Baked milk tolerant patient: Is there any special feature?

BACKGROUND: Determining whether patients with cow's milk allergy (CMA) can tolerate foods produced with baked milk could provide a better quality of life, a better prognosis, and an option for desensitization. OBJECTIVES: The aim of this study was to identify which patients over four years of age with persistent CMA could tolerate baked milk, to compare the clinical and laboratory characteristics of reactive and non-reactive groups and to describe their clinical evolution. MATERIALS AND METHODS: A cross-sectional study was conducted (January/13 to November/14) that included all the patients followed at a food allergy center who met the inclusion criteria. The patients underwent an oral food challenge (OFC) with a muffin (2.8g of cow's milk protein). To exclude cow's milk (CM) tolerance, the patients were subsequently challenged with unheated CM. RESULTS: Thirty patients met all the inclusion criteria. Fourteen patients (46.7%) were considered non-reactive to baked milk and reactive to unheated CM. When the groups that were reactive and non-reactive to baked milk were compared, no statistically significant differences in clinical features were found. The prick test for α-lactalbumin (p=0.01) and casein (p=0.004) and the serum specific IgE for casein (p=0.05) presented statistical differences. After one year, none of the patients who were reactive to baked milk were ingesting CM, while 28% of the tolerant patients were consuming fresh CM (p=0.037). CONCLUSIONS: Baked milk can be tolerated by patients with CMA, especially those with lower levels of casein and α-lactalbumin. This option can improve quality of life and accelerate tolerance.

Single-element solution comparisons with a high-performance inductively coupled plasma optical emission spectrometric method.

A solution-based inductively coupled plasma optical emission spectrometric (ICP-OES) method is described for elemental analysis with relative expanded uncertainties on the order of 0.1% relative. The single-element determinations of 64 different elements are presented, with aggregate performance results for the method and parameters for the determination of each element. The performance observed is superior to that previously reported for ICP-OES, resulting from a suite of technical strategies that exploit the strengths of contemporary spectrometers, address measurement and sample handling noise sources, and permit rugged operation with small uncertainty. Taken together, these strategies constitute high-performance ICP-OES.

Determination of As, Cd, Cr, and Hg in SRM 2584 (trace elements in indoor dust) by high-resolution inductively coupled plasma mass spectrometry.

Standard reference material (SRM) 2584 (Trace Elements in Indoor Dust) was developed as a reference standard for evaluating field methods and for validating laboratory and reference methods for the assessment of lead contamination and exposure. In addition to lead, the toxic trace elements As, Cd, Cr, and Hg, at approximately 17, 10, 140, and 5 microg g(-1), respectively, have been certified in the SRM. These four analytes were successfully determined by use of high-resolution inductively coupled plasma mass spectrometry (HR-ICP-MS). Isobaric interferences at masses of As and Cr were resolved by using the high resolution mode (nominal 8000) and the medium resolution mode (nominal 3000), respectively, of the instrument. The effects of a significant drift in analyte sensitivity in the course of measurement were rectified by use of internal standardization, single spike standard addition, and an optimized analysis sequence. The results were compared with those obtained by instrumental neutron activation analysis (INAA) and isotope dilution inductively coupled plasma mass spectrometry (ID-ICP-MS). The results for the quality control, SRM 2704 (Buffalo River Sediment), were in good agreement with the certified values, indicated by the uncertainty intervals of the measured values overlapping the certified intervals at 95% confidence level.

Payment of emergency department bills by Medicaid patients.

OBJECTIVE: To analyze ED services used by and payment received from patients who request to stay and assume responsibility for their bills after being denied emergency care payment by their Medicaid providers. METHODS: A retrospective chart review over an 18-month period was conducted. Charges for these visits were obtained from the physician billing service and hospital finance records. RESULTS: Of 193 patient visits identified, 192 charts were located and reviewed for chief complaint, diagnostic tests, and interventions performed. In total, the visits resulted in $18,120 in physician charges and $28,126 in hospital charges. Three payments amounting to $134 were collected, leaving $46,246 in nonreimbursed charges. CONCLUSIONS: Nearly all patients who elect to be seen in this pediatric ED after being denied by their Medicaid managed care providers do not pay their bills. ED resources, including laboratory studies, radiographs, and consultations, are used to evaluate and treat these patients without compensation. The cost of this nonreimbursed care must be recovered from other patient care charges.

