Bioimpedance analysis was used to measure conductive tissue extracellular fluid (ECF) volume changes in the residual limbs of four unilateral transtibial amputee subjects during standing and walking ...conditions. Results showed that all residual limbs experienced ECF volume decreases during 5 min standing intervals. During 5 min of walking immediately after a standing interval, the residual limbs of healthy subjects increased in ECF volume while those of diseased subjects, one with peripheral vascular disease and another with cardiovascular insufficiency and a high-salt intake, decreased. One subject demonstrated less absolute value ECF volume change during standing and walking at 12 months post-surgical revision compared with at six months. Presentation of bioimpedance data to patients improved compliance to practitioner recommendations and patient understanding. Results were useful towards clinical assessment, patient education, and decision-making about treatment.
Abnormalities of cardiac structure and function are common in children infected with the human immunodeficiency virus (HIV). It is unclear, however, whether these abnormalities are attributable to ...the disease itself, associated infections, or possible cardiotoxic effects of the most commonly used treatment, zidovudine.
We performed echocardiography in 24 children with symptomatic HIV infection immediately before they started zidovudine therapy and a mean of 1.32 years after therapy began. Sixteen of these children were also studied a mean of 1.26 years before starting zidovudine treatment. Comparison groups included 27 age-matched children with symptomatic HIV infection who had not received zidovudine and 191 normal children.
As compared with the normal children, the children treated with zidovudine had progressive left ventricular dilatation and an increase in ventricular-wall stress at end-systole (a measure of ventricular afterload); dilatation and stress were significantly elevated both before and during zidovudine treatment. The ratio of ventricular thickness to internal dimension was below normal before zidovudine treatment began (P < 0.001). After treatment with zidovudine, however, overall left ventricular mass was increased (P = 0.02), as was peak wall stress (a stimulus to ventricular hypertrophy) (P = 0.01). Ventricular contractility remained normal, but fractional shortening of the left ventricle was decreased (P = 0.004). No statistically significant differences were detected at follow-up in any of these measurements between HIV-infected children treated with zidovudine and those not so treated.
Progressive left ventricular dilatation occurred in children with symptomatic HIV infection. Compensatory hypertrophy also occurred but was inadequate to maintain peak systolic wall stress within the normal range. The progressive elevation of ventricular afterload due to dilatation resulted in depressed ventricular performance, but intrinsic ventricular contractility remained normal. Zidovudine did not appear to worsen or ameliorate these cardiac changes.
Study objective Emergency department (ED) consultation is a common practice. There are few data on consultant availability or changes in availability over time, which may hinder resource planning and ...allocation. We conduct serial surveys of Massachusetts EDs to investigate these trends. Methods We surveyed ED directors in Massachusetts in 2006 (n=61 EDs), 2009 (n=63), and 2015 (n=63) about ED characteristics in the previous year, including specialty-specific consultant availability in person (yes/no) and continuous consultant availability (yes/no). We tested trends in consultant availability ( P for trend) and used multivariable logistic regression to calculate odds of continuous availability in 2014 versus 2005. Results Response rates were greater than 80% each year. From 2005 to 2014, there was an increase in the median number of annual ED visits from 32,025 (interquartile range IQR 23,000 to 50,000) to 42,000 (IQR 26,000 to 59,300), number of full-time attending physicians from 11 (IQR 8 to 16) to 12 (IQR 8 to 22), and number of full-time ED nurses from 27 (IQR 17 to 54) to 42 (IQR 25 to 65). In adjusted models, there was a significantly reduced odds of consultant availability in 2014 versus 2005 for general surgery (odds ratio OR 0.05; 95% confidence interval CI 0.01 to 0.35), neurology (OR 0.39; 95% CI 0.17 to 0.86), obstetrics/gynecology (OR 0.40; 95% CI 0.16 to 0.97), orthopedics (OR 0.34; 95% CI 0.13 to 0.89), pediatrics (OR 0.19; 95% CI 0.06 to 0.54), plastic surgery (OR 0.10; 95% CI 0.03 to 0.32), and psychiatry (OR 0.25; 95% CI 0.12 to 0.52). Conclusion In Massachusetts EDs between 2005 and 2014, ED consultant availability significantly declined despite accounting for other ED characteristics.
