Showing papers by "Saint Francis University published in 2007"

A Comparison of Vancomycin and Metronidazole for the Treatment of Clostridium difficile–Associated Diarrhea, Stratified by Disease Severity

Abstract: Background. The incidence and severity of Clostridium difficile–associated diarrhea (CDAD) has been increasing, and there have been recent reports of metronidazole treatment failure. Metronidazole is still commonly used as first-line treatment for CDAD but has never been compared with vancomycin in a prospective, randomized, double-blind, placebo-controlled trial. We conducted such a trial, stratifying patients according to disease severity, to investigate whether one agent was superior for treating either mild or severe disease. Methods. From October 1994 through June 2002, patients with CDAD were stratified according to whether they had mild or severe disease based on clinical criteria and were randomly assigned to receive oral metronidazole (250 mg 4 times per day) or oral vancomycin (125 mg 4 times per day) for 10 days. Both groups received an oral placebo in addition to the study drug. Patients were followed up for 21 days to assess cure, treatment failure, relapse, or intolerance. Results. One hundred seventy-two patients were enrolled, and 150 of these patients successfully completed the trial. Among the patients with mild CDAD, treatment with metronidazole or vancomycin resulted in clinical cure in 90% and 98% of the patients, respectively ( P p .36). Among the patients with severe CDAD, treatment with metronidazole or vancomycin resulted in clinical cure in 76% and 97% of the patients, respectively (P p .02). Clinical symptoms recurred in 15% of the patients treated with metronidazole and 14% of those treated with vancomycin. Conclusions. Our findings suggest that metronidazole and vancomycin are equally effective for the treatment of mild CDAD, but vancomycin is superior for treating patients with severe CDAD.

Glucocorticoid-induced osteoporosis: pathophysiology and therapy.

Abstract: Glucocorticoid-induced osteoporosis (GIO) is the most common form of secondary osteoporosis. Fractures, which are often asymptomatic, may occur in as many as 30-50% of patients receiving chronic glucocorticoid therapy. Vertebral fractures occur early after exposure to glucocorticoids, at a time when bone mineral density (BMD) declines rapidly. Fractures tend to occur at higher BMD levels than in women with postmenopausal osteoporosis. In human subjects, the early rapid decline in BMD is followed by a slower progressive decline in BMD. Glucocorticoids have direct and indirect effects on the skeleton. The primary effects are on osteoblasts and osteocytes. Glucocorticoids impair the replication, differentiation and function of osteoblasts and induce the apoptosis of mature osteoblasts and osteocytes. These effects lead to a suppression of bone formation, a central feature in the pathogenesis of GIO. Glucocorticoids also favor osteoclastogenesis and as a consequence increase bone resorption. Bisphosphonates are effective in the prevention and treatment of GIO. Anabolic therapeutic strategies are under investigation.

Cardiac-Resynchronization Therapy in Heart Failure with Narrow QRS Complexes

Abstract: Background Indications for cardiac-resynchronization therapy (CRT) in patients with heart failure include a prolonged QRS interval (≥120 msec), in addition to other functional criteria. Some patients with narrow QRS complexes have echocardiographic evidence of left ventricular mechanical dyssynchrony and may also benefit from CRT. Methods We enrolled 172 patients who had a standard indication for an implantable cardioverter–defibrillator. Patients received the CRT device and were randomly assigned to the CRT group or to a control group (no CRT) for 6 months. The primary end point was the proportion of patients with an increase in peak oxygen consumption of at least 1.0 ml per kilogram of body weight per minute during cardiopulmonary exercise testing at 6 months. Results At 6 months, the CRT group and the control group did not differ significantly in the proportion of patients with the primary end point (46% and 41%, respectively). In a prespecified subgroup with a QRS interval of 120 msec or more, the pea...

