Showing papers by "Saint Francis University published in 2006"
TL;DR: The gold standard in the pharmacological treatment of glucocorticoid-induced osteoporosis in postmenopausal women involves the use of bisphosphonates, which should be started soon after beginning chronic glucoc Corticoid therapy.
Abstract: Glucocorticoid-induced osteoporosis occurs in two phases: a rapid, early phase in which bone mineral density is reduced, possibly as a result of excessive bone resorption, and a slower, progressive phase in which bone mineral density declines because of impaired bone formation. Although the indirect effects of glucocorticoids on bone are evident, their direct effects on osteoblasts, osteoclasts and osteocytes are primarily operative in the pathogenesis of glucocorticoid-induced osteoporosis. The management of patients exposed to glucocorticoids includes general health measures, sufficient calcium and vitamin D, and reducing the therapeutic regimen to the minimal effective dose. The gold standard in the pharmacological treatment of glucocorticoid-induced osteoporosis in postmenopausal women involves the use of bisphosphonates, which should be started soon after beginning chronic glucocorticoid therapy. Anabolic and alternative therapeutic strategies are currently under investigation in glucocorticoid-induced osteoporosis.
382 citations
TL;DR: Appropriate ICD shocks occur more frequently than SCD in patients with nonischemic cardiomyopathy, which suggests that episodes of nonsustained ventricular tachycardia frequently terminate spontaneously in such patients.
Abstract: Background— Ventricular tachyarrhythmias long enough to cause implantable cardioverter defibrillator (ICD) shocks are generally thought to progress to cardiac arrest. In previous ICD trials, shocks have been considered an appropriate surrogate for sudden cardiac death (SCD) because the number of shocks has been thought to be equivalent to the mortality excess in patients without ICDs. The practice of equating ICD shocks with mortality is controversial and has not been validated critically. Methods and Results— The Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) trial was a prospective, randomized, multicenter trial of ICD therapy in 458 patients with nonischemic cardiomyopathy. Patients were randomized to receive standard medical therapy (STD) or STD plus an ICD. Shock electrograms were reviewed, and the cause of death was evaluated by a separate blinded events committee. There were 15 SCD or cardiac arrests in the STD group and only 3 in the ICD arm. In contrast, of the 229 ...
294 citations
TL;DR: NICD overexpression prevents BMP-2 and Wnt biological effects by suppressing Wnt but not BMP signaling, and HES-1 appears to mediate effects of Notch on osteoblastogenesis.
206 citations
TL;DR: MAC, AAC, and AVS are associated with a significant risk of incident congestive heart failure, cardiovascular and all-cause mortalities, and worse outcome in older patients with preexisting cardiovascular disease.
Abstract: In the elderly, mitral annular calcification (MAC) and aortic valve sclerosis (AVS) are associated with increased cardiovascular morbidity and mortality. Aortic annular calcification (AAC) commonly occurs with MAC. However, the prognostic value of AAC, singly or in combination with MAC and AVS, for incident cardiovascular disease and mortality is unknown. From the Cardiovascular Health Study, we analyzed 3,782 participants (76 ± 5 years of age, 60% women) who had an echocardiogram at the 1994 to 1995 examination and who were prospectively followed for an average of 6.6 years (range 0.01 to 8.5). All 3 calcification categories were associated with incident congestive heart failure (MAC: hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.35 to 2.18, AAC: HR 1.62, 95% CI 1.28 to 2.06, and AVS: HR 1.50, 95% CI 1.19 to 1.89) and death. A stronger association with incident cardiovascular disease and mortality was observed with a larger number of calcification categories and with increased MAC severity. Moreover, in the participants with prevalent cardiovascular disease at echocardiographic examination (n = 1,054), MAC and AAC were still associated with cardiovascular mortality (MAC: HR 1.91, 95% CI 1.04 to 3.50; AAC: HR 2.11, 95% CI 1.16 to 3.85) even in fully adjusted models. In conclusion, MAC, AAC, and AVS are associated with a significant risk of incident congestive heart failure, cardiovascular and all-cause mortalities, and worse outcome in older patients with preexisting cardiovascular disease. Elderly patients with these findings represent a high-risk group and may require close medical attention.