Assessing dressing ability in dementia.

Cognitive impairment can profoundly affect the skills required for activities of daily living (ADL). Most cognitive screening measures assess cognitive status rather than the cognitive functions that underlie ADL tasks. The dressing assessment guide (DAG) assesses the cognitive and functional abilities in dressing of patients with dementia. The DAG evaluates everyday and overlearned tasks and uses cues to provide a context for action. Nurses can easily administer the guide, and the resulting data provide the basis for nursing interventions.

Determination of mercury in zinc ore concentrate reference materials using flow injection and cold-vapor atomic absorption spectrometry.

A flow-injection, cold-vapor atomic absorption spectrophotometric method was developed for the determination of trace amounts of mercury in a proposed zinc ore concentrate Standard Reference Material (SRM 113b). The samples were digested with nitric and hydrochloric acids in closed Teflon digestion vessels. The experimental details for sample preparation and the flow injection method are discussed. The effect of matrix and various acid concentrations on the extraction and subsequent analysis of mercury were also studied. The method has a detection limit of 0.08 mug Hg/g in the sample. A certified reference material (CZN-1) was analyzed and the results obtained agreed well with the certified value.

Improving documentation of aggressive behavior in nursing home residents.

1. Although 66% of the 1.3 million elderly nursing home residents in the US exhibit aggressive tendencies, research indicates that caregivers underdocument aggressive incidents. As a result, the extent of aggression is unknown. 2. This study found that LPNs reported the largest percentage (41%) of the 51 documented aggressive incidents, which reportedly occurred most frequently in the bathroom (49% of the time) between 5 AM and noon (86% of the time). Most aggressive residents (55.1%) never had visitors. 3. This study concludes that nursing practice would benefit from a consistent definition of aggression, an easy-to-use clinical instrument to collect data on aggression, and caregiver education programs on assessing aggression.

Psychological correlates of loneliness in the older adult.

Loneliness is the emotional response to the discrepancy between desired and available relationships. As people grow old, the likelihood of experiencing age-related losses increases. Such losses may impede the maintenance or acquisition of desired relationships, resulting in a higher incidence of loneliness. This pilot study examines how loneliness relates to age-related losses, hopelessness, self-transcendence, and spiritual well-being in a convenience sample of 107 adults aged 65 years or older. The collective utility of the independent variables in predicting loneliness was investigated by means of a regression decision tree with an automatic random subset crossvalidation procedure. This procedure explained 46% of the variance. Higher scores for age-related losses and hopelessness were associated with higher loneliness scores. Higher scores for self-transcendence and existential spiritual well-being were associated with lower loneliness scores.

Euglena gracilis chloroplast elongation factor Tu. Purification and initial characterization.

The chloroplast protein synthesis elongation factor Tu (EF-Tuchl) has been purified to near homogeneity from Euglena gracilis. Chromatography of the postribosomal supernatant of light-induced Euglena on DEAE-Sephadex reveals two forms of EF-Tuchl. Further purification has shown that one species consists of a complex between EF-Tuchl and a factor that stimulates its activity. The other species consists of free EF-TUchl. The factor has been purified from both chromatographic forms by taking advantage of the molecular weight shift that occurs upon disruption of the complex between EF-Tuchl and the stimulatory factor. EF-Tuchl consists of a single polypeptide chain with a molecular weight of about 50,000. EF-Tuchl is as active on Escherichia coli ribosomes as it is on its homologous ribosomes but displays no detectable activity on eukaryotic cytoplasmic ribosomes. It is stimulated in polymerization by E. coli EF-Ts and will form a complex with the prokaryotic factor that can be isolated by gel filtration chromatography. Like E. coli EF-Tu, it is sensitive to modification by N-ethylmaleimide and is inhibited by the antibiotic kirromycin. Thus, the chloroplast factor has many features that reflect the close relationship between prokaryotic and chloroplast translational systems.