Mechanisms of Anabolic Therapies for Osteoporosis

Abstract: Antiresorptive agents help to restore skeletal balance by reducing bone turnover, primarily at the tissue level. Another therapeutic approach is to enhance bone formation with the use of anabolic agents, which differ fundamentally from antiresorptive drugs in their primary mechanism of action. This article reviews the mechanisms of polypeptide anabolic agents and strontium as potential therapeutic options for osteoporosis.

Age‐Related Changes in Trabecular Architecture Differ in Female and Male C57BL/6J Mice

Abstract: We used μCT and histomorphometry to assess age-related changes in bone architecture in male and female C57BL/6J mice. Deterioration in vertebral and femoral trabecular microarchitecture begins early, continues throughout life, is more pronounced at the femoral metaphysis than in the vertebrae, and is greater in females than males. Introduction: Despite widespread use of mice in the study of musculoskeletal disease, the age-related changes in murine bone structure and the relationship to whole body BMD changes are not well characterized. Thus, we assessed age-related changes in body composition, whole body BMD, and trabecular and cortical microarchitecture at axial and appendicular sites in mice. Materials and Methods: Peripheral DXA was used to assess body composition and whole body BMD in vivo, and μCT and histomorphometry were used to measure trabecular and cortical architecture in excised femora, tibia, and vertebrae in male and female C57BL/6J mice at eight time-points between 1 and 20 mo of age (n = 6–9/group). Results: Body weight and total body BMD increased with age in male and female, with a marked increase in body fat between 6 and 12 mo of age. In contrast, trabecular bone volume (BV/TV) was greatest at 6–8 wk of age and declined steadily thereafter, particularly in the metaphyseal region of long bones. Age-related declines in BV/TV were greater in female than male. Trabecular bone loss was characterized by a rapid decrease in trabecular number between 2 and 6 mo of age, and a more gradual decline thereafter, whereas trabecular thickness increased slowly over life. Cortical thickness increased markedly from 1 to 3 mo of age and was maintained or slightly decreased thereafter. Conclusions: In C57BL/6J mice, despite increasing body weight and total body BMD, age-related declines in vertebral and distal femoral trabecular bone volume occur early and continue throughout life and are more pronounced in females than males. Awareness of these age-related changed in bone morphology are critical for interpreting the skeletal response to pharmacologic interventions or genetic manipulation in mice.

Bone morphogenetic proteins and their antagonists

Abstract: Skeletal homeostasis is determined by systemic hormones and local factors. Bone morphogenetic proteins (BMPs) are unique because they induce the commitment of mesenchymal cells toward cells of the osteoblastic lineage and also enhance the differentiated function of the osteoblast. BMP activities in bone are mediated through binding to specific cell surface receptors and through interactions with other growth factors. BMPs are required for skeletal development and maintenance of adult bone homeostasis, and play a role in fracture healing. BMPs signal by activating the mothers against decapentaplegic (Smad) and mitogen activated protein kinase (MAPK) pathways, and their actions are tempered by intracellular and extracellular proteins. The BMP antagonists block BMP signal transduction at multiple levels including pseudoreceptor, inhibitory intracellular binding proteins, and factors that induce BMP ubiquitination. A large number of extracellular proteins that bind BMPs and prevent their binding to signaling receptors have emerged. The extracellular antagonists are differentially expressed in cartilage and bone tissue and exhibit BMP antagonistic as well as additional activities. Both intracellular and extracellular antagonists are regulated by BMPs, indicating the existence of local feedback mechanisms to modulate BMP cellular activities.

Pain reduction during pediatric immunizations: evidence-based review and recommendations.

