Showing papers by "Texas Medical Center published in 2012"
TL;DR: The dependence of tumor cells on the dysregulated lipid metabolism suggests that proteins involved in this process are excellent chemotherapeutic targets for cancer treatment.
Abstract: Alteration of lipid metabolism has been increasingly recognized as a hallmark of cancer cells. The changes of expression and activity of lipid metabolizing enzymes are directly regulated by the activity of oncogenic signals. The dependence of tumor cells on the dysregulated lipid metabolism suggests that proteins involved in this process are excellent chemotherapeutic targets for cancer treatment. There are currently several drugs under development or in clinical trials that are based on specifically targeting the altered lipid metabolic pathways in cancer cells. Further understanding of dysregulated lipid metabolism and its associated signaling pathways will help us to better design efficient cancer therapeutic strategy.
211 citations
TL;DR: Knowledge of primary food sources of energy and nutrients can help health professionals design effective strategies to reduce excess energy consumed by US adults and increase the nutrient adequacy of their diets.
Abstract: Identification of current food sources of energy and nutrients among US adults is needed to help with public health efforts to implement feasible and appropriate dietary recommendations. To determine the food sources of energy and 26 nutrients consumed by US adults the 2003–2006 National Health and Nutrition Examination Survey (NHANES) 24-h recall (Day 1) dietary intake data from a nationally representative sample of adults 19+ years of age (y) (n = 9490) were analyzed. An updated USDA Dietary Source Nutrient Database was developed for NHANES 2003–2006 using current food composition databases. Food grouping included ingredients from disaggregated mixtures. Mean energy and nutrient intakes from food sources were sample-weighted. Percentages of total dietary intake contributed from food sources were ranked. The highest ranked sources of energy and nutrients among adults more than 19 years old were: energy—yeast bread/rolls (7.2%) and cake/cookies/quick bread/pastry/pie (7.2%); protein—poultry (14.4%) and beef (14.0%); total fat—other fats and oils (9.8%); saturated fatty acids—cheese (16.5%) and beef (9.1%); carbohydrate—soft drinks/soda (11.4%) and yeast breads/rolls (10.9%); dietary fiber—yeast breads/rolls (10.9%) and fruit (10.2%); calcium—milk (22.5%) and cheese (21.6%); vitamin D—milk (45.1%) and fish/shellfish (14.4%); and potassium—milk (9.6%) and coffee/tea/other non-alcoholic beverages (8.4%). Knowledge of primary food sources of energy and nutrients can help health professionals design effective strategies to reduce excess energy consumed by US adults and increase the nutrient adequacy of their diets.
197 citations
TL;DR: The hypothesis that sleep disorders have become epidemic because of widespread vitamin D deficiency is proposed and the therapeutic effects together with the anatomic-functional correspondence warrant further investigation and consideration of vitamin D in the etiology and therapy of sleep disorders.
114 citations
TL;DR: TBI progression rates after starting enoxaparin in small, stable injuries 24 hours after injury are similar to those of placebo and are subclinical.
Abstract: BACKGROUNDOur group has created an algorithm for venous thromboembolism prophylaxis after traumatic brain injury (TBI), which stratifies patients into low, moderate, and high risk for spontaneous injury progression and tailors a prophylaxis regimen to each arm. We present the results of the Delayed
103 citations
TL;DR: The prevalence of overweight/obese children rises in communities with lower household income and children residing in lower income communities exhibit poorer dietary and physical activity behaviors, which affect obesity.
75 citations
TL;DR: Patients receiving LMWH were at higher risk for hemorrhage progression, and the risk of using LMWH may exceed its benefit, and safety of LMWH for VTE prophylaxis in patients with brain injury was unable to demonstrate.
Abstract: BACKGROUNDVenous thromboembolism (VTE) is a significant risk in trauma patients. Although low–molecular weight heparin (LMWH) is effective in VTE prophylaxis, its use for patients with traumatic intracranial hemorrhage remains controversial. The purpose of this study was to evaluate the safety of LM
73 citations
TL;DR: Deterioration of health services quality, staffing levels and violence against doctors continued from 2003 through 2006, although these may have improved slightly in 2007, and in 2009 and 2010, reports suggest that assassinations of doctors and out-migration have continued.
Abstract: SUMMARYObjectives
This study aims to assess how conflict has affected the function of Iraqi health services and its doctors.
Methods
Interviews were conducted in person or by mobile phone with 401 Iraqi doctors entering Jordan since 2003, using respondent-driven sampling methods.
Results
Of the Iraqi doctors interviewed in 2008, 94% came from Baghdad, although 25% had moved within Iraq in the past year. They reported a steady year-by-year decline in Iraqi health services from 2003 through 2006, with perhaps some improvement in 2007. By 2006, 67% of doctors said essential drugs were present less than half of the time (95% confidence interval [CI] 54–81), and 69% (95% CI 56–84) said essential equipment was available or working half the time or less. By 2006, 95% said their facilities lacked skilled health workers, and 90% noted reduced quality of care. Violent death rates among doctors in Baghdad reached 47.6/1000/yr (95% CI 42.0–53.7) in 2006. In the same year, migration rates for Baghdad doctors moving elsewhere in Iraq were 143.8/1000/yr (95% CI 134.0–154.1), and departure from Iraq was 299.5/1000/yr (95% CI 285.3–314.3).
