Frequency of non-aureus staphylococci and mammaliicocci species isolated from quarter clinical mastitis: a six-year retrospective study.

Non-aureus staphylococci and mammaliicocci (NASM) are the most frequently isolated bacterial group from bovine milk samples. Most studies focus on subclinical mastitis caused by NASM, however NASM can cause clinical mastitis (CM) as well. We evaluated retrospective data from 6 years (2017-2022) to determine the species and frequency of NASM isolated from quarter bovine CM. The data comprised of microbiological results from quarter CM samples routinely submitted to Quality Milk Production Services (QMPS), Cornell University, NY, US, for microbial identification by MALDI-TOF MS. A total of 9,909 microbiological results from 410 dairy herds were evaluated. Our results showed that 29 distinct NASM species were identified, with the 8 most prevalent NASM species being Staphylococcus chromogenes, S. haemolyticus, S. simulans, S. epidermidis, S. sciuri (now Mammaliicoccus sciuri), S. agnetis/S. hyicus, S. borealis, and S. xylosus. The NASM distribution remained similar among seasons, but the frequency of NASM CM cases was higher during the summer. Our results showed different patterns of variations in the isolation frequency over time, depending on the bacterial species: increasing or decreasing trends, cyclic fluctuations, and except for S. borealis, a significant seasonality effect for our study's most prevalent NASM was observed. This study showed that S. chromogenes remains the most frequent (43%) NASM species identified from bovine CM, followed by S. haemolyticus (18%), and S. simulans (12%).

A clinically relevant review of tizanidine hydrochloride dose relationships to pharmacokinetics, drug safety and effectiveness in healthy subjects and patients.

AIMS: Tizanidine, one of the few oral antispastic therapies approved for use in the USA, has a narrow therapeutic index that can often make optimal patient dosing difficult. We surveyed the published literature for data on potential tizanidine dose relationships to pharmacokinetics, drug safety and effectiveness, as well as to provide practical drug dosing advice. RESULTS: The number of primary studies that describe tizanidine dose proportionality relationships was somewhat limited, even when including studies that used doses above those currently recommended or data from drug-drug interaction studies that resulted in supra-therapeutic tizanidine concentrations. DISCUSSION AND CONCLUSIONS: There is substantial evidence to show that plasma tizanidine concentrations are linearly related to dose in healthy subjects and patients, although there is a high degree of intersubject variability. The most common adverse events and pharmacodynamic effects are related to plasma concentrations. The clinical implications of the large interpatient variability in plasma tizanidine concentrations and its narrow therapeutic index make it necessary to individualise patient therapy. Practical advice on tizanidine dosing and/or switching between formulations is provided.

Information theoretic analysis of pulmonary stretch receptor spike trains.

Primary afferent neurons transduce physical, continuous stimuli into discrete spike trains. Investigators have long been interested in interpreting the meaning of the number or pattern of action potentials in attempts to decode the spike train back into stimulus parameters. Pulmonary stretch receptors (PSRs) are visceral mechanoreceptors that respond to deformation of the lungs and pulmonary tree. They provide the brain stem with feedback that is used by cardiorespiratory control circuits. In anesthetized, paralyzed, artificially ventilated rabbits, we recorded the action potential trains of individual PSRs while continuously manipulating ventilator rate and volume. We describe an information theoretic-based analytical method for evaluating continuous stimulus and spike train data that is of general applicability to any continuous, dynamic system. After adjusting spike times for conduction velocity, we used a sliding window to discretize the stimulus (average tracheal pressure) and response (number of spikes), and constructed co-occurrence matrices. We systematically varied the number of categories into which the stimulus and response were evenly divided at 26 different sliding window widths (5, 10, 20, 30,..., 230, 240, 250 ms). Using the probability distributions defined by the co-occurrence matrices, we estimated associated stimulus, response, joint, and conditional entropies, from which we calculated information transmitted as a fraction of the maximum possible, as well as encoding and decoding efficiencies. We found that, in general, information increases rapidly as the sliding window width increases from 5 to approximately 50 ms and then saturates as observation time increases. In addition, the information measures suggest that individual PSRs transmit more "when" than "what" type of information about the stimulus, based on the finding that the maximum information at a given window width was obtained when the stimulus was divided into just a few (usually <6) categories. Our results indicate that PSRs provide quite reliable information about tracheal pressure, with each PSR conveying about 31% of the maximum possible information about the dynamic stimulus, given our analytical parameters. When the stimulus and response are divided into more categories, slightly less information is transmitted, and this quantity also saturates as a function of observation time. We consider and discuss the importance of information contained in window widths on the time scales of an excitatory postsynaptic potential and Hering-Breuer reflex central delay.

