1
|
Mathai S, Krupad K, Sohal S, Mehta A, Montgomery M, Murthy S, Visveshwaran G, Sims D, Jorde U. Comparison of In-Hospital Outcomes in Acute Myocardial Infarction-Cardiogenic Shock (AMICS) versus Non-AMICS Following ECPELLA. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
2
|
Grewal J, Mughal M, Nnaoma C, Montgomery M, Kapoor S. Axillary IABP Migration into SMA. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
3
|
Siddiqui E, Okoh A, Tibuakuu M, Hirji S, Hameed I, Osho A, Singh S, Grewal J, Montgomery M, Camacho M, Bravo C. Racial Differences in In-Hospital Outcomes after the Use of Temporary Mechanical Circulatory Support as a Bridge to Heart Transplant. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
4
|
Abstract
Lead is a toxic heavy metal that has been used extensively in modern society, causing widespread environmental contamination even in isolated parts of the world. Irrefutable evidence associates lead at different exposure levels with a wide spectrum of health and social effects, including mild intellectual impairment, hyperactivity, shortened concentration span, poor school performance, violent/aggressive behavior, and hearing loss. Lead has an impact on virtually all organ systems, including the heart, brain, liver, kidneys, and circulatory system, resulting in coma and death in severe cases. In recent years, a consensus was reached regarding the absence of a threshold for the key health effects associated with lead exposure and the permanent and irreversible nature of many health and social consequences of lead exposure. The public health problem of environmental lead exposure has been widely investigated in developed countries like the United States of America, where actions taken have led to significant reductions in children's blood lead concentrations. In contrast, there is a relative dearth of information and action regarding lead poisoning in developing countries, particularly in African countries, despite evidence of widespread and excessive childhood lead exposure. In this paper, we will review the information from available published papers, the 'grey Literature', and unpublished reports to give an overview of lead exposure in South African children over the past two decades, with particular emphasis on sources of exposure in the home environment.
Collapse
Affiliation(s)
- Angela Mathec
- University of the Witwatersrand; Po Box 87373Houghton2041, South Africa
| | | | - Mary Montgomery
- Harvard University School of Public Health,Boston. Massachusetts, United States of America
| | - Halina Röllin
- University of the Witwatersrand,Johannesburg, South Africa
| |
Collapse
|
5
|
Huyer LD, Mandla S, Wang Y, Campbell S, Yee B, Euler C, Lai BF, Bannerman D, Lin DSY, Montgomery M, Nemr K, Bender T, Epelman S, Mahadevan R, Radisic M. Macrophage immunomodulation through new polymers that recapitulate functional effects of itaconate as a power house of innate immunity. Adv Funct Mater 2021; 31:2003341. [PMID: 33708036 PMCID: PMC7942808 DOI: 10.1002/adfm.202003341] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Indexed: 05/12/2023]
Abstract
Itaconate (ITA) is an emerging powerhouse of innate immunity with therapeutic potential that is limited in its ability to be administered in a soluble form. We developed a library of polyester materials that incorporate ITA into polymer backbones resulting in materials with inherent immunoregulatory behavior. Harnessing hydrolytic degradation release from polyester backbones, ITA polymers resulted in the mechanism specific immunoregulatory properties on macrophage polarization in vitro. In a functional assay, the polymer-released ITA inhibited bacterial growth on acetate. Translation to an in vivo model of biomaterial associated inflammation, intraperitoneal injection of ITA polymers demonstrated a rapid resolution of inflammation in comparison to a control polymer silicone, demonstrating the value of sustained biomimetic presentation of ITA.
Collapse
Affiliation(s)
- L. Davenport Huyer
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - S. Mandla
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Y. Wang
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - S. Campbell
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - B. Yee
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - C. Euler
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - B. F. Lai
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - D. Bannerman
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - D. S. Y. Lin
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - M. Montgomery
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - K. Nemr
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - T. Bender
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - S. Epelman
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - R. Mahadevan
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - M. Radisic
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
6
|
McMahon DE, Hysell K, Montgomery M, Frangos J. Superficial Cutaneous Zygomycosis Presenting as Resistant Intertrigo: A Case Report. Open Forum Infect Dis 2020; 7:ofaa043. [PMID: 32123691 PMCID: PMC7036596 DOI: 10.1093/ofid/ofaa043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/05/2020] [Indexed: 12/17/2022] Open
Abstract
Zygomycosis is an angioinvasive fungal infection with a high mortality rate. Cutaneous zygomycosis is the second most common form of the disease, typically characterized by necrotic eschars in an immunocompromised host. We report an unusual case of superficial intertrigo resistant to conventional therapies caused by Mucor circinelloides in a patient with HIV and diabetes.
Collapse
Affiliation(s)
- Devon E McMahon
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Correspondence: D. McMahon, Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Avenue, Boston, MA 02115 ()
| | - Kristen Hysell
- Department of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mary Montgomery
- Department of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason Frangos
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
7
|
|
8
|
Ringe J, Baik S, Shalabi D, Montgomery M, Rosenbloom J, Nikbakht N. 162 Unique expression of a fibronectin isoform in mycosis fungoides. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
9
|
Suzuki J, Johnson J, Montgomery M, Hayden M, Price C. Outpatient Parenteral Antimicrobial Therapy Among People Who Inject Drugs: A Review of the Literature. Open Forum Infect Dis 2018; 5:ofy194. [PMID: 30211247 PMCID: PMC6127783 DOI: 10.1093/ofid/ofy194] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/06/2018] [Indexed: 11/14/2022] Open
Abstract
Hospitalizations for people who inject drugs (PWID) with infectious complications requiring prolonged antibiotic therapy are increasing in the context of the opioid epidemic. Although outpatient parenteral antimicrobial therapy (OPAT) is routinely offered to patients without a history of injection drug use (IDU), PWID are often excluded from consideration of OPAT. To better assess the evidence base for the safety and effectiveness of OPAT for PWID, we conducted a review of the published literature. Results suggest that OPAT may be safe and effective for PWID, with rates of OPAT completion, mortality, and catheter-related complications comparable to rates among patients without a history of IDU. Rates of hospital readmissions may be higher among PWID, but instances of misuse of the venous catheter were rarely reported. More research is needed to study the safety and effectiveness of OPAT among PWID, as well as studying the combination of OPAT and addiction treatment.