Abstract Objective Child sleep problems are prevalent and have been linked to poor behavior, worse school performance, and obesity. Low health literacy (HL) is associated with suboptimal parenting ...practices and worse health outcomes, but the relationship between parent HL and child sleep-related issues is not known. We examined the association between parent HL and child sleep-related issues. Methods This was a cross-sectional analysis of data from caregivers enrolled in a cluster randomized trial of a primary care-based child obesity prevention program in 4 pediatric clinics. Parent HL was assessed using the Short Test of Functional Health Literacy in Adults. At the 9-month well-child visit, sleep-related factors were assessed: presence of TV in room where child sleeps, regular naptimes and bedtimes (≥5 days/wk), low daytime and nighttime sleep duration (>1 SD below mean on the basis of national data). Multiple logistic regression analyses were performed. Results We enrolled 557 caregivers of 9-month-old children (49.7% Hispanic, 26.9% black, 56.2% <$20,000 annual income); 49.6% reported having a TV in the room where their child sleeps; 26.6% did not have regular naptimes norbedtimes. Median sleep duration was 2.3 (interquartile range, 1.5–3.0) hours (daytime), and 9.0 (interquartile range, 8.0–10.0) hours (night) (30.2% low daytime; 20.3% low nighttime sleep duration). Children of parents with low HL were more likely to have a bedroom TV (66.7% vs 47.7%, P = .01; adjusted odds ratio, 2.2; 95% confidence interval, 1.1–4.3) and low night-time sleep (37.0% vs 18.5%; P = .002; adjusted odds ratio, 2.4; 95% confidence interval, 1.2–4.8). Conclusions Low parent HL is associated with TV in the bedroom and low night sleep duration. Additional study is needed to further explore these associations and intervention strategies to address child sleep problems.
Abstract Introduction This study was designed to determine if physicians’ attitudes and recommendations surrounding implantable cardioverter-defibrillators (ICDs) are regionally associated with ICD ...use. Methods and Results A national sample of 9969 members of the American College of Cardiology was surveyed electronically. Responses were merged with rates of ICD implantation from the National Cardiovascular Data Registry. Multivariable regression was used to assess trends between regional use and responses. We received 1210 responses (12%) and used 1124 after exclusions. Across regions, physicians were equally likely to recommend ICDs to males or females with ischemic (∼99% for both; P = NS) or nonischemic cardiomyopathy (85 vs. 88% P = 0.85). Significant increasing trends in the probability recommending ICD therapy were found when the patient was “frail” (21% to 32%; P = .03) or had a life expectancy <1 year (5% to 10%; P = .05). These differences were not associated with attitudes toward ICDs. Conclusions Independent of variations in physicians’ attitudes towards ICDs, physicians in regions of low ICD use are not less likely to recommend ICDs in situations clearly supported by guidelines while those in regions of high ICD use are more likely to recommend ICDs to patients who might have limited benefit.
The electromyographic interference pattern (EMG-IP) contains information about the number, firing rate, and recruitment characteristics of motor units, and information regarding the waveforms of the ...recruited motor units. Muscle and nerve diseases produce characteristic changes in the IP that can be distinguished by IP analysis. This analysis complements analysis of the motor unit potentials. The electromyographer usually assesses the IP signals subjectively by their appearance on the oscilloscope screen and by their sound on the audio monitor. Techniques have been developed to automate IP analysis with and without force monitoring. These techniques give objective information, quantitate the degree of abnormality, and permit electromyographers-in-training to compare their subjective analysis of the IP with more objective findings.
To examine the ability of several commonly used tests for evaluation of passive transfer of immunoglobulin to predict mortality in dairy replacement heifers.
Prospective observational study.
246 ...dairy replacement heifers between 1 and 8 days of age.
Using serum samples obtained from each calf, total serum protein concentration and results of zinc sulfate turbidity, sodium sulfite turbidity, radial immunodiffusion, and glutaraldehyde coagulation were determined. Calves were monitored for 100 days, and relative risks for death were calculated. Logistic regression models predicting death also were developed.
None of the logistic regression models detected a significant association between test results and mortality. The greatest relative risks of mortality were observed in calves with serum protein concentrations < 4.5 g/dl, serum IgG1 concentrations < 500 mg/dl, and sodium sulfite test scores < 1+.
Calves with lower passive transfer values had increased risk of death; however, failure of passive transfer is not an infallible predictor of mortality.
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