News Article | May 4, 2017
According to Molly Moilanen, co-chair of Minnesotans for a Smoke-Free Generation, a coalition of more than 50 health organizations, "Almost 95 percent of adult smokers started by 21. That means to prevent addiction, we must keep people from starting before then. Raising the tobacco age will help do that." A national consensus is growing to prevent addictions and future health problems by raising the sales age for tobacco products to 21. Two states and more than 220 cities and counties throughout the United States have raised the tobacco age. Edina was the first city in Minnesota to raise the smoking age earlier this week. Minnesotans for a Smoke-Free Generation is a coalition of Minnesota organizations that share a common goal of saving Minnesota youth from a lifetime of addiction to tobacco. Each year in Minnesota tobacco use is responsible for more than 6,300 deaths and more than $3 billion in preventable health care costs. 95 percent of adult smokers started before the age of 21. The coalition supports policies that prevent initiation and reduce youth smoking, including keeping tobacco prices high, raising the tobacco sale age to 21, limiting access to candy-, fruit- and menthol-flavored tobacco and funding future tobacco prevention programs. Partners include: A Healthier Southwest, African American Leadership Forum, Allina Health, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association in Minnesota, Apple Tree Dental, Association for Nonsmokers – Minnesota, Becker County Energize, Blue Cross and Blue Shield of Minnesota, CentraCare Health, Children's Defense Fund – Minnesota, Children's Hospitals and Clinics of Minnesota, ClearWay MinnesotaSM, Comunidades Latinos Unidas En Servicio – CLUES, Essentia Health, Four Corners Partnership, Gillette Children's Specialty Healthcare, HealthEast, HealthPartners, Hennepin County Medical Center, Hope Dental Clinic, Indigenous Peoples Task Force, ISAIAH, LAAMPP Institute, Lake Region Healthcare, Lincoln Park Children and Families Collaborative, Local Public Health Association of Minnesota, March of Dimes, Mayo Clinic, Medica, Minnesota Academy of Family Physicians, Minnesota Association of Community Health Centers, Minnesota Cancer Alliance, Minnesota Chapter of the American Academy of Pediatrics, Minnesota Council of Health Plans, Minnesota Hospital Association, Minnesota Medical Association, Minnesota Oral Health Coalition, Minnesota Public Health Association, Model Cities of St. Paul, Inc., NAMI Minnesota, North Memorial Health Care, NorthPoint Health and Wellness Center, PartnerSHIP 4 Health, Perham Health, Rainbow Health Initiative, SEIU Healthcare Minnesota, St. Paul Chamber of Commerce, Tobacco Free Alliance, Twin Cities Medical Society, UCare and WellShare International. Find out more at: smokefreegenmn.org. To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/legislation-would-raise-minnesotas-smoking-age-to-21-300451619.html
News Article | May 4, 2017
Digi Smart Solutions help organizations comply with public health requirements and food safety regulations set by the U.S. Food and Drug Administration (FDA), the U.S. Department of Agriculture (USDA) and Centers for Disease Control and Prevention (CDC). "With the wealth of our assets and expertise we have best-in-class products for local businesses as well as international enterprises. Our solutions span the entire chain of custody to help companies achieve operational efficiencies, complete visibility and verification of compliance," said Kevin C. Riley, Digi's chief operating officer who oversees the Smart Solutions group. "Additionally, as markets' needs continue to unfold, we'll be able to update our products to address those changes." A Tailored Solution for Each Industry Digi Smart Solutions address the day-to-day issues of maintaining product quality and safety while lowering costs and achieving overarching goals of higher customer satisfaction and brand reputation. They also address the needs of customers with unique challenges that span operational and safety regulatory requirements. Digi has established itself as a clear leader with more than 10,000 locations under management, a combined 25 years of temperature management experience and more than 1 billion temperature sensor readings. A sample of current customers includes Tim Hortons, Love's Travel Stops, Hennepin County Medical Center, Rite Aid Corporation, and the University of Notre Dame. The Digi Smart Solutions group has three primary areas: Foodservice: Products are designed to address the wide variety of environments in the foodservice industry including Quick Service Restaurants (QSR), full service restaurants, corporate dining, grocery stores, convenience stores and food service operations within other locations (i.e. movie theaters, rest stops, etc.). The system helps customers meet stringent task management, food safety and sanitation needs to securely capture, document, and report equipment and food temperatures to meet and exceed the U.S. FDA's Food