Collapse
Affiliation(s)
- Joji Suzuki
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jennifer Johnson
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Mary Montgomery
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Christin Price
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
10
|
Sultani G, Bentley N, Osborne B, Joshi S, Araki T, Montgomery M, Polly P, Byrne F, Wu L, Turner N. PO-011 Impact of compartment-specific changes in NAD biosynthesis on diethylnitrosamine-induced liver cancer. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
11
|
Rosenbloom J, Montgomery M, South A, Uitto J, Macarak E. 141 Potential consequences of the interaction of squamous cell carcinoma cells with EDA fibronectin in recessive dystrophic epidermolysis bullosa. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
12
|
Martin D, Albensi L, Van Haute S, Froese M, Montgomery M, Lam M, Gierys K, Lajeunesse R, Guse L, Basova N. Healthy Skin Wins: A Glowing Pressure Ulcer Prevention Program That Can Guide Evidence-Based Practice. Worldviews Evid Based Nurs 2017; 14:473-483. [PMID: 28755424 DOI: 10.1111/wvn.12242] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND In 2013, an observational survey was conducted among 242 in-patients in a community hospital with a pressure ulcer (PU) prevalence of 34.3%. An evidence-based pressure ulcer prevention program (PUPP) was then implemented including a staff awareness campaign entitled "Healthy Skin Wins" with an online tutorial about PU prevention. AIMS To determine the effectiveness of the PUPP in reducing the prevalence of PUs, to determine the effectiveness of the online tutorial in increasing hospital staff's knowledge level about PU prevention, and to explore frontline staff's perspectives of the PUPP. METHODS This was a mixed methods study. A repeat observational survey discerned if the PUPP reduced PU prevalence. A pre-test post-test design was used to determine whether hospital staff's knowledge of PU prevention was enhanced by the online tutorial. Qualitative interviews were conducted with nurses, allied health professionals, and health care aides to explore staff's perspectives of the PUPP. RESULTS A comparison of initial and repeat observational surveys (n = 239) identified a statistically significant reduction in the prevalence of PU to 7.53% (p < .001). The online tutorial enhanced staff knowledge level with a statistically significantly higher mean post-test score (n = 80). Thirty-five frontline staff shared their perspectives of the PUPP with "it's definitely a combination of everything" and "there's a disconnect between what's needed and what's available" as the main themes. CONCLUSIONS Incorporating evidence-based PU prevention into clinical practice greatly reduced the prevalence of PUs among hospital in-patients. Due to the small sample size for the pre-test post-test component, the effectiveness of the online tutorial in improving the knowledge level of PU prevention among hospital staff requires further research. LINKING EVIDENCE TO ACTION Evidence-based PU prevention strategies are facilitated by using a multidisciplinary approach. Educational tools about PU prevention must target all members of the healthcare team including healthcare aides, patients and families.
Collapse
Affiliation(s)
- Donna Martin
- Xi Lambda, Associate Professor, University of Manitoba, Rady Faculty of Health Sciences, College of Nursing, Winnipeg, Manitoba, Canada
| | - Lisa Albensi
- Xi Lambda, Director of Health Services, Southern Health Sante-Sud Regional Authority, Bethesda Regional Health Centre, Steinbach, Manitoba, Canada
| | - Stephanie Van Haute
- Program Development Officer, Manitoba HIV Program, Winnipeg Manitoba; Nursing Supervisor, St. Boniface Hospital, Winnipeg Manitoba; Facility Patient Care Manager, Seven Oaks General Hospital, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | - Maria Froese
- Physiotherapist, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Mary Montgomery
- Occupational Therapist, Seven Oaks Hospital, Occupational Therapy, Winnipeg, Manitoba, Canada
| | - Mavis Lam
- Registered Dietician, Seven Oaks Hospital, Clinical Nutrition, Winnipeg, Manitoba, Canada
| | - Kendra Gierys
- Continuing Education Instructor, Seven Oaks Hospital, Critical Care, Winnipeg, Manitoba, Canada
| | - Rob Lajeunesse
- Program Care Team Manager, Seven Oaks Hospital, Renal Health, Winnipeg, Manitoba, Canada
| | - Lorna Guse
- Associate Professor, University of Manitoba, Rady Faculty of Health Sciences, College of Nursing, Winnipeg, Manitoba, Canada
| | - Nataliya Basova
- Xi Lambda, Registered Nurse, Health Sciences Centre, Central Support Services, Surgical Relief Team, Winnipeg, Manitoba, Canada
| |
Collapse
|
13
|
Nußberger AM, Montgomery M, Luo Y, Yu H. Commentary: Parsing the Behavioral and Brain Mechanisms of Third-Party Punishment. Front Neurosci 2017; 11:374. [PMID: 28706474 PMCID: PMC5489590 DOI: 10.3389/fnins.2017.00374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/15/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anne-Marie Nußberger
- Department of Experimental Psychology, University of OxfordOxford, United Kingdom
| | - Mary Montgomery
- Department of Experimental Psychology, University of OxfordOxford, United Kingdom
| | - Yingyi Luo
- Institute of Linguistics, Chinese Academy of Social SciencesBeijing, China
- Faculty of Science and Engineering, Waseda UniversityTokyo, Japan
| | - Hongbo Yu
- Department of Experimental Psychology, University of OxfordOxford, United Kingdom
- Center for Brain and Cognitive Sciences, Peking UniversityBeijing, China
- *Correspondence: Hongbo Yu
| |
Collapse
|
14
|
Montgomery M. Chávez, Sergio. 2016. Border lives: fronterizos, transnational migrants, and commuters in Tijuana. New York: Oxford University Press. 203 pp. Pb.: £16.99. ISBN: 9780199380589. Social Anthropology 2017. [DOI: 10.1111/1469-8676.12370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
15
|
Affiliation(s)
- C L Yang
- British Columbia Children's Hospital, Department of Pediatrics, Division of Respiratory Medicine, Vancouver, BC, Canada.
| | - M Chilvers
- British Columbia Children's Hospital, Department of Pediatrics, Division of Respiratory Medicine, Vancouver, BC, Canada
| | - M Montgomery
- Alberta Children's Hospital, Pediatrics and Child Health, Calgary, AB, Canada
| | - S J Nolan
- The University of Liverpool, Department of Biostatistics, Liverpool, UK
| |
Collapse
|
16
|
|
17
|
Smith R, Montgomery M, Kilroy G, Tang S, Müller S. Tropical low formation during the Australian monsoon: the events of January 2013 (paper updated July 2016). ACTA ACUST UNITED AC 2015. [DOI: 10.22499/2.6503.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
18
|
Håkansson B, Montgomery M, Cadiere GB, Rajan A, Bruley des Varannes S, Lerhun M, Coron E, Tack J, Bischops R, Thorell A, Arnelo U, Lundell L. Randomised clinical trial: transoral incisionless fundoplication vs. sham intervention to control chronic GERD. Aliment Pharmacol Ther 2015; 42:1261-70. [PMID: 26463242 DOI: 10.1111/apt.13427] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 08/08/2015] [Accepted: 09/21/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Until recently only two therapeutic options have been available to control symptoms and the esophagitis in chronic gastro-oesophageal reflux disease (GERD), i.e. lifelong proton pump inhibitor (PPI) therapy or anti-reflux surgery. Lately, transoral incisionless fundoplication (TIF) has been developed and found to offer a therapeutic alternative for these patients. AIM To perform a double-blind sham-controlled study in GERD patients who were chronic PPI users. METHODS We studied patients with objectively confirmed GERD and persistent moderate to severe GERD symptoms without PPI therapy. Of 121 patients screened, we finally randomised 44 patients with 22 patients in each group. Those allocated to TIF had the TIF2 procedure completed during general anaesthesia by the EsophyX device with SerosaFuse fasteners. The sham procedure consisted of upper GI endoscopy under general anaesthesia. Neither the patient nor the assessor was aware of the patients' group affiliation. The primary effectiveness endpoint was the proportion of patients in clinical remission after 6-month follow-up. Secondary outcomes were: PPI consumption, oesophageal acid exposure, reduction in Quality of Life in Reflux and Dyspepsia and Gastrointestinal Symptom Rating Scale scores and healing of reflux esophagitis. RESULTS The time (average days) in remission offered by the TIF2 procedure (197) was significantly longer compared to those submitted to the sham intervention (107), P < 0.001. After 6 months 13/22 (59%) of the chronic GERD patients remained in clinical remission after the active intervention. Likewise, the secondary outcome measures were all in favour of the TIF2 procedure. No safety issues were raised. CONCLUSION Transoral incisionless fundoplication (TIF2) is effective in chronic PPI-dependent GERD patients when followed up for 6 months. Clinicaltrials.gov: CT01110811.
