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PubMed2002

Anatomy of a murder: telemetric footprints.

A man with complete heart block received a Pacesetter Affinity pacemaker, programmed DDD. Two months later, the patient was beaten to death and the coroner requested telemetric information. Pacemaker stored Event Records for the previous 40 hours were retrieved and using the zoom scale, the events leading to death were examined. This included sinus tracking during the beating followed by atrial and ventricular pacing interpreted as an unconscious vagal response associated with profound blood loss. Then followed a chaotic rapid ventricular activity or terminal ventricular fibrillation. The telemetric footprints provided valuable time stamps on the events preceding the victim's death.

Aged↗

PubMed2002

Pacemaker stored electrograms: teaching us what is really going on in our patients.

Stored electrograms (EGMs), well-known diagnostic tools in implantable cardioverter defibrillators, have now been incorporated in pacemakers as well, thereby increasing their diagnostic capabilities. The clinician can detect and diagnose patient arrhythmias with EGMs and directly validate diagnostic data stored by the devices. The appropriateness of detection algorithms can also be judged. Initial experiences with pacemaker EGMs reveals their potential to detect and diagnose sensing or detection algorithm problems. These so-called "false-positive" EGMs help to optimize pacemaker programming. Date and time stamp can correlate an event to patient symptoms. Recent advances, like onset recordings and marker annotation, have further increased the effectiveness of stored EGMs. The use of patient-triggered magnet-stored EGMs facilitates diagnostic workups in symptomatic pacemaker patients and reveals nondevice related symptoms in a considerable number of cases. Stored EGMs in pacemakers will soon be a standard diagnostic tool that can illustrate what is really going on in our patients.

Arrhythmias, Cardiac↗

PubMedDate not supplied

Missouri rural adolescent pregnancy project (MORAPP).

The purpose of this study was to investigate the pregnancy outcomes and services available to adolescent women in Missouri, comparing rural and urban residents. A secondary analysis of a large public use data set obtained from the Missouri Department of Health was done for the 5-year period 1992 to 1996. Data were collected by county, with each of the 114 counties of the state classified as rural or urban. The SAS program was used for analysis. Results demonstrated definite patterns of similarity and dissimilarity among the teen mothers based on residence, when age and race were controlled. There were over 54,000 births to adolescent mothers in the 5-year study period. Among the outcomes of pregnancy studied were: abortion rates, inadequate weight gain, intrauterine growth retardation, and low-birthweight (LBW) infants. Among the services available to the young mothers that were studied were fertility services, WIC (women, infants, and children supplemental nutrition) program, food stamps, and Medicaid coverage for pregnancy and infant care. The outcomes are probably generalizable to Midwestern, rural/urban states similar to Missouri.

Adolescent↗

PubMedDate not supplied

Dropping out of maternal and child home visits.

The purpose of this study was to examine the relationship between nurse and client characteristics and the reason for client termination from public health nursing maternal and child home visits. The results indicate that clients who dropped out of services received more contacts from the nurses, missed more appointments with the nurses, and were given advice from the nurses on more topics. They also differed from clients who continued with services until the nursing care plan goals were met in reference to marital status, mental illness, source of payment for services, and use of WIC and food stamps. Nurses whose clients were more likely to continue until goals were met were higher in conscientiousness, learned more from experience, and learned less from coworkers or learning on their own. They also worked more hours per week. These findings have implications for practice and research.

Adolescent↗

PubMed2001

Computed tomography-guided endoscopic removal of an osteoid osteoma from the femur.

The case of a 19-year-old male patient who complained of dull pain in his right knee for more than 18 months and was finally diagnosed with intracortical osteoid osteoma in the femoral diaphysis is presented. A new operative method was used to locate and remove the tumor. Under spinal anesthesia with the patient in the prone position, a lateral and a posterior approach were marked with special bone cutting tubes under computed tomographic control. The usual arthroscopic instruments (punch, retrograde suction stamp) were used to remove the nidus under arthroscopic visualization, thereby avoiding the disadvantages of open excisions, such as large incisions, bone loss, long hospitalization, and risk of infection. The advantages and disadvantages are thoroughly discussed and compared with conventional surgical procedures.