Conclusions
Deterioration of health services quality, staffing levels and violence against doctors continued from 2003 through 2006, although these may have improved slightly in 2007. In 2009 and 2010, reports suggest that assassinations of doctors and out-migration have continued. Few have returned. Copyright © 2011 John Wiley & Sons, Ltd.
53 citations
TL;DR: A complex process, such as patient deterioration, requires sufficient time and effort to achieve improved outcomes and create a deeply embedded culture of patient safety, and the collaborative model can accelerate improvements achieved by individual institutions.
Abstract: OBJECTIVES: The Child Health Corporation of America formed a multicenter collaborative to decrease the rate of pediatric codes outside the ICU by 50%, double the days between these events, and improve the patient safety culture scores by 5 percentage points. METHODS: A multidisciplinary pediatric advisory panel developed a comprehensive change package of process improvement strategies and measures for tracking progress. Learning sessions, conference calls, and data submission facilitated collaborative group learning and implementation. Twenty Child Health Corporation of America hospitals participated in this 12-month improvement project. Each hospital identified at least 1 noncritical care target unit in which to implement selected elements of the change package. Strategies to improve prevention, detection, and correction of the deteriorating patient ranged from relatively simple, foundational changes to more complex, advanced changes. Each hospital selected a broad range of change package elements for implementation using rapid-cycle methodologies. The primary outcome measure was reduction in codes per 1000 patient days. Secondary outcomes were days between codes and change in patient safety culture scores. RESULTS: Code rate for the collaborative did not decrease significantly (3% decrease). Twelve hospitals reported additional data after the collaborative and saw significant improvement in code rates (24% decrease). Patient safety culture scores improved by 4.5% to 8.5%. CONCLUSIONS: A complex process, such as patient deterioration, requires sufficient time and effort to achieve improved outcomes and create a deeply embedded culture of patient safety. The collaborative model can accelerate improvements achieved by individual institutions.
44 citations
TL;DR: Three routes are shown that throttle the open channel conductance when the linker between the TM2 and CB domain is shortened by deletions or constrained by either cross-linking or heavy metal coordination, the conductance of the channel is reduced.
Abstract: MscL is a bacterial mechanosensitive channel that protects cells from lysis upon acute decrease in external osmotic environment. It is one of the best characterized mechanosensors known, thus serving as a paradigm of how such molecules sense and respond to stimuli. In addition, the fact that it can be genetically modified, expressed, isolated, and manipulated has led to its proposed use as a triggered nanovalve for various functions including sensors within microelectronic array chips, as well as vesicular-based targeted drug release. X-ray crystallography reveals a homopentameric complex with each subunit containing two transmembrane α-helices (TM1 and TM2) and a single carboxyl terminal α-helix arranging within the complex to form a 5-fold cytoplasmic bundle (CB), whose function and stability remain unclear. In this study, we show three routes that throttle the open channel conductance. When the linker between the TM2 and CB domain is shortened by deletions or constrained by either cross-linking or heav...
37 citations
TL;DR: The study found no significant difference across the individual atypical agents in the risk of falls/fractures in community-dwelling older adults.
Abstract: Background Atypical antipsychotic agents are extensively prescribed in the elderly to treat various behavioral and psychiatric disorders Past literature has documented an increased risk of falls and factures with the use of risperidone and olanzapine compared with nonuse However, none of the studies assessed the comparative safety profiles of atypical agents with respect to falls and fractures Objective The goal of this study was to evaluate the risk of falls and fractures associated with the use of risperidone, olanzapine, and quetiapine in community-dwelling adults aged ≥50 years Methods The study involved a propensity score–adjusted approach in new users of risperidone, olanzapine, or quetiapine anytime between July 1, 2000, and June 30, 2008, using data from the IMS LifeLink Health Plan Claims database Patients were followed up until a hospitalization/emergency department visit for fall/fracture or the end of the study period, whichever occurred earlier The Cox proportional hazards regression model was used to evaluate the comparative risk of falls/fractures The covariates in the final model included propensity scores and their interaction terms Results There were 12,145 new users of atypical agents in the study population (5083 risperidone, 4377 olanzapine, and 2685 quetiapine) A total of 417 cases of falls/fractures with at least 1 hospitalization/ emergency department visit after the use of the antipsychotic agents were identified The number of falls for risperidone, olanzapine, and quetiapine were 179 (356%), 123 (284%), and 115 (434%), respectively After adjusting for propensity scores, the Cox proportional hazards model showed that there was no statistically significant difference with use of risperidone (hazard ratio = 110 [95% CI, 086–139]) or quetiapine (hazard ratio = 112 [95% CI, 086–146]) compared with olanzapine (reference group) in the risk of falls or fractures Conclusions The study found no significant difference across the individual atypical agents in the risk of falls/fractures in community-dwelling older adults Future studies are required to evaluate the overall safety profiles of the antipsychotic agents in this population
35 citations
TL;DR: A line team provided for standardized, consistent central-line maintenance care leading to a significant, sustained decrease in CLABSI in a NICU, which decreased by 65% after implementation of the line team.