96 citations
TL;DR: Five of the six known CCN genes are expressed by osteoblasts and their transcription is regulated by TGF beta, BMP-2 and cortisol.
88 citations
TL;DR: A history of childhood maltreatment, including reports of sexual abuse, does not appear to be a negative prognostic indicator for gastric bypass surgery, although the depression levels represented significant reductions from pre-surgery and fell within the non-depressed range.
Abstract: Background: The prognostic significance of sexual abuse for extremely obese patients who undergo bariatric surgery is uncertain. This study examined self-reported childhood sexual abuse and other forms of childhood maltreatment in relation to preoperative presentation and to 12-month postoperative outcomes in gastric bypass patients. Methods: 137 extremely obese patients undergoing gastric bypass surgery completed a questionnaire battery before surgery and again 12 months after surgery. Weight loss was determined with measured weight and height, childhood maltreatment was assessed with the Childhood Trauma Questionnaire, and associated eating disorder and psychological functioning were assessed with established measures. Results: 32% of patients self-reported childhood sexual abuse, 37% reported some form of non-sexual childhood abuse or neglect, and 31% reported no form of childhood maltreatment. Significant and clinically robust improvements in weight and in all measures of eating and psychological functioning were observed at 12 months after surgery. Patients who reported histories of childhood sexual abuse and other forms of childhood maltreatment differed little from patients who reported no childhood maltreatment in body mass index, eating disorder features, and psychological functioning both pre- and postoperatively at 12-month follow-up. Patients who reported childhood sexual abuse had statistically significantly higher levels of depression at 12 months after surgery, although the depression levels represented significant reductions from pre-surgery and fell within the non-depressed range. Conclusion: Extremely obese patients who seek gastric bypass surgery report higher rates of childhood maltreatment than normative community samples. A history of childhood maltreatment, including reports of sexual abuse, does not appear to be a negative prognostic indicator for gastric bypass surgery.
86 citations
TL;DR: The EDE-Q appeared to differentiate between non/infrequent bingers and recurrent bingers better than the QEWP-R, based on measures of convergent validity, and demonstrated an advantage because it identified binge eaters with elevated weight and shape overconcern.
81 citations
TL;DR: It is demonstrated that the presentation of IGF-I as a circulating complex is essential for skeletal remodeling and the anabolic response to PTH, and postulate that the ternary complex itself, rather than IGF- I alone, influences bone acquisition in a compartment-specific manner.
Abstract: The role of circulating IGF-I in skeletal acquisition and the anabolic response to PTH is not well understood. We generated IGF-I-deficient mice by gene deletions of IGF ternary complex components including: (1) liver-specific deletion of the IGF-I gene (LID), (2) global deletion of the acid-labile (ALS) gene (ALSKO), and (3) both liver IGF-I and ALS inactivated genes (LA). Twelve-week-old male control (CTL), LID, ALSKO, and LA mice were treated with vehicle (VEH) or human PTH(1-34) for 4 weeks. VEH-treated IGF-I-deficient mice (i.e. LID, ALSKO and LA mice) exhibited reduced cortical cross-sectional area (P = 0.001) compared with CTL mice; in contrast, femoral trabecular bone volume fractions (BV/TV) of the IGF-I-deficient mice were consistently greater than CTL (P < 0.01). ALSKO mice exhibited markedly reduced osteoblast number and surface (P < 0.05), as well as mineral apposition rate compared with other IGF-I-deficient and CTL mice. Adherent bone marrow stromal cells, cultured in beta-glycerol phosphate and ascorbic acid, showed no strain differences in secreted IGF-I. In response to PTH, there were both compartment- and strain-specific effects. Cortical bone area was increased by PTH in CTL and ALSKO mice, but not in LID or LA mice. In the trabecular compartment, PTH increased femoral and vertebral BV/TV in LID, but not in ALSKO or LA mice. In conclusion, we demonstrated that the presentation of IGF-I as a circulating complex is essential for skeletal remodeling and the anabolic response to PTH. We postulate that the ternary complex itself, rather than IGF-I alone, influences bone acquisition in a compartment-specific manner (i.e. cortical vs trabecular bone).