Collapse
Affiliation(s)
- B Håkansson
- Department of Surgery, Ersta Hospital, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden
| | - M Montgomery
- Department of Surgery, Ersta Hospital, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden
| | - G B Cadiere
- Department of Surgery and Gastroenterology, Park Leopold Clinic, CHIREC, Brussels, Belgium
| | - A Rajan
- Department of Surgery and Gastroenterology, Park Leopold Clinic, CHIREC, Brussels, Belgium
| | | | - M Lerhun
- CHU Hotel Dieu Institut des Maladies de l' Appareil Digestif, Nantes, France
| | - E Coron
- CHU Hotel Dieu Institut des Maladies de l' Appareil Digestif, Nantes, France
| | - J Tack
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - R Bischops
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - A Thorell
- Department of Surgery, Ersta Hospital, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden
| | - U Arnelo
- Department of Surgery, Centre for Digestive Diseases, Karolinska University Huddinge Hospital, Karolinska Institutet, Stockholm, Sweden
| | - L Lundell
- Department of Surgery, Centre for Digestive Diseases, Karolinska University Huddinge Hospital, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
19
|
Abstract
Rumination syndrome is the non-purposeful regurgitation of recently ingested food from the stomach to the mouth, where it is either expelled or reswallowed. Adolescent rumination syndrome (ARS) is a rare condition of which many physicians are unaware. Patients often are misdiagnosed or undergo costly testing, and as a result, diagnosis and treatment are often delayed. While ARS is not life-threatening, it does have medical and emotional effects on the patient and the patient's family. Diagnosis of ARS is based upon the Rome III diagnostic criteria. Antroduodenal manometry, while not required for a diagnosis, can be helpful to confirm the diagnosis. The pathogenesis of this disorder is complex and not well understood. However, because of its behavioral component, treatment of ARS requires a multidisciplinary approach that includes both medical management of symptoms and implementation of strategies that address behavioral, psychological, and general quality-of-life components of the disorder.
Collapse
Affiliation(s)
- Hayat M Mousa
- Division of Pediatric Gastroenterology, Nationwide Children's Hospital, 700 Children's Drive, JW 1985, Columbus, OH, 43205, USA,
| | | | | |
Collapse
|
20
|
Spicer C, Fite K, Montgomery M, Dollar B. Percutaneous needle biopsy in the setting of decubitus ulcer and spondylodiscitis: are the yields rates for these procedures clinically useful? J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2013.12.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
21
|
|
22
|
Levin ML, Zemtsova GE, Montgomery M, Killmaster LF. Effects of homologous and heterologous immunization on the reservoir competence of domestic dogs for Rickettsia conorii (israelensis). Ticks Tick Borne Dis 2014; 5:33-40. [PMID: 24201056 PMCID: PMC5659121 DOI: 10.1016/j.ttbdis.2013.07.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 06/24/2013] [Accepted: 07/03/2013] [Indexed: 11/28/2022]
Abstract
A number of spotted fever group (SFG) rickettsiae cause serious infections in humans. Several antigenically related rickettsial agents may coexist within the same geographical area, and humans or vertebrate hosts may be sequentially exposed to multiple SFG agents. We assessed whether exposure of a vertebrate reservoir to one SFG Rickettsia will affect the host's immune response to a related pathogen and the efficiency of transmission to uninfected ticks. Two pairs of dogs were each infected with either Rickettsia massiliae or Rickettsia conorii israelensis, and their immune response was monitored twice weekly by IFA. The four immunized dogs and a pair of naïve dogs were each challenged with R. conorii israelensis-infected Rhipicephalus sanguineus nymphs. Uninfected Rh. sanguineus larvae were acquisition-fed on the dogs on days 1, 7, and 14 post-challenge. These ticks were tested for the presence of rickettsial DNA after molting to the nymphal stage. The naive dogs became infected with R. conorii israelensis and were infectious to ticks for at least 3 weeks, whereas reservoir competence of dogs previously infected with either R. massiliae or R. conorii was significantly diminished. This opens an opportunity for decreasing the efficiency of transmission and propagation of pathogenic Rickettsia in natural foci by immunizing the primary hosts with closely related nonpathogenic SFG bacteria. However, neither homologous immunization nor cross-immunization significantly affected the efficiency of R. conorii transmission between cofeeding infected nymphs and uninfected larvae. At high densities of ticks, the efficiency of cofeeding transmission may be sufficient for yearly amplification and persistent circulation of a rickettsial pathogen in the vector population.
Collapse
Affiliation(s)
- M L Levin
- Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | | | |
Collapse
|
23
|
Hopkinson N, Wallis C, Higgins B, Gaduzo S, Sherrington R, Keilty S, Stern M, Britton J, Bush A, Moxham J, Sylvester K, Griffiths V, Sutherland T, Crossingham I, Raju R, Spencer C, Safavi S, Deegan P, Seymour J, Hickman K, Hughes J, Wieboldt J, Shaheen F, Peedell C, Mackenzie N, Nicholl D, Jolley C, Crooks G, Crooks G, Dow C, Deveson P, Bintcliffe O, Gray B, Kumar S, Haney S, Docherty M, Thomas A, Chua F, Dwarakanath A, Summers G, Prowse K, Lytton S, Ong YE, Graves J, Banerjee T, English P, Leonard A, Brunet M, Chaudhry N, Ketchell RI, Cummings N, Lebus J, Sharp C, Meadows C, Harle A, Stewart T, Parry D, Templeton-Wright S, Moore-Gillon J, Stratford- Martin J, Saini S, Matusiewicz S, Merritt S, Dowson L, Satkunam K, Hodgson L, Suh ES, Durrington H, Browne E, Walters N, Steier J, Barry S, Griffiths M, Hart N, Nikolic M, Berry M, Thomas A, Miller J, McNicholl D, Marsden P, Warwick G, Barr L, Adeboyeku D, Mohd Noh MS, Griffiths P, Davies L, Quint J, Lyall R, Shribman J, Collins A, Goldman J, Bloch S, Gill A, Man W, Christopher A, Yasso R, Rajhan A, Shrikrishna D, Moore C, Absalom G, Booton R, Fowler