Abstract: To determine the association of a central-line maintenance team on the incidence of central-line-associated bloodstream infections (CLABSIs) in the neonatal intensive care unit (NICU) Central line maintenance in the NICU was limited to a line team starting in March 2008 CLABSI rates were determined before (December 2006 to February 2008) and after implementation of the line team ( March 2008 to August 2010) utilizing consistent National Healthcare Safety Network definitions Rates were calculated by birth weight categories and overall Data analysis was performed by two-proportion t test using Minitab Overall CLABSI decreased by 65% after implementation of the line team Pre intervention, mean overall CLABSI rate was 116 /1000, as compared with 40/1000 after intervention (P<0001) Birth-weight-specific CLABSI rates also decreased significantly Decreased infection rates were sustained over time A line team provided for standardized, consistent central-line maintenance care leading to a significant, sustained decrease in CLABSI in a NICU
TL;DR: CustEFW was a better predictor of abnormal birthweight and adverse outcomes compared to traditional popEFW standards.
TL;DR: Increases in the incidence of spontaneous worsening were seen as severities of injury progressed from the Parkland Protocol’s LR to MR to HR arms, and the time frames for these spontaneous worsenings seem to be such that the protocol's theoretical recommendations for venous thromboembolism prophylaxis are worth pursuing.
Abstract: BACKGROUND We have created a theoretical algorithm for venous thromboembolism prophylaxis after traumatic brain injury (TBI) known as the Parkland Protocol, which stratifies patients into low-, medium-, and high-risk categories for spontaneous progression of hemorrhage. This prospective study characterizes the incidence and timing of radiographic progression of the TBI patterns in these categories. METHODS Inclusion criterion was presentation with intracranial blood between February 2010 and March 2011; exclusion was receipt of only one computed tomographic scan of the head during the inpatient stay or preinjury warfarin. At admission, all patients were preliminarily categorized per the Parkland Protocol as follows: low risk (LR), patients meeting the modified Berne-Norwood criteria; moderate risk (MR), injuries larger than the modified Berne-Norwood criteria without requiring a neurosurgical procedure; high risk (HR), any patient with a craniotomy/monitor. RESULTS A total of 245 patients with intracranial hemorrhage were enrolled during the 13-month study period. Of patients preliminarily classified as LR at admission (n = 136), progression was seen in 25.0%. Spontaneous worsening was seen in 7.4% of LR patients at 24 hours after injury, and no LR patients progressed at 72 hours after injury. In patients initially classified as MR at admission (n = 42), progression was seen in 42.9%, with 91.5% of patients demonstrating stable computed tomographic head scans at 72 hours after injury. In patients initially classified as HR (n = 67), 64.2% demonstrated spontaneous progression of their TBI patterns, with 10.5% continuing to progress at 72 hours after injury. Most repeat scans were performed as routinely scheduled studies (81-91%). CONCLUSION Increases in the incidence of spontaneous worsening were seen as severities of injury progressed from the Parkland Protocol's LR to MR to HR arms. The time frames for these spontaneous worsenings seem to be such that the protocol's theoretical recommendations for venous thromboembolism prophylaxis are worth pursuing as future points of investigation.
Boston Children's Hospital1, St. Joseph's Hospital and Medical Center2, University of California, San Diego3, Harvard University4, University of Florida5, University of Texas Southwestern Medical Center6, University of Pennsylvania7, Santa Clara Valley Medical Center8, Texas Medical Center9, University of Missouri10, Mount Sinai St. Luke's and Mount Sinai Roosevelt11, Southwest Washington Medical Center12, Lutheran Medical Center13
TL;DR: No pediatric OPTX initially observed developed a tension pneumothorax or adverse event related to observation, and neither the presence of rib fractures nor need for PPV alone necessitates intervention.
TL;DR: Increased AT-ENPP1 is associated with AT dysfunction, increased liver triglyceride deposition, and systemic insulin resistance in young normoglycemic men and is identified as a potential target of therapy for health complications of At dysfunction, including type 2 diabetes and cardiovascular disease.