Adult↗

PubMed2002

Detection of Chlamydophila (Chlamydia) abortus and Toxoplasma gondii in smears from cases of ovine and caprine abortion by the streptavidin-biotin method.

Fetal membranes from 59 cases of ovine and six of caprine abortion from a total of 52 flocks or herds were collected. Immunohistochemical examination of cotyledons fixed in formalin and embedded in paraffin wax detected Chlamydophila abortus in 44 (68%) cases. Immunocytochemical examination of smears made from the surface of fetal membranes detected the organism in 37 (57%) cases. Light microscopical examination of such smears stained by Stamp's method detected C. abortus in 26 (40%) cases. The streptavidin-biotin method described proved to have 100% specificity and 84% sensitivity in the detection of C. abortus in cotyledon smears. Sensitivity could probably be increased still further by the simultaneous examination of smears made from the cut surface of several cotyledons. In five cases Toxoplasma gondii was detected in the cotyledons by immunohistochemical examination. In three of these cases the presence of T. gondii was revealed also by immunocytological examination. In four cases, simultaneous C. abortus and T. gondii infection of the cotyledons was observed. The two pathogens and the lesions caused by them occurred in separate locations.

Abortion, Veterinary↗

PubMed2002

Evaluation of bedmaking-related airborne and surface methicillin-resistant Staphylococcus aureus contamination.

The number of airborne methicillin-resistant Staphylococcus aureus (MRSA) before, during and after bedmaking was investigated. Air was sampled with an Andersen air sampler in the rooms of 13 inpatients with MRSA infection or colonization. Sampling of surfaces, including floors and bedsheets, was performed by stamp methods. MRSA-containing particles were isolated on all the sampler stages-stage 1 (>7 microm diameter) to stage 6 (0.65-1.1 microm). The MRSA-containing particles were mostly 2-3 microm diameter before bedmaking and >5 microm during bedmaking. The number was significantly higher 15 min after bedmaking than during the resting period, but the differences in counts after 30 and 60 min were not significant. MRSA was detected on many surfaces. The results suggest that MRSA was recirculated in the air, especially after movement. To prevent airborne transmission, healthcare staff should exercise great care to disinfect inanimate environments. Further studies will be needed to confirm the level of MRSA contamination of air during bedmaking and establish measures for prevention of airborne transmission.

Air Microbiology↗

PubMed2002

Desktop and mobile software development for surgical practice.

PURPOSE: The aim of this study was to develop a mobile software solution that will merge patient data with a centralized patient database, aid surgical decision making, and document clinical services. METHODS: iIncise is a computerized, menu-driven database that was developed for real-time entry of historical, clinical, and laboratory data. Within the process, examination data, testing rationale, and test results are captured. AAST staging criteria are presented during data entry to describe and classify organ injuries accurately. A legible, time-stamped, conclusive report can be generated for printed or electronic entry into the medical record. The handheld version of the database runs on a Compaq iPAQ Pocket PC in either stand-alone mode or via LAN or WAN through the Internet. Microsoft Information Internet Server 5.0 provides data transaction services to Microsoft SQL Server 2000 to merge multiuser replicate data between the back ends stored on the desktop and handheld devices. RESULTS: The printed report provides superior documentation for comprehensive evaluation and management services, including history and physical examination, documentation of medical decision making, appropriateness of diagnostic/or therapeutic services, and coordination of care in accordance with Health Care Financing Administration (HCFA) regulations. CONCLUSIONS: Rapid data entry, ease of use, and appropriate documentation of detailed and legible patient visits and procedural notes are early benefits. Wireless data transmission between handheld devices and the desktop database provides the required speed, flexibility, and multitasking environment necessary for the mobile surgeon.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed2000

Effects of acute pain reduction methods on the chronic inflammatory lesions and behaviour of lambs castrated and tail docked with rubber rings at less than two days of age.

