Implementation of a clinical pathway to screen and treat medical inpatients for opioid withdrawal.

Background: Opioid-related inpatient hospital stays are increasing at alarming rates. Unidentified and poorly treated opioid withdrawal may be associated with inpatients leaving against medical advice and increased health care utilization. To address these concerns, we developed and implemented a clinical pathway to screen and treat medical service inpatients for opioid withdrawal.

Optimal Design of Switchable Wearable Antenna Array for Wireless Sensor Networks.

In the paper, we present a novel approach to the optimum design of wearable antenna arrays intended for off-body links of wireless body area networks. Specifically, we investigate a four-element array that has a switchable radiation pattern able to direct its higher gain towards a signal source and a lower gain towards an interference. The aim is to increase the signal to interference ratio.

MRI safety risks in the obese: The case of the disposable lighter stored in the pannus.

Obese patients constitute 40% of the adult population. MRIs of obese patients are typically challenging because of the effects of a large field of view on image quality and the increased risk of thermal burns from contact with the bore. In this case report, the impacts of obesity on MRI procedures and safety are introduced.

Many-Objective Automated Optimization of a Four-Band Antenna for Multiband Wireless Sensor Networks.

This paper describes a new design and an optimization framework for a four-band antenna to be used in wireless sensor networks. The antenna is designed to operate effectively in two open frequency bands (ISM-Industrial, Scientific, Medical), 2.4 GHz and 5.

A Conceptual Enterprise Framework for Managing Scientific Data Stewardship.

Scientific data stewardship is an important part of long-term preservation and the use/reuse of digital research data. It is critical for ensuring trustworthiness of data, products, and services, which is important for decision-making. Recent U.

Decellularized Matrix and Supplemental Fat Grafting Leads to Regeneration following Traumatic Fingertip Amputation.

Decellularized scaffold materials are capable of regenerating missing tissues when utilized under appropriate conditions. Fat grafting also has reported advantages in revitalizing damaged tissue beds. This report details a case of traumatic fingertip amputation treated with a combination of decellularized materials in conjunction with fat grafting, resulting in a supple and functional reconstruction of the affected digit.

Field-Based Optimal Placement of Antennas for Body-Worn Wireless Sensors.

We investigate a case of automated energy-budget-aware optimization of the physical position of nodes (sensors) in a Wireless Body Area Network (WBAN). This problem has not been presented in the literature yet, as opposed to antenna and routing optimization, which are relatively well-addressed. In our research, which was inspired by a safety-critical application for firefighters, the sensor network consists of three nodes located on the human body.

Impact of indoor environment on path loss in body area networks.

In this paper the influence of an example indoor environment on narrowband radio channel path loss for body area networks operating around 2.4 GHz is investigated using computer simulations and on-site measurements. In contrast to other similar studies, the simulation model included both a numerical human body phantom and its environment-room walls, floor and ceiling.

Underestimating the impact of ventilator-associated pneumonia by use of surveillance data.

We calculated rates of ventilator-associated pneumonia (VAP) by using surveillance data, clinical data, and coding data. Compared with the VAP rates calculated on the basis of surveillance data, the VAP rates calculated on the basis of coding data were significantly overestimated in 4 of 5 intensive care units. Efforts to improve coding and clinical documentation will address much but not all of this discrepancy between surveillance and administrative data.

Analysis of Bordetella pertussis isolates collected in Japan before and after introduction of acellular pertussis vaccines.

Because of recent concern that whole-cell pertussis vaccination can drive antigenic divergence of circulating isolates of Bordetella pertussis, we compared 12 clinical isolates of B. pertussis collected in Japan, the first country to introduce acellular pertussis vaccines, with the vaccine strain. We used pulsed-field gel electrophoresis, sequencing of ptx and prn genes and expression of fimbriae.

Use of pertussis toxin encoded by ptx genes from Bordetella bronchiseptica to model the effects of antigenic drift of pertussis toxin on antibody neutralization.

Recently, concern has been voiced about the potential effect that antigenic divergence of circulating strains of Bordetella pertussis might have on the efficacy of pertussis vaccines. In order to model antigenic drift of pertussis toxin, a critical component of many pertussis vaccines, and to examine the effects of such drift on antibody neutralization, we engineered a strain of B. pertussis to produce a variant pertussis toxin molecule that contains many of the amino acid changes found in the toxin encoded by Bordetella bronchiseptica ptx genes.

