Learning efficient representations for concepts has been proven to be an important basis for many applications such as machine translation or document classification. Proper representations of medical concepts such as diagnosis, medication, procedure codes and visits will have broad applications in healthcare analytics. However, in Electronic Health Records (EHR) the visit sequences of patients include multiple concepts (diagnosis, procedure, and medication codes) per visit. This structure provides two types of relational information, namely sequential order of visits and co-occurrence of the codes within each visit. In this work, we propose Med2Vec, which not only learns distributed representations for both medical codes and visits from a large EHR dataset with over 3 million visits, but also allows us to interpret the learned representations confirmed positively by clinical experts. In the experiments, Med2Vec displays significant improvement in key medical applications compared to popular baselines such as Skipgram, GloVe and stacked autoencoder, while providing clinically meaningful interpretation.

Importance Certain individuals, when infected by SARS-CoV-2, tend to develop the more severe forms of Covid-19 illness for reasons that remain unclear. Objective To determine the demographic and clinical characteristics associated with increased severity of Covid-19 infection. Design Retrospective observational study. We curated data from the electronic health record, and used multivariable logistic regression to examine the association of pre-existing traits with a Covid-19 illness severity defined by level of required care: need for hospital admission, need for intensive care, and need for intubation. Setting A large, multihospital healthcare system in Southern California.

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Glucose-induced β-cell action potential (AP) repolarization is regulated by potassium efflux through voltage gated (Kv) and calcium activated (K Ca ) potassium channels. Thus, ablation of the primary Kv channel of the β-cell, Kv2.1, causes increased AP duration. However, Kv2.1 −/− islet electrical activity still remains sensitive to the potassium channel inhibitor tetraethylammonium. Therefore, we utilized Kv2. −/− mouse islet AP repolarization. Inhibition of SK channels decreased AP firing frequency by 66% and increased AP duration by 67% only when Kv2.1 is ablated or inhibited and enhanced GSIS by 2.7-fold. Human islets also express SK3 channels and their β-cell AP frequency is significantly accelerated by 4.8-fold with apamin. These results uncover important repolarizing roles for both Kv and K Ca channels and identify distinct roles for SK channel activity in regulating calcium-versus sodium-dependent AP firing.

Abstract. Background: Many people rely on EDs for routine health care. Often, however, screening and counseling for health risks are not provided. Objective: To determine prevalence rates of chronic disease and injury risk factors and access to routine health care in a random sample of ED patients in 3 cities. Methods: A prospective survey was conducted a t 3 hospital EDs in Akron, OH, Boston, MA, and Denver, CO. A modified version of the national Behavioral Risk Factor Surveillance Survey was administered by trained researchers to a convenience sample of noncritically ill patients during randomly selected shifts. Results: Of 1,143 eligible patients, 923 (81%) agreed to participate. Their mean age was 39 (range = 17-96) years. Most were female (58%), white (60%), and unmarried (68%). Thirty-eight percent had no access to primary care. Injury-prone behaviors were prevalent: 53% of the respondents did not wear seat belts regularly; 15% had no working smoke detector; 3% kept loaded, unlocked handguns in their homes; 11% had attempted suicide; 23% had a positive CAGE screen for alcoholism; 3% had operated a motor vehicle in the preceding month while alcohol-intoxicated; and 11% had ridden in an automobile with an intoxicated driver. Cancer and chronic disease risks were also common: 48% smoked; 16% had not received a blood pressure check in the preceding year; and 4% reported unsafe sexual practices. Among women aged >50 years, 42% had not received a Pap test in the prior 2 years and 14% had never had mammography. Many prevalence rates and access to care varied among the 3 sites. However, for most risk factors, prevalence rates did not differ in patients with and without access to primary health care. Conclusions: ED patients have high rates of injury and chronic disease risks, and many have no other source of routine health care. Research is needed to determine whether ED-based programs, designed to reduce injury and chronic disease risks, are feasible and cost-effective. Key words: risk factor surveillance; injury prevention; emergency medicine; screening. ACADEMIC EMERGENCY MEDICINE 1998; 5~781-787 ACH YEAR >90 million patients seek care in E hospital-based EDs.'.* Many of the conditions for which they seek treatment, including falls, traffic-related injuries, alcohol and drug intoxication, interpersonal violence, tobacco-related illnesses, and sexually transmitted diseases, arise from high-risk behaviors and lifestyles and are preventable. In 1994 SAEM concluded that emergency care "include[sl preventive and educational, as well as curative, medical s e r~i c e s . "~ SAEM as-