Lesions were produced by castration and tail docking of two-day-old Dorset-cross lambs with elastrator rings with (RRla) and without (RR) local anaesthetic or after destruction of the innervation by crushing close to the ring (Brr). The lesions were monitored twice weekly for six weeks and the behaviour of handled controls (H), RR and RRla lambs was recorded for two 3 h periods 10, 20, 31 and 41 days after treatment. There was no significant effect of castration and tail docking, with or without pain reduction methods, on daily liveweight gain. In the Brr lambs, the dead tails were cast 10 days earlier than from RR and RRla lambs. The time taken for the scrotal lesion to reach maximum severity was halved in Brr and RRla lambs, although the maximum severity of the lesion was unaffected by the methods of pain reduction. During the four 6 h behavioural observation periods, RR lambs showed a significant increase in the mean (+/- sd) frequency of foot stamping (RR13 +/- 13; H2 +/- 2.5), tail wagging (61 +/- 26; 15 +/- 6), head turning to the scrotum and inside hind-leg (12 +/- 10; 1 +/- 1). Less abnormal behaviour was found after RRla than after RR treatment. This unexpected finding may be evidence of long-lasting increases in pain sensitivity after an episode of intense acute pain in young animals.

Animal Welfare↗

PubMed2001

High-dose paclitaxel in combination with doxorubicin, cyclophosphamide and peripheral blood progenitor cell rescue in patients with high-risk primary and responding metastatic breast carcinoma: toxicity profile, relationship to paclitaxel pharmacokinetics and short-term outcome.

We assessed the feasibility and pharmacokinetics of high-dose infusional paclitaxel in combination with doxorubicin, cyclophosphamide, and peripheral blood progenitor cell rescue. Between October 1995 and June 1998, 63 patients with high-risk primary [stage II with >or= 10 axillary nodes involved, stage IIIA or stage IIIB inflammatory carcinoma (n = 53)] or with stage IV responsive breast cancer (n = 10) received paclitaxel 150-775 mg/m(2)infused over 24 hours, doxorubicin 165 mg/m(2)as a continuous infusion over 96 hours, and cyclophosphamide 100 mg kg(-1). There were no treatment-related deaths. Dose-limiting toxicity was reversible, predominantly sensory neuropathy following administration of paclitaxel at the 775 mg/m(2) dose level. Paclitaxel pharmacokinetics were non-linear at higher dose levels; higher paclitaxel dose level, AUC, and peak concentrations were associated with increased incidence of paraesthesias. No correlation between stomatitis, haematopoietic toxicities, and paclitaxel dose or pharmacokinetics was found. Kaplan-Meier estimates of 30-month event-free and overall survival for patients with primary breast carcinoma are 65% (95% CI; 51-83%) and 77% (95% CI; 64-93%). Paclitaxel up to 725 mg/m(2) infused over 24 hours in combination with with doxorubicin 165 mg/m(2) and cyclophosphamide 100 mg kg(-1) is tolerable. A randomized study testing this regimen against high-dose carboplatin, thiotepa and cyclophosphamide (STAMP V) is currently ongoing.

Adult↗

PubMed2006

Stampidine as a novel nucleoside reverse transcriptase inhibit with potent anti-HIV activity.

Stavudine (STV, d4T, 2',3'-didehydro-3'-deoxythymidine, CAS 3056-17-5) is a standard anti-HIV drug. Stampidine (STAMP, DDE-113, HI-113, N-[p-(4-bromophenyl)-2',3'-didehydro-3'-deoxy-5'-thymidylyl]-L-alanine methyl ester, CAS 217178-62-6) is a novel aryl phosphate derivative of stavudine with more potent anti-HIV activity and more favorable pharmacodynamic features. The remarkable potency of stampidine against clinical HIV-1 isolates with NRTI- or NNRTI-resistance (NRTI, nucleoside reverse transcriptase inhibitor; NNRTI, non-nucleoside reverse transcriptase inhibitor) warrants the further development of this new anti-HIV agent.