Abstract: The pain associated with immunizations is a source of anxiety and distress for the children receiving the immunizations, their parents, and the providers who must administer them. Preparation of the child before the procedure seems to reduce anxiety and subsequent pain. The limited available data suggest that intramuscular administration of immunizations should occur in the vastus lateralis (anterolateral thigh) for children 36 months of age. Controversy exists in site selection for 18- to 36-month-old children. A number of studies suggest that the ventrogluteal area is the most appropriate for all age groups. Longer needles are usually associated with less pain and less local reaction. During the injection, parental demeanor clearly affects the child9s pain behaviors. Excessive parental reassurance, criticism, or apology seems to increase distress, whereas humor and distraction tend to decrease distress. Distraction techniques vary with the age, temperament, and interests of the child, but their efficacy is well supported in the literature. Sucrose solution instilled directly into the mouth or administered on a pacifier reduces evidence of distress reliably in children

Evaluation of GAFCHROMIC® EBT film for CyberKnife® dosimetry

Abstract: External beam therapy (EBT) GAFCHROMIC film is evaluated for dosimetry and characterization of the CyberKnife radiation beams. Percentage depth doses, lateral beam profiles, and output factors are measured in solid water using EBT GAFCHROMIC film (International Specialty Products, Wayne, NJ) for the 6 MV radiation beams of diameter 5 to 60 mm produced by the CyberKnife (Accuray, Sunnyvale, CA). The data are compared to those measured with the PTW 60008 diode and the Wellhofer CC01 ion chamber in water. For the small radiation field sizes used in stereotactic radiosurgery, lateral electronic disequilibrium and steep dose gradients exist in a large portion of these fields, requiring the use of high-resolution measurement techniques. For small beams, the detector size approaches the dimensions of the beam and adversely affects measurement accuracy in regions where the gradient varies across the detector. When film is the detector, the scanning system is usually the resolution-limiting component. Radiographic films based upon silver halide (AgH) emulsions are widely used for relative dosimetry of external radiation treatment beams in the megavoltage energy range, because of their good spatial resolution and capability to provide integrated dosimetry over two dimensions. Film dosimetry, however, has drawbacks due to its steep energy dependence at low photon energies as well as film processor and densitometer artifacts. EBT radiochromic film, introduced in 2004 specifically for IMRT dosimetry, may be a detector of choice for the characterization of small radiosurgical beams, because of its near-tissue equivalence, radiation beam energy independence, high spatial resolution, and self developing properties. For radiation beam sizes greater than 10 mm, the film measurements were identical to those of the diode and ion chamber. For the smaller beam diameters of 7.5 and 5 mm, however, there were differences in the data measured with the different detectors, which are attributed to their different spatial resolution and non-water-equivalence.

Ultrasound-guided interscalene needle placement produces successful anesthesia regardless of motor stimulation above or below 0.5 mA.

Abstract: BACKGROUND:We quantified the motor response after ultrasound (U-S)-guided needle placement for interscalene block (ISB). We then compared block characteristics based on motor response above or below 0.5 mA.METHODS:Sixty-one patients scheduled for ambulatory shoulder surgery under ISB and general ane

Accuracy of Self-reported Weight Among Bariatric Surgery Candidates: The Influence of Race and Weight Cycling

Abstract: Objective: Research on the accuracy of self-reported weight has indicated that the degree of misreporting (underestimating) weight is associated with increasing weight but is variable across patient groups. We examined the degree of discrepancy between actual and self-reported BMI in severely obese bariatric surgery candidates, and whether the degree of accuracy varied by race and by eating-related and psychological factors. Research Methods and Procedures: Participants were 179 obese female gastric bypass surgery candidates (31 black, 22 Hispanic, 126 white) who were asked to self-report height and weight as part of a larger assessment battery. Actual height and weight were then measured and a discrepancy score was generated (actual BMI − reported BMI). Results: In this group of severely obese patients, degree of misreporting was unrelated to BMI. The race groups did not differ in actual or self-reported BMI but differed significantly in the degree of misestimation between self-reported and actual BMI. Post hoc tests indicated that black women underestimated their BMI significantly more than white women; Hispanic women did not differ from the other race groups. No eating-related or psychological variables assessed predicted percentage discrepancy; however, the accuracy in self-reported weight was related to history of weight cycling. Discussion: Overall, obese bariatric surgery candidates were accurate in self-report of weight, although the degree of accuracy differed by race and weight cycling history.

Do patients' unrealistic weight goals have prognostic significance for bariatric surgery?