Does syndrome X exist in hypertensive elderly persons with impaired glycemic control?

BACKGROUND: This report focuses on the glycemic state in relation to insulin and lipid levels of a cohort of elderly hypertensive persons to estimate the prevalence of syndrome X. METHODS: A cross-sectional study was performed at the University of Tennessee, Memphis, and the General Clinical Research Center (GCRC) on 95 participants in the Trial of Nonpharmacologic Interventions in the Elderly (TONE) study who agreed to participate in an ancillary study. A standard oral glucose tolerance test (OGTT) with insulin and C-peptide levels and a fasting lipid profile were obtained. RESULTS: In this sample of healthy elderly participants with hypertension who were taking an antihypertensive medication, 43 (45.3%) had normal glucose tolerance (NGT), 41 (43.2%) had impaired glucose tolerance (IGT), and 11 (11.6%) had undiagnosed non-insulin-dependent diabetes mellitus (NIDDM). Fasting hyperinsulinemia occurred in only one participant, who was in the IGT group. Hypertriglyceridemia and low high density lipoprotein (HDL) occurred in four persons, none of whom had hyperinsulinemia. Persons in the NIDDM and IGT groups had decreased beta cell function compared to persons in the NGT group, but did not have increased peripheral insulin resistance as estimated from the OGTT data. CONCLUSIONS: Our data demonstrated that in this cohort of elderly hypertensive participants with a high prevalence of central obesity, impaired glycemic control was common, but was not associated with fasting hyperinsulinemia or peripheral insulin resistance. Furthermore, we conclude that syndrome X essentially did not occur in these participants and postulate that the primary etiology for their impaired glycemic control is beta cell dysfunction. Further research is needed to elucidate these relationships.

Prevalence of undiagnosed non-insulin-dependent diabetes mellitus and impaired glucose tolerance in a cohort of older persons with hypertension.

OBJECTIVE: To determine the prevalence of undiagnosed non-insulin-dependent diabetes mellitus (NIDDM) and impaired glucose tolerance (IGT) in a cohort of older persons with hypertension. To examine the usefulness of screening for NIDDM in this study population. DESIGN: Cross-sectional study. SETTING: University of Tennessee, Memphis and the General Clinical Research Center (GCRC). PATIENTS: Ninety-five participants in the Trial of Nonpharmacologic Interventions in the Elderly (TONE) study who agreed to participate in an ancillary study. MEASUREMENTS: A standard oral glucose tolerance test (OGTT) with insulin and C-peptide levels was performed before the beginning of the TONE intervention. RESULTS: In this cohort, 43 participants (45.3%) had normal glucose tolerance (NGT), 41 (43.2%) had IGT, and 11 (11.6%) had undiagnosed NIDDM. The positive predictive value for NIDDM of a fasting glucose > or = 115 mg/dL in our participants was 57%. Hyperinsulinemia occurred in only one participant, a subject in the IGT group. CONCLUSIONS: Our data demonstrate that undiagnosed NIDDM is common in our cohort of older persons who are being treated for essential hypertension and that impaired glucose tolerance may be more common than in the general population of the same age. Further, our data show that the vast majority of this older, obese, hypertensive cohort did not have fasting hyperinsulinemia. We also infer that a fasting glucose alone has a low positive predictive value for screening of NIDDM in our older cohort. As the prevalence of NIDDM and impaired glucose tolerance in older hypertensive patients in the general population is unknown, we believe that further investigation is needed to characterize the relationship of hypertension, glycemic status, and hyperinsulinemia in the general population.

