Showing papers by "Saint Francis University published in 2010"

Coronary artery calcium score and risk classification for coronary heart disease prediction.

Abstract: Context The coronary artery calcium score (CACS) has been shown to predict future coronary heart disease (CHD) events. However, the extent to which adding CACS to traditional CHD risk factors improves classification of risk is unclear. Objective To determine whether adding CACS to a prediction model based on traditional risk factors improves classification of risk. Design, Setting, and Participants CACS was measured by computed tomography in 6814 participants from the Multi-Ethnic Study of Atherosclerosis (MESA), a population-based cohort without known cardiovascular disease. Recruitment spanned July 2000 to September 2002; follow-up extended through May 2008. Participants with diabetes were excluded from the primary analysis. Five-year risk estimates for incident CHD were categorized as 0% to less than 3%, 3% to less than 10%, and 10% or more using Cox proportional hazards models. Model 1 used age, sex, tobacco use, systolic blood pressure, antihypertensive medication use, total and high-density lipoprotein cholesterol, and race/ethnicity. Model 2 used these risk factors plus CACS. We calculated the net reclassification improvement and compared the distribution of risk using model 2 vs model 1. Main Outcome Measures Incident CHD events. Results During a median of 5.8 years of follow-up among a final cohort of 5878, 209 CHD events occurred, of which 122 were myocardial infarction, death from CHD, or resuscitated cardiac arrest. Model 2 resulted in significant improvements in risk prediction compared with model 1 (net reclassification improvement = 0.25; 95% confidence interval, 0.16-0.34; P Conclusion In this multi-ethnic cohort, addition of CACS to a prediction model based on traditional risk factors significantly improved the classification of risk and placed more individuals in the most extreme risk categories.

Notch and the Skeleton

Abstract: Notch receptors are transmembrane receptors that regulate cell fate decisions. There are four Notch receptors in mammals. Upon binding to members of the Delta and Jagged family of transmembrane proteins, Notch is cleaved and the Notch intracellular domain (NICD) is released. NICD then translocates to the nucleus, where it associates with the CBF-1, Suppressor of Hairless, and Lag-2 (CSL) and Mastermind-Like (MAML) proteins. This complex activates the transcription of Notch target genes, such as Hairy Enhancer of Split (Hes) and Hes-related with YRPF motif (Hey). Notch signaling is critical for the regulation of mesenchymal stem cell differentiation. Misexpression of Notch in skeletal tissue indicates a role as an inhibitor of skeletal development and postnatal bone formation. Overexpression of Notch inhibits endochondral bone formation and osteoblastic differentiation, causing severe osteopenia. Conditional inactivation of Notch in the skeleton causes an increase in cancellous bone volume and enhanced osteoblastic differentiation. Notch ligands are expressed in the hematopoietic stem cell niche and are critical for the regulation of hematopoietic stem cell self-renewal. Dysregulation of Notch signaling is the underlying cause of diseases affecting the skeletal tissue, including Alagille syndrome, spondylocostal dysostosis, and possibly, osteosarcoma.

Update in New Anabolic Therapies for Osteoporosis

Abstract: Skeletal anabolic agents enhance bone formation, which is determined by the number and function of osteoblasts. Cell number is controlled by factors that regulate the replication, differentiation, and death of cells of the osteoblastic lineage, whereas cell function is controlled by signals acting on the mature osteoblast. Bone morphogenetic proteins (BMP) and Wnt induce the differentiation of mesenchymal cells toward osteoblasts, and IGF-I enhances the function of mature osteoblasts. The activity of BMP, Wnt, and IGF-I is controlled by proteins that, by binding to the growth factor or to its receptors, can antagonize its effects. Changes in the expression or binding affinity of these extracellular antagonists can be associated with increased or decreased bone formation and bone mass. Novel approaches to anabolic therapies for osteoporosis may include the use of factors with anabolic properties, or the neutralization of a growth factor antagonist. Selected approaches include the use of neutralizing antibodies to Wnt antagonists, the enhancement of BMP signaling by proteasome inhibitors, or the use of activin soluble receptors, IGF-I, or PTH analogs. An anabolic agent needs to be targeted specifically to the skeleton to avoid unwanted nonskeletal effects and ensure safety. Clinical trials are being conducted to test the long-term effectiveness and safety of novel bone anabolic agents.

