Product-oriented approaches to reducing youth gun violence

Injury prevention experts have suggested that gun manufacturers could reduce youth violence by changing the design of guns. Product safety features could make guns more difficult for children to fire unintentionally and more difficult to use if stolen or obtained illegally. This article gives a brief history of efforts to make safer, smarter guns and assesses the potential of the product safety approach for reducing youth gun violence. Among the article's key findings: Research from the injury prevention field suggests that changing product design may be more effective in preventing injuries than trying to change personal behaviors; Existing product safety technologies for guns could reduce unintentional gun injuries, especially to young children. In addition, emerging technologies will enable gun manufacturers to "personalize" guns, which could prevent unauthorized users of any age from firing the weapons. Personalization could decrease access to guns by adolescents; Gun manufacturers have been slow to incorporate safety features into their products; but legislative, regulatory, and litigation efforts are under way to mandate safer guns. The authors envision a future when the law requires product safety features--including personalization--on all new firearms. These product safety features have the potential to reduce both intentional and unintentional firearm injury and death.     

Anti-clumping factor A immunoglobulin reduces the duration of methicillin-resistant Staphylococcus aureus bacteremia in an experimental model of infective endocarditis

SA-IGIV is a human polyclonal immunoglobulin containing elevated levels of antibodies specific for the fibrinogen-binding MSCRAMM protein clumping factor A (ClfA). In vitro, SA-IGIV specifically recognized ClfA that was expressed on the surface of Staphylococcus aureus and inhibited bacterial adherence to immobilized human fibrinogen by >95%. Moreover, SA-IGIV efficiently opsonized ClfA-coated fluorescent beads and facilitated phagocytosis by human polymorphonuclear leukocytes. To determine its potential therapeutic efficacy, SA-IGIV was evaluated in combination with vancomycin in a rabbit model of catheter-induced aortic valve infective endocarditis (IE) caused by methicillin-resistant S. aureus (MRSA). The combination therapy was more effective than vancomycin alone in sterilizing all valvular vegetations when used therapeutically during early (12-h) IE. The combination therapy resulted in clearance of bacteremia that was significantly faster than that of vancomycin alone in animals with well-established (24-h) IE. Therefore, in both early and well-established MRSA IE, the addition of SA-IGIV to a standard antibiotic regimen (vancomycin) increased bacterial clearance from the bloodstream and/or vegetations.     

Go wireless to spark productivity

The mother/baby unit of Ohio's Good Samaritan Hospital instituted a wireless communication system. Here, review its benefits.     

Intravascular therapy process improvement in a multihospital system: don't get stuck with substandard care

Using the process of FOCUS PDSA (a quality improvement format), two clinical nurse specialists reviewed the delivery of intravenous care at a multihospital (4-hospital) system. The clinical nurse specialists formed a multi-facility nursing team to lead the assessment, develop a plan, implement changes, and evaluate the process. This process reflects the use of clinical nurse specialists as experts in using research-based data, national recommendations, and benchmark data to ultimately improve practice and reduce risks and overall costs. This process allows the clinical nurse specialist to be viewed as an innovator, a project manager, and a program developer in a major system. The clinical nurse specialists were selected to lead this process improvement based on their knowledge and competencies in the specific area of intravenous therapy.     

Estrogen inhibits the initiation of fatty streaks throughout the vasculature but does not inhibit intra-plaque hemorrhage and the progression of established lesions in apolipoprotein E deficient mice

Estrogen has previously been shown to inhibit development of early atherosclerotic lesions in hyperlipidemic mice. However, it is still not known whether estrogen also inhibits progression and destabilization of lesions once established and whether there are other effects of long-term hormone therapy in mice. To address this question, male, 20-week old, apolipoprotein E deficient mice were administered 17-beta estradiol or placebo subcutaneously for between 4 and 40 weeks. Estrogen administration did not cause regression of established lesions in the carotid arteries, aortic arch and thoracic aorta but prevented the initiation of new lesions in the abdominal aorta and iliac, femoral and popliteal arteries. Although the established lesions were slightly smaller in the innominate artery of the estrogen treated mice, estrogen did not prevent lesion progression. Estrogen administration also had no effect on the frequency of intra-plaque hemorrhage, atrophy of the fibrous cap, medial erosion, and fibro-fatty nodules, but did reduce the frequency of fatty streaks that form on top of or adjacent to the established lesions in the innominate artery. These data suggest that estrogen inhibits the initiation of the fatty streak but does not alter the progression of established lesions through stages of instability and healing.     