80 citations
Journal Article•
TL;DR: Episodes of disorientation and fall history were the best predictors of pediatric falls for this sample and the Morse Fall Scale's sensitivity, specificity and false positive rate suggested that the scale does little better than chance at detecting true fallers and may inaccurately identify non-fallers as high risk.
Abstract: Purpose To identify risk factors in hospitalized children using two validated adult fall risk scales. Methods For each fall patient identified, a non-fall patient was matched for chronological age and year of hospitalization. The retrospective chart review coded the presence or absence of risk factors and completed both the Morse Fall Scale and Hendrich II Fall Risk Model. Findings Overall, a significant difference was detected between pediatric fallers and non-fallers on the Morse Fall Scale. The Morse Fall Scale's sensitivity, specificity and false positive rate suggested that the scale does little better than chance at detecting true fallers and may inaccurately identify non-fallers as high risk. Conclusions Episodes of disorientation and fall history were the best predictors of pediatric falls for this sample.
69 citations
TL;DR: The findings indicate that invasion of fetal villi by maternal T cells is associated with focal destruction of the syncytiotrophoblast, clarifying how placental immunodefensive mechanisms may be contravened.
Abstract: The conjoint immunohistochemistry-in situ hybridization (IHC-ISH) procedure permits, under routine light microscopic conditions, simultaneous documentation of either a male or female karyotype plus the immunological phenotype of individual cells within paraffin-embedded tissues. We have used this technique to characterize the inflammatory response in placental villitis of unknown etiology (VUE). A male placenta with severe VUE and appropriate control placentas were analyzed. In situ hybridization probes concurrently label both the X and Y chromosomes. On the same tissue section, individual cells were characterized with antibodies to CD3, CD68, or CD20. The amnion and syncytiotrophoblast were delineated by cytokeratin antibody (AE1/AE3). A complete karyotyping was performed on amnion cells to validate the procedure. Amnion cell karyotyping confirmed the accuracy of the procedure. The VUE case revealed that 88.8% of intravillous CD3þ lymphocytes were female (maternal), while 11.2% were male (fetal). Intervillous CD3þ lymphocytes and CD68þ macrophages were universally female. Intravillous CD68þ cells were only 10.5% female. Perivillous CD68þcells were 94.6% female. Remarkably, multinucleated giant cells were exclusively maternal. This study confirms that lymphocytes in VUE are predominately but not exclusively maternal T cells. Our findings indicate that invasion of fetal villi by maternal T cells is associated with focal destruction of the syncytiotrophoblast, clarifying how placental immunodefensive mechanisms may be contravened.
69 citations
TL;DR: There is some evidence that systemic inflammatory diseases, such as rheumatoid arthritis (RA), lupus, scleroderma or dermatomyositis may increase the risk for the development of malignancies, predominantly lymphoproliferative disorders.
TL;DR: Dense tufts of arthroconidiating hyphae were demonstrated histologically on the skin surface of many animals that developed dermatomycosis, and theseArthroconidia may act as infective propagules involved in the transfer of disease between reptiles.
Abstract: Veiled chameleons (Chamaeleo calyptratus) were experimentally challenged with the fungus Chrysosporium anamorph of Nannizziopsis vriesii (CANV). Chameleons were exposed to conidia in their captive environment, or were inoculated by direct application of a conidial suspension inoculum on intact and on abraded skin. The CANV induced lesions in all experimental groups and was recovered from infected animals, fulfilling Koch's postulates and confirming that it may act as a primary fungal pathogen in this species of reptile. A breach in cutaneous integrity, as simulated by mild scarification, increased the risk of infection but was not required for the CANV to express pathogenicity. Initial hyphae proliferation occurred in the outer epidermal stratum corneum, with subsequent invasion of the deeper epidermal strata and dermis. A spectrum of lesions was observed ranging from liquefactive necrosis of the epidermis to granulomatous inflammation in the dermis. CANV dermatomycosis appears to be contagious and can readily spread within a reptile collection, either directly through contact with infective arthroconidia or indirectly via fomites. Dense tufts of arthroconidiating hyphae were demonstrated histologically on the skin surface of many animals that developed dermatomycosis, and these arthroconidia may act as infective propagules involved in the transfer of disease between reptiles.