Comparison of Planned Dose Distributions Calculated by Monte Carlo and Ray-Trace Algorithms for the Treatment of Lung Tumors With CyberKnife: A Preliminary Study in 33 Patients

Abstract: Purpose To compare dose distributions calculated using the Monte Carlo algorithm (MC) and Ray-Trace algorithm (effective path length method, EPL) for CyberKnife treatments of lung tumors. Materials and Methods An acceptable treatment plan is created using Multiplan 2.1 and MC dose calculation. Dose is prescribed to the isodose line encompassing 95% of the planning target volume (PTV) and this is the plan clinically delivered. For comparison, the Ray-Trace algorithm with heterogeneity correction (EPL) is used to recalculate the dose distribution for this plan using the same beams, beam directions, and monitor units (MUs). Results The maximum doses calculated by the EPL to target PTV are uniformly larger than the MC plans by up to a factor of 1.63. Up to a factor of four larger maximum dose differences are observed for the critical structures in the chest. More beams traversing larger distances through low density lung are associated with larger differences, consistent with the fact that the EPL overestimates doses in low-density structures and this effect is more pronounced as collimator size decreases. Conclusions We establish that changing the treatment plan calculation algorithm from EPL to MC can produce large differences in target and critical organs' dose coverage. The observed discrepancies are larger for plans using smaller collimator sizes and have strong dependency on the anatomical relationship of target-critical structures.

Using the communication assessment tool in family medicine residency programs.

Abstract: Background and objectives The Communication Assessment Tool (CAT), developed by Makoul et al assesses patient perceptions of physicians' interpersonal and communication skills. The objective of this study was to gather initial benchmarking data for the use of the CAT in family medicine residency programs. Methods Data were collected from patients seeing 127 residents from six family medicine residency programs. A total of 1,931 patients completed the paper and pencil version of the CAT following an appointment with a resident; 1,880 of the CAT forms met the inclusion criteria for analysis. Results The overall mean percentage of items from which residents were rated as excellent was 69.7%. Significant differences were found in the overall percentage of items rated as excellent based on training year, with PGY-1 (77.0%) residents being rated significantly higher than PGY-2 (69.5%) and PGY-3 (68.1%) residents. There were no significant differences found in the overall percentage of items rated as excellent based on the native language or gender of the residents. Conclusions This initial benchmarking data can allow family medicine residency programs to compare the performance of their residents with the performance of residents from other programs. We recommend that the results of the CAT be used as both an evaluative and learning tool.

Assessing patient perceptions of hospitalist communication skills using the Communication Assessment Tool (CAT).

Abstract: BACKGROUND: Hospitalists care for an increasing percentage of hospitalized patients, yet evaluations of patient perceptions of hospitalists' communication skills are lacking. OBJECTIVE: Assess hospitalist communication skills using the Communication Assessment Tool (CAT). METHODS: A cross-sectional study of patients, age 18 or older, admitted to the hospital medicine service at an urban, academic medical center with 873 beds. Thirty-five hospitalists assigned to both direct care and teaching service were assessed. MEASUREMENTS: Hospitalist communication was measured with the CAT. The 14-item survey, written at a fourth grade level, measures responses along a 5-point scale (“poor” to “excellent”). Scores are reported as a percentage of “excellent” responses. RESULTS: We analyzed 700 patient surveys (20 for each of 35 hospitalists). The proportion of excellent ratings for each hospitalist ranged from 38.5% to 73.5%, with an average of 59.1% excellent (SD=9.5). Highest ratings on individual CAT items were for treating the patient with respect, letting the patient talk without interruptions, and talking in terms the patient can understand. Lowest ratings were for involving the patient in decisions as much as he or she wanted, encouraging the patient to ask questions, and greeting the patient in a way that made him or her feel comfortable. Overall scale reliability was high (Cronbach's alpha = 0.97). CONCLUSIONS: The CAT can be used to gauge patient perceptions of hospitalist communication skills. Many hospitalists may benefit from targeted training to improve communication skills, particularly in the areas of encouraging questions and involving patients in decision making. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.

Survey of colleges of pharmacy to assess preparation for and promotion of residency training.

Abstract: Objective. To assess the prevalence of curricular programs or other structured activities designed to prepare students for and to promote residency training. Methods. An electronic survey instrumen...