Safety Modernization Act (FSMA) and Model Food Code. The solutions streamline manual operational checklists and provide insight to managers on how well their teams are adhering to quality and food safety guidelines. In educational settings (K-12, higher education), Digi Smart Solutions allow local and state agencies to document and streamline processes for schools participating in Food and Nutrition Service (FNS) Child Nutrition Programs. These programs require a food safety program based on Hazard Analysis Critical Control Point (HACCP) principles that conform to guidance issued by the USDA. The guidelines address all aspects of foodservice (receiving, storing, preparing, cooking, cooling, reheating, holding, assembling, packaging, transporting and serving). Transportation and Logistics: Products provide real-time and location-based temperature monitoring. Recent innovations in GPS and low power wireless sensing technology give customers complete visibility throughout the transport chain. As part of the FSMA, the FDA issued new food safety rules to prevent food contamination during transportation. Specific areas of FSMA compliance include transport asset sanitation and pre-cooling, temperature control and tracking, temperature certification and data exchange, and data retention. Digi Smart Solutions transportation products follow HACCP and National Institute for Standards and Technology (NIST) standards to provide a traceable independent audit of both reefer units and product temperatures. For more information, see "Digi International Introduces Digi SafeTemps for Transportation and Logistics." Healthcare and Pharmacy: Digi Smart Solutions for healthcare provides task management and real-time temperature monitoring solutions of critical items in pharmacy, hospital, blood bank and laboratory settings, including vaccines, medications, and other critical items. For pharmaceuticals, Digi Smart Solutions helps support the CDC Guidelines for Vaccine Storage (2016), along with the various Board of Pharmacy standards and Department of Health Vaccine For Children requirements. Digi Smart Solutions are comprised of easy-to-install hand-held probes, wireless sensors, gateways and easy-to-use software that allow temperature data and tasks to be monitored, logged, and retrieved. Additionally, the solutions offer an open API for integration into back-office systems. Digi Smart Solutions are available in a variety of subscription-based models for HACCP and NIST environments, and requires no capital expense. Hardware and software are included as part of the subscription with information hosted on servers managed by Digi. About Digi International Digi International (NASDAQ: DGII) is a leading global provider of business and mission-critical machine-to-machine (M2M) and Internet of Things (IoT) connectivity products and services. We help our customers create next-generation connected products and deploy and manage critical communications infrastructures in demanding environments with high levels of security, relentless reliability and bulletproof performance. Founded in 1985, we've helped our customers connect over 100 million things, and growing. For more information, visit Digi's website at www.digi.com, or call 877-912-3444 (U.S.) or 952-912-3444 (International). To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/digi-international-cold-chain-solutions-relaunches-as-digi-smart-solutions-group-300451197.html
News Article | January 5, 2016
Dr. Uzma Samadani is chair for traumatic brain injury research at Hennepin County Medical Center and associate professor of neurosurgery at the University of Minnesota. Dr. Robert Glatter is director of sports medicine and traumatic brain injury in the Department of Emergency Medicine at Lenox Hill Hospital and assistant professor at the Hofstra North Shore-LIJ School of Medicine. The authors and four colleagues recently published "The Football Decision" (Amazon Digital Services, 2015) and contributed this related article to Live Science's Expert Voices: Op-Ed & Insights. You hear about it in news stories and see it in movies: People are struggling to understand what the risk is of a concussion causing long-term brain damage. Their biggest fear is that they will develop chronic traumatic encephalopathy (CTE), which results in abnormal deposits of proteins in the brain, possibly causing a severe form of early onset dementia. Despite its discovery in 1957 by renowned neurologist Dr. Macdonald Critchley, CTE was only recently defined, diagnostically, by a U.S. National Institutes of Health (NIH)-funded committee, when the members met to spell out CTE criteria in February 2015. Now, with the opening of the movie "Concussion," starring Will Smith, which tells the story of Dr. Bennet Omalu, the pathologist who discovered CTE in Mike Webster and several other NFL players, more attention is being paid to the long-term risks associated with concussions . The movie is an emotional portrayal of patients with CTE, and resulted in a recent editorial by