Abstract: Research has shown that obese individuals report goal weight losses in excess of those achievable with standard treatments for obesity. Little is known about the goal weights of bariatric surgery patients, or the prognostic significance of unrealistic goals on surgical outcomes, including weight losses and changes in associated behavioral and psychological domains. A consecutive series of 139 gastric bypass (GBP) surgery candidates reported weight loss goals prior to GBP surgery and at 6 and 12 months after surgery. Dream, Happy, Acceptable, and Disappointed weights following treatment were reported. Consistent with previous research, goal weights at baseline were lower than those attainable even with surgery. Repeated measures analyses, controlling for baseline BMI, revealed no changes in any of the goal weights from baseline to 6 and 12 months following surgery. After controlling for baseline BMI, weight loss expectations at baseline did not predict weight loss at either follow-up point. Unrealistic weight goals were also largely unrelated to psychological functioning prior to surgery, and were unrelated to the magnitude of the improvements in eatingrelated behaviors and psychological functioning after surgery. Interestingly, mean goal weights parallel current weight classifications: i.e., dream BMI corresponds with the cutoff for normal (BMI ≤ 5), happy BMI (=27) with the lower bound for “overweight” and acceptable BMI (=30) with the lower bound for obesity. Among GBP surgery patients, goal weights are remarkably consistent over time, and unrealistic weight loss goals do not appear to have negative prognostic significance on surgical outcomes.

T1-weighted magnetic resonance imaging shows fatty deposition after myocardial infarction.

Abstract: Pathologic studies have shown an increased lipid content in areas of myocardial infarction (MI). We sought to show the ability of precontrast T1-weighted MRI to noninvasively detect fat deposition in MI and show its association with infarct age. Thirty-two patients with MI were studied. Precontrast inversion-recovery (IR) cine steady-state free precession (SSFP) imaging was used to generate both fat- and muscle-nulled images to locate areas of fat deposition in the left ventricular (LV) myocardium. Postcontrast delayed hyperenhanced (DHE) imaging was also performed. Image contrast in regions of MI on precontrast images and postcontrast DHE images was measured. The association of image contrast with infarct age was determined by means of correlations and Student's t-test. We found a significant association between infarct age and image contrast in both fat- and muscle-nulled images. Precontrast T1-weighted MRI is a promising method for detecting myocardial fat deposition in chronic MI, and can be used to assess myocardial infarct age.

Operation Child-ID: reunifying children with their legal guardians after Hurricane Katrina

Abstract: Children constitute a vulnerable population and special considerations are necessary in order to provide proper care for them during disasters. After disasters such as Hurricane Katrina, the rapid identification and protection of separated children and their reunification with legal guardians is necessary in order to minimise secondary injuries (i.e. physical and sexual abuse, neglect and abduction). At Camp Gruber, an Oklahoma shelter for Louisianans displaced by Hurricane Katrina, a survey tool was used to identify children separated from their guardians. Of the 254 children at the camp, 36 (14.2 per cent) were separated from their legal guardians. Answering 'no' to the question of whether the accompanying adult was the guardian of the child prior to Hurricane Katrina was a strong predictor (27.8 per cent versus 3.2 per cent) of being listed as 'missing' by the National Center for Missing and Exploited Children (NCMEC). All the children at Camp Gruber who were listed as 'missing' by the NCMEC were subsequently reunited with their guardians.

Bicycle-Theft Victimization in Contemporary Urban China A Multilevel Assessment of Risk and Protective Factors

Abstract: China has been characterized as a “bicycle nation.” Since the economic reform was initiated in the early 1980s, bicycles have become a major target of criminal activities because of their availability, utility, and monetary value, and because of the difficulty of securing them. The present study discusses the Chinese concern with bicycle theft and explores the social and legal aspects of bicycle-theft victimization in China. Drawing upon the lifestyle-exposure and routine-activities perspectives, the present study specifies a number of important household- and neighborhood-level variables as indicators of target attractiveness, guardianship, and exposure to potential offenders to explore the risk of bicycle theft in urban China. Using data collected from a recent survey in the city of Tianjin, the study conducts multilevel analyses of the risk and protective factors for bicycle-theft victimization. The data show that house type (row houses) and number of adult household members are significant protective ...