Connective Tissue Growth Factor Is Required for Skeletal Development and Postnatal Skeletal Homeostasis in Male Mice

Abstract: Connective tissue growth factor (CTGF), a member of the cysteine-rich 61 (Cyr 61), CTGF, nephroblastoma overexpressed (NOV) (CCN) family of proteins, is synthesized by osteoblasts, and its overexpression inhibits osteoblastogenesis and causes osteopenia. The global inactivation of Ctgf leads to defective endochondral bone formation and perinatal lethality; therefore, the consequences of Ctgf inactivation on the postnatal skeleton are not known. To study the function of CTGF, we generated Ctgf(+/LacZ) heterozygous null mice and tissue-specific null Ctgf mice by mating Ctgf conditional mice, where Ctgf is flanked by lox sequences with mice expressing the Cre recombinase under the control of the paired-related homeobox gene 1 (Prx1) enhancer (Prx1-Cre) or the osteocalcin promoter (Oc-Cre). Ctgf(+/LacZ) heterozygous mice exhibited transient osteopenia at 1 month of age secondary to decreased trabecular number. A similar osteopenic phenotype was observed in 1-month-old Ctgf conditional null male mice generated with Prx1-Cre, suggesting that the decreased trabecular number was secondary to impaired endochondral bone formation. In contrast, when the conditional deletion of Ctgf was achieved by Oc-Cre, an osteopenic phenotype was observed only in 6-month-old male mice. Osteoblast and osteoclast number, bone formation, and eroded surface were not affected in Ctgf heterozygous or conditional null mice. In conclusion, CTGF is necessary for normal skeletal development but to a lesser extent for postnatal skeletal homeostasis.

The Licensing of Barbers in the USA

Abstract: Barbering is one of the earliest professions to be licensed in the USA. This article discusses the origins of barber licensing, as well as its current status and scope, and then estimates the effects that such licensing has had on barbers' earnings. To estimate these effects we use micro-level data from the 2000 US Census along with several measures of the strictness of state licensing of barbers. Our results suggest that certain licensing provisions may have increased barber earnings by between 11 and 22 per cent. The magnitude of our estimates is somewhat higher than those found in studies examining the effects of licensing in similar professions.

Radiographic appearance of confirmed pulmonary lymphoma in cats and dogs

Abstract: Herein we describe the thoracic radiographic appearance of confirmed pulmonary lymphoma. Patients with thoracic radiographs and cytologically or histologically confirmed pulmonary lymphoma were sought by contacting American College of Veterinary Radiology members. Seven cats and 16 dogs met the inclusion criteria, ranging in age from 4 to 15 years. Method of diagnosis was via ultrasound-guided cytology (four), surgical biopsy (two), ultrasound-guided biopsy (one), and necropsy (16). Radiographic findings varied but ranged from normal (one) to alveolar (six) and/or unstructured interstitial infiltrates (11), nodules and/or masses (eight), and bronchial infiltrates (four). Additional thoracic radiographic findings included pleural effusion and lymphadenopathy. The results of this evaluation indicate a wide variability in thoracic radiographic abnormalities in cats and dogs with pulmonary lymphoma.

Prescribing Errors in a Pediatric Clinic

Abstract: Objective: This project was completed to determine the frequency and type of prescribing errors occuring in a pediatric clinic. Study design: Records for all patient encounters in the pediatric acute care clinic from February through April 2007 were reviewed. Prescriptions entered into the electronic medical records (EMR) were reviewed the day after they were written. Results: A total of 3523 records containing 1802 new prescriptions were reviewed. Prescribing errors were found in 175 prescriptions (9.7%). The most common type of error was an incomplete prescription (42%), followed by dosing errors (34%). Anti-infectives were most commonly written in error followed by anti-inflammatories. Conclusions: Prescribing errors were commonly identified in a pediatric clinic utilizing electronic medical records. Incomplete prescriptions and dosing errors were the most commonly occurring errors. Recognizing the types of errors has been beneficial for developing educational programs intended to decrease prescribing ...

A novel spontaneous mutation of Irs1 in mice results in hyperinsulinemia, reduced growth, low bone mass and impaired adipogenesis.

