was estimated to be 3.36% nationwide. At the provincial level, the adjusted CFR was the highest in Quebec (5.13%)—where the proportion of deaths among older individuals was also the highest among the four provinces—followed by Ontario (3.17%), British Columbia (1.97%), and Alberta (1.13%). Provincial-level variations in CFR were considerable, suggesting that public health interventions focused on densely populated areas and elderly individuals can ameliorate the mortality burden of the COVID-19 pandemic.

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23. Regional Variation in Outpatient Antibiotic Prescribing in a Commercially-insured Population, United States, 2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa417.022 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S12-S12

Author(s):

Destani J Bizune ◽

Danielle Palms ◽

Laura M King ◽

Monina Bartoces ◽

Ruth Link-Gelles ◽

...

Keyword(s):

United States ◽

Otitis Media ◽

Acute Otitis Media ◽

Urgent Care ◽

Antibiotic Prescribing ◽

Tier 2 ◽

Regional Variability ◽

Patient Age ◽

Patient Âgé ◽

Tier 3

Abstract Background Studies have shown that the Southern United States has higher rates of outpatient antibiotic prescribing compared to other regions in the country, but reasons for this variation are unclear. We aimed to determine whether the regional variability in outpatient antibiotic prescribing for respiratory diagnoses can be explained by differences in patient age, care setting, comorbidities, and diagnosis in a commercially-insured population. Methods We analyzed the 2017 IBM® MarketScan® Commercial Database of commercially-insured individuals aged < 65 years. We included visits with acute respiratory tract infection (ARTI) diagnoses from retail clinics, urgent care centers, emergency departments, and physician offices. ARTI diagnoses were categorized as: Tier 1, antibiotics are almost always indicated (pneumonia); Tier 2, antibiotics are sometimes indicated (sinusitis, acute otitis media, pharyngitis); and Tier 3, antibiotics are not indicated (asthma, allergy, bronchitis, bronchiolitis, influenza, nonsuppurative otitis media, viral upper respiratory infections, viral pneumonia). We calculated risk ratios and 95% confidence intervals (CI) stratified by US Census region and ARTI tier using log-binomial models controlling for patient age, comorbidities (Elixhauser and Complex Chronic Conditions for Children), and setting of care, with Tier 3 visits in the West, the strata with the lowest antibiotic prescription rate, as the reference for all strata. Results A total of 100,104,860 visits were analyzed. In multivariable modeling, ARTI visits in the South and Midwest were highly associated with receiving an antibiotic for Tier 2 conditions vs. patients in other regions (Figure 1). Figure 1. Multivariable model comparing risk of receiving an antibiotic for an ARTI by region and diagnostic tier in urgent care, retail health, emergency department, and office visits, MarketScan® 2017, United States Conclusion Regional variability in outpatient antibiotic prescribing for Tier 2 and 3 ARTIs remained even after controlling for patient age, comorbidities, and setting of care. It is likely that this variability is in part due to non-clinical factors such as regional differences in clinicians’ prescribing habits and patient expectations. Targeted and enhanced public health stewardship interventions are needed to address cultural factors that affect antibiotic prescribing in outpatient settings. Disclosures All Authors: No reported disclosures

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Trends in the Prevalence of Dementia in Japan

International Journal of Alzheimer s Disease ◽

10.1155/2012/956354 ◽

2012 ◽

Vol 2012 ◽

pp. 1-11 ◽

Cited By ~ 19

Author(s):

Hiroko H. Dodge ◽

Teresa J. Buracchio ◽

Gwenith G. Fisher ◽

Yutaka Kiyohara ◽

Kenichi Meguro ◽

...

Keyword(s):

Diagnostic Criteria ◽

Large Population ◽

National Level ◽

Population Attributable Risk ◽

Vascular Diseases ◽

Epidemiological Studies ◽

Regional Variability ◽

Large Variability ◽

Dementia Prevalence ◽

Over Time

There is a paucity of data regarding trends in dementia and its subtype prevalence in Japan. Our aims in the current paper are to: (1) summarize epidemiological studies of dementia in Japan including relevant details of study protocol and diagnostic criteria, (2) compare the age-specific prevalence of all-cause dementia among studies, and (3) assess the trends in Alzheimer's disease (AD) versus vascular dementia (VaD) over time. We reviewed diagnostic criteria, all-cause dementia prevalence, and the AD/VaD ratio from 8 large population studies of dementia in Japan. Compared with the Okinawa 1992 study, studies conducted in 1994, 1998, 2005, and 2008 had a higher prevalence of all-cause dementia using Poisson regression models, after controlling for age and sex. In contrast to the US and some European countries, all-cause dementia prevalence is increasing in Japan. The prevalence of AD as opposed to VaD seems to be increasing over time, but large variability in diagnostic criteria, possible regional variability, and differences in prevalence of subtypes of dementia between men and women make it difficult to draw a conclusion about this trend at the national level. Further studies, for example, comparing the population attributable risk of vascular diseases to the prevalence and incidence of dementia could help to clarify the regional variations in etiological subtypes.

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Influence of microbial species on small intestinal myoelectric activity and transit in germ-free rats

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.2001.280.3.g368 ◽

2001 ◽

Vol 280 (3) ◽

pp. G368-G380 ◽

Cited By ~ 157

Author(s):

Einar Husebye ◽

Per M. Hellström ◽

Frank Sundler ◽

Jie Chen ◽

Tore Midtvedt

Keyword(s):

Small Intestine ◽

Intestinal Microflora ◽

Burst Activity ◽

Intestinal Transit ◽

Myoelectric Activity ◽

Regular Spike ◽

Spike Burst ◽

Germ Free ◽

Microbial Species ◽

Small Intestinal

The effect of an intestinal microflora consisting of selected microbial species on myoelectric activity of small intestine was studied using germ-free rat models, with recording before and after specific intestinal colonization, in the unanesthetized state. Intestinal transit, neuropeptides in blood (RIA), and neuromessengers in the intestinal wall were determined. Clostridium tabificum vp 04 promoted regular spike burst activity, shown by a reduction of the migrating myoelectric complex (MMC) period from 30.5 ± 3.9 min in the germ-free state to 21.2 ± 0.14 min ( P < 0.01). Lactobacillus acidophilus A10 and Bifidobacterium bifidum B11 reduced the MMC period from 27.9 ± 4.5 to 21.5 ± 2.1 min ( P < 0.02) and accelerated small intestinal transit ( P < 0.05). Micrococcus luteus showed an inhibitory effect, with an MMC period of 35.9 ± 9.3 min compared with 27.7 ± 6.3 min in germ-free rats ( P < 0.01). Inhibition was indicated also for Escherichia coli X7gnotobiotic rats. No consistent changes in slow wave frequency were observed. The concentration of neuropeptide Y in blood decreased after introduction of conventional intestinal microflora, suggesting reduced inhibitory control. Intestinal bacteria promote or suppress the initiation and aboral migration of the MMC depending on the species involved. Bacteria with primitive fermenting metabolism (anaerobes) emerge as important promoters of regular spike burst activity in small intestine.

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