Mortality and Timing of Withdrawal of Life-Sustaining Therapies After Out-of-Hospital Cardiac Arrest: Two-Center Retrospective Pediatric Cohort Study.

Objectives: Pediatric out-of-hospital cardiac arrest (OHCA) is associated with substantial morbidity and mortality. Limited data exist to guide timing and method of neurologic prognostication after pediatric OHCA, making counseling on withdrawal of life-sustaining therapies (WLSTs) challenging. This study investigates the timing and mode of death after pediatric OHCA and factors associated with mortality.

Implementation and outcomes of a comprehensive emergency care curriculum at a low-resource referral hospital in Liberia: A novel approach to application of the WHO Basic Emergency Care toolkit.

Background: Emergency care is vital in low- and middle-income countries (LMICs) but many frontline healthcare workers in low-resource settings have no formal training in emergency care. To address this gap, the World Health Organization (WHO) developed Basic Emergency Care (BEC): Approach to the acutely ill and injured, a multi-day, open-source course for healthcare workers in low-resource settings. Building on the BEC foundation, this study uses an implementation science (IS) lens to develop, implement, and evaluate a comprehensive emergency care curriculum in a single emergency facility in Liberia.

Emergency department antimicrobial use in a low-resource setting: results from a retrospective observational study at a referral hospital in Liberia.

Objective: Data on antimicrobial use in low-income and middle-income countries (LMICs) remain limited. In Liberia, the absence of local data impedes surveillance and may lead to suboptimal treatment, injudicious use and resistance against antimicrobials. This study aims to examine antimicrobial prescribing patterns for patients in the emergency department (ED) of a large Liberian public hospital.

Ankle Accelerometry for Assessing Physical Activity Among Adolescent Girls: Threshold Determination, Validity, Reliability, and Feasibility.

Purpose: Ankle accelerometry allows for 24-hr data collection and improves data volume/integrity versus hip accelerometry. Using Actical ankle accelerometry, the purpose of this study was to (a) develop sensitive/specific thresholds, (b) examine validity/reliability, (c) compare new thresholds with those of the manufacturer, and (d) examine feasibility in a community sample (low-income, urban adolescent girls).

Method: Two studies were conducted with 6th- through 7th-grade girls (aged 10-14 years old): First was a laboratory study (n = 24), in which 2 Actical accelerometers were placed on the ankle and worn while measuring energy expenditure (Cosmed K4b2, metabolic equivalents [METs]) during 10 prescribed activities.

Decreased fat and nitrogen losses in patients with AIDS receiving medium-chain-triglyceride-enriched formula vs those receiving long-chain-triglyceride-containing formula.

Objective: The purpose of this study was to compare two enteral formulas, differing only in fat source, for product acceptance, tolerance, and effect on fat malabsorption and nutritional status in subjects with acquired immune deficiency syndrome (AIDS).

Design: The double-blind, randomized 15-day trial was divided into a 3-day period in which solid food was consumed followed by a 12-day experimental period in which liquid formulas were consumed.

Setting/subjects: Twenty-three men and one woman with AIDS and fat malabsorption completed the study.

Dietary habits of first-year medical students assessed during clinical nutrition course.

To enhance the Introduction to Clinical Nutrition course at the University of Alabama at Birmingham, medical students taking the course from 1989 to 1992 (n = 616) were required to analyze by computer the nutrient composition of their own diets for a 24-h period. In 1991 and 1992, they were required to repeat the analysis at the completion of the course. Overall, fat comprised 30% of energy intake, and along with saturated fat and the cholesterol-saturated fat index, it declined virtually each year compared with the previous year.

Peptides from multiple regions of the lectin domain of P-selectin inhibiting neutrophil adhesion.

The selectins are a family of three structurally related glycoproteins that are integral components of leukocyte adhesion to the vascular endothelium. Their involvement in the recruitment and extravasation of neutrophils is critical in mounting an inflammatory reaction. The carbohydrate nature of the selectin ligands suggests that the binding regions of the selectins are contained within the lectin-like domains of the selectins.

A meal conference format to teach ambulatory nutrition concepts.

Third-year medical students participated in a program using a meal conference approach to teach ambulatory nutrition concepts called "Building Better Health Through Nutrition." The series of three interactive presentations was given during the required family medicine clerkship. A pretest and posttest were used to measure acquisition of nutrition knowledge.

Tc-99m antifibrin Fab' fragments for imaging venous thrombi: evaluation in a canine model.

An antifibrin antibody (T2G1s) Fab' fragment labeled with technetium-99m was tested for its ability to produce images of fresh thrombi in dogs. In gamma camera images, all thrombi were evident by 2-4 hours after injection. Mean thrombus-to-blood and thrombus-to-muscle ratios averaged 4.

The efficacy of sighs in patients with COPD undergoing general anesthesia and controlled ventilation.

Fourteen patients with COPD underwent elective procedures below the umbilicus, all receiving a standard anesthetic. They were randomized to one of four groups differentiated by the presence or absence of sighing during mechanical ventilation. Patients who were sighed experienced both statistically and clinically significant improvement in their oxygenation efficiency as measured by the alveolar to arterial oxygen gradient.