Abstract: Context: Adipose tissue (AT) helps to regulate body fat partitioning and systemic lipid/glucose metabolism. We have recently reported lipid/glucose metabolism abnormalities and increased liver triglyceride content in an AT-selective transgenic model overexpressing ectonucleotide pyrophosphatase/phosphodiesterase-1 (ENPP1), the AdiposeENPP1-Tg mouse. Objective: The aim of the study was to test the translational hypothesis that AT-ENPP1 overexpression associates with AT dysfunction (changes in AT gene expression, plasma fatty acid, and adipokine levels), increased liver triglyceride deposition, and systemic insulin resistance in humans. Design/Setting/Participants: A total of 134 young normoglycemic men and women were subjected to body composition studies, hyperinsulinemic-euglycemic clamps, and AT needle biopsy. Twenty men also had liver/muscle nuclear magnetic resonance spectroscopy. Main Outcome Measures: Predetermined measures included AT expression of ENPP1 and other lipid metabolism/inflammation genes...
TL;DR: Poverty and lack of awareness need to be tackled, according to the World Bank.
Abstract: Poverty and lack of awareness need to be tackled
The neglected tropical diseases are a group of chronic parasitic and related infections such as hookworm, schistosomiasis, lymphatic filariasis, Chagas disease, and leishmaniasis that often affect the “bottom billion” in Africa, Asia, and Latin America.1 Extreme poverty, defined by the World Bank as average daily consumption of $1.25 (£0.8; €1.0) or less, is the main social factor associated with a high prevalence of these diseases.1 The World Health Organization, the World Bank, and professionals have advocated strongly for global programmes to deliver packages of essential drugs to treat the tropical diseases with the highest prevalence, such as tuberculosis and malaria, while simultaneously developing new or improved drugs and vaccines.2 Diseases such as Chagas disease, cysticercosis, leishmaniasis, and dengue are listed in the 17 tropical diseases being targeted by WHO for control or elimination in low and middle income countries.3 4 Others, such as toxocariasis, a chronic parasitic infection that causes asthma and epilepsy,5 6 and trichomoniasis, a sexually transmitted disease associated with vaginal HIV-1 shedding,7 are not. That these diseases affect literally millions of Americans living in poverty,8 with prevalence rates of selected tropical diseases in some areas of the US comparable to rates in low and middle income countries, is less well known.9
Roughly 15% of …
TL;DR: The single and double exposure techniques were evaluated and the light and radiation congruency could be detected within 1 mm, which will satisfy the American Association of Physicists in Medicine task group report number 142 recommendation of 2 mm tolerance.
Abstract: Background
The radiation field on most megavoltage radiation therapy units are shown by a light field projected through the collimator by a light source mounted inside the collimator. The light field is traditionally used for patient alignment. Hence it is imperative that the light field is congruent with the radiation field.
01 Jul 2012
TL;DR: This commentary hypothesizes that a G-protein signaling pathway comprising Gαq - PLCβ - TPA-1 - DKF-2 activates Ce-Duox1/BLI-3, which is connected to p38 MAPK signaling and innate immunity in the worm and investigations in other organisms demonstrating that some of these components are involved in dual oxidase activation.
Abstract: We recently published work demonstrating that ROS (reactive oxygen species) generated by the dual oxidase, Ce-Duox1/BLI-3, in response to infection in Caenorhabditis elegans activates the transcription factor SKN-1, initiating a protective response. Moreover, we showed that the crucial innate immune pathway, p38 MAPK signaling, was responsible for relaying the activating signal. In this commentary, we speculate on the signaling pathway upstream of Ce-Duox1/BLI-3 that triggers its activity. Specifically, we hypothesize that a G-protein signaling pathway comprising Gαq - PLCβ - TPA-1 - DKF-2 activates Ce-Duox1/BLI-3. Our rationale is based on work showing that these components are connected to p38 MAPK signaling and innate immunity in the worm, and investigations in other organisms demonstrating that some of these components are involved in dual oxidase activation.
TL;DR: The feasibility, safety and effectiveness stents in the pediatric population are demonstrated, although scrutiny of results of larger experience with longer follow-up is important.
Abstract: To address elastic recoil of vessel wall and intimal dissection that can follow balloon angioplasty, stents have been designed and these appear to produce more effective relief of obstruction. Of the two types of stents, namely, balloon expandable and self expandable, balloon expandable stents are most commonly used in children. The usefulness of stents in the management of vascular obstructive lesions not amenable to balloon angioplasty is well established and has been successfully used to treat branch pulmonary artery stenosis, coarctation of the aorta, stenotic right ventricular outflow tract conduits, obstructive lesions of the systemic and pulmonary veins and others. The techniques of implantation, indications, immediate and follow-up results and complications were reviewed. The stents have also been effectively used in keeping open naturally occurring or artificially created inter-circulatory connections and as adjuncts in hybrid procedures, but these have not been discussed in this review. Future directions include investigative work on biodegradable stents and growth stents to address issues related to increase in vessel size in infants and children, use of drug eluding stents to prevent neo-intimal proliferation to avoid pulmonary vein restenosis and refinement of stent technology in hybrid procedures such as neonatal palliation of hypoplastic left heart syndrome and transcatheter completion of Fontan procedure. The feasibility, safety and effectiveness stents in the pediatric population are demonstrated, although scrutiny of results of larger experience with longer follow-up is important.