TL;DR: Patients who have a recent cardiomyopathy diagnosis do not have any less ICD benefit than those with a remote diagnosis and ICD therapy should be considered in such patients as soon as they are identified as long as a reversible cause of left ventricular dysfunction is excluded.
TL;DR: It was found that the Epson scanner performed equally well with both types of film giving agreement to better than 90% in all indices and artifacts were very distinct in all EBT scans and can be attributed to the way the film is transported through the scanner.
Abstract: Intensity-modulated radiotherapy (IMRT) treatment plan verification is often done using Kodak EDR2 film and a Vidar Dosimetry PRO film digitizer. However, since many hospitals are moving towards a filmless environment, access to a film processor may not be available. Therefore, we have investigated a newly available Gafchromic EBT film for IMRT dosimetry. Planar IMRT dose distributions are delivered to both EBT and EDR2 film and scanned with the Vidar VXR-16 as well as an Epson Expression 1680 flatbed scanner. The measured dose distributions are then compared to those calculated with a Pinnacle treatment planning system. The IMRT treatments consisted of 7-9 6 MV beams for treatment of prostate, head and neck, and a few other sites. The films were analyzed using FilmQATM (3cognition LLC) software. Comparisons between measured and calculated dose distributions are reported as dose difference (DD) (pixels within +/-5%), distance to agreement (DTA) (3 mm), as well as gamma values (y) (dose= +/-3%, dist. =2 mm). Using EDR2 with the Vidar scanner is an established technique and agreement between calculated and measured dose distributions was better than 90% in all indices (DD, DTA, and gamma). However, agreement with calculations deteriorated reaching the lower 80% for EBT film scans with the Vidar scanner in logarithmic mode. The EBT Vidar scans obtained in linear mode showed an improved agreement to the upper 80% range, but artifacts were still observed across the scan. These artifacts were very distinct in all EBT scans and can be attributed to the way the film is transported through the scanner. In the Epson scanner both films are rigidly immobilized and the light source scans over the film. It was found that the Epson scanner performed equally well with both types of film giving agreement to better than 90% in all indices.
TL;DR: The regulation and functions of different MMPs and TIMPs in bone are described, and an insight is provided into the role of M MPs in bone development, remodeling and pathology.
Abstract: Matrix metalloproteinases (MMPs), a family of Zn2+-dependent endopeptidases, mediate different physiological processes by digesting components of the extracellular matrix. Nevertheless, overexpression of MMPs is implicated in the pathogenesis of various diseases. Different MMPs and tissue inhibitors of MMPs (TIMPs) are expressed in bone cells, and their biosynthesis is regulated by local and systemic hormones and factors. The levels of enzymatically active MMPs in bone are further controlled by secretion, activation of proenzymes, inhibition by TIMPs, cellular uptake and degradation. Members of the cysteine and serine family of proteinases also coordinate some of the biological activities of MMPs in bone. The functions of MMPs and TIMPs in bone include regulation of processes, such as degradation of collagen and other components of the bone matrix, migration and survival of bone cells, endochondral bone formation and bone resorption. Abnormal expression of MMPs may lead to pathological conditions affecting bone and cartilage. Various pharmacological agents can inhibit MMPs, and some of these inhibitors may be potential therapeutic agents for certain bone diseases. This review briefly describes the regulation and functions of different MMPs and TIMPs in bone, and provides an insight into the role of MMPs in bone development, remodeling and pathology.
TL;DR: The newly diagnosed children with Crohn disease exhibited reduced bone remodeling, possibly due to T-cell INF-gamma and OPG, consistent with decreased bone resorption.
TL;DR: It is shown that chop null mice exhibit decreased bone formation and impaired osteoblastic function, indicating that CHOP is necessary for the normal expression of the osteoblast phenotype.