Continuous hydride generation, using sodium tetrahydroborate(ll1) as a reductant in conjunction with atomic absorption spectrometry (AAS) and inductively coupled plasma atomic emission spectrometry (ICP-AES), has been used to form arsines selectively from arsenate (Asv), arsenite (AsV, monomethylarsonic acid (MMAA) and dimethylarsinic acid (DMAA). The reaction media studied have been shown to allow the rapid determination of As111 alone, DMAA alone, Aslll + AsV and "total" arsenic, i.e., As111 + AsV + MMAA + DMAA.Interference effects produced by heavy metal ions are suppressed by the addition of masking agents.

Irradiation of dimethylpyridine vapors (2-5 Torr) at 254 nm results in the formation of two sets of isomerization products. One set, formed in the larger yield, is substantially quenched when the irradiations are carried out in the presence of 15-21 Torr of nitrogen and is not formed when the irradiations are carried out with light of λ > 290 nm. In addition, a second set of reactions, which involve the interconversion of 2,3-and 2,5-dimethylpyridines, is enhanced by the addition of nitrogen, and these reactions are the only photoisomerization reactions observed when the irradiations are carried out with light of λ > 290 nm. In addition to the photoisomerizations, four of the dimethylpyridines also undergo demethylation to yield monomethylpyridines, and 2,6-dimethylpyridine undergoes methylation to yield a trimethylpyridine product. A variety of crossover experiments confirmed that the photoisomerizations are intramolecular. Based on the major phototransposition products, the six dimethylpyridines can be divided into two triads. Interconversion of the three members of each triad results in the major phototransposition products. These intra-triad interconversions are suggested to occur via 2,6-bonding, originating in a vibrationally excited S 2 (π,π*) state of the dimethylpyridine, followed by nitrogen migration and rearomatization. This allows nitrogen to insert within each carbon-carbon bond. Phototransposition of 2,6-dideuterio-3,5-dimethylpyridine to a mixture of 5,6-dideuterio-2,4-dimethylpyridine and 3,4-dideuterio-2,5-dimethylpyridine is consistent with this mechanism. In addition to these intra-triad reactions, 2,5-dimethylpyridine, a member of triad 1, was observed to interconvert with 2,3-dimethylpyridine, a member of triad 2. These inter-triad reactions are suggested to occur via interconverting Dewar pyridine intermediates, formed from the triplet state of the dimethylpyridines. These Dewar pyridine intermediates were also observed by 1 H NMR spectroscopy after irradiation of the dimethylpyridines in CD 3 CN at -30 °C.

Rajan S, Torres J, Thompson MS, Philipson LH. SUMO downregulates GLP-1-stimulated cAMP generation and insulin secretion. Am J Physiol Endocrinol Metab 302: E714 -E723, 2012. First published January 10, 2012; doi:10.1152/ajpendo.00486.2011.-Glucagon-like peptide-1 (GLP-1)-based incretin therapy is becoming central to the treatment of type 2 diabetes. Activation of incretin hormone receptors results in rapid elevation of cAMP followed by enhanced insulin secretion. However, the incretin effect may be significantly impaired in diabetes. The objective of this study is to investigate downregulation of GLP-1 signaling by small ubiquitin-related modifier protein (SUMO). Mouse islets exposed to high glucose showed increased expression of endogenous SUMO transcripts and its conjugating enzyme Ubc-9. Overexpression of SUMO-1 in mouse insulinoma 6 (MIN6) cells and primary mouse ␤-cells resulted in reduced static and real-time estimates of intracellular cAMP upon receptor stimulation with exendin-4, a GLP-1 receptor (GLP-1R) agonist. GLP1-R was covalently modified by SUMO. Overexpression of SUMO-1 attenuated cell surface trafficking of GLP-1R, which resulted in significantly reduced insulin secretion when stimulated by exendin-4. Partial knock down of SUMO-conjugating enzyme Ubc-9 resulted in enhanced exendin-4-stimulated insulin secretion in mouse islets exposed to high glucose. Thus, SUMO modification of the GLP-1R could be a contributing factor to reduced incretin responsiveness. Elucidating mechanisms of GLP-1R regulation by sumoylation will help improve our understanding of incretin biology and of GLP-1-based treatment of type 2 diabetes.