Frequent handling in the neonatal intensive care unit and intraventricular hemorrhage.

The association between periventricular-intraventricular hemorrhage (PV-IVH) and frequent handling resulting from various neonatal intensive care procedures and routine interventions was evaluated in a prospective clinical study. Inborn premature babies with birth weight less than or equal to 1500 gm (n = 156) who did not have PV-IVH or who had grade 1 PV-IVH at less than or equal to 1 hour were randomly assigned to the reduced manipulation protocol (n = 62) or to standard care (n = 94). A bedside microcomputer-based data acquisition system was used to monitor the duration of rest or the number of interventions per day. Infants assigned to receive reduced manipulation spent a significantly higher percentage of time each day at rest than did those who received standard manipulation (p less than 0.006). However, the incidence of grades 2 to 4 PV-IVH did not differ significantly (30% in the study vs 37% in the standard manipulation group). When we analyzed the effect of manipulation in relation to risk of PV-IVH, while taking into account other perinatal variables, standard manipulation was not associated with increased risk of grades 2 to 4 PV-IVH. However, low birth weight, maternal smoking, general anesthesia, early grade 1 PV-IVH, low hematocrit, lowest arterial oxygen pressure within the first 6 hours of life, and large base deficit at 6 hours of age all increased the relative risk of grades 2 to 4 PV-IVH.

Inventory of knowledge and skills relating to disease prevention and health promotion.

An inventory of the knowledge and skills appropriate for the instruction of medical students in the disciplines of disease prevention and health promotion was developed by a steering committee of medical practitioners and teachers, with the input of over 70 colleagues. The inventory, which is intended as a guide for curriculum planners, defines the fundamentals of subject areas appropriate for the general education of all physicians, including the skills and knowledge related to delivery of personal disease prevention/health promotion services, quantitative methods, health services organization and delivery, and community dimensions of medical practice, as well as attitudes and philosophy.

Health promotion and allied health professionals: considerations for program design.

There is growing public and corporate interest in health promotion programs. Available literature suggests that health promotion may contribute to greater longevity and life satisfaction while resulting in lower health care costs. Allied health professionals are perfectly positioned to make the difference between a successful or unsuccessful health promotion effort, whether in their own lives or in the lives of patients. However, allied health professionals need to commit themselves to making behavior changes to improve their own health so that they can effectively assist patients in making similar changes. These ideas are demonstrated through a study of an employee health promotion program for allied health professionals in a health maintenance organization.

Diabetes, hypertension and other associated diseases.

Coexisting hypertension and diabetes mellitus is common particularly in the obese, minorities, and the socioeconomically disadvantaged. Hypertension contributes substantially to the vascular complications of diabetes mellitus and to the increased mortality of diabetes mellitus. Nondrug treatment of both conditions consists of cardiovascular risk factor reduction, emphasizing weight management, salt restriction, smoking cessation, and alcohol moderation. With observing a few precautions the drug treatment of hypertension in diabetes mellitus is similar to that of the nondiabetic.

Comparison of the use of reserpine versus alpha-methyldopa for second step treatment of hypertension in the elderly.

A retrospective chart analysis was conducted on all new elderly hypertensive patients referred to a community hypertension clinic who were being treated with either reserpine or alpha-methyldopa plus a diuretic. There were no significant differences between the two groups on entry in age, gender, co-morbid diagnoses, or systolic or diastolic blood pressure. There were no significant differences between the two groups in terms of side effects over three years, but the proportion of persons having compliance problems was significantly lower in the reserpine group. Mean diastolic pressures were significantly lower after one, two, and three years, and systolic pressures were lower after one and two years in the reserpine group. Reserpine is at least as effective as alpha-methyldopa in treating hypertension in the elderly and is associated with fewer problems in compliance.