TL;DR: Among Mexican Americans, persons with diabetes, obesity, and the metabolic syndrome were more likely to have ischemic electrocardiographic abnormalities, longer QTc intervals, and higher resting heart rates.
Abstract: INTRODUCTION: Resting ischemic electrocardiographic abnormalities have been associated with cardio-vascular mortality. Simple markers of abnormal autonomic tone have also been associated with diabetes, obesity, and the metabolic syndrome in some populations. Data on these electrocardiographic abnormalities and correlations with coronary risk factors are lacking among Mexican Americans wherein these conditions are prevalent. This study aimed to evaluate the prevalent resting electrocardiographic abnormalities among community-dwelling Mexican Americans, and to correlate these findings with coronary risk factors, particularly diabetes, obesity, and the metabolic syndrome. METHODS: Study subjects (n = 1280) were drawn from the Cameron County Hispanic Cohort comprised of community-dwelling Mexican Americans living in Brownsville, Texas at the United States-Mexico border. Ischemic electro-cardiographic abnormalities were defined as presence of ST/T wave abnormalities suggestive of ischemia, abnormal Q waves, and left bundle branch block. Parameters that reflect autonomic tone, such as heart rate-corrected QT interval and resting heart rate, were also measured. RESULTS: Ischemic electrocar-diographic abnormalities were more prevalent among older persons and those with hypertension, diabetes, obesity, and the metabolic syndrome. Subjects in the highest quartiles of QTc interval and resting heart rate were also more likely to have diabetes, hypertension, obesity, or the metabolic syndrome. CONCLU- SIONS: Among Mexican Americans, persons with diabetes, obesity, and the metabolic syndrome were more likely to have ischemic electrocardiographic
abnormalities, longer QTc intervals, and higher resting heart rates. A resting electrocardiogram can play a complementary role in the comprehensive evaluation of cardiovascular risk in this minority population.
01 Jan 2012
TL;DR: In this paper, Tinkoff et al. evaluated the adjusted mortality of the region's trauma system over time as a means to identify any significant temporal variation in patient mortality and concluded that if the triage and referral patterns in our trauma system were functioning appropriately, the risk-adjusted mortality should not vary significantly between level I, II, and III/IV centers within our region.
Abstract: Trauma systems exist to provide optimal acute care for injured patients of all ages. Hoyt and Coimbra suggested that many severely injured patients are never taken to trauma centers, and only 15% of trauma patients actually require the additional services offered by level I and II centers (1). Effective trauma systems must therefore be inclusive and function cohesively to provide the most appropriate care to patients. This is ensured by the leadership of surgeons in the community.
A clear classification of hospital roles based upon trauma response and capabilities was established by the American College of Surgeons Committee on Trauma in 1976. These tiers of care range from level I/II, providing comprehensive care, to levels III, IV and V, providing stabilization and transport to higher-level facilities (2). Further refinement in the definition of trauma systems led to the concept of inclusive versus exclusive systems. Inclusive trauma systems comprise all acute care facilities in a geographical region regardless of their level of verification or expertise. Exclusive systems rely on a few high-level centers to care for the most severely injured patients (3). Utter et al showed that although both types of systems similarly triage patients, severely injured patients treated within inclusive systems experience better survival rates (4). Tinkoff et al recently published a report of the inclusive statewide trauma system in Delaware. Their findings of decreasing mortality of the most critically injured patients over 10 years compared favorably to a cohort of injury severity–matched patients from the National Trauma Data Bank, thus reinforcing the benefits of inclusive trauma systems (5).
A standard measurement of the quality of care among trauma systems is hospital mortality, since this is the most accessible and obvious endpoint. Proper triage enhances trauma system effectiveness and positively influences patient survival. As such, if a trauma system is properly functioning, patients with the highest probability of death based on anatomic injury should be referred to a level I or II center.
We sought to characterize the cumulative experience of our region's trauma system in caring for one of the growing segments of the trauma patient population—those injured in ground-level falls (GLFs). Specifically, we sought to evaluate the referral practice whereby those patients with higher predicted mortality should be admitted to level I and II trauma centers where resources are available to provide definitive care for critically injured patients. Conversely, those patients with lower predicted mortality should comprise the group of patients admitted to level III and IV trauma centers. We hypothesized that if the triage and referral patterns in our trauma system were functioning appropriately, the risk-adjusted mortality should not vary significantly between level I, II, and III/IV centers within our region. Additionally, we evaluated the adjusted mortality of our region's trauma system over time as a means to identify any significant temporal variation in patient mortality. The overarching goal of this study was to demonstrate areas for quality improvement as well as the strengths of our regional trauma system.
TL;DR: Although a dedicated corps of full-time active-duty and eserve component military physicians now provide most S battlefield medical and surgical care, the military serices have continued to benefit from close collaborations nd interaction with civilian counterparts.