Abstract: C/EBP homologous protein (CHOP) suppresses adipogenesis and accelerates osteoblastogenesis in vitro. However, the effects of CHOP in the skeleton in vivo are not known. To investigate the actions of CHOP on bone remodeling, we examined the skeletal phenotype of chop null mice from 1 to 12 months of age. Chop null mice appeared normal and their growth and serum insulin like growth factor (IGF) I and osteocalcin levels were normal. X-ray analysis of the skeleton revealed no abnormalities and bone mineral density was normal. Static and dynamic histomorphometry revealed that chop null mice had decreased bone formation rates, without changes in osteoblast cell number, indicating an osteoblastic functional defect. The number of osteoblasts and osteoclasts and eroded surface were normal. Northern blot analysis revealed decreased type I collagen and osteocalcin mRNA levels in calvariae of chop null mice. In conclusion, chop null mice exhibit decreased bone formation and impaired osteoblastic function, indicating that CHOP is necessary for the normal expression of the osteoblastic phenotype. J. Cell. Biochem. © 2005 Wiley-Liss, Inc.
15 Apr 2006-Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
TL;DR: It is proposed that intravenous magnesium sulfate may alleviate restless legs syndrome in some pregnant women.
Abstract: We report a case of restless legs syndrome that improved after intravenous magnesium sulfate administration. A 34-year-old gravida 1 para 0 woman, with a 13-year history of restless legs syndrome, was prescribed bed rest due to pre-term labor at 26 weeks. While at rest, the subject experienced severe restless legs syndrome. The subject was later admitted to the hospital for pre-term labor. Treatment for pre-term labor included intravenous magnesium sulfate. RLS symptoms completely resolved during treatment, beginning the first day of administration. Studies involving intravenous magnesium treatment for restless legs syndrome have not included pregnant women. The authors propose that intravenous magnesium sulfate may alleviate restless legs syndrome in some pregnant women.
TL;DR: Of all pathogens isolated from SSIs, 60% were resistant to the agent administered and antibiotics given most frequently were chloramphenicol, aminopenicillins and benzylpenicillin.
TL;DR: The study cloretazine regimen had minimal activity in a very high risk subset of patients with relapsed AML, directly comparable to that of 233 matched patients treated with other single agents.
TL;DR: The findings reflect HIV's adverse impact on maternal QOL and the need for interventions to alleviate this infection's social and emotional effects.
Abstract: To study the effect of HIV infection on quality of life (QOL) during pregnancy and puerperium, QOL was measured in a cohort study at St. Francis Hospital Nsambya, Kampala, Uganda. Dartmouth COOP charts were administered to 132 HIV-positive and 399 HIV-negative women at 36 weeks of pregnancy and six weeks post-partum. Responses were coded from 0 = best health-status to 4 = worst health-status and scores of 3–4 defined as poor. Odds ratios (OR) (95% confidence intervals(CI)) for poor scores were calculated and independent predictors of poor QOL examined using logistic regression. In pregnancy, HIV-positive women were more likely to have poor scores in feelings: OR = 3.2(1.9–5.3), daily activities: OR = 2.8(1.4–5.5), pain: OR = 2.1(1.3–3.5), overall health: OR = 1.7(1.1–2.7) and QOL: OR = 7.2(3.6–14.7), all p= ≤ 0.01. Differences in physical fitness, change in health, social activities and social support were not statistically significant (all p>0.2). HIV infection was independently associated with ...
TL;DR: In conclusion, endogenous Tsg is required for normal BMP activity in osteoblastic cells in vitro, but it plays a minor role in the regulation of adult bone homeostasis in vivo.
TL;DR: The pathways responsible for the inhibitory effects of Notch on osteoblastogenesis and the contributions of the RAM domain and ankyrin repeats to this process in cells of the osteoblastic lineage are determined.
Abstract: Notch proteins belong to a family of single pass transmembrane receptors that are activated after interactions with the membrane-bound ligands Delta and Jagged/Serrate. We determined the pathways responsible for the inhibitory effects of Notch on osteoblastogenesis and the contributions of the RAM domain and ankyrin repeats to this process in cells of the osteoblastic lineage.
Introduction: Notch receptors play a role in osteoblast differentiation. Activation of Notch results in its cleavage and the release of its intracellular domain (NICD), which interacts with the CBF1/RBP-Jκ, Suppressor of Hairless, Lag-1 (CSL) family of transcription factors. The interaction is presumably mediated by the RBP-Jκ–associated module (RAM) of NICD, although the role of the ankyrin repeats is uncertain.