RW, Mackinlay C, Sapey E, Lock S, Walker P, Jha A, Satia I, Bradley B, Mustfa N, Haqqee R, Thomas M, Patel A, Redington A, Pillai A, Keaney N, Fowler S, Lowe L, Brennan A, Morrison D, Murray C, Hankinson J, Dutta P, Maddocks M, Pengo M, Curtis K, Rafferty G, Hutchinson J, Whitfield R, Turner S, Breen R, Naveed SUN, Goode C, Esterbrook G, Ahmed L, Walker W, Ford D, Connett G, Davidson P, Elston W, Stanton A, Morgan D, Myerson J, Maxwell D, Harrris A, Parmar S, Houghton C, Winter R, Puthucheary Z, Thomson F, Sturney S, Harvey J, Haslam PL, Patel I, Jennings D, Range S, Mallia-Milanes B, Collett A, Tate P, Russell R, Feary J, O'Driscoll R, Eaden J, Round J, Sharkey E, Montgomery M, Vaughan S, Scheele K, Lithgow A, Partridge S, Chavasse R, Restrick L, Agrawal S, Abdallah S, Lacy-Colson A, Adams N, Mitchell S, Haja Mydin H, Ward A, Denniston S, Steel M, Ghosh D, Connellan S, Rigge L, Williams R, Grove A, Anwar S, Dobson L, Hosker H, Stableforth D, Greening N, Howell T, Casswell G, Davies S, Tunnicliffe G, Mitchelmore P, Phitidis E, Robinson L, Prowse K, Bafadhel M, Robinson G, Boland A, Lipman M, Bourke S, Kaul S, Cowie C, Forrest I, Starren E, Burke H, Furness J, Bhowmik A, Everett C, Seaton D, Holmes S, Doe S, Parker S, Graham A, Paterson I, Maqsood U, Ohri C, Iles P, Kemp S, Iftikhar A, Carlin C, Fletcher T, Emerson P, Beasley V, Ramsay M, Buttery R, Mungall S, Crooks S, Ridyard J, Ross D, Guadagno A, Holden E, Coutts I, Cullen K, O'Connor S, Barker J, Sloper K, Watson J, Smith P, Anderson P, Brown L, Nyman C, Milburn H, Clive A, Serlin M, Bolton C, Fuld J, Powell H, Dayer M, Woolhouse I, Georgiadi A, Leonard H, Dodd J, Campbell I, Ruiz G, Zurek A, Paton JY, Malin A, Wood F, Hynes G, Connell D, Spencer D, Brown S, Smith D, Cooper D, O'Kane C, Hicks A, Creagh-Brown B, Lordan J, Nickol A, Primhak R, Fleming L, Powrie D, Brown J, Zoumot Z, Elkin S, Szram J, Scaffardi A, Marshall R, Macdonald I, Lightbody D, Farmer R, Wheatley I, Radnan P, Lane I, Booth A, Tilbrook S, Capstick T, Hewitt L, McHugh M, Nelson C, Wilson P, Padmanaban V, White J, Davison J, O'Callaghan U, Hodson M, Edwards J, Campbell C, Ward S, Wooler E, Ringrose E, Bridges D, Long A, Parkes M, Clarke S, Allen B, Connelly C, Forster G, Hoadley J, Martin K, Barnham K, Khan K, Munday M, Edwards C, O'Hara D, Turner S, Pieri-Davies S, Ford K, Daniels T, Wright J, Towns R, Fern K, Butcher J, Burgin K, Winter B, Freeman D, Olive S, Gray L, Pye K, Roots D, Cox N, Davies CA, Wicker J, Hilton K, Lloyd J, MacBean V, Wood M, Kowal J, Downs J, Ryan H, Guyatt F, Nicoll D, Lyons E, Narasimhan D, Rodman A, Walmsley S, Newey A, Buxton M, Dewar M, Cooper A, Reilly J, Lloyd J, Macmillan AB, Roots D, Olley A, Voase N, Martin S, McCarvill I, Christensen A, Agate R, Heslop K, Timlett A, Hailes K, Davey C, Pawulska B, Lane A, Ioakim S, Hough A, Treharne J, Jones H, Winter-Burke A, Miller L, Connolly B, Bingham L, Fraser U, Bott J, Johnston C, Graham A, Curry D, Sumner H, Costello CA, Bartoszewicz C, Badman R, Williamson K, Taylor A, Purcell H, Barnett E, Molloy A, Crawfurd L, Collins N, Monaghan V, Mir M, Lord V, Stocks J, Edwards A, Greenhalgh T, Lenney W, McKee M, McAuley D, Majeed A, Cookson J, Baker E, Janes S, Wedzicha W, Lomas Dean D, Harrison B, Davison T, Calverley P, Wilson R, Stockley R, Ayres J, Gibson J, Simpson J, Burge S, Warner J, Lenney W, Thomson N, Davies P, Woodcock A, Woodhead M, Spiro S, Ormerod L, Bothamley G, Partridge M, Shields M, Montgomery H, Simonds A, Barnes P, Durham S, Malone S, Arabnia G, Olivier S, Gardiner K, Edwards S. Children must be protected from the tobacco industry's marketing tactics. BMJ 2013; 347:f7358. [PMID: 24324220 DOI: 10.1136/bmj.f7358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nicholas Hopkinson
- British Thoracic Society Chronic Obstructive Pulmonary Disease Specialist Advisory Group, National Heart and Lung Institute, Imperial College, London SW3 6NP, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Inwald DP, Arul GS, Montgomery M, Henning J, McNicholas J, Bree S. Management of children in the deployed intensive care unit at Camp Bastion, Afghanistan. J ROY ARMY MED CORPS 2013; 160:236-40. [PMID: 24307254 PMCID: PMC4154587 DOI: 10.1136/jramc-2013-000177] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The deployed Intensive Therapy Unit (ITU) in the British military field hospital in Camp Bastion, Afghanistan, admits both adults and children. The purpose of this paper is to review the paediatric workload in the deployed ITU and to describe how the unit copes with the challenge of looking after critically injured and ill children. METHODS Retrospective review of patients <16 years of age admitted to the ITU in the British military field hospital in Camp Bastion, Afghanistan, over a 1-year period from April 2011 to April 2012. RESULTS 112/811 (14%) admissions to the ITU were paediatric (median age 8 years, IQR 6-12, range 1-16). 80/112 were trauma admissions, 13 were burns, four were non-trauma admissions and 15 were readmissions. Mechanism of injury in trauma was blunt in 12, blast (improvised explosive device) in 45, blast (indirect fire) in seven and gunshot wound in 16. Median length of stay was 0.92 days (IQR 0.45-2.65). 82/112 admissions (73%) were mechanically ventilated, 16/112 (14%) required inotropic support. 12/112 (11%) died before unit discharge. Trauma scoring was available in 65 of the 80 trauma admissions. Eight had Injury Severity Score or New Injury Severity Score >60, none of whom survived. However, of the 16 patients with predicted mortality >50% by Trauma Injury Severity Score, seven survived. Seven cases required specialist advice and were discussed with the Birmingham Children's Hospital paediatric intensive care retrieval service. The mechanisms by which the Defence Medical Services support children admitted to the deployed adult ITU are described, including staff training in clinical, ethical and child protection issues, equipment, guidelines and clinical governance and rapid access to specialist advice in the UK. CONCLUSIONS With appropriate support, it is possible to provide intensive care to children in a deployed military ITU.
