Save Your Back: Comparison of the Compressive Force on the Lower Back Based on Differences in the Training Techniques

INTRODUCTION

Musculoskeletal injury prevention for nurses is aimed at removing the need to manually position patients. In the ED, this is not always possible or practical. The purpose of this study is to compare the calculated estimated compressive force on the lumbar spine between recommended lifting techniques and the SHAPE lifting method during the horizontal transfer of a patient.

METHODS

Twenty-one student nurses completed the horizontal transfer of a simulated patient while motion was collected using inertial measurement units. Motion data were analyzed to calculate an estimated compressive force on the lumbar spine while completing the movement based on current recommended lifting methods and while using the SHAPE lifting method.

RESULTS

A significant reduction in estimated peak and average compressive force at the lumbar spine was found during both the push and the pull portions (P < .001) of the horizontal transfer.

DISCUSSION

While the optimal way to limit musculoskeletal injury among nurses is to eliminate the need for manual handling of a patient, this is not always possible in the ED. It is critical that when emergency nurses must reposition a patient, they perform the movement in the most biomechanically sound method while using a friction reduction. These findings, coupled with the previous biomechanical risk factor reduction related to the SHAPE lifting intervention, gives promise to a safer lifting strategy for emergency nurses moving forward.

Psychometric evaluation of protective measures in Native STAND: A multi-site cross-sectional study of American Indian Alaska Native high school students

American Indian and Alaska Native (AI/AN) youth are strong in culture and rich in heritage and experience unique strengths and challenges throughout adolescence. Documenting conditions that protect against risk factors associated with poor health outcomes are needed. We explored scales that measure self-esteem, culture, social support, and community from a sample of 1,456 youth involved in Native STAND, a culturally-relevant evidence-based sexual health intervention. We established content validity by reviewing existing literature and community feedback. Construct validity was examined using factor analysis. The final self-esteem model included seven items, factor loadings ranged from 0.47 to 0.63 for positive self-esteem and 0.77 to 0.81 for negative self-esteem. The final culture model included three items, factor loadings 0.73 to 0.89. The social support scale included four items, factor loadings ranged from 0.86 to 0.87 for family social support and 0.75 to 0.77 for friends social support. The community and community safety scale included three items; factor loadings ranged from 0.52 to 0.82. Coefficient alphas for scales ranged from α = 0.63 to α = 0.86. This study validated scales in a national sample of AI/AN youth-psychometric scales provide an essential tool for documenting the needs and strengths of AI/AN youth.

The Adaption of the Work Environment Survey for Public Health Nurses

The study presents the iterative process of the adaption and psychometric properties evaluation of the Work Environment/Support/Encouragement section of the Revised Casey-Fink Nurse Retention Survey^© (2009) to measure the work environment of public health nurses (PHNs). This secondary data analysis was based on data collected from a convenience sample of 596 PHNs across North Carolina that were originally used to study PHNs workforce retention. Classical test theory analyses were used to evaluate scale reliability and identify potential problematic items that were further examined from a substantive perspective using content validity survey. Confirmatory factor analysis and exploratory factor analysis were performed to evaluate the construct validity and assist further development of the scale. Analyses suggest a three-factor structure for the retained 19-item scale including managerial support, professional nursing role, and recognition, with reliability ranging from alpha of .859 to .959.

CHARACTERISTICS OF HOSPITALIZED OLDER ADULTS WITH RECURRENT CLOSTRIDIUM DIFFICILE: INTERVENTION OPPORTUNITIES

Clostridium difficile infection (CDI) is the leading cause for gastroenteritis-associated deaths (Hall et al., 2012). Risk factors include advanced age, antibiotic use, and hospital admission, yet multiple others are not widely known. CDI recurrence risk may be as high as 40% after initial treatment (Garey et al., 2008; Kelly & Lamont, 2008). Older adults may present atypically, and treatment guidelines for initial and recurrent CDI have evolved from older standards. A retrospective cohort research study explored characteristics of hospitalized adults ages 55 and older with CDI between December 31, 2013 through December 31, 2015, identified by ICD diagnosis codes. Recurrence within one year, laboratory measurements, chronic diseases, and psychosocial data were captured from the electronic health record (EHR). Over the study period, 871 patients had a recurrence rate of 23.9% (n=208). Caucasian females comprised over half the sample, and 9.1% expired during initial hospitalization. Almost two-thirds (n=576, 66.1%) lived in private residences prior to admission. CDI recurrence was more prevalent if discharged to skilled nursing facility and home health care services. Hypertension, heart failure, and chronic kidney disease were most prevalent in the recurrent CDI group. Polypharmacy was noted in over two-thirds of sample. A large portion of the sample displayed hypoalbuminemia on admission.Utilizing the EHR to aggregate data promotes interventions to reduce recurrence, prolonged stay, and aggressive treatment per current guidelines. Multidisciplinary approaches include deprescribing, nutritional support, and chronic disease management. Person-centered care and individualized interventions should begin on admission with close outpatient follow-up and hopeful reduced readmissions.