Materials and Methods: To determine the contributions of the RAM domain and ankyrin repeats to the inhibitory effects of Notch on osteoblastogenesis, ST-2 and MC3T3-E1 cells were transfected or transduced with vectors expressing NICD, RAM (NICD ΔRAM), and ankyrin (NICD ΔANK) deletion mutants.
Results: Notch increased the transactivation of transiently transfected 12xCSL-Luc constructs, containing 12 repeats of an RBP-Jκ/CSL binding site, and of the hairy and E (spl) (HES)-1 promoter. Deletion of the ankyrin repeats resulted in the loss of 12xCSL-Luc and HES-1 promoter transactivation, whereas deletion of the RAM domain caused a partial loss of 12xCSL-Luc and sustained HES-1 promoter transactivation. NICD overexpression inhibited osteocalcin mRNA levels and alkaline phosphatase activity in ST-2 cells, and deletion of the ankyrin repeats, and to a lesser extent of the RAM domain, resulted in loss of the NICD inhibitory effect. NICD inhibited Wnt signaling and deletion of ankyrin repeats or the RAM domain restored Wnt signaling activity.
Conclusions: The RAM domain and ankyrin repeats are required for Notch signaling and activity, and the CSL pathway is central to the inhibitory effect of Notch on osteoblastogenesis.
TL;DR: It is suggested that 20 or more sessions are needed for optimal acute changes in exercise performance, but improvement in dyspnea and quality of life may occur earlier.
Abstract: Although pulmonary rehabilitation has proven effectiveness in multiple outcome areas, the optimum duration of this intervention is not clear. We evaluated in an observational study the trajectory of change in upper and lower extremity exercise performance, exertional dyspnea and health status over the course of 12 weeks (24 sessions) of pulmonary rehabilitation in individuals with chronic obstructive pulmonary disease. Demonstrating a plateau in response in these areas might be of practical use for pulmonary rehabilitation programs. We measured outcomes at baseline and at four session (two week) intervals over the course of our comprehensive outpatient pulmonary rehabilitation program. These included treadmill endurance time at approximately 85% of initial maximal workrate, the number of arm lifts per minute, dyspnea at isotime during treadmill walking and the Chronic Respiratory Disease Questionnaire (CRQ) total score. Thirteen patients with chronic obstructure pulmonary disease (COPD) (five male, eight ...
TL;DR: The authors found that business students were more tolerant of business practices with ethical issues than non-business students, and no significant difference was found in the attitudes toward illegal business practices between them.
TL;DR: Complete resection of IPNB results in a good prognosis and no recurrence, and Histopathological findings revealed carcinoma in situ, IPNB, in the majority of intrahepatic bile ducts, with no lymph node metastasis, and it extended continuously to the epithelium of the common biles duct.
Abstract: Intraductal papillary neoplasm of the bile duct (IPNB) or liver is a recently noted rare disease, and its pathogenesis remains unclear. Here we present a case of IPNB with an interesting morphology, which was treated by resection of the right hemiliver and extrahepatic bile duct. A 79-year-old woman was found to have a high alkaline phosphatase level and slight dilatation of the right intrahepatic bile duct on imaging studies. The right intrahepatic bile duct became dilated over a 2-year period; however, no solid mass could be detected, and tumor markers were not elevated. Hepatic resection was scheduled because a mucin-producing bile duct carcinoma of the liver was suspected. A right hemihepatectomy was conducted, and the extrahepatic bile duct was also resected after malignant cells were found in the surgical stump of the right bile duct and in the bile itself. Macroscopically, diffuse dilatation of the intrahepatic bile duct was noted, but no solid component or mucin within the duct was found. Histopathological findings revealed carcinoma in situ, IPNB, in the majority of intrahepatic bile ducts, with no lymph node metastasis, and it extended continuously to the epithelium of the common bile duct. No tumor recurrence or biliary dilatation was observed at follow-up 2 years after surgery. It is important to consider malignancy in the presence of a dilated bile duct and in the absence of any cause of occlusion. Complete resection of IPNB results in a good prognosis and no recurrence.