Abstract: Although a dedicated corps of full-time active-duty and eserve component military physicians now provide most S battlefield medical and surgical care, the military serices have continued to benefit from close collaborations nd interaction with civilian counterparts. In addition to he individual service and facility-specific relationships ith civilian trauma experts and trauma centers described lsewhere, there has been a concerted effort to establish, aintain, and expand programs that promote professional nteractions and exchange of information between military nd civilian surgeons and surgical leadership. These interactions are not new. The history of civilian rofessional medical support for the military can be traced ack nearly a century. In 1916, foreseeing the possibility hat American involvement in the European hostilities of orld War I might become a reality, The Committee of merican Physicians for Medical Preparedness, chaired by
TL;DR: Nearly one-half of adolescent girls received the HPV vaccine among those who were recommended to receive the vaccine by their health care provider, highlighting the importance of predisposing and enabling factors for HPV vaccination.
Abstract: Objectives To determine the prevalence and predictors of human papillomavirus (HPV) vaccination in adolescent girls who were recommended to receive the vaccine by their health care providers. Design Cross-sectional study. Setting United States in 2007–08. Participants Parents or guardians most knowledgeable about health and health care of adolescent girls aged 12 to 17 years participating in the 2007 National Survey of Children's Health (NSCH). Intervention NCSH was a population-based telephone survey using a complex probability sampling design. Main outcome measures Prevalence of HPV vaccination in adolescent girls who were recommended to receive the HPV vaccine and predisposing, enabling, and need factors associated with HPV vaccination. Results Of 12.38 million adolescent girls aged 12 to 17 years, 3.69 million (29.76%) were recommended to receive the HPV vaccine by their health care provider. The majority who received the HPV vaccine recommendation were 13 to 17 years of age (83%), were white (71%), and had one or more preventive visits (94%). Among those for whom the HPV vaccine was recommended, 48.75% (95% CI 45.37–52.13) received the vaccine. Multivariate logistic regression analysis of those who were recommended revealed that enabling and predisposing factors were significantly associated with the HPV vaccination. Children living at 101% to 200% of the Federal Poverty Level (odds ratio 0.54 [95% CI 0.30–0.98]) and children in households with two or more adults (0.51 [0.33–0.80]) were negatively associated with HPV vaccination, whereas children with any preventive medical care visit(s) (2.28 [1.36–3.84]) in the previous year were positively associated with HPV vaccination. Conclusion Nearly one-half of adolescent girls received the HPV vaccine among those who were recommended by their health care provider. The study finding emphasizes the importance of predisposing and enabling factors for HPV vaccination. Policy and education efforts can focus on these factors to improve HPV vaccination rates.
TL;DR: The very first transcatheter intervention to treat congenital cardiac defects was reported by Rubio-Alvarez et al. in 1953, when they performed pulmonary valvotomy using a modified ureteral catheter and progressive dilatation of peripheral arterial stenotic lesions, balloon atrial septostomy and transCatheter occlusion of patent ductus arteriosus were described.
Abstract: The very first transcatheter intervention to treat congenital cardiac defects was reported by Rubio-Alvarez et al. [1] in 1953, when they performed pulmonary valvotomy using a modified ureteral catheter. A decade later Dotter, Rashkind, Porstmann and their associates described progressive dilatation of peripheral arterial stenotic lesions, balloon atrial septostomy and transcatheter occlusion of patent ductus arteriosus, respectively. The purpose of this review is to present these and other historical developments of catheter-based interventions in the treatment of heart disease in children. Historical aspects of 1. balloon angioplasty/valvuloplasty of valvar pulmonary stenosis, valvar aortic stenosis, fixed subaortic stenosis, native aortic coarctation, postsurgical aortic recoarctation, branch pulmonary artery stenosis, mitral stenosis, cyanotic heart defects with pulmonary oligemia, stenotic bioprosthetic valves, congenital tricuspid and mitral stenosis, truncal valve stenosis, subvalvar pulmonary stenosis, supravalvar pulmonary stenosis (congenital membranous or postoperative), stenosis of the aorta (Leriche syndrome, atherosclerotic and Takayasu’s arteritis), baffle obstruction following Mustard or Senning procedure (both systemic and pulmonary venous obstructions), superior and inferior vena caval obstructions, pulmonary vein stenosis, pulmonary venoâocclusive disease, vertical vein stenosis in total anomalous pulmonary venous connection, pulmonary venous obstruction following repair of total anomalous pulmonary venous obstruction, specially designed pulmonary artery bands, cor triatriatum, cor triatriatum dexter, and coronary artery stenotic lesions that develop after Kawasaki disease; 2. stents to enlarge stenotic lesions of branch pulmonary arteries, systemic veins, systemic and pulmonary venous pathways after Mustard procedure, aorta, right ventricular outflow conduits, pulmonary veins and native right ventricular outflow tract or to keep the ductus arteriosus open in patients with pulmonary atresia and hypoplastic left heart syndrome and maintaining patency of stenosed aorto-pulmonary collateral vessels, surgically created but obstructed shunts or acutely thrombosed shunts as well as covered stents; 3. transcatheter occlusion of cardiac defects comprising of atrial septal defect, patent foramen ovale, patent ductus arteriosus, ventricular septal defect and aortopulmonary window and 4. catheter-based atrial septostomy such as Rashkind balloon atrial septostomy, Park’s blade atrial septostomy, balloon angioplasty of the atrial septum, trans-septal puncture and atrial septal stents were presented.