Application of a mixture DOE for the prediction of formulation critical temperatures during lyophilisation process optimisation

During lyophilisation cycle design, primary drying parameters (chamber pressure and shelf temperature) are adjusted to maximize the sublimation rate and prevent cake collapse, by maintaining the product continuously below its critical temperatures. The objective of this study was to employ mixture design of experiments to generate empirical models capable of predicting glass transition of the maximally freeze concentrated solution (Tg') and collapse temperature (Tc) of amorphous protein (BSA and IgG1) formulations. Additionally, the models developed aid the design of high concentration protein formulations with maximised critical temperatures to obtain shorter and more cost-effective lyophilisation cycles. Formulations contain sucrose as cryo/lyo-protectant and arginine/arginine-HCl as multifunctional excipient (e.g. solubility enhancer, viscosity and aggregation suppressor). The impact of formulation components at varied ratios on critical temperatures was evaluated; the amorphous excipients decrease critical temperatures, on the contrary, the protein increases critical temperatures. The robustness of the empirical models generated with BSA formulations was verified with BSA and IgG1 formulations. The models showed greater accuracy in predicting Tg' than the Fox-Flory equation. For the first time, empirical models are reported to predict both critical temperatures. Finally, unconventional collapse events observed for formulations with and without arginine/arginine-HCl at different protein concentrations are also discussed.

Parenteral protein formulations: An overview of approved products within the European Union

The study presented is a comprehensive overview of commercial parenteral protein formulations, approved by the European Medicines Agency (EMA), 1995-2018. The objective of this overview was to analyse current trends in the design of commercial parenteral protein products and thereby support formulation scientists in the design of new formulations. The main data source was the publicly available European Public Assessment Reports (EPARs) published by the EMA for each authorised product. An analysis of the percentage of formulations in a liquid and lyophilised form was conducted. In addition, the number of products containing individual excipients, classified into functional categories is provided. Finally, the overview includes comprehensive details of product compositions obtained from EMA, US Food and Drug Administration (FDA) and product Marketing Authorisation Holder. Data analysis highlighted trends in the number of products approved, and the higher percentage of liquid parenteral protein formulations (66%) compared to lyophilised formulations (34%). This overview identifies the most commonly incorporated excipients employed as buffering agents, stabilisers/bulking agents, surfactants, preservatives and tonicifiers, including their concentration ranges of use in both liquid and lyophilised formulation approaches. Finally, antibody-based formulations were a particular focus of this overview. The relationship between parenteral routes of administration and antibody concentrations in approved products was also investigated.

Bartonella spp. as a Possible Cause or Cofactor of Feline Endomyocarditis-Left Ventricular Endocardial Fibrosis Complex

Endomyocarditis is a commonly detected post-mortem finding in domestic cats presenting for sudden onset cardiovascular death, yet the aetiology remains unresolved. Cats are documented reservoir hosts for Bartonella henselae, the infectious cause of cat scratch disease in man. Various Bartonella spp. have been associated with culture-negative endocarditis, myocarditis and sudden death in man and animals. We hypothesized that Bartonella spp. DNA could be amplified more often from the hearts of cats with feline endomyocarditis-left ventricular endocardial fibrosis (FEMC-LVEF) complex compared with cats with hypertrophic cardiomyopathy (HCM) or cats with grossly and microscopically unremarkable hearts (designated non-cardiac disease controls). Formalin-fixed and paraffin wax-embedded, cardiac tissues from 60 domestic and purebred cats aged 3 months to 18 years were examined, and histological features were recorded. Cardiac tissue sections were tested for Bartonella DNA using multiple 16-23S intergenic transcribed spacer region polymerase chain reaction (PCR) primer sets, including two Bartonella genera, a Bartonella koehlerae species-specific and a Bartonella vinsonii subsp. berkhoffii-specific assay, followed by DNA sequence confirmation of the species or genotype. Special precautions were taken to avoid DNA cross-contamination between tissues. Bartonella spp. DNA was amplified by PCR and sequenced from 18 of 36 cats (50%) with FEMC-LVEF and 1/12 (8.3%) cats with HCM. Bartonella spp. DNA was not amplified from any non-cardiac disease control hearts. Based on PCR/DNA sequencing, one Bartonella spp. was amplified from 10 cats, while the remaining eight were coinfected with more than one Bartonella spp. To our knowledge, this study represents the first documentation of B. vinsonii subsp. berkhoffii genotype I infection in cats (n = 11). Fluorescence in-situ hybridization testing facilitated visualization of Bartonella bacteria within the myocardium of four of seven PCR-positive FEMC-LVEF hearts. Collectively, these findings support the hypothesis that Bartonella spp. may play a primary role or act as a cofactor in the pathogenesis of FEMC-LVEF. Studies involving cats from other geographical regions and definitive demonstration of Bartonella spp. within regions of inflammation are needed to confirm an association between Bartonella spp. and FEMC-LVEF induced morbidity and mortality in cats.