Response of alveolar macrophages from inducible nitric oxide synthase knockout or wild-type mice to an in vitro lipopolysaccharide or silica exposure

The role of nitric oxide (NO) in pulmonary disease has been controversial with both antiinflammatory (scavenging radicals and inhibiting NF-êB activation) and proinflammatory (forming highly reactive peroxynitrite and augmenting NF-êB activation by inflammatory agents) actions reported. Therefore, a study has been initiated to determine whether deletion of the inducible nitric oxide synthase (iNOS) gene in the C57BL/6J mouse alters the pulmonary macrophage response to lipopolysaccharide (LPS) or silica. The objective of the initial phase of this study was to determine the difference in responsiveness of alveolar macrophages (AMs), harvested from naive wild-type (WT) or iNOS knockout (iNOS KO) mice, to an in vitro LPS or silica exposure. Primary AMs were obtained by bronchoalveolar lavage (BAL) from age- and weight-matched iNOS KO and WT mice. The cells were treated with interferon-gamma (IFN-?) (50 U/ml), IFN-? (50 U/ml) + LPS (1 microg/ml), LPS (0.01-100 microg/ml), or silica (25-250 microg/ml). The following parameters were measured: nitrate and nitrite (NOx), tumor necrosis factor-á (TNF-á), macrophage inflammatory protein-2 (MIP-2), intracellular generation of the reactive oxygen species (ROS) hydrogen peroxide (H(2)O(2) and superoxide (O(*-2)), and basal (unstimulated) total antioxidant capacity. Data show a significant increase in NOx production upon exposure to IFN-? +/- LPS in the WT but not iNOS KO AMs. NOx production by iNOS KO or WT AMs was not altered by in vitro exposure to LPS or silica alone. LPS, but not silica, induced TNF-á and MIP-2 production in both iNOS KO and WT AMs. Statistical analysis of concentration response curves found a significant tendency for greater mediator production in the iNOS KO versus WT AMs. Basal intracellular production of H(2)O(2) and O(*- 2) was significantly greater in the iNOS KO compared to WT AMs. In contrast, LPS- (10 microg/ml) or silica- (100 microg/ml) stimulated intracellular oxidant production was lower in iNOS KO AMs, but overall (basal + stimulated) inflammatory capacity was similar between the cell types. The basal total antioxidant production of the iNOS KO AMs was approximately twofold higher than the WT AMs. In conclusion, certain compensatory changes appear to occur in AMs from iNOS KO mice. In response to the inability to induce NO production, iNOS KO AMs exhibit significantly higher basal generation of H(2)O(2) and (O(*- 2)) as well as higher total antioxidant levels. In addition, LPS induced TNF-á and MIP-2 production tend to be higher in AMs from iNOS KO mice. Such compensatory changes in the AM response may affect the response of iNOS KO mice to inflammatory exposures.     

Toxicokinetics and biotransformation of p-nitrophenol in red abalone (Haliotis rufescens)

Red abalone (Haliotis rufescens) were exposed to 3.6 microM (0.5 ppm) 14C-labelled p-nitrophenol (PNP) for 24 h, then were allowed to depurate in clean seawater for another 24 h. Absorption, conditional uptake clearance and elimination rate constants were 0.12+/-0.04 h(-1), 3.2+/-1.1 ml g(-1) h(-1) and 0.05+/-0.02 h(-1), respectively. The sigmoidal shape of the PNP uptake curve suggests a biphasic process. A whole-organism total concentration factor (TCF) of 2.37+/-0.07 was determined from equilibrium tissue and water concentrations, with the highest concentration of PNP plus metabolites found in gill tissue (11.8+/-0.2 nmol g(-1), wet weight). Digestive gland, foot muscle and remaining body tissues accumulated 8.8+/-0.9, 7.7+/-0.6 and 7.5+/-0.6 nmol g(-1) radiolabelled residues, respectively. Abalone depurated 91.6% of absorbed PNP within 24 h, of which 87.5+/-3.1% was unmetabolized parent compound, 13.1+/-3.1% was p-nitrophenylsulfate, 0.32+/-0.09% was p-nitroanisole, and 0.14+/-0.07% was p-acetamidophenol.