Collapse
Affiliation(s)
- David P Inwald
- Faculty of Medicine, Imperial College, Wright Fleming Institute, London, UK
| | - G S Arul
- Birmingham Children's Hospital, Birmingham, UK
| | | | - J Henning
- Ministry of Defence Hospital, Unit Northallerton, The James Cook University Hospital, Middlesbrough, UK
| | - J McNicholas
- Ministry of Defence Hospital Unit Portsmouth, Queen Alexandra Hospital, Portsmouth, UK
| | - S Bree
- Ministry of Defence Hospital Unit Derriford, Derriford Hospital, Plymouth, UK
| |
Collapse
|
25
|
|
26
|
Behjati S, Jamieson K, Montgomery M, Patel N, Jaswon M. Do paediatric high dependency units in district general hospitals improve patient care? A local review of children presenting with seizures. Arch Dis Child 2012; 97:582. [PMID: 21220266 DOI: 10.1136/adc.2010.206201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
27
|
Dehò A, Lutman D, Montgomery M, Petros A, Ramnarayan P. Emergency management of children with acute severe asthma requiring transfer to intensive care. Emerg Med J 2010; 27:834-7. [PMID: 20558488 DOI: 10.1136/emj.2009.082149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Children presenting to emergency departments (ED) with acute severe asthma unresponsive to initial medical therapy may require endotracheal intubation and mechanical ventilation. There is little data on complications during the acute management of children with life-threatening asthma, particularly at hospitals where specialist paediatric staff are lacking. It was hypothesised that a better understanding of complications, particularly associated with intubation and mechanical ventilation, would improve acute management in ED, aid quality improvement initiatives at district general hospitals (DGH) and form the basis for educational interventions from regional paediatric critical care units. METHODS A retrospective case note review was performed for all children referred to a regional intensive care retrieval service with status asthmaticus over a 2-year period. Initial treatment, patient-related factors, indication for endotracheal intubation and the type and occurrence of adverse events during acute management at the DGH were studied. Bivariate and multivariate analyses were undertaken to identify factors associated with the occurrence of complications. RESULTS 51 (85%) of the 60 children transferred to a paediatric intensive care unit for acute severe asthma required intubation. 36 (70.5%) experienced one or more complications during intubation and in the early phase of mechanical ventilation. The most common complications were hypotension (requiring fluid resuscitation and/or inotropic support) and severe bronchospasm with acute hypercarbia. The indication for intubation significantly affected the chances of a complication occurring during stabilisation. CONCLUSIONS There is considerable morbidity in asthmatic children who are referred to paediatric intensive care. The majority of complications may be anticipated and prevented resulting in improved management at DGH.
Collapse
Affiliation(s)
- Anna Dehò
- Children's Acute Transport Service, Great Ormond Street Hospital, London, UK
| | | | | | | | | |
Collapse
|
28
|
Loftus B, Newsom B, Montgomery M, Von Gynz-Rekowski K, Riser M, Inman S, Garces P, Rill D, Zhang J, Williams J. Autologous attenuated T-cell vaccine (Tovaxin®) dose escalation in multiple sclerosis relapsing–remitting and secondary progressive patients nonresponsive to approved immunomodulatory therapies. Clin Immunol 2009; 131:202-15. [DOI: 10.1016/j.clim.2009.01.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 12/14/2008] [Accepted: 01/06/2009] [Indexed: 11/24/2022]
|
29
|
Soni S, Termuhlen A, Bajwa R, Clayton J, Montgomery M, Hardin D. Prevalence, Risk Factors and Management of Metabolic Syndrome After Stem Cell Transplantation In Pediatric Patients. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
30
|
Abstract
The retrieval of critically ill patients is frequently done in difficult circumstances and often under considerable time pressures. These adverse conditions have a finite risk of serious injury or death. The level of risk is poorly described in the literature and reliable data on accident rates are hard to find. Most of the information comes from North America. There are no clear published statistics for the UK. We report for the first time data on accidents and casualties involving vehicles classified as having an ambulance body type and air ambulances within Great Britain between 1999 and 2004.
Collapse
Affiliation(s)
- D Lutman
- Children's Acute Transport Service, 44B Bedford Row, London WC1R 4LL, UK
| | | | | | | |
Collapse
|
31
|
Sun X, Barolo S, Bilder D, Montgomery M, Sinha N. Emerging from the fog: Hypotheses and paradigms in developmental biology—The Society for Developmental Biology 2005 Annual Meeting Report. Dev Biol 2006; 289:273-82. [PMID: 16337185 DOI: 10.1016/j.ydbio.2005.10.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Accepted: 10/17/2005] [Indexed: 10/25/2022]
Abstract
The Society for Developmental Biology 64th annual meeting took place by the beautiful San Francisco Bay from July 27th to August 1st, 2005. Organized under the leadership of Judith Kimble (SDB President, U. Wisconsin-Madison), the meeting attracted over one thousand developmental biologists from all over the world. They gathered to present data, exchange ideas and enjoy basking in the warm sun on the piers. Strong themes emerged from the diverse subjects discussed at the meeting, demonstrating exciting trends towards the unifying goal of understanding the progression from a single cell to an adult organism. Cell and Tissue Polarity was a recurring topic at the meeting. Questions like "is there polarity", "how is it achieved" and "how is it linked to stem cell maintenance" were discussed. Post-transcriptional regulation involving protein degradation and microRNA (miRNA) modulation of gene expression was featured in the context of transition between meiosis to mitosis and asymmetries in the embryo. It is apparent that Evolutionary Developmental Biology, once a major driving influence in the early days of the field, continues to enjoy a renaissance as researchers familiar with traditional model organisms are increasingly attracted to the field and as modern genetic and molecular approaches are applied to an increasingly varied assortment of organisms. The attention is beginning to pay off as laboratories are starting to generate significant results shedding light into how developmental programs are altered to generate morphological diversity. In the Satellite Symposium on Plant Development held on July 27th, 2005, the overriding theme was on the identity and maintenance of Stem Cells in Plants. Finally, researchers working on diverse organisms have shown a strong effort to address Developmental Coordination: on the subcellular, cellular and tissue levels. Advanced imaging techniques are combined with traditional genetic methods to scrutinize and compare dynamic processes in four dimensions. This tremendous increase in resolution has facilitated the identification of key signaling mechanisms that embryos utilize to form coordinated body plans. For an exceptional effort in keeping with Society tradition, the 2005 annual meeting also offered opportunities to address broader issues revolving around education and professional development as well as a special session on embryonic stem cell research. Throughout the 5-day meeting, participants found time to honor the contributions of colleagues, exchange career and grant planning strategies, contemplate the big picture and recognize the efforts of young investigators, postdoctoral fellows and students.
Collapse
Affiliation(s)
- Xin Sun
- Laboratory of Genetics, University of Wisconsin-Madison, Madison, WI 53706, USA.
| | | | | | | | | |
Collapse
|
32
|
Montgomery M, Mathee A. A preliminary study of residential paint lead concentrations in Johannesburg. Environ Res 2005; 98:279-83. [PMID: 15910783 DOI: 10.1016/j.envres.2004.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2004] [Revised: 10/20/2004] [Accepted: 10/22/2004] [Indexed: 05/02/2023]
Abstract
While efforts are underway to phase out the use of leaded petrol in South Africa, relatively little attention has been devoted to the potential for childhood exposure to lead used in paint. This is one of the first studies undertaken on the African continent to report on the presence of lead-based paint. In South Africa, there is a dearth of information available on the extent of past and current use of lead-based paint. Recent studies demonstrate that large numbers of young South African children continue to be at risk of elevated blood lead concentrations. To investigate the prevalence of lead-based paint in Johannesburg dwellings, the South African Medical Research Council recently undertook a preliminary study in which samples of residential paint were collected from homes in 60 randomly selected suburbs across the city. The results indicate that 17% of all of the samples collected were lead-based paint (paint that contains lead levels equal to or greater than 0.5% by weight). The percentage of lead by weight in the samples ranged from 0.01% to 29.00%. Lead-based residential paint was found in 20% of the sampled homes, located in both new and old suburbs, and in suburbs from a variety of different socioeconomic backgrounds. These results, in conjunction with those emanating from other studies of childhood lead exposure currently being conducted by the Medical Research Council, indicate that weathering, peeling, or chipping lead-based paint may play an important role in childhood lead exposure in South Africa. Children who have a pica tendency may be at particular risk.