Predictors of depression in black women with hypertension

Black women have the highest prevalence of hypertension in the world, and depression is associated with both hypertension and lack of health promoting behaviors. Thus, it is important to identify factors that may contribute to depression in hypertensive women. This cross-sectional study was conducted with a convenience sample of 80 black women ages 18-60 who were prescribed anti-hypertensive medication. Data were collected using self-report instruments. The study showed that lower income level, greater number of comorbidities, lower active coping scores, and poorer medication adherence were significantly associated with higher depression scores. These findings have important implications for the development of screening protocols and interventions for black women.

1,25-dihydroxyvitamin D(3) and PI3K/AKT inhibitors synergistically inhibit growth and induce senescence in prostate cancer cells

BACKGROUND

1-Alpha, 25-dihydroxyvitamin D(3) (1,25(OH)(2)D(3)) inhibits proliferation of multiple cancer cell types including prostate cells and upregulates p21 and/or p27, while loss of Pten and PI3K/AKT activation stimulates survival and downregulates p21 and p27. We hypothesized that inhibition of the PI3K/AKT pathway synergizes with the antiproliferative signaling of 1,25(OH)(2)D(3).

METHODS

Viability, cell cycle and senescence of cells were evaluated upon combinational treatment with 1,25(OH)(2)D(3) and pharmacological PI3K/AKT inhibitors.

RESULTS

Pharmacological inhibitors of PI3K or Akt and 1,25(OH)(2)D(3) synergistically inhibited growth of DU145, LNCaP, primary human prostate cancer cell strains and Pten null mouse prostatic epithelial cells (MPEC). The inhibitors used included API-2 (Triciribine) and GSK690693 which are currently in clinical trials for treatment of cancer. A novel mechanism for antiproliferative effects of 1,25(OH)(2)D(3) in prostate cells, induction of senescence, was discovered. Combination of 1,25(OH)(2)D(3) and AKT inhibitor cooperated to induce G(1) arrest, senescence, and p21 levels in prostate cancer cells. As AKT is commonly activated by PTEN loss, we evaluated the role of Pten in responsiveness to 1,25(OH)(2)D(3) using shRNA knockdown and by in vitro knockout of Pten. MPEC that lost Pten expression remained sensitive to the antiproliferative action of 1,25(OH)(2)D(3), and showed higher degree of synergism between AKT inhibitor and 1,25(OH)(2)D(3) compared to Pten-expressing counterparts.

CONCLUSIONS

These findings provide the rationale for the development of therapies utilizing 1,25(OH)(2)D(3) or its analogs combined with inhibition of PI3K/AKT for the treatment of prostate cancer.

Does shave biopsy accurately predict the final breslow depth of primary cutaneous melanoma?

Shave biopsy (SB) is used for the diagnosis of suspicious skin lesions, including melanoma. Its accuracy for melanoma has not been confirmed. We examined our experience with SB to determine its ability to predict true Breslow depth (BD). We performed a retrospective review of the tumor registry for all patients diagnosed with melanoma by SB from 1995 to 2004. Site and depth of lesion, tumor stage, correlation of BD between SB and wide local excision (WLE), and changes in surgical management due to discordance were examined. Melanoma-in-situ was defined as a depth of 0 for this analysis. One hundred thirty-nine patients were diagnosed with melanoma by SB. Pathology after WLE were as follows: 54 (39%) patients had no residual disease, 67 (48%) had a BD equal to or less than the SB, and 18 (13%) had a thicker BD compared with the SB. For these 18 patients, the median BD by SB and WLE was 1.1 mm (range 0-6.5) and 3.5 mm (range 0.5-20.5), respectively (P = 0.0017). Upstaging of final BD from SB to WLE was significantly associated with increasing tumor depth and higher stage of melanoma (P < 0.0001). Only seven of the 139 patients (5%) required further surgery because of the increased depth of the WLE. SB underestimated the final BD of melanoma in 13 per cent of patients, but changed the management of few patients. SB is a valuable tool for practitioners in the diagnosis of melanoma. Nevertheless, patients diagnosed with melanoma by SB should be counseled about the rare need for additional surgery.