Molecular characterization of two Bordetella bronchiseptica strains isolated from children with coughs.

During a surveillance program associated with the Italian clinical trial for the evaluation of new acellular pertussis vaccines, two bacterial isolates were obtained in cultures of samples from immunocompetent infants who had episodes of cough. Both clinical isolates were identified as Bordetella bronchiseptica by biochemical criteria, although both strains agglutinated with antisera specific for Bordetella parapertussis, suggesting that the strains exhibited some characteristics of both B. bronchiseptica and B.

Epilepsy education: a nursing perspective.

The nurse-clinician offers a unique perspective in the early education of patients with epilepsy. As part of the health-care team, the nurse assumes an important role in providing comprehensive epilepsy education. Epilepsy may occur at any time throughout life, and age-related needs necessitate ongoing assessment and intervention.

Analysis of proteins encoded by the ptx and ptl genes of Bordetella bronchiseptica and Bordetella parapertussis.

Bordetella pertussis is the only bacteria] species which is known to produce pertussis toxin (PT); however, both Bordetella bronchiseptica and Bordetella parapertussis contain regions homologous to the ptx genes of B. pertussis that encode the toxin subunits. After finding that several children with B.

Localization of the promoter for the ptl genes of Bordetella pertussis, which encode proteins essential for secretion of pertussis toxin.

The ptl locus of Bordetella pertussis, which encodes proteins necessary for the secretion of pertussis toxin into the extracellular medium, is located directly downstream from the ptx locus, which encodes the structural subunits of the toxin. We have found that the ptx promoter is essential for expression of the ptl genes. A strain of B.

Binding of pertussis toxin to lipid vesicles containing glycolipids.

The binding of pertussis toxin and its B oligomer to lipid vesicles containing glycosphingolipids was studied. Both pertussis toxin and the B oligomer bound to lipid vesicles containing ganglioside GD1a. Binding of pertussis toxin to these vesicles decreased upon treatment of the vesicles with neuraminidase, suggesting that sialic acid residues are important for efficient binding of the toxin to GD1a.

Interaction of pertussis toxin with cells and model membranes.

The interaction of pertussis toxin (PT) with cells and model membranes was investigated by examining PT-induced intoxication of Chinese hamster ovary cells and by studying the binding of PT and its subunits to phospholipid vesicles. Since certain bacterial toxins require an acidic environment for efficient interaction with membranes and subsequent entry into the cell, the requirement for an acidic environment for PT action was examined. PT, unlike bacterial toxins such as diphtheria toxin, did not require an acidic environment for efficient intoxication of Chinese hamster ovary cells.

Binding of ATP by pertussis toxin and isolated toxin subunits.

The binding of ATP to pertussis toxin and its components, the A subunit and B oligomer, was investigated. Whereas, radiolabeled ATP bound to the B oligomer and pertussis toxin, no binding to the A subunit was observed. The binding of [3H]ATP to pertussis toxin and the B oligomer was inhibited by nucleotides.

Immune response to dimeric subunits of the pertussis toxin B oligomer.

Immunization of mice with the dimeric subunits of pertussis toxin (S2-S4 and S3-S4) induced an antibody response detectable by enzyme-linked immunosorbent assay and immunoblot techniques. These antibodies were able to neutralize the ability of pertussis toxin to alter the morphology of Chinese hamster ovary cells. Mice immunized with the dimers were also protected against the leukocytosis-promoting effects of toxin.

Biochemical properties of pertussis toxin.

Pertussis toxin is an exotoxin produced by the organism Bordetella pertussis. The toxin binds to receptors on the eukaryotic cell surface. After introduction into the eukaryotic cell, the toxin is activated by ATP and subsequently ADP-ribosylates a family of GTP-binding regulatory proteins interrupting signal transduction within the cell.

Structural characterization of pertussis toxin A subunit.

The relationship between the structure of the A subunit of pertussis toxin and its function was analyzed. Limited tryptic digestion of the A subunit converted the protein to two stable fragments (Mr = 20,000 and 18,000). Antibodies raised to synthetic peptides homologous to regions in the A subunit were used to map these fragments.

Bilateral congenital cholesteatoma: a cause or result of chronic otitis media with effusion?

Bilateral congenital cholesteatoma in children is unusual, and our experience with a case arising in a 6-year-old boy is described. Various theories of the origin of this disease are briefly reviewed. The possibility that this entity may be more common than previously realized, and its relationship to eustachian tube obstruction and middle ear effusions, are also discussed.