Anti-HIV Agents↗

PubMed2006

Synthesis, separation and anti-HIV activity of distereoisomers of N-[p-(4-bromophenyl) -2',3'-didehydro-3'-deoxy-5'-thymidylyl]-L-alanine methyl ester (stampidine).

The distereoisomers of stampidine (STAMP, DDE-113, HI-113, N-[p-(4-bromophenyl)-2'3'-didehydro-3'-deoxy-5'-thymidylyl]-L-alanine methyl ester, CAS 217178-62-6) were separated using two different procedures. The first method involved separation of the isomers by fractional crystallization, and the second method utilized a preparative HPLC. Both isomers were active against the HIV-1 strain HTLV(IIIB) and neither isomer was more or less active than distereoisomeric mixture of stampidine.

Anti-HIV Agents↗

PubMed2006

Potency of stampidine against multi-nucleoside reverse transcriptase inhibitor resistant human immunodeficiency viruses.

The in vitro potency of stampidine (STAMP, DDE-113, HI-113, N-[p-(4-bromophenyl)-2',3'-didehydro-3'-deoxy-5'-thymidylyl]-L-alanine methyl ester, CAS 217178-62-6) was examined against 8 clinical non-B subtype HIV-1 isolates with resistance to stavudine (STV, d4T), adefovir and tenofovir, 19 clinical zidovudine-resistant HIV-1 isolates, and 6 recombinant HIV-1 clones with multi-resistance against nucleoside reverse transcriptase inhibitors. Stampidine exhibited potent anti-HIV activity against each one of these 33 HIV-1 isolates with subnanomolar to nanomolar IC50 values.

Anti-HIV Agents↗

PubMed2001

Tissue engineering: complete autologous valve conduit--a new moulding technique.

OBJECTIVE: The use of fibrin gel, which can be produced from patients' blood, was investigated as an autologous, biodegradable scaffold. A new moulding technique was developed to create a complete aortic root. METHODS: A new moulding technique was generated for the creation of complete valve conduit. On the basis of biomechanical valve design studies, a tricuspid "ventricular" and "aortic" stamp were developed. A silicone-coated aluminum cylinder was used to circumferentially limit the mould. The cell/gel suspension was filled into the mould and polymerization was started. RESULTS: The creation of complex structures such as complete valve conduits is possible with the moulding technique described. With a layer thickness of up to 2 mm, histological investigations showed excellent tissue development with viable fibroblasts surrounded by collagen bundles. CONCLUSION: Fibrin gel unifies many properties of an ideal scaffold: The formation of complex structures is possible, the degradation and polymerization is controllable and the formation of the extracellular matrix is excellent.

Aortic Valve↗

PubMedDate not supplied

[Shock wave therapy for recalcitrant plantar fasciitis with heel spur: a prospective randomized placebo-controlled double-blind study].

AIM: Efficacy of low-energy shock wave therapy for recalcitrant plantar fasciitis. METHOD: 32 patients were randomly assigned into real and placebo ESWT groups, treatment comprised 1000 impulses of 0,08 mJ/mm 2 at 14 kV (OssaTron OSA 120, HMT AG, Switzerland) in 12 cases repeated after six weeks or placebo (energy-absorbing foil). Follow-up evaluation (19, 32 and 48 wks.) included specific questionnaire, clinical-functional examination and measurement of plantar pressure while walking (Emed AT-4. pedograph, Novel GmbH, Munich). Examiner and patients were blinded. RESULTS: 88 % of the treatment group were pain free or had good results. None of the placebo group were pain free, 33.3 % had good results (Roles and Maudsley Score). The treatment group showed significantly better outcome for morning and resting pain, pressure stamp-tolerance and walking ability. Pedography did not show a clear correlation between pain relief and load pattern. CONCLUSION: The results of this study corroborate the value of ESWT for recalcitrant plantar fascitis. As a non invasive technique with low side effects, it can complement the row of conservative treatments.

