Bacteremia in the Spinal Cord Injury Population

Abstract

Positive blood cultures were found in 41 patients on the Spinal Cord Injury Service at the Milwaukee VAMC during the period of July, 1980 to December, 1985 giving an incidence of bacteremia of 1.3%. Mortality rate was 17%. Most common pathogens were E. Coli, Proteus mirabilis, Serratia marcescens and Staphylococcus aureus. A review of 29 available charts revealed genitourinary and respiratory tracts as the most common sources of infection (72.4% and 10.3% respectively). Other sources of infection were skin, postoperative, intravenous catheter site and cellulitis. Initial febrile response was seen in 93.1% of patients with 48.1% having temperature greater than 38.3°C. Hypotension (blood pressure less than 90/50 mm Hg) was noted in five out of the 29 (17.1%) patients. Clinical diagnosis of disseminated intravascular coagulation was made in two out of the 29 (6.9%) patients. Underlying risk factors were poor nutrition, respirator dependency, indwelling Foley catheters and manipulative procedures. Incidence and mortality rates are similar to the non-SCI population as reported elsewhere. The risk factors are different; therefore preventive management is extremely important.     

Entrustables and Entrustment: Through the Looking Glass at the Clinical Making of a Nurse Practitioner

Entrustable professional activities (EPAs) formally address the supervision level required for nurse practitioner (NP) skills of students and fellows. Entrustment is the decision to entrust students and fellows with the responsibility to practice professional skills without direct supervision. EPAs offer the promise of consistency within and among NP programs about the expected skills of NP students and fellows and how and when they are acquired. EPAs highlight how and when the supervision and entrustment decisions are made. Their use in medical and graduate medical education suggests that EPAs would provide a common vocabulary among NP students, fellows, and physician colleagues.     

Design,synthesis and biological evaluation of novel quinoline [4,3-b]chromene derivatives as AChE inhibitors through an efficient one-pot,four-component microwave-mediated reaction

An efficient synthesis of chromeno[4,3-b]quinoline derivatives via one-pot, four-component reaction of 4-hydroxycoumarin, formaldehyde, cyclohexanedione, ammonium ceric nitrate under microwave irradiation was accomplished. The structures of these compounds were unambiguously confirmed by single crystal X-ray diffraction. Furthermore, the anti-AChE activities of these compounds in vitro were investigated at concentrations of 20 μM and 50 μM by using a standard Ellman’s method. The relationship of inhibitory activities and structures of these chromeno [4,3-b]quinolines was also systematically studied. Of all the compounds investigated, 4ag emerged as the most potent AChE inhibitor with IC₅₀ values of 5.63 µM, and it might be used as potent lead for the development anti-AChE agents. Moreover, molecular modelling was conducted to understand the optimal interaction of AChE with these types of compounds.     

In vivo application of an optical segment tracking approach for bone loading regimes recording in humans: A reliability study

This paper demonstrates an optical segment tracking (OST) approach for assessing the in vivo bone loading regimes in humans. The relative movement between retro-reflective marker clusters affixed to the tibia cortex by bone screws was tracked and expressed as tibia loading regimes in terms of segment deformation. Stable in vivo fixation of bone screws was tested by assessing the resonance frequency of the screw-marker structure and the relative marker position changes after hopping and jumping. Tibia deformation was recorded during squatting exercises to demonstrate the reliability of the OST approach. Results indicated that the resonance frequencies remain unchanged prior to and after all exercises. The changes of Cardan angle between marker clusters induced by the exercises were rather minor, maximally 0.06°. The reproducibility of the deformation angles during squatting remained small (0.04°/m–0.65°/m). Most importantly, all surgical and testing procedures were well tolerated. The OST method promises to bring more insights of the mechanical loading acting on bone than in the past.     