Dr. Omalu calling for a ban on football, hockey and soccer in children under the age of 18. [Concussions Linked to Brain Changes in Former NFL Players ] But is a ban for children in sports the right answer? The public response that followed Dr. Omalu's editorial about an all-out ban has been mixed. Some people have said that they believe that this goes way too far, with potentially negative implications for a child's social and emotional development. Other parents who are fearful of CTE have said that, until we have further information about the exact mechanisms and genetic influences that define a higher-risk profile for developing CTE, it might be safest to put such a ban in place. There are three reasons why a ban is the wrong answer. First, it's impossible to legislate away all adolescent risk-taking behaviors. The adolescent brain is not fully myelinated — the nerves have not fully attained their coverings. Rather than sending signals through relatively few established pathways, as it does in adults, the brain tries multiple pathways. Thus, the adolescent brain has high synaptic plasticity (the ability to change direction) and is wildly creative, relative to the more inhibited, fully myelinated — and degenerating — adult brain. Legislation won't change this biological fact: Children are more impulsive, less restrained and more inclined to take risks. Football is on the riskier end of the spectrum of sports: In tackle football, there are about 10 deaths per million participants per year (not all due to brain trauma), but it is still less risky than equestrian sports (20 deaths per million per year) and skiing, snowboarding, skateboarding or bicycling (each with 10 to 15 deaths per million per year). The second reason not to eliminate tackle football is that it's not entirely clear that eliminating all risk-taking behaviors from childhood is in the interest of our society. When they're playing football, children learn to assess risk based not only on their own capabilities, but also on the capabilities of their teammates, who are there to protect the other members of the team and work for everyone's interests. This capacity for rapid risk assessment and plan execution, and the reliance on teamwork and the assessment of evolving challenges may serve our children well in their later professional lives. Without the experience of some risk in childhood, we might not have adults who engage in risk-taking behaviors — like astronauts, explorers, entrepreneurs, fire rescue personnel or surgeons, for example. In our book, "The Football Decision," we surveyed neurosurgical department chairs and brain injury experts, and found that they are at least 16 times more likely than typical undergraduates to have played contact sports in college. They are 1.5 times more likely than the average American to have sustained a concussion. And, 83 percent of neurosurgeons would allow their own children to play contact sports.
Bart G.,Hennepin County Medical Center |
Bart G.,University of Minnesota
Journal of Addictive Diseases | Year: 2012
Illicit use of opiates is the fastest growing substance use problem in the United States, and the main reason for seeking addiction treatment services for illicit drug use throughout the world. It is associated with significant morbidity and mortality related to human immunodeficiency virus, hepatitis C, and overdose. Treatment for opiate addiction requires long-term management. Behavioral interventions alone have extremely poor outcomes, with more than 80% of patients returning to drug use. Similarly poor results are seen with medication-assisted detoxification. This article provides a topical review of the three medications approved by the Food and Drug Administration for long-term treatment of opiate dependence: the opioid-agonist methadone, the partial opioid-agonist buprenorphine, and the opioid-antagonist naltrexone. Basic mechanisms of action and treatment outcomes are described for each medication. Results indicate that maintenance medication provides the best opportunity for patients to achieve recovery from opiate addiction. Extensive literature and systematic reviews show that maintenance treatment with either methadone or buprenorphine is associated with retention in treatment, reduction in illicit opiate use, decreased craving, and improved social function. Oral naltrexone is ineffective in treating opiate addiction, but recent studies using extended-release naltrexone injections have shown promise. Although no direct comparisons between extended-release naltrexone injections and either methadone or buprenorphine exist, indirect comparison of retention shows inferior outcome compared with methadone and buprenorphine. Further work is needed to directly compare each medication and determine individual factors that can assist in medication selection. Until such time, selection of medication should be based on informed choice following a discussion of outcomes, risks, and benefits of each medication. © 2012 Taylor and Francis Group, LLC.