Pyroclastic activity at Home Plate in Gusev Crater, Mars

Home Plate is a layered plateau in Gusev crater on Mars. It is composed of clastic rocks of moderately altered alkali basalt composition, enriched in some highly volatile elements. A coarsegrained lower unit lies under a finer-grained upper unit. Textural observations indicate that the lower strata were emplaced in an explosive event, and geochemical considerations favor an explosive volcanic origin over an impact origin. The lower unit likely represents accumulation of pyroclastic materials, whereas the upper unit may represent eolian reworking of the same pyroclastic materials.

Date fighting experiences among college students: are they associated with other health-risk behaviors?

OBJECTIVE

The authors examined the clustering of health-risk behaviors among college students who reported date fight involvement.

PARTICIPANTS AND METHODS

The authors administered a Web-based survey to a stratified random sample of 3,920 college students from 10 universities in North Carolina.

RESULTS

Among men, 5.6% reported date fight victimization, and 1% reported date fight perpetration. Victimization among men was associated with (1) first drink at age 15 years or younger, (2) a recent threat of violence by someone who had been drinking, (3) smoking, (4) amphetamine use, and (5) older age. Among women, 6.7% reported date fight victimization, which was associated with (1) older age, (2) assault from a student who had been drinking, (3) sex with 2 or more persons, (4) consumption of alcohol in high school, (5) illegal drug use, (6) nonsexual assault requiring medical treatment, and (7) living off campus. Of the women, 4.2% reported date fight perpetration, which was associated with (1) minority race/ethnicity, (2) older age, (3) frequency of sexual intercourse, and (4) alcohol and marijuana use.

CONCLUSIONS

Date fight experiences were associated with multiple health-risk behaviors among this sample of college students.

Effects of soybean glyceollins and estradiol in postmenopausal female monkeys

Glyceollins are a novel class of soybean phytoalexins with potential cancer-protective antiestrogenic effects. The purpose of this study was to evaluate the estrogen-antagonist effects of glyceollin-enriched soy protein on biomarkers for breast cancer risk. Thirty female postmenopausal cynomolgus macaques were randomized to one of three dietary treatments for 3 wk: 1) estradiol (E2, 1 mg/day) + casein/lactalbumin (control); 2) E2 + soy protein isolate (SPI) containing 194 mg/day isoflavonoids; and 3) E2 + glyceollin-enriched soy protein (GLY) containing 189 mg/day isoflavonoids + 134 mg/day glyceollins. Doses are expressed in calorically scaled human equivalents. Mean serum glyceollin concentrations at 4 h postfeeding were 134.2 +/- 34.6 nmol/L in the GLY group and negligible in the SPI group (P = 0.0007). Breast proliferation was significantly increased in the control group (+237%, P = 0.01) but not in the SPI group (+198%, P = 0.08) or GLY group (+36%, P = 0.18). Gene expression of trefoil factor 1 and progesterone receptor, two markers of estrogen receptor activity in breast epithelium, were also significantly higher in the control (P < 0.05 for both) but not in the GLY group. These preliminary findings suggest that soybean glyceollins are natural compounds with potential estrogen-modulating properties in the breast.

Split-course versus continuous thoracic radiation therapy for limited-stage small-cell lung cancer: final report of a randomized phase III trial

The optimal integration of radiation and chemotherapy for limited-stage small-cell lung cancer (SCLC) remains unclear. This phase III trial was conducted to determine whether chemotherapy plus interdigitating split-course thoracic radiation therapy (RT) improved survival compared with standard-dose continuous thoracic RT. One hundred fourteen patients were randomized to receive 50 Gy thoracic RT delivered in 2.0-Gy fractions given continuously (5 weeks) concurrent with the first 2 cycles of chemotherapy (arm A) or 50 Gy delivered via an interdigitating split course in 2.5-Gy fractions (8 weeks) concurrent with the first 3 cycles of chemotherapy (arm B). During the split-course RT, once-daily radiation was delivered on days 8-17 of each of the first two 21-day cycles and days 8-11 of the third 21-day cycle. All patients received the following chemotherapy: cisplatin/etoposide on cycles 1, 2, and 5 and cyclophosphamide/vincristine/doxorubicin on cycles 3, 4, and 6. Prophylactic cranial irradiation was recommended after a complete response to all therapy. One hundred ten eligible patients were randomized. Grade 3/4 esophagitis was reported in 9% of patients receiving continuous thoracic RT versus 4% of patients receiving split-course RT. Grade 3/4 hematologic toxicity was common in both treatment arms. Complete/partial response was observed in 80% of patients on arm A versus 84% on arm B. Overall survival rates at 5 years were 18% and 17% for arms A and B, respectively. Interdigitating split-course thoracic RT delivered in 2.5-Gy fractions was tolerable in patients with limited-stage SCLC but did not provide a survival advantage.