Baduanjin exercise improved premenstrual syndrome symptoms in Macau women

ObjectiveTo investigate the effect of Baduanjin, a traditional Chinese medical exercise, on improving premenstrual syndrome (PMS) symptoms in women.MethodsForty reproductive age women with PMS in Macau practiced standardized Baduanjin exercise for three menstrual cycles. A questionnaire, the daily record of severity of problems (DRSP), was used to measure symptom severity. DRSP was filled out every day starting from the last cycle before exercise (i.e., the first menstrual cycle) to the third cycle after exercise initiation (i.e., the fourth menstrual cycle). The total scores and the scores of each item during the 5 premenstrual days and follicular phase (5-9 postmenstrual days) were calculated.ResultsAfter exercise, the total DRSP scores during the 5 premenstrual days and differences in the total DRSP scores between the 5 premenstrual days and the follicular phase were both significantly reduced. Of note, the physical symptom total scores in the 5 premenstrual days and the differences between its total score in the 5 premenstrual days and in the follicular phase were both significantly reduced. The differences between the total scores of depressed mood, anxious mood, loss of interest, and reduction in social activity during the 5 premenstrual days and the follicular phase were also reduced.ConclusionsBaduanjin exercise was able to improve the mental and especially the physical symptoms of PMS.     

Effect of ACL graft material on joint forces during a simulated in vivo motion in the porcine knee: Examining force during the initial cycles

This study compared three‐dimensional forces in knees containing anterior cruciate ligament (ACL) graft materials versus the native porcine ACL. A six‐degree‐of‐freedom (DOF) robot simulated gait while recording the joint forces and moments. Knees were subjected to 10 cycles of simulated gait in intact, ACL‐deficient, and ACL‐reconstructed knee states to examine time zero biomechanical performance. Reconstruction was performed using bone‐patellar tendon‐bone allograft (BPTB), reconstructive porcine tissue matrix (RTM), and an RTM‐polymer hybrid (Hybrid). Forces and moments were examined about anatomic DOFs throughout the gait cycle and at three key points during gait: heel strike (HS), mid stance (MS), toe off (TO). Compared to native ACL, each graft restored antero‐posterior (A‐P) forces throughout gait. However, all failed to mimic normal joint forces in other DOFs. For example, each reconstructed knee showed greater compressive forces at HS and TO compared to the native ACL knee. Overall, the Hybrid graft restored more of the native ACL forces following reconstruction than did BPTB, while RTM grafts were the least successful. If early onset osteoarthritis is in part caused by altered knee kinematics, then understanding how reconstruction materials restore critical force generation during gait is an essential step in improving a patient's long‐term prognosis. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1458–1463, 2014.     

Aging and Diversity: An Active Learning Experience,by Chandra M. Mehorta and Lisa S. Wagner

This study evaluated a 10-week chair yoga intervention on cognition, balance, activities of daily living (ADLs), anxiety, and depression for persons with Alzheimer's disease (AD). Residents were assigned to three groups: (a) mild AD (n?=?6), (b) moderate AD (n?=?6), or (c) severe AD (n?=?7). There was no significant change in balance, anxiety, or cognition. ADLs showed a significant effect (p?=?.02), which suggests that yoga may have more benefit early in the progression of AD. Depression increased significantly (p < .01). Yoga over an extended period of time with a larger sample size may demonstrate benefits to persons with AD and serve as means to improve overall quality of life.     

Do low-priced ski pass owners perceive a higher quality of life? A case study of the Leisure Card Tirol

ObjectivesThe study investigated a potential correlation between owning a superregional low-cost ski and leisure card, namely the Leisure Card Tirol (LCT), and perceived quality of life (QOL).DesignA cross-sectional, quantitative approach (online questionnaire) was chosen.MethodsIn total, 1588 LCT users as well as 684 non-users (residents living in the Alpine region of Tyrol, Austria) were reached throughout the study period.ResultsCompared to non-users, LCT users reported significantly higher scores in all domains of QOL. However, the correlation was neither mediated nor moderated by the level of general physical activity (in contrast to alpine skiing in particular).ConclusionsAs superregional low-cost leisure cards were suggested as a way of facilitating access to skiing—at least according to its buyers—owning the LCT was associated with higher perceived QOL. Subsequent research should elaborate the extent to which this correlation is causal. If there is a causal link, such cards should be actively promoted to improve/maintain residents’ QOL.