Collapse
Affiliation(s)
- M Montgomery
- The Watson Institute for International Scholars, Brown University, 111 Thayer Street, Brown University, Box 1970, Providence, RI 02912-1970, USA.
| | | |
Collapse
|
33
|
Mathee A, von Schirnding Y, Montgomery M, Röllin H. Lead poisoning in South African children: the hazard is at home. Rev Environ Health 2004; 19:347-361. [PMID: 15742678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Lead is a toxic heavy metal that has been used extensively in modern society, causing widespread environmental contamination even in isolated parts of the world. Irrefutable evidence associates lead at different exposure levels with a wide spectrum of health and social effects, including mild intellectual impairment, hyperactivity, shortened concentration span, poor school performance, violent/aggressive behavior, and hearing loss. Lead has an impact on virtually all organ systems, including the heart, brain, liver, kidneys, and circulatory system, resulting in coma and death in severe cases. In recent years, a consensus was reached regarding the absence of a threshold for the key health effects associated with lead exposure and the permanent and irreversible nature of many health and social consequences of lead exposure. The public health problem of environmental lead exposure has been widely investigated in developed countries like the United States of America, where actions taken have led to significant reductions in children's blood lead concentrations. In contrast, there is a relative dearth of information and action regarding lead poisoning in developing countries, particularly in African countries, despite evidence of widespread and excessive childhood lead exposure. In this paper, we will review the information from available published papers, the 'grey literature', and unpublished reports to give an overview of lead exposure in South African children over the past two decades, with particular emphasis on sources of exposure in the home environment.
Collapse
Affiliation(s)
- Angela Mathee
- South African Medical Research Council, South Africa.
| | | | | | | |
Collapse
|
34
|
Courtney M, Yacopetti J, James C, Walsh A, Montgomery M. Queensland public sector nurse executives: professional development needs. AUST J ADV NURS 2002; 19:8-14. [PMID: 12002630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
In a time of health care reform and rapid change, nurse executives need effective leadership skills to be able to respond to a challenging environment, provide quality cost-effective care and promote the professional development of nursing. This research aimed to provide an understanding of nursing executives' roles and professional development needs and obtain concise information for the development of strategies and professional development programs to enhance the effectiveness of the present and future roles of nursing executives. A descriptive cross-sectional postal survey was sent to all public sector Level 4 and 5 nursing executives in Queensland (n = 281), with a response rate of 52.3% (n = 147). Financial management, human resource management and information technologies were identified as the areas where professional development was most needed. Structured educational activities such as short courses or seminars covering information technology, financial and budget management and general business management were identified as the type of activities best suited to nurse executives' needs. The most frequently reported barriers to professional development were difficulties obtaining relief staff, inadequate time, financial cost and inadequate district manager and regional support to enable access to professional development programs.
Collapse
Affiliation(s)
- Mary Courtney
- Centre for Nursing Research, School of Nursing, Queensland University of Technology, Brisbane, Australia
| | | | | | | | | |
Collapse
|
35
|
Abstract
Cardiogenic fate maps are used to address questions on commitment, differentiation, morphogenesis and organogenesis of the heart. Recently, the accuracy of classical cardiogenic fate maps has been questioned, raising concerns about the conclusions drawn in studies based on these maps. We present accurate fate maps of the heart-forming region (HFR) in avian embryos and show that the putative cardiogenic molecular markers Bmp2 and Nkx2.5 do not govern the boundaries of the HFR as suggested in the literature. Moreover, this paper presents the first fate map of the HFR at stage 4 and addresses a void in the literature concerning rostrocaudal patterning of heart cells between stages 4 and 8.
Collapse
Affiliation(s)
- A Redkar
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | | | | |
Collapse
|
36
|
Abstract
OBJECTIVE determine the frequency of initial rhythms in in-hospital resuscitation and examine its relationship to survival. Assess changes in outcome over time. METHODS retrospective cohort (registry) including all admissions to the Medical Center of Central Georgia in which a resuscitation was attempted between 1 January, 1987 and 31 December, 1996. RESULTS the registry includes 3327 admissions in which 3926 resuscitations were attempted. Only the first event is reported. There were 961 hospital survivors. Survival increased from 24.2% in 1987 to 33.4% in 1996 (chi(2)=39.0, df=1, P<0.0001). Survival was affected strongly by initial rhythm (chi(2)=420.0, df=1, P<0.0001) and decreased from 63.2% for supraventricular tachycardia (SVT) to 55.3% for ventricular tachycardia (VT), 51.0% for perfusing rhythms (PER), 34.8% for ventricular fibrillation (VF), 14.3% for pulseless electrical activity (PEA) and 10.0% for asystole (ASYS). PEA was the most frequent rhythm (1180 cases) followed by perfusing (963), asystole (580), VF (459), VT (94) and SVT (38). DISCUSSION the powerful effect of initial rhythm on survival has been reported in pre-hospital and in-hospital resuscitation. VF is considered the dominant rhythm and generally accounts for the most survivors. We report good outcome for each; however, VF represents only 13.8% of events and 16.7% of survivors. PEA accounts for more survivors (169) than does VF (160). Our improved outcome is partially explained by changes in rhythms, but other institutional variables need to be identified to fully explain the results. Further studies are needed to see if our findings can be sustained or replicated.
Collapse
Affiliation(s)
- D C Parish
- Department of Internal Medicine, Medical Center of Central Georgia and Mercer University School of Medicine, 707 Pine Street, Macon, GA 31201, USA.
| | | | | | | | | | | |
Collapse
|
37
|
Holmes AJ, Bowyer J, Holley MP, O'Donoghue M, Montgomery M, Gillings MR. Diverse, yet-to-be-cultured members of the Rubrobacter subdivision of the Actinobacteria are widespread in Australian arid soils. FEMS Microbiol Ecol 2000; 33:111-120. [PMID: 10967210 DOI: 10.1111/j.1574-6941.2000.tb00733.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Phylogenetic analyses of ribosomal RNA gene sequences (rDNAs) retrieved from an Australian desert soil sample (Sturt National Park) revealed the presence of a number of clones which branched deeply from the high GC Gram-positive division line of descent. The most abundant group of these clones were related to Rubrobacter. An oligonucleotide probe was designed to have broad specificity to Rubrobacter and relatives. This probe was used to interrogate eight rDNA libraries representing four distinct land forms within the Australian arid zone. Relative abundance of Rubrobacter-relatives in these samples ranged from 2.6 to 10.2%. Clones from these libraries were selected for sequence analysis on the basis of a heteroduplex mobility assay to maximise the diversity represented in the sample. Phylogenetic analyses of these rDNA clones and Rubrobacter-related clones reported in the literature show strong support for three distinct groups. Database-searching revealed 'Rubrobacteria' were relatively abundant in a number of published soil rDNA libraries but absent from others. A PCR assay for group-1 'Rubrobacteria' was used to test for their presence in 21 environmental samples. Only marine and arid-zone soil samples gave positive PCR results. Taken together these results indicate 'Rubrobacteria' are a widespread group of variable abundance and diversity.