TL;DR: Immediate, intermediate and long-term follow-up data following balloon aortic valvuloplasty suggest reasonably good results, avoiding/postponing the need for surgical intervention, however, late follow- up data indicate that significant aorti insufficiency with left ventricular dilatation may develope, some require surgical intervention and are of concern.
Abstract: Following the description by Lababidi in 1983 of balloon aortic valvuloplasty, it has been adopted by several groups of workers for relief of aortic valve stenosis. The indications for the procedure are peak-to-peak systolic pressure gradients in excess of 50 mmHg with symptoms or ECG changes or a gradient greater than 70 mmHg irrespective of the symptoms or ECG changes. One or more balloon dilatation catheters are placed across the aortic valve percutaneously, over extra-stiff guide wire (s) and the balloon (s) inflated until waist produced by the stenotic valve is abolished. A balloon/annulus ratio is 0.8 to 1.0 is recommended. While trans-femoral arterial route is the most commonly used for balloon aortic valvuloplasty, trans-umbilical arterial or venous or trans-venous routes are preferred in neonate and young infants to avoid femoral arterial injury. Reduction of peak-to-peak systolic pressure gradient along with a fall in left ventricular peak systolic and enddiastolic pressures is seen after balloon aortic valvuloplasty in the majority of patients. Significant aortic insufficiency, though rare, may develop, particularly in the neonate. At intermediate-term follow-up, peak-to-peak gradients, at repeat cardiac catheterization and noninvasive Doppler gradients remain low for the group as a whole. Nevertheless, restenosis, defined as peak-to-peak gradient ≥ 50 mmHg may develop in nearly one quarter of the patients. Predictors of restenosis are age ≤ 3 years and an immediate post-valvuloplasty aortic valve gradient ≥ 30 mmHg. The restenosis may be addressed by repeat balloon valvuloplasty or surgical valvotomy. Feasibility and effectiveness repeat balloon valvuloplasty in relieving restenosis has been demonstrated. Long-term follow-up data suggest, low Doppler peak instantaneous gradients, minimal additional restenosis beyond what was observed at intermediate-term follow-up and progression of aortic insufficiency in nearly one-quarter of patients. Event-free rates are in mid 70s and low 60s respectively at 5 and 10-years after initial balloon valvuloplasty. A number of complications have been reported, but are rare. Comparison with surgical results is fraught with problems, but overall, the balloon therapy appears to carry less morbidity. Immediate, intermediate and long-term follow-up data following balloon aortic valvuloplasty suggest reasonably good results, avoiding/postponing the need for surgical intervention. However, late follow-up data indicate that significant aortic insufficiency with left ventricular dilatation may develope, some require surgical intervention and are of concern. Curr
TL;DR: A retrospective analysis of the registry of the Texas Trauma Service Area G, which serves the east Texas area, from the years 2004–2010 was performed and demonstrated that the highest rates of all-terrain vehicle-related injuries in east Texas are found in two neighboring rural eastern counties.
Abstract: The state of Texas was ranked 10th for all-terrain vehicle-related deaths among all states from 2007–2009. Health Service Region 4/5N of eastern Texas has a statistically significant higher rate of all-terrain vehicle-related injuries in children under the age of 18 than Texas as a whole (p < 0.001.) It is unknown why east Texas has a higher all-terrain vehicle-related injury rate. A retrospective analysis of the registry of the Texas Trauma Service Area G, which serves the east Texas area, from the years 2004–2010 was performed. Variations within the region were assessed using a geographic information system and the analysis demonstrated that the highest rates of all-terrain vehicle-related injuries in east Texas are found in two neighboring rural eastern counties. Recording mechanism of injury was an important adjunct to identifying all-terrain vehicle-related injuries. Using E-codes alone underestimated the actual injuries. Other findings demonstrated that children under age 16 had a high rate...
TL;DR: Symphysiotomy is an operation in which the fibres of the pubic symphysis are partially divided to allow separation of the joint and thus enlargement of the pelvic dimensions thereby facilitating vaginal delivery of the foetus in the presence of mild to moderate cephalopelvic disproportion.