Mental stress may induce QT-interval prolongation and T-wave notching

Abstract: Background: The effects of active and passive mental stress (PMS) on the QT interval were studied by using an intraindividual regression method of QT-interval correction for heart rate. Methods: Thirty healthy males (age 21.2 ± 1.8 years) performed a mental arithmetic for 1 minute, which was considered as active mental stress (AMS) because of the performance requirement. A 1-minute unpleasant video clip was used for PMS. Two baseline and two (an early and a late) ECGs were prepared in both mental stress periods. The individual QT–RR relationship was assessed by linear regression analysis of 7–15 (11.0 ± 1.9) controlled QT–RR data pairs, also obtained from ECGs gained during a successive set of 9 isometric stretching exercises. Results: Heart rate has increased significantly at both measurements in response to AMS (P < 0.0001), but not in response to passive stress. QTc significantly prolonged early in AMS (P = 0.0004), then normalized by the end of the period. During PMS, no significant QTc changes were observed. The evolution of bifid T waves was noted in 14 subjects: 8 presented bifid T waves during both AMS and exercise, and 6 during only exercise. Conclusions: AMS and PMS elicit different cardiovascular reactions. Our results indicate that changes in the autonomic tone, probably abrupt sympathetic predominance, may cause QTc prolongation and bifid T waves. This suggests that besides stress quality and intensity, the dynamics of stress application and perception also influence repolarization.

Mitral Annular Remodeling with Varying Degrees and Mechanisms of Chronic Mitral Regurgitation

Abstract: Hypotheses Degree of mitral annular remodeling is directly associated with severity of chronic mitral regurgitation (MR). Mitral annular remodeling occurs in a symmetric fashion, regardless of MR severity. In addition to MR severity, MR mechanism plays a significant role in mitral annular remodeling. Background Limited data exists on mitral annular remodeling in patients with MR. Identification of annular changes may be important in aiding surgical repair. Methods Mitral annular dimensions (anteroposterior, intercommissural, surface area, and circumference) were measured in end systole and diastole using 3-dimensional reconstructive software in 83 patients: trace to no MR (23), mild MR (15), moderate MR (26), and severe MR (19). Annular sphericity indices were determined by dividing intercommissural by anteroposterior dimensions. Patients were further subgrouped by mechanism of MR. Results With increasing MR severity, there was a corresponding increase in all annular measurements, most pronounced in the anteroposterior dimension, circumference, and area. Larger increases were seen in patients with prolapse/flail and dilated mechanisms. Furthermore, the mitral annulus became more circular (sphericity index approached 1.0) with increasing MR severity. Patients with prolapse/flail mechanisms exhibited normal left ventricular volumes despite significant annular enlargement. Conclusions Mitral annular remodeling is directly associated with MR severity and occurs in an asymmetric fashion, yet is not limited to one region of the annulus. Mechanism of MR plays a significant role in annular remodeling. Annular remodeling can occur independently of left ventricular remodeling.

Criminological Research in Contemporary China Challenges and Lessons Learned From a Large-Scale Criminal Victimization Survey

Abstract: This article discusses research experience gained from a large-scale survey of criminal victimization recently conducted in Tianjin, China. The authors review some of the more important challenges that arose in the research, their responses to these challenges, and lessons learned that might be beneficial to other scholars who are interested in conducting criminological research in China. Their experience underscores the importance of understanding the Chinese political, cultural, and academic context, and the utility of collaborating with experienced and knowledgeable colleagues "on site." Although there are some special difficulties and barriers, their project demonstrates the feasibility of original criminological data collection in China.