(3,6-Dimethyl-3,6-diazaoctan-1,8-dithiolato-S1,N3,N6,S8)oxotechnetium(V) pertechnetate.

[TcO(C8H18N2S2)]TcO4, Mr = 484.2, monoclinic, P2(1)/c, a = 7.447 (2), b = 16.

Brain imaging agents: synthesis and characterization of (N-piperidinylethyl) hexamethyl diaminodithiolate oxo technetium(V) complexes.

Two 99mTc complexes of (N-piperidinylethyl) hexamethyl diaminodithiol (NEP-DADT) have shown high brain uptake in rodents and lower primates. One of these 99mTc complexes has given positive images of the brain in man which are qualitatively related to regional brain blood flow (rCBF). In order to determine the structure of these 99mTc products, the corresponding 99Tc(NEP-DADT) complexes were prepared and characterized by HPLC, TLC, fast-atom-bombardment mass spectrometry (FAB MS) and other analytical techniques.

Cocaine: long-term administration depletes cardiac enzymes in the rat.

Arterioles and myocytes of the cardiac ventricle were examined histochemically to determine their metabolic profiles in normal rats and in rats treated either acutely or chronically with cocaine. Following long-term, but not acute, cocaine administration, enzymes involved in both aerobic and anaerobic metabolism as well as in hexosemonophosphate shunt were greatly decreased. These data suggest that long-term usage of cocaine leads to severely impaired coronary metabolism.

Design, preparation, and biodistribution of a technetium-99m triaminedithiol complex to assess regional cerebral blood flow.

A new ligand (N-piperidinylethyl-DADT, 5) has been prepared which forms two complexes with 99mTc when stannous chloride is used as a reducing agent for [99mTc] pertechnetate. Biodistribution studies of one of the complexes in mice showed that 2.2% of the injected dose of the tracer was in the brain at 5 min postintravenous injection with 0.

Zinc and Chlamydia trachomatis.

Zinc was noted to have significant effects upon the infection of McCoy cells by each of two strains of Chlamydia trachomatis. With a high or low Chlamydia inoculant, the number of infected cells increased up to 200% utilizing supplemental zinc (up to 1 X 10(-4) M) in the inoculation media compared with standard Chlamydia cultivation media (8 X 10(-6) M zinc). Ferric chloride and calcium chloride did not effect any such changes.

Zinc and the heat-labile enterotoxin of Escherichia coli.

Enterotoxigenic Escherichia coli is a major cause of diarrhoea in man. When zinc in concentrations of 10(-6) M or 10(-5) M was added to the growth medium, there was a significant increase in heat-labile enterotoxin production by each of six toxigenic strains. Zinc in these concentrations did not alter bacterial growth or the activity of preformed toxin.

The use of cyclosporine in living-related renal transplantation. Donor-specific hyporesponsiveness and steroid withdrawal.

Fourteen HLA-identical (HLA-ID) and 62 haploidentical (HP-ID) living-related donor (LRD) renal allograft recipients were transplanted using cyclosporine (CsA) and prednisone immunosuppression. No patients were preconditioned with pretransplant blood transfusions (third-party or donor-specific)--and, therefore, none were sensitized to their donor. Patient 93% (13/14) and graft 93% (13/14) survival for the HLA-ID patients is not significantly different (P greater than .

Nutrient chemotactic agents and the in vitro selective control of bacterial colonization.

Certain nutrient chemotactic agents after 3-18 hours of incubation with viable mammalian cells in culture can cause significant alterations in subsequent attachment of Escherichia coli to the mammalian (receptor) cells. Results were amongst the most significant with an essentially non-oxidizable amino acid analogue. Differences obtained were dependent upon the number of washings of the receptor cells after incubation with the chemotactic agents and the incubation concentrations.

Antibiotic and nonantibiotic ionophores can alter bacterial adherence to mammalian cells.

Epithelioid (HeLa) and fibroblastic (L) cells in culture incubated for 18 hr with the ionophores amphotericin B and amiloride were noted to bind significantly more and less bacteria, respectively, than control cells incubated without ionophores. These effects were related to dose and incubation length and were present at concentrations approximating those in vivo after administration of maximal doses of these drugs given to humans therapeutically. Electron microscopy of both receptor cell lines revealed increased length and number of cellular projections in the amphotericin-treated cells and flattening and loss of membrane individuality in the amiloride-treated cells.

Zinc and bacterial adherence.

Zinc significantly enhances the ability of piliated Gram-negative and Gram-positive bacteria to attach to HeLa cells. This effect is related to the concentration of zinc and degree of bacterial piliation, and is not present with unpiliated organisms. Bacterial viability is not necessary for this effect, and sulfhydryl blockers decrease the response.

Effect of estrogens on bacterial adherence to HeLa cells.

Incubating confluent cell culture HeLa cells for 18 h with increasing concentrations of estrogens progressively enhanced the subsequent attachment of a variety of radiolabeled bacteria to the HeLa cells. This effect was not caused by other hormones and was not produced by 1-h incubations of HeLa cells or bacteria with hormones. Estrogens did not similarly affect two other receptor cell lines studied.