Abstract: Symphysiotomy is an operation in which the fibres of the pubic symphysis are partially divided to allow separation of the joint and thus enlargement of the pelvic dimensions thereby facilitating vaginal delivery of the foetus in the presence of mild to moderate cephalopelvic disproportion. It is performed with local anaesthesia, does not require an operating theatre or advanced surgical skills. It can be a lifesaving procedure for both mother and baby in obstructed labour, especially in rural areas and resource-poor settings of developing countries, where a 24 hours availability of a caesarean section cannot be guaranteed. It is a simple underused technology that can be performed by a graduate doctor or midwife in rural health facilities and hospitals where most of the times, in Nigeria, there are no practicing specialist obstetricians. In rural hospital and in communities where sympysiotomy is still being performed, it is evident that it is preferred to caesarean section because of the socio-cultural desire to achieve a vaginal delivery. This paper highlights our experiences with symphysiotomy in a rural Roman Catholic hospital providing evidence on the safety of symphysiotomy and the need for its revival and reinstatement in the obstetric arsenal in Nigeria and similar countries in sub-Saharan Africa where maternal mortality as a result of prolonged and neglected obstructed labour still occur ( Afr J Reprod Health 2012; 16[3]: 93-100). Resume Symphysiotomie est une operation dans laquelle les fibres de la symphyse pubienne sont partiellement divisees pour permettre la separation de l’articulation et permet en consequence l'elargissement commune et des dimensions du bassin, facilitant ainsi l'accouchement vaginal des fœtus en presence d’une disproportion cephalo-pelvienne d’intensite legere a modere. Elle est realisee sous l’anesthesie locale, et n'exige pas une salle d'operation ou des competences chirurgicales avancees en chirurgie. Elle peut etre une procedure de sauvetage pour la mere et le bebe dans les dystocies, surtout dans les zones rurales dont les ressources sont limitees des pays en developpement, ou une operation cesarienne ne peut etre assuree pour 24 heures par jour. C’est est une technologie simple qui est sous-utilises et qui peuvent etre pratiquee par un medecin qualifie ou une sagefemme dans les etablissements de sante ruraux et les hopitaux ou la plupart du temps, au Nigeria, il n'y a pas d'obstetriciens specialises exercant. Dans les hopitaux ruraux et dans les communautes ou la sympysiotomie est toujours pratiquee, il est evident qu'il est preferable a l’operation cesarienne en raison de la volonte socioculturelle pour parvenir a un accouchement vaginal. Cet article met en lumiere nos experiences avec la symphysiotomie dans un hopital rural catholique romain et fournit des preuves sur la securite de la symphysiotomie et la necessite de sa renaissance et de sa reintegration dans l'arsenal obstetrique au Nigeria et les pays similaires en Afrique sub-saharienne ou la mortalite maternelle se produire toujours a cause de la dystocie prolongee et negligee ( Afr J Reprod Health 2012; 16[3]: 93-100). Keywords: Obstructed Labour, cephalo-pelvic disproportion, symphysiotomy, resource-poor communities, Nigeria.
TL;DR: Management options and decision making from the interventional cardiologists point of view for PA-IVS will be focused on.
Abstract: Pulmonary atresia with intact ventricular septum (PA-IVS) is a complex congenital heart malformation with a diverse set of anatomical and clinical findings. The incidence is 4.1 per 100,000 live births and is less than 1% of all congenital heart disease. During embryogenesis, PA-IVS is postulated to occur after development of ventricular septum which is later than the development of PA with ventricular septal defect. Every case of PA-IVS poses a considerable challenge to the pediatric cardiologist and cardiovascular surgeon. Although echocardiography is often the first line tool in cardiac imaging, cardiac catheterization is the gold standard for diagnosing PA-IVS and describing the important anatomical features that determine the plan of treatment. This article will focus on the management options and decision making from the interventional cardiologists point of view.
TL;DR: A simulated wrist-cutting suicide attempt scenario was developed and implemented, with the goal of integrating the concepts of psychiatric emergency care, contraband, environmental assessment, and personal safety into nursing students and novice nurses' learning.
Abstract: A simulated wrist-cutting suicide attempt scenario was developed and implemented, with the goal of integrating the concepts of psychiatric emergency care, contraband, environmental assessment, and personal safety. Faculty also wanted to convey and provide care and support for participants through-out the visually and emotionally stimulating activity. The under-lying premise was that providing readings and lecture material on these topics was insufficient to the level of learning and performance needed by nursing students and novice nurses. How-ever, actual student clinical episodes integrating these concepts were also infrequent, unpredictable, and often not conducive to student learning. Therefore, faculty implemented a simulation teaching modality to deliver the concepts in a vivid and memorable format. A standardized rating scale on perceived learning and care from faculty during the course of the simulation was administered immediately following participation in the activity. Participants were overwhelmingly positive in their assessment of the activity, reporting an enhanced appreciation for safety in the conduct of inpatient psychiatric nursing care.Further, the faculty member's observation and post-simulation processing of the activity noted cognitive, behavioral, and emotional responses at the individual and group levels related to communication, observation and assessment, decision making,and interpersonal support