Sandoval Y.,Hennepin County Medical Center |
Smith S.W.,Hennepin County Medical Center |
Thordsen S.E.,Hennepin County Medical Center |
Apple F.S.,University of Minnesota
Journal of the American College of Cardiology | Year: 2014
Supply/demand (type 2) myocardial infarction is a commonly encountered clinical challenge. It is anticipated that it will be detected more frequently once high-sensitivity cardiac troponin assays are approved for clinical use in the United States. We provide a perspective that is based on available data regarding the definition, epidemiology, etiology, pathophysiology, prognosis, management, and controversies regarding type 2 myocardial infarction. Understanding these basic concepts will facilitate the diagnosis and treatment of these patients as well as ongoing research efforts. © © 2014 by the American College of Cardiology Foundation Published by Elsevier Inc.
Schmidt A.H.,Hennepin County Medical Center
Journal of Orthopaedic Trauma | Year: 2011
Objectives: To compare hospital charges and length of stay in a series of adult patients with isolated, otherwise uncomplicated tibia fractures with and without acute compartment syndrome (ACS). Design: Retrospective case-control study. Setting: Urban Level I trauma center. Patients: Forty-six previously healthy adults with isolated tibia fractures (open or closed), with or without ACS but without other complication, associated injury, or social circumstance that influenced hospital stay or charges. Intervention: Intramedullary nailing in all patients with immediate fasciotomy and delayed fasciotomy closure in the subset of patients who developed ACS. Main Outcome Measure: Hospital length of stay in days and hospital charges. Results: Forty-six otherwise uncomplicated patients with isolated tibial shaft fractures were identified. Twelve fractures were open. ACS occurred in five patients, all with closed fractures. In 41 patients without ACS (12 open fractures, 29 closed fractures), the mean hospital stay was 3.0 days and mean hospital charges were $23,800. The five patients with ACS underwent a mean of 1.6 additional surgeries to treat the fasciotomy wound, were hospitalized for a mean of 9.0 days, and the mean hospital charges were $49,700. These differences were highly significant for hospital stay (P < 0.005) and charges (P < 0.00004). In contrast, there were no differences in length of stay or hospital charges in patients with closed or open fractures, respectively. Conclusion: The cost of ACS is significant, resulting in hospital stays that are increased threefold and hospital charges that are more than doubled in this cohort of patients. The impact of compartment syndrome on these factors was more important than whether the fracture was open or closed. In addition to the obvious benefit to the patient, methods that decrease the incidence of compartment syndrome and need for fasciotomy such as improved diagnosis to prevent unnecessary fasciotomy and methods to reduce intramuscular pressure and avoid fasciotomy in cases of incipient ACS would also be of value in reducing medical costs. Copyright © 2011 by Lippincott Williams & Wilkins.