RF to IP bridge system and method of use

Abstract: A two component highly portable and lightweight system for extending the transmission capabilities of Land Mobile Radio systems into areas lacking coverage due to structures, depth below the earth's surface, or varying terrain or other dead zones lacking coverage. The system utilizes the Radio over IP protocol to transfer two-way audio from one radio to another radio for re-broadcast inside a dead zone over a 900 MHz Ethernet-based point-to-point wireless link. The novel system includes RF to TCP/IP conversion and digital data transmission followed by a TCP/IP conversion to RF radio link and provides components and a method for bridging RF radio into dead zones.

Nephroblastoma overexpressed (Nov) is a novel bone morphogenetic protein antagonist.

Abstract: Nephroblastoma overexpressed (Nov), a member of the CCN family of proteins, is expressed by osteoblasts and its transcription is regulated by transforming growth factor (TGF)-beta and bone morphogenetic proteins (BMP). CCN proteins can interact with TGF-beta, BMPs, and Wnt. We explored the function of Nov in skeletal cells, in vitro and in vivo. Constitutive overexpression of Nov in cells of the osteoblastic lineage impaired osteoblastic differentiation, opposed the biological effects of BMP-2 and Wnt 3 and impaired BMP-2 and Wnt signaling, indicating that Nov has BMP-2 antagonistic activity. Transgenic mice overexpressing Nov under the control of the osteocalcin promoter exhibited osteopenia secondary to decreased bone formation, confirming the effects in vitro. GST pulldown experiments demonstrated direct Nov-BMP interactions. In conclusion, Nov has BMP antagonistic properties and inhibits osteoblastogenesis and osteoblastic function.

Hospital Pharmacy Pulse - Recent Publications on Medications and Pharmacy

Abstract: Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest will be abstracted monthly regarding a broad scope o...

China's Juvenile Delinquency Prevention Law The Law and the Philosophy

Abstract: The present study introduces and discusses the Juvenile Delinquency Prevention Law of the People's Republic of China. The law was promulgated in the context of Chinese socioeconomic reforms and legal reforms in response to the rising delinquency since the early 1980s. The study explains the social and political background of the law with respect to the patterns of delinquency in China. The law has several main features that reflect the Chinese philosophical underpinnings of crime prevention and control, and the study discusses the connection between the law and the traditional Chinese philosophy and thinking. Finally, the study discusses the challenges to the enforcement of the law in Chinese society, which has lacked a legal tradition in its history.

In-home wound care management utilizing information technology.

Abstract: Chronic wounds are a major healthcare crisis, presenting challenges for home health agencies lacking specially trained staff to properly monitor and manage these wounds. Consequently, the home health industry needs to improve wound management methods and technologies to properly care for patients with chronic wounds. Saint Francis University's Center of Excellence for Remote and Medically Under-Served Areas partnered with a home health agency (University of Pittsburgh Medical Center Lee Regional Community Nursing Service) to identify a solution to this problem.

Antiretroviral treatment of HIV in Uganda: A comparison of three different delivery models in a single hospital.

Abstract: This exploratory study examined health worker's perspectives and the type of HIV care received in three different delivery models of antiretroviral treatment (ART) at St Francis Hospital, Kampala, Uganda. Two of the clinics were financed by external donors and the third through out-of-pocket payments. Key informant interviews with health workers investigated potential challenges with ART care, and exit interviews with patients collected data on the care received. Despite the fact that all three clinics were located in the same hospital, services offered and quality of care varied extensively. Health staff at all ART clinics identified the lack of collaboration between different HIV programmes and low patient adherence as the main challenges. More women than men accessed ART through the externally financed programmes. These programmes provided more comprehensive care because of higher staff density and more frequent laboratory monitoring compared to the private clinic. Despite these shortcomings and the fact that prescriptions were often renewed without a preceding medical check-up at the private clinic, many chose to pay a monthly average equivalent of US$60 for ART in return for privacy and access to drugs without HIV disclosure requirements. Stigma and fear of abandonment were thought to be the main barriers for access to ART.