The Memphis and Atlanta continuing care programs for diabetes. II. Comparative analyses of demographic characteristics, treatment methods, and outcomes over a 9-10-year follow-up period.

A total of 1467 black patients (911 in Atlanta, 556 in Memphis) were selected (1969-70) and followed longitudinally and prospectively until death (404 patients) or through 31 December 1979, when 676 were alive and active and 387 were lost to follow-up. The women/men ratio in each cohort was 4.7/1. Women had more excess body wt than men at maximum weight and at time of diagnosis. At selection, the Atlanta cohort was older (60.2 vs 56.8 yr), had diabetes longer (7.5 vs 5.2 yr), and had a higher initial mean random plasma glucose (MRPG) level (217 vs 195 mg/dl) than the Memphis cohort. The Atlanta cohort was on sulfonylurea/phenformin therapy, which was discontinued at entry. After 9-10 yr follow-up, the MRPG level was not significantly different from the initial level in either cohort, and the Atlanta cohort level was still significantly higher (221 vs 185 mg/dl). Mean weight loss after 9-10 yr follow-up was significantly greater in Atlanta (17.7 vs 6.8 lb). Those under good control in 1979, as indicated by random plasma glucose (RPG) of less than 150 mg/dl, lost more weight (means: Atlanta, 23 lb; Memphis, 8.7 lb) than those under poor control in 1979 (RPG greater than 300 mg/dl; means: Atlanta, 14.7 lb; Memphis, 1.3 lb). In the pooled alive and active cohorts (1979), 29.1% were under good control (RPG less than 150 mg/dl); 52.9%, fair control (RPG = 150-300 mg/dl); and 18.0%, poor control (RPG greater than 300 mg/dl). Of the 639 alive and active patients, paired plasma glucose levels were less than 200 mg/dl in 207 patients in 1969-70 and less than 200 mg/dl in 322 in 1979.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of hypertension in the elderly: a time for caution?

The authors review recent studies of treatment of hypertension and suggest modified guidelines for the treatment of elderly hypertensive patients. Treatment is recommended for elderly persons with systolic-diastolic hypertension if the systolic pressure is consistently above 160 mm Hg or the diastolic blood pressure is consistently above 100 mm Hg. Treatment of isolated systolic hypertension should not be excessively vigorous, and systolic blood pressure should not be lowered much below 160 mm Hg.

A cohort study of mortality in two clinic populations of patients with diabetes mellitus.

Mortality rates of two cohorts of patients with diabetes mellitus are estimated and compared. The Atlanta cohort is defined as all black patients receiving care at the diabetes clinic of Grady Memorial Hospital for the first time during calendar year 1971. The Memphis cohort is defined as all black patients referred from the City of Memphis Hospital outpatient clinic to a decentralized neighborhood clinic operated by the Memphis and Shelby County Health Department during September 1969 through August 1970. The Atlanta program discontinued all prescriptions of oral hypoglycemic drugs and emphasized instead an aggressive diet therapy. The Memphis program has used diet therapy but also insulin and/or oral hypoglycemic agents according to current guidelines. The ratios of observed to expected deaths (standardized mortality ratios) were remarkably similar for the two cohorts. In both cohorts the standardized mortality ratios were greatest for the youngest patients and for those patients whose duration of illness was longest. Nine-year survival rates, estimated by the life-table method and adjusted for differences in frequency distributions of entry age and duration of diabetes, were also similar for the two cohorts.

Control of systolic blood pressure in elderly black patients.

To study what effect the level of control of systolic blood pressure (SBP) has in elderly persons with systolic-diastolic hypertension, 503 elderly black hypertensive patients were followed up for as long as nine years. The combined rate of hospitalizations and mortality for hypertension-related disorders was significantly (P less than 0.01) higher for the group with inadequate control of SPB (mean, 183.6 mm Hg) than for the group with partial (mean, 151.2 mm Hg) or complete (mean, 131.5 mm Hg) control. The group with complete control of SBP had a significantly (P less than 0.005) higher combined rate of hospitalizations and mortality for hypertension-related disorders than did the group with partial control. This suggests that a target goal for control of systolic as well as diastolic blood pressure should be set for elderly black hypertensive patients. However, the control of SBP should not be to rigorous.

