a micro-bead device to explore plasmodium falciparum-infected, spherocytic or aged red blood cells...

RESEARCH ARTICLE Open Access Depression is associated with longer emergency department length of stay in acute coronary syndrome patients Donald Edmondson 1* , Jonathan D Newman 1 , Melinda J Chang 2 , Peter Wyer 3 and Karina W Davidson 1 Abstract Background: Patient demographic characteristics have been associated with longer emergency department (ED) treatment times, but the influence of psychosocial characteristics has not been assessed. We evaluated whether depression was associated with greater ED length of stay (LOS) in non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA) patients presenting to a large metropolitan academic medical center. Methods: We calculated ED LOS for NSTEMI or UA patients enrolled an observational cohort study by taking the difference between ED triage time in the medical record and time of transfer to an inpatient bed from standardized transfer documentation forms. Depression status was defined as current, past, or never by clinical interview and also by self-report on the Beck Depression Inventory. Results: Participants were 120 NSTEMI/UA patients [mean age= 62, 36% women, 56% Hispanic, 26% Black/African American, 40% NSTEMI, mean global registry of acute cardiac events (GRACE) score= 93.9]. Mean ED LOS was 11.6 hours, SD= 8.3. A multiple linear regression model that included the above demographic and clinical variables, and time of presentation to ED, explained 11% of the variance in ED LOS, F (11, 108)= 2.35, p= .01, R 2 adj.= .11. Currently depressed patients spent 5.4 more hours (95% CI= .40, 10.4 hours) in the ED on average than patients who had never been depressed. Conclusions: Currently depressed NSTEMI/UA patients are in the ED for an average of 5 hours longer than those who have never been depressed. Further research is needed to identify the reasons for this difference. Keywords: Emergency department length of stay, Crowding, Depression Background Thirty percent of acute coronary syndrome [ACS; unstable angina (UA), ST-elevation myocardial infarction (STEMI), and non-ST elevation myocardial infarction (NSTEMI)] patients report substantial depression symp- toms during hospitalization, and those patients are at nearly twice the risk of their non-depressed counterparts for ACS recurrence or mortality [1,2]. However, mechan- isms for the association between depression and adverse clinical outcome are still in question. The emergency department (ED) is the first point of contact with the medical system for the majority of patients treated for ACS, and recent research suggests that psychosocial factors may influence aspects of the interaction of the patient and emergency care [3,4]. Emergency department length of stay (LOS) is a key marker of ED performance, and longer ED LOS may be associated with adverse clinical outcomes for some condi- tions [5], in particular those with ACS. Indicators of ED performance have been associated with adverse cardiovascular outcomes in patients who present with chest pain [6], and with worse psychiatric outcomes in ACS patients [7], so we sought to determine whether depressed ACS patients experienced different ED care than non- depressed ACS patients. A number of institutional factors such as hospital occupancy, number of surgical admissions, number of geographically proximate EDs, and number of ED admissions have been associated with longer * Correspondence: [email protected] 1 Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, USA Full list of author information is available at the end of the article © 2012 Edmondson et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Edmondson et al. BMC Emergency Medicine 2012, 12:14 http://www.biomedcentral.com/1471-227X/12/14

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Page 1: A micro-bead device to explore Plasmodium falciparum-infected, spherocytic or aged red blood cells prone to mechanical retention by spleen endothelial slits

ORAL PRESENTATION Open Access

A micro-bead device to explore Plasmodiumfalciparum-infected, spherocytic or aged redblood cells prone to mechanical retention byspleen endothelial slitsGuillaume Deplaine1,2,3†, Innocent Safeukui1,2*†, Fakhri Jeddi3, François Lacoste4, Valentine Brousse5, Sylvie Perrot1,2,Sylvestre Biligui3,6, Micheline Guillotte1,2, Corinne Guitton7, Safi Dokmak8, Béatrice Aussilhou8, Alain Sauvanet8,Anne Couvelard9, François Paye10, Marc Thellier3,6, Dominique Mazier3,6, Geneviève Milon11, Narla Mohandas12,Odile Mercereau Puijalon1,2, Peter H David1,2, Pierre A Buffet3,6

From Parasite to Prevention: Advances in the understanding of malariaEdinburgh, UK. 20-22 October 2010

Experimental tools to identify human red blood cells(RBC) prone to mechanical retention upstream fromthe spleen venous sinus inter-endothelial slits are cur-rently suboptimal. We designed a micro-bead devicemimicking the geometry of the human narrow andshort inter-endothelial slits. Upon filtration through amixture of 5-25 μm diameter micro-beads, Plasmodiumfalciparum-hosting RBC (Pf-RBC) were retained in aparasite developmental stage-dependent way, the reten-tion rates of a subset of ring-RBC being similar inmicro-beads and in isolated-perfused human spleens.We found that this retention might be linked principallyto the reduced surface-area-to-volume ratio of Pf-RBC.Interestingly, other rigid RBC, such as heat-treated RBC,and RBC from hereditary spherocytosis patients werealso retained in micro-beads without any hemolysis.Micro-beads allow (i) depletion of heterogeneous RBCpopulation from its rigid-RBC subpopulation ii) charac-teriziation of distinct molecular signatures of rigid ver-sus deformable RBC subpopulations. This simplemethod portends wide medical applications, such as

improving the quality of stored RBC concentrates priorto transfusion.

Author details1Institut Pasteur, Unité d’Immunologie Moléculaire des Parasites, Départementde Parasitologie Mycologie, F- 75015 Paris, France. 2CNRS, URA2581, Paris,France. 3INSERM - UPMC (Paris 6 University) UMRs945, F-75013 Paris, France.4Fond Ackermann, Fondation de France. 5Department of Pediatrics, NeckerHospital, AP-HP, F-75015 Paris, France. 6Department of Parasitology, PitiéSalpétrière Hospital, AP-HP, F-75013 Paris, France. 7Department of Haematology,Kremlin-Bicêtre Hospital, AP-HP, F-94270 Le Kremlin-Bicêtre, France.8Department of Surgery, Beaujon Hospital, AP-HP, F-92110 Clichy, France.9Department of Pathology, Beaujon Hospital, AP-HP, F-92110 Clichy, France.10Department of Surgery, Saint-Antoine Hospital, AP-HP, F-75018 Paris, France.11Institut Pasteur, mmunophysiologie et Parasitisme Intracellulaire, Départementde Parasitologie Mycologie, F-75015 Paris, France. 12New York Blood Centre,New York, NY 10065, USA.

Published: 20 October 2010

doi:10.1186/1475-2875-9-S2-O10Cite this article as: Deplaine et al.: A micro-bead device to explorePlasmodium falciparum-infected, spherocytic or aged red blood cellsprone to mechanical retention by spleen endothelial slits. MalariaJournal 2010 9(Suppl 2):O10.

† Contributed equally1Institut Pasteur, Unité d’Immunologie Moléculaire des Parasites, Départementde Parasitologie Mycologie, F- 75015 Paris, FranceFull list of author information is available at the end of the article

Deplaine et al. Malaria Journal 2010, 9(Suppl 2):O10http://www.malariajournal.com/content/9/S2/O10

© 2010 Safeukui et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.

http://creativecommons.org/licenses/by/2.0

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