Collapse
Affiliation(s)
- AJ Holmes
- Key Centre for Biodiversity and Bioresources, Department of Biological Sciences, Macquarie University, 2109, Sydney, N.S.W., Australia
| | | | | | | | | | | |
Collapse
|
38
|
Abstract
During chick embryogenesis, cells destined to form cardiac myocytes are located within the primitive streak at stage 3 in the same relative anterior-posterior distribution as in the prelooped heart. The most rostral cells contribute to the extreme anterior pole of the heart, the bulbus cordis, and the most caudal to the extreme posterior end, the sinoatrial region. After gastrulation, these cells commit to the myocyte lineage and, retaining their relative positions, migrate to the anterior lateral plate. From stages 5 to 10 they diversify into atrial and ventricular myocytes, with the former located posteriorly and the latter, anteriorly. To determine the effect of a change in the rostro-caudal position of these cells on their diversification, anterior lateral plate mesoderm and the underlying endoderm were cut and rotated 180 degrees along the longitudinal axis, at stages 4-8. The subsequent diversification of these precursor cells into atrial and ventricular myocytes was examined using lineage-specific markers. Our results showed that altering location along the longitudinal axis through stage 6 changed the normal fate of a precursor cell. The orientation of the overlying ectoderm did not alter normal morphogenesis or determination of fate.
Collapse
Affiliation(s)
- V Patwardhan
- Department of Anatomy and Cell Biology, Temple University, Philadelphia, Pennsylvania 19140, USA
| | | | | | | |
Collapse
|
39
|
Abstract
A total of 104 couples participated in a randomized crossover trial to compare a new baggy condom with a straight-shaft condom produced by the same manufacturer. Participants completed a coital log after using each condom. All couples used five condoms of each type. Among 102 couples who did not report major deviations from the protocol, the breakage rate was eight of 510 (1.6%) for the baggy condom, and six of 510 (1.2%) for the standard condom (rate difference, RD = 0. 4%, 95% confidence interval of the RD, CI = -1.0%; +1.8%). Slippage was reported in 50 baggy condom logs and in 58 standard condom logs; the slippage rate was 50 of 510 (9.8%) for the baggy condom, and 58 of 510 (11.4%) for the standard condom (RD = -1.6%, 95% CI = -5.4%; +2.2%). Slippage was most often partial (<1 inch) and may not indicate condom failure. Severe slippage rates were 11 of 510 (2.2%) for the baggy condom, and 18 of 510 (3.5%) for the standard condom (RD = -1.4%, 95% CI = -3.4%; +0.7%). The findings support the conclusion that the two condoms are equivalent with respect to breakage and slippage. The participants appeared to prefer the baggy condom, suggesting that the new product may be more acceptable to the public than the traditional straight-shaft condoms, and may be easier to use consistently over long time periods.
Collapse
Affiliation(s)
- M Macaluso
- Department of Epidemiology and International Health, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama 35294-2010, USA
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Johnson JA, Connolly MA, Jacobs P, Montgomery M, Brown NE, Zuberbuhler P. Cost of care for individuals with cystic fibrosis: a regression approach to determining the impact of recombinant human DNase. Pharmacotherapy 1999; 19:1159-66. [PMID: 10512065 DOI: 10.1592/phco.19.15.1159.30580] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We estimated direct medical costs of care and important determinants of the costs in patients with cystic fibrosis (CF), including therapy with recombinant human DNase (rhDNase). Costs were estimated with resource use data from the Epidemiologic Study of Cystic Fibrosis. Ordinary least squares regression was used to determine the effect of clinical and demographic variables on individual cost of care. The estimated cost of caring for 303 patients in Alberta was $2,279,801 in 1996. The mean cost of care was $7524 (range $386-92,376)/patient. Regression results indicated that age and forced expiratory volume predicted had a negative association with costs. Being female, receiving rhDNase, and having Pseudomonas aeruginosa or Burkholderia cepacia were all associated with high costs. Our estimates indicated large interindividual variation in cost of care for patients with CF.
Collapse
Affiliation(s)
- J A Johnson
- Institute of Health Economics, Faculty of Pharmacy and Pharmaceutical Sciences, the University of Alberta, Edmonton, Canada
| | | | | | | | | | | |
Collapse
|
41
|
Abstract
OBJECTIVE Assess the frequency and outcome of inhospital resuscitation and determine the relationship between patient age and survival and whether it is affected by initial rhythm. DESIGN Retrospective, single-institution, registry study of inhospital resuscitation. SETTING A 550-bed, tertiary-care, teaching hospital in Macon, GA. PATIENTS All admissions for which a resuscitation was attempted in the Medical Center of Central Georgia during the period of January 1, 1987 through December 31, 1993. The registry sample included 2,394 admissions, for which 2,813 resuscitation attempts were made; only the first resuscitation attempt during an admission was analyzed. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Rates of survival to discharge steadily increased from 24.4% in 1987 to 38.6% in 1993; the overall survival rate was 26.8%. Age, used as a continuous variable, was strongly related to survival (odds ratio = 0.984; p < .0001). Categorically, overall survival rates for pediatric, adult, and geriatric patients were 56.4%, 29.0%, and 24.0%, respectively. Survival rates also varied significantly (odds ratio = 0.469; p < .0001) among initial rhythms, i.e., supraventricular tachycardia (60.7%), ventricular tachycardia (57.6%), perfusing rhythms (49.84%), ventricular fibrillation (32.0%), pulseless electrical activity (14.6%), and asystole (9.1%). The relationship between age and survival did not change across the years included in the study, but did vary as a function of initial rhythm (p < .0001). Age was positively related to survival when initial rhythm was supraventricular tachycardia (p = .04), negatively related to survival when the initial rhythm was perfusing (p < .0001) or pulseless electrical activity (p = .0002), and not related to survival when the initial rhythm was ventricular tachycardia (p = .98), ventricular fibrillation (p = .14), or asystole (p = .21). CONCLUSIONS The relationship between patient age and a successful resuscitation attempt is not as simple as reported earlier. Whether age is related to increased or decreased survival, or is unrelated to survival, depends on the rhythm extant when resuscitation attempts begin. Survival rates were higher than most reported elsewhere and improved significantly over time. Multicentered studies are needed to determine whether these results are unique to the institution studied.
Collapse
Affiliation(s)
- D C Parish
- Department of Internal Medicine, Medical Center of Central Georgia and Mercer University School of Medicine, Macon, USA
| | | | | | | | | |
Collapse
|
42
|
Lee FY, Montgomery M, Hazan EJ, Keel SB, Mankin HJ, Kattapuram S. Recurrent giant-cell tumor presenting as a soft-tissue mass. A report of four cases. J Bone Joint Surg Am 1999; 81:703-7. [PMID: 10360699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- F Y Lee
- Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA
| | | | | | | | | | | |
Collapse
|
43
|
Mehta A, Dreyer KJ, Montgomery M, Wittenberg J. A World Wide Web Internet engine for collaborative entry and peer review of radiologic teaching files. AJR Am J Roentgenol 1999; 172:893-6. [PMID: 10587117 DOI: 10.2214/ajr.172.4.10587117] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Radiologists can now use the Internet as a dissemination medium for radiologic teaching files. This has greatly increased the availability of radiologic information to a larger number of people. However, the creation of the teaching files themselves remains a static and labor-intensive process. As a partial solution to this problem, we set out to create a World Wide Web-based Internet engine for the collaborative entry and peer review of radiologic teaching files. CONCLUSION We created a system that facilitates, simplifies, and improves the generation of radiologic teaching files. We used the Internet to help promote the creation of teaching files in a more timely, efficient, and effective manner.