Baker J.V.,Hennepin County Medical Center
Journal of the American Heart Association | Year: 2013
HIV infection leads to activation of coagulation, which may increase the risk for atherosclerosis and venous thromboembolic disease. We hypothesized that HIV replication increases coagulation potentially through alterations in extrinsic pathway factors. Extrinsic pathway factors were measured among a subset of HIV participants from the Strategies for Management of Anti-Retroviral Therapy (SMART) trial. Thrombin generation was estimated using validated computational modeling based on factor composition. We characterized the effect of antiretroviral therapy (ART) treatment versus the untreated state (HIV replication) via 3 separate analyses: (1) a cross-sectional comparison of those on and off ART (n=717); (2) a randomized comparison of deferring versus starting ART (n=217); and (3) a randomized comparison of stopping versus continuing ART (n=500). Compared with viral suppression, HIV replication consistently showed short-term increases in some procoagulants (eg, 15% to 23% higher FVIII; P<0.001) and decreases in key anticoagulants (eg, 5% to 9% lower antithrombin [AT] and 6% to 10% lower protein C; P<0.01). The net effect of HIV replication was to increase coagulation potential (eg, 24% to 48% greater thrombin generation from computational models; P<0.01 for all). The pattern of changes from HIV replication was reversed with ART treatment and consistent across all 3 independent comparisons. HIV replication leads to complex changes in extrinsic pathway factors, with the net effect of increasing coagulation potential to a degree that may be clinically relevant. The key influence of changes in FVIII and AT suggests that HIV-related coagulation abnormalities may involve changes in hepatocyte function in the context of systemic inflammation.
Leatherman J.,Hennepin County Medical Center
Chest | Year: 2015
Acute exacerbations of asthma can lead to respiratory failure requiring ventilatory assistance. Noninvasive ventilation may prevent the need for endotracheal intubation in selected patients. For patients who are intubated and undergo mechanical ventilation, a strategy that prioritizes avoidance of ventilator-related complications over correction of hypercapnia was first proposed 30 years ago and has become the preferred approach. Excessive pulmonary hyperinflation is a major cause of hypotension and barotrauma. An appreciation of the key determinants of hyperinflation is essential to rational ventilator management. Standard therapy for patients with asthma undergoing mechanical ventilation consists of inhaled bronchodilators, corticosteroids, and drugs used to facilitate controlled hypoventilation. Nonconventional interventions such as heliox, general anesthesia, bronchoscopy, and extracorporeal life support have also been advocated for patients with fulminant asthma but are rarely necessary. Immediate mortality for patients who are mechanically ventilated for acute severe asthma is very low and is often associated with out-of-hospital cardiorespiratory arrest before intubation. However, patients who have been intubated for severe asthma are at increased risk for death from subsequent exacerbations and must be managed accordingly in the outpatient setting. © 2015 AMERICAN COLLEGE OF CHEST PHYSICIANS.
Johnson A.R.,Hennepin County Medical Center
Foot & ankle specialist | Year: 2011
Frostbite can be a devastating and even debilitating injury. Early identification and proper treatment of frostbite is critical in saving digits and limbs. Tissue plasminogen activator (tPA) has been shown to be effective in reducing the number of digits amputated after severe frostbite injury. Nothing has been presented in the podiatric literature regarding the use of tPA in treating frostbite patients for preserving toes and feet. Intravenous tPA and IV heparin were used to treat severe frostbite injuries that did not show improvement after rapid rewarming, had absent Doppler pulses in the distal limb or digits, showed limited or no perfusion by Tc-99 3-phase bone scan, and had no contraindications to use of tPA. All 11 patients included in this study were treated at Hennepin County Medical Center between 2008 and 2010. A total of 73 digits (upper and lower extremity) were considered at risk for amputation after evaluation with Tc-99 bone scan. Of those digits that were affected, 43 were amputated. Intravenous tPA is a safe and effective treatment to reduce the number of digital amputations after severe frostbite injury. The authors' protocol for treating severe frostbite includes the use of tPA. Levels of Evidence: Therapeutic, Level IV.
Kinney T.,Hennepin County Medical Center
Surgical Clinics of North America | Year: 2010
A high-quality pancreatic protocol computed tomography (CT) is the primary imaging modality for diagnosing and staging pancreatic malignancy. The main limitation of CT is the lack of sensitivity for early pancreatic lesions. Endoscopic ultrasound (EUS) provides an excellent complement to CT for both diagnosis and staging of pancreatic cancer, and allows easy access for needle aspiration and tissue diagnosis. Magnetic resonance (MR) can be helpful for evaluating small hepatic nodules or cystic lesions of the pancreas, but in general, the role of MR and positron emission tomography remains limited to special situations when the results of CT and EUS are equivocal. © 2010 Elsevier Inc.