TL;DR: The onset of trichotillomania can be triggered by a psychological stressor such as a divorce of parents, birth of a sibling, sibling rivalry, or moving to a new home.
Abstract: Trichotillomania is an impulse control disorder that creates an irresistible urge to pull out one’s own body hair. Hair pulling sites may include the scalp, eyebrows, eyelashes, pubic hair, and arm hair.1 It is estimated to affect 1 to 2% of Americans, many of whom go undiagnosed. This disorder is more commonly reported in girls, with typical age at onset of 9 to 13 years.2 Thirty percent of adults with trichotillomania pull primarily from the eyelids or eyebrows.3 Eyelashes and eyebrows subjected to hair pulling will exhibit irregular patches of alopecia and blunt-tipped hairs of different lengths.3
The onset of trichotillomania can be triggered by a psychological stressor such as a divorce of parents, birth of a sibling, sibling rivalry, or moving to a new home.2 Fifty-two percent of people with trichotillomania have major depression, and 27% have generalized anxiety disorder.4 Hair pulling …
TL;DR: In the aftermath of an event that displaces large numbers of people, it is likely that children will be exposed to numerous injury hazards, and volunteers with expertise in child injury prevention are needed to make an evacuee shelter safer for children.
Abstract: INTRODUCTION: Children represent a vulnerable population, and special considerations are necessary to care for them properly during disasters. Comprehensive disaster responses include addressing the unique needs of children during mass-casualty incidents, such as the prevention of unintentional injuries. Early in the morning of 04 September 2005, approximately 1,600 Hurricane Katrina and/or flood survivors from New Orleans, including approximately 300 children, arrived at Camp Gruber, an Oklahoma National Guard base in Eastern Oklahoma. PROBLEM: The primary function of Camp Gruber to train support personnel for the Oklahoma National Guard. This is not a child-safe environment. It was hypothesized that the camp contained numerous child injury hazards and that these hazards could be removed systematically using local child injury prevention experts, thereby preventing unintentional injuries to the displaced children. METHODS: On 08 September, "Operation Child-Safe" was launched by the Pediatric Injury Response Team to identify and remove pediatric injury hazards from Camp Gruber. Injury prevention experts from the Safe Kids Tulsa Area (SKTA) Chapter, the closest pediatric injury prevention group in the region, spearheaded the operation. Several visits were required to remove all of the injury hazards that were identified. RESULTS: Many hazards were identified and removed immediately, while others were addressed in a formal letter to the Camp Gruber Commander for required consent to implement changes. Hazards identified in the camp included, but were not limited to: (1) dangerous chemicals; (2) choking hazards; (3) open electrical outlets; and (4) missing smoke detectors. Bicycle helmets, car seats, strollers, portable cribs, and other safety-related items were passed out to families in need. A licensed daycare facility also was established in order to give the adult guardians a break from constant supervision. Over the course of one month, only one preventable injury (minor head injury) was reported during camp operations, and this particular injury occurred two days before "Operation Child-Safe" was initiated (Day 3 of camp operations). CONCLUSIONS: In the aftermath of an event that displaces large numbers of people, it is likely that children will be exposed to numerous injury hazards. Volunteers with expertise in child injury prevention are needed to make an evacuee shelter safer for children. Language: en
Journal Article•
TL;DR: An overview of sedation and analgesia assessment tools developed for the critical pediatric patient who is mechanically ventilated and pharmacologically paralyzed is provided.
Abstract: Evaluation of pain and sedation in the PICU patient population is challenging. This article provides an overview of sedation and analgesia assessment tools developed for the critical pediatric patient who is mechanically ventilated and pharmacologically paralyzed. Studies reviewed include adult critical care, pediatric, and neonatal patients. No single tool has emerged that can adequately address pain management in the mechanically ventilated pharmacologically paralyzed pediatric patient. Nurses, as an integral part of the health care of critical pediatric patients, should endeavor to develop evidence-based methods for the evaluation of simple yet accurate scales to monitor sedation and pain in the pharmacologically paralyzed pediatric patient.