Collapse
Affiliation(s)
- A Mehta
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston 02114. USA
| | | | | | | |
Collapse
|
44
|
|
45
|
Abstract
BACKGROUND Patients with repaired esophageal atresia often show persistent motility disorders of the esophagus. METHODS In this study, the authors used a newly developed method, videomanometry, to study intraluminal pressures and function of the pharynx and upper esophagus in such a group of patients and compared the results with those in healthy age-matched controls. RESULTS A significant difference was found between timing of the pharynx contraction and upper esophageal sphincter (UES) relaxation, indicating a dyscoordination of swallowing in the patient group. Transit time of bolus from the pharynx to the esophagus was also shorter for the patient group. Such dyscoordination may be a risk factor that can cause aspiration and respiratory symptoms. CONCLUSION UES resting pressure and residual pressure on swallowing, did not differ between the two groups.
Collapse
Affiliation(s)
- M Montgomery
- Department of Pediatric Surgery, St. Göran's/Karolinska Hospital, Karolinska Institute, Stockholm, Sweden
| | | | | | | |
Collapse
|
46
|
Abstract
Purified bovine milk proteins that were added to cultures of murine spleen cells significantly increased cell proliferation and production of immunoglobulin M. Casein and a whey mixture consisting of alpha-lactalbumin, bovine serum albumin, bovine gamma globulin, and beta-lactoglobulin (beta-LG) were stimulatory. Of the three beta-LG preparations that are commercially available (beta-LG containing variants A and B, purified variant A, and purified variant B), the unseparated mixture containing both the A and B variants showed the most immunomodulatory activity. Both alkaline treatment and trypsin digestion of the beta-LG preparation markedly reduced its effectiveness. Polymyxin B, while greatly diminishing the stimulatory effect of lipopolysaccharide, had no significant effect on either the enhancement of cell proliferation or the enhancement of immunoglobulin production by beta-LG. In the presence of S-(n-butyl)-homocysteine sulfoxamine, the stimulatory effect of beta-LG on cell proliferation and IgM production in vitro was markedly reduced.
Collapse
Affiliation(s)
- K F Wong
- Department of Human Ecology, Mount Saint Vincent University, Halifax, NS, Canada
| | | | | | | | | |
Collapse
|
47
|
Abstract
A neuropathological study of autism was established and brain tissue examined from six mentally handicapped subjects with autism. Clinical and educational records were obtained and standardized diagnostic interviews conducted with the parents of cases not seen before death. Four of the six brains were megalencephalic, and areas of cortical abnormality were identified in four cases. There were also developmental abnormalities of the brainstem, particularly of the inferior olives. Purkinje cell number was reduced in all the adult cases, and this reduction was sometimes accompanied by gliosis. The findings do not support previous claims of localized neurodevelopmental abnormalities. They do point to the likely involvement of the cerebral cortex in autism.
Collapse
Affiliation(s)
- A Bailey
- MRC Child Psychiatry Unit, Institute of Psychiatry, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
BACKGROUND Scintigraphy is considered the "gold standard" for investigating gastric emptying. The lack of standards regarding registration technique and meal composition has been a problem especially in pediatric patients. METHODS In this study, gastric emptying of a solid meal was assessed by scintigraphy in 10 patients with repaired esophageal atresia (5 to 10 years old), and the results were compared with those in 11 healthy control children (5 to 11 years old). The meal consisted of pancakes with a fixed energy composition labeled with Tc-99m. Fractional meal retention values were plotted as a function of time. RESULTS Half-emptying time and lag phase values were longer in the patient group, whereas the emptying rate was slower and the retention values at 60 and 90 minutes were higher than in the control group. Extremely long lag phase and slow emptying rates were seen in two patients with reflux symptoms and abdominal complaints. Gastric emptying in healthy children has not previously been studied by scintigraphy. The results of this study show that values for gastric emptying of solids in healthy children correspond well to those reported in healthy adults. CONCLUSION Scintigraphy is an easy and reliable method for gastric emptying studies in children. The radioactive dose can be kept very low, which makes it a safe method even for pediatric patients. Delayed gastric emptying can occur in patients who have repaired esophageal atresia, and may be associated with reflux symptoms and abdominal complaints.
Collapse
Affiliation(s)
- M Montgomery
- Department of Pediatric Surgery, St Göran's/Karolinska Hospital, Karolinska Institute, Stockholm, Sweden
| | | | | | | | | |
Collapse
|
49
|
Affiliation(s)
- M Montgomery
- Department of Radiology, Massachusetts General Hospital, Boston, USA
| | | |
Collapse
|
50
|
Kaplan JL, Braitman LE, Dalsey WC, Montgomery M, Mangione A. Alkalinization is ineffective for severe hyperkalemia in nonnephrectomized dogs. Hyperkalemia Research Group. Acad Emerg Med 1997; 4:93-9. [PMID: 9043534 DOI: 10.1111/j.1553-2712.1997.tb03713.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether alkalinization with sodium bicarbonate (NaHCO3) in near-lethal hyperkalemia either lowers potassium (K) rapidly or shortens duration of cardiac conduction disturbances. METHODS A controlled canine laboratory investigation of 3 treatments for severe hyperkalemia. Conditioned dogs (n = 8; 17-30 kg) received, in random order, 2 mmol/kg of each of 3 treatments (matched in sodium and water) in separate experiments > or = 1 week apart: 1.05% NaHCO3 over 60 minutes (infusion therapy); 8.4% NaHCO3 over 5 minutes, then 14 mL/kg sterile water over 55 minutes (bolus therapy); 8.4% NaCl over 5 minutes, then 14 mL/kg sterile water over 55 minutes (saline therapy). Prior to administering one of the above therapies, the animals were anesthetized with 0.5-2.5% isoflurane and ventilated to maintain a normal PCO2. After 30 minutes of equilibration, 2 mmol/kg/hr (loading dose) of a 2-mmol/mL KCl solution was given until idioventricular or relative junctional bradycardic dysrhythmias were sustained for 15 minutes. Then KCl was decreased to 1 mmol/kg/hr (maintenance dose) for 2 hours and 45 minutes. Treatment was begun after 45 minutes of maintenance KCl infusion. RESULTS The pretreatment K level (all studies) was 9.06 +/- 0.82 mmol/L (mean +/- SD). Although the mean K level decreased more after saline therapy than after bolus therapy at every time, differences were neither statistically significant nor clinically important during the first 30 minutes. The means of the differences in decreases (saline minus bolus) were small, 0.26 (95% CI, -0.48 to 1.00) at 15 minutes, 0.16 (95% CI, -0.67 to 0.98) at 30 minutes. Dysrhythmia duration was shorter with bolus therapy than for saline therapy in only 1 of 5 dogs (p = 0.38). CONCLUSIONS Hypertonic saline bolus lowered plasma K as effectively as NaHCO3 bolus in this animal model within the first 30 minutes. Clinically meaningful decreases due to alkalinization alone within 30 minutes are unlikely.
Collapse
Affiliation(s)
- J L Kaplan
- Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA 19141, USA.
| | | | | | | | | |
Collapse
|