Analysis of the 1980 heat wave in Memphis.

During the heat wave of 1980, average daily temperatures in Memphis first rose above the mean on June 25 and remained elevated for 26 consecutive days. In July, 1980, 83 heat-related deaths were recorded as compared to non in July 1979. Most of these deaths occurred in elderly, poor, black, inner-city residents. There was a statistically significant increase in total mortality rates, death from natural causes, cardiovascular mortality rates, and the rate for persons dead on arrival. Virtually all the excess mortality was in persons over the age of 60. The rise in heat-related emergency room visits occurred three days prior to the rise in heat-related deaths. Local planning for future heat waves should focus on the inner-city black elderly. Heat-related deaths and emergency room visits should be reported to public health officials.

Evaluation of a decentralized system for chronic disease care: seven years of observation.

Observations of a publicly-financed system for the medical care of a large number of persons with chronic diseases have been made over seven years. The system combines decentralized, nurse-staffed neighborhood clinics, operated by a public health department, with a central referral clinic for consultations and the management of complicated problems. After seven years in the chronic disease program 55% of 1,004 patients with diagnoses of diabetes mellitus, hypertension, and cardiac diseases were still receiving care, 19% had died, and 26% had been lost to the program. In the seventh year, the mean diastolic blood pressure in hypertensives was 84 mm Hg and the mean serum glucose in diabetics was 203 mg/dl. For the group under care, hospital days/1000/year were 74% of the rate during the year before referral to the program and out-patient visits/1000/year were approximately the same as before referral. However, two-thirds of the visits, formerly made to a public hospital, were now being made to neighborhood clinics. The system appears to be an effective method of providing medical services for persons who formerly used the public hospital as their source of outpatient care.

The Memphis diabetes continuing care program.

Since 1963 a network of nurse-operated, physician-backed decentralized clinics has provided continuing care for more than 5000 diabetic patients referred from the medical center clinics. Protocols that provide therapy goals and management details are used by the nurses and nutritionists in this network. To reduce fragmentation of care, intercurrent illnesses as well as other chronic diseases are treated using protocols in these clinics or in the home. This study examines certain outcome data in a subset of 556 diabetic patients under continuing care over a 7-yr period in this network, with comparisons being made to care before referral. Blood glucose is maintained at comparable levels in both decentralized and hospital clinics. Blood pressure levels in hypertensive patients are maintained in a satisfactory range. Total hospitalization rates are reduced by 47%. For ketoacidosis and amputation, hospitalization is decreased by 69% compared with the experience before referral. The maintenance care costs are decreased substantially compared with costs before referral due to the less expensive ambulatory services and the reduced need for hospitalization. The data support the concept that decentralization is an effective means of providing continuing care to patients with diabetes mellitus.

Why people are hospitalized. A description of preventable factors leading to admission for medical illness.

We evaluated factors leading to the admission of 136 patients to the general medical services of two large metropolitan hospitals. We developed explicit criteria for the contribution of various specific factors to illness prevention and control in these patients. According to these criteria, the illness was found to be preventable in 44 per cent and the illness could have been controlled without admission in 31 per cent if a standard medical regimen had been followed. Social circumstances of individual patients influenced the admission decision in 21 per cent. Lack of medical or community resources or failure to make use of them contributed to 21 per cent of admissions. Alcohol abuse and smoking were factors in 17 per cent and 15 per cent respectively. Compliance played a role in 21 per cent. In 29 per cent of admissions more than one preventable factor was identified. Personal habits and lifestyle, less-than-optimal management or prior illness, social considerations or lack of community resources were factors in 78 per cent of the admissions.