Double-Blind Method↗

PubMed2005

Ultrahigh-density storage media prepared by artificially assisted self-assembling methods.

Two types of recording media possessing nanodot structures were investigated. The media were prepared by an artificially assisted self-assembling (AASA) method, which includes simple nanopatterning using a nanoimprint and fine nanopatterning using self-assembling organic molecules. One type of recording media is circumferential magnetic patterned media prepared on a 2.5-in.-diam glass plate. A Ni master disk possessing spiral patterns with 60-250 nm width lands and a 400 nm width groove was pressed to a resist film on a CoCrPt film to transfer the spiral patterns. A diblock copolymer solution was cast into the obtained grooves, and then annealed to prepare self-assembling dot structures aligned along the grooves. According to the dot patterns, the lower magnetic films were patterned by ion milling to yield patterned media with 40 nm diameter. We have also prepared FePt dot media with high magnetic anisotropy for near-field and magnetic-field hybrid recording aiming at more than 1 Tbin.2 density. A Ni stamp disk with aligned dot structures was also prepared by the AASA method to produce patterned media at the lowest cost. The other type of media was organic patterned media for X-Y type near-field optical storage. Bulky dye molecules were evaporated in vacuum to produce self-assembling amorphous nanodots. The dots were arranged by the AASA method, i.e., according to the polymethylmethacrylate film hole arrays or chemically patterned surface.

Journal Article↗

PubMed2006

Microchameleons: nonlinear chemical microsystems for amplification and sensing.

In biological systems, the coupling of nonlinear biochemical kinetics and molecular transport enables functional sensing and "signal" amplification across many length scales. Drawing on biological inspiration, we describe how artificial reaction-diffusion (RD) microsystems can provide a basis for sensing applications, capable of amplifying micro- and nanoscopic events into macroscopic visual readouts. The RD applications reviewed here are based on a novel experimental technique, WETS for Wet Stamping, which offers unprecedented control over RD processes in microscopic and complex geometries. It is discussed how RD can be used to sense subtle differences in the thickness and/or absorptivity of thin absorptive films, amplify macromolecular phase transitions, detect the presence and quality of self-assembled monolayers, and provide dynamic spatiotemporal readouts of chemical "metabolites."

Absorption↗

PubMed2006

The use of focus groups to design an internet-based program for chlamydia screening with self-administered vaginal swabs: what women want.

OBJECTIVE: To ascertain the opinions, concerns and perceptions of sexually active women to guide the development of an internet-based chlamydia outreach and screening program using self-administered vaginal swabs as a first step to prevention. METHODS: Seven focus groups were conducted by trained facilitators. Questions were designed to initially open the discussion and elicit the members' own perceptions. Secondary, more probing questions were asked later to confirm participants' responses and elicit truthful answers. The main discussion topics were women's ideas about internet recruitment for chlamydia screening, preferred genital sample type, self-sampling at home using vaginal swabs and using the mail to return specimens. Participants were 42 women, aged 14-49 years. Structured discussions were facilitated using open-ended questions about access to chlamydia testing via the internet. Data were collected and reviewed for common themes and emphasis. RESULTS: All women actively participated in the discussions, providing valuable information. The concepts of self-sampling and the overall project were viewed positively, along with draft advertisements, questionnaires and self-sampling instructions; some modifications were suggested. Common themes included offering free kits available within their community or by direct mail, as well as pre-addressed, stamped mailers for returning the kit to the laboratory for testing. Commonly perceived obstacles and potential risks included: maintenance of confidentiality; situations of embarrassment; and ensuring simplicity of packaging. Women indicated confidence in their ability to collect vaginal specimens and willingness to call for their test results. CONCLUSIONS: Focus-group surveys were a useful tool and provided valuable feedback to inform the design of a specialised website to educate and facilitate access to chlamydia screening through home sampling.

Adolescent↗