Leiomyosarcoma of the Inferior Vena Cava: Surgical Management and Clinical Results

Leiomyosarcoma of the inferior vena cava (IVC) is a rare lesion with less than 300 cases reported. Optimal management and long-term outcomes are not well described. From August 1984 to June 2004, eight patients with leiomyosarcoma of the IVC were treated at our institution. Clinical and pathologic data, surgical management, and outcomes were assessed. Eight cases were identified (4 males) with a median age of 52 (range 29–66). Presenting symptoms included abdominal pain (n = 5, 63%), lower extremity edema (n = 2, 25%), and palpable mass (n = 2, 25%). Tumor location was between the renal and iliac veins (low) (n = 4, 50%), between the hepatic and renal veins (middle) (n = 3, 38%), and above the hepatic veins with right atrial extension (high) (n = 1, 12%). Two patients with preoperative IVC occlusion were managed with tumor excision and IVC ligation. Three patients had primary repair of the IVC after tumor excision. A polytetrafluorothylene (PTFE) tube graft was used for IVC reconstruction in three cases. There was no postoperative mortality. Postoperative morbidity included deep venous thrombosis (DVT) (n = 1), lower extremity edema (mild n = 1; moderate n = 1), GI bleed (n = 1), and chronic renal insufficiency (n = 1). One patient is currently receiving adjuvant chemotherapy. Four patients received chemotherapy after recurrence, and one received palliative radiation therapy as well. Median survival to this point was 60 months with a median follow-up of 39 months. The 5-year overall survival and disease-free survival was 31 per cent for both (CI 0.1–1.0). The type of IVC reconstruction had no effect on survival ( P = 0.22). Recurrence was discovered in four patients (50%) at a median time of 14 months. Resection of leiomyosarcoma of the IVC should be attempted whenever feasible. The management of the IVC can be managed with primary repair, ligation, or prosthetic graft. Long-term survival is possible if complete resection can be achieved.

Success rate of modular component exchange for the treatment of an unstable total hip arthroplasty

Hip instability is the leading cause of morbidity after total hip arthroplasty. Surgical strategies that have been used to eliminate recurrent instability include component revision, trochanteric advancement, or the use of constrained components. Between 1986 and 1997, 731 revision total hip arthroplasties were performed at our institution. A total of 29 patients underwent modular component exchange to treat hip instability. After revision surgery, 16 of 29 (55%) patients experienced redislocation. Nine (31% overall) patients dislocated repeatedly after modular component exchange. Five of the 9 patients who dislocated repeatedly (17% overall) ultimately required rerevision to obtain stability. Modular component exchange is an unpredictable procedure in definitively solving hip stability problems. The limitations of this procedure in treating this complex multifactorial problem must be understood by patient and surgeon alike.

Enhanced binding of lymphocytes from patients with multiple sclerosis to tumour necrosis factor-alpha (TNF-alpha)-treated endothelial monolayers: associations with clinical relapse and adhesion molecule expression

This study investigated the adherent properties and adhesion molecule expression of blood mononuclear cells (MNC) from a total of 84 patients with multiple sclerosis (MS). The MNC from MS patients were significantly more adherent than cells from normal healthy subjects to endothelial monolayers pretreated with 0.01 U/ml TNF-alpha (103% increase; P = 0.002), 0.1 U/ml TNF-alpha (80% increase; P < 0.01) and 1.0 U/ml TNF-alpha (41% increase; P < 0.02), and to endothelium pretreated with 10 U/ml IL-1 beta (44% increase; P < 0.05) and 100 U/ml interferon-gamma (IFN-gamma) (100% increase; P < 0.05). This augmented adhesion was a property of the lymphocytes, in particular CD4+ cells, and was inversely related to the time of onset of clinical relapse. The percentage of lymphocytes bearing the adhesion molecules CD49d, CD29 and CD62L was increased in MS blood, but the level of CD29 and CD62L expression was reduced. We infer that circulating lymphocytes in MS are predisposed to cross endothelial barriers at sites where inflammation has already commenced.