Abstract: A spontaneous mouse mutant, designated ‘small’ (sml), was recognized by reduced body size suggesting a defect in the IGF1/GH axis. The mutation was mapped to the chromosome 1 region containing Irs1, a viable candidate gene whose sequence revealed a single nucleotide deletion resulting in a premature stop codon. Despite normal mRNA levels in mutant and control littermate livers, western blot analysis revealed no detectable protein in mutant liver lysates. When compared with the control littermates, Irs1 sml /Irs1 sml (Irs1 sml/sml ) mice were small, lean, hearing impaired; had 20% less serum IGF1; were hyperinsulinemic; and were mildly insulin resistant. Irs1 sml/sml mice had low bone mineral density, reduced trabecular and cortical thicknesses, and low bone formation rates, while osteoblast and osteoclast numbers were increased in the females but not different in the males compared with the Irs1 C/C controls. In vitro, Irs1 sml/sml bone marrow stromal cell cultures showed decreased alkaline phosphatase-positive colony forming units (pre-osteoblasts; CFU-APC) and normal numbers of tartrate-resistant acid phosphatase-positive osteoclasts. Irs1 sml/sml stromal cells treated with IGF1 exhibited a 50% decrease in AKT phosphorylation, indicative of defective downstream signaling. Similarities between engineered knockouts and the spontaneous mutation of Irs1 sml were identified as well as significant differences with respect to heterozygosity and gender. In sum, we have identified a spontaneous mutation in the Irs1 gene associated with a major skeletal phenotype. Changes in the heterozygous Irs1 C/sml mice raise the possibility that similar mutations in humans are associated with short stature or osteoporosis.

Microwave Instruments: Green Machines for Green Chemistry?

Abstract: In this column, the authors discuss the ease of using microwave ovens for various activities in the undergraduate chemistry laboratory and suggest a few models of microwave systems for readers to consider.

Effects of ethanol intoxication and gender on blood coagulation.

Abstract: BACKGROUND: Ethanol intoxication is a common contributor to traumatic injury. It is unknown whether ethanol consumption contributes to the coagulation differences seen between men and women after trauma. Our aim was to examine the combined effect of ethanol intoxication and gender on coagulation. METHODS: Fifty-eight healthy subjects participated and chose to enter into a control group (CG; n = 20; 10 men and 10 women) or drinking group (DG; n = 38; 20 men and 18 women). Venous blood samples for thrombelastography, plasminogen activator inhibitor, thrombin-antithrombin complex, and tissue plasminogen activator were drawn at the beginning of the study. Subjects then interacted in a social atmosphere for at least 2 hours, eating and consuming alcoholic (DG) or nonalcoholic (CG) beverages. After 2 hours, blood alcohol level was determined and blood was drawn for a second set of coagulation studies. RESULTS: Demographics were similar between groups except for age (36.7 years CG vs. 29.9 years DG; p = 0.009). All baseline thrombelastography measurements were similar between the CG and DG. Blood alcohol levels in the DG were similar between genders at the end of study. At the end of study, a decreased rate of fibrin formation, decreased clot strength, and a decreased rate of fibrin cross-linking was seen in men but not in women. Fibrinolysis was inhibited in drinkers compared with controls. CONCLUSIONS: Consumption of commonly ingested quantities of alcohol correlated with the development of a hypocoagulable state in men but had no effect on coagulation status in women. This phenomenon may contribute to differences in post-trauma coagulation status previously noted between genders. Language: en

Educational outreach to reduce immunization pain in office settings.

Abstract: practices. WHAT THIS STUDY ADDS: In this study, an academic detailing strategy featuring a single teaching visit to the offices of pediatric practitioners in our community, focusing on reduction of injection pain, had demonstrable effects on practice behaviors up to 6 month after application. abstract The goal was to examine the impact of a teaching module on immunization pain reduction practices in pediatric offices 1 and 6 months after the intervention. METHODS: Fourteen practices were selected randomly to receive a 1-hour teaching session on immunization pain reduction techniques, and 13 completed the study. Before the intervention, telephone inter- views were conducted with parents concerning their children's recent immunization experiences. At 1 and 6 months after the intervention, parents of children who had recent immunizations were interviewed by using the same questionnaires. Clinicians also were surveyed at baseline and at 6 months. RESULTS: A total of 839 telephone interviews and 92 clinician surveys were included. Significant changes from baseline were identified at 1 and 6 months after the intervention. At 1 month, parents were more likely to report receiving information (P.04), using strategies to reduce pain (P.01), learning something new (P.01), using a ShotBlocker (P.01), using sucrose (P.01), and having higher levels of satisfaction (P.015). At 6 months, all rates remained signif- icantly higher than baseline findings (all P.01) except for satisfac- tion. Clinician surveys revealed significant increases in the use of longer needles, sucrose, pinwheels, focused breathing, and ShotBlockers at 6 months. CONCLUSIONS: A 1-hour teaching session had measurable effects on the use of pain-reducing strategies at 1 and 6 months after the inter- vention. This research supports the hypothesis that small-group teach- ing sessions at the site of care can be associated with changes in practice behaviors. Pediatrics 2010;126:e1514-e1521