Effect of Bacillius Coagulans and Galactomannans on Obese Patients Undergoing Sleeve Gastrectomy, A Randomized-Controlled Clinical Trial.

BACKGROUND: The purpose of this study was to examine the effect of probiotics and prebiotics (LactoWise®) on weight loss, blood pressure, and clinical lab values in morbidly obese patients undergoing laparoscopic sleeve gastrectomy (LSG). MATERIALS METHODS: Sixty patients undergoing LSG were recruited to participate in the study and randomized into either a LactoWise® or placebo group. The LactoWise® group (LWG) received 4.5 billion live cells of bacillus coagulans and galactomannans (300 mg); the placebo group received 600 mg of calcium citrate yielding 126 mg of elemental calcium. Both groups took their assigned capsule daily for 3-months post-surgery. Standard clinical lab values were measured pre-surgery and at 3-months post-surgery. Weight and blood pressures were measured at baseline, 2 weeks, 6 weeks, and 3 months post-surgery. RESULTS: A total of 35 patients with a mean age of 47.7 ± 12.4 years and a mean body mass index (BMI) of 46.6 ± 8.2 kg/m2 completed the study. There was a significant difference in BMI at baseline between the two study groups (43.0 ± 7.0 vs. 49.2 ± 8.3, P = .02). Weight loss was greater in the LWG compared to placebo at 6 weeks but showed no significant difference at 3 months post-op. In addition, there was a significant drop in triglycerides (TG) (P = .02) over time in the LWG (P = .01). The LWG had a significant decrease in AST and LDL compared to the placebo group (P = .03). CONCLUSION: Bariatric surgery (BS) produces positively impacting metabolic results in morbidly obese patients. Our study shows that in the case of triglycerides, LDL, weight loss and AST, administering of a probiotic/prebiotic blend may play a role in improving clinical outcomes of morbidly obese patients undergoing LSG.

Intraoperative cyclorotation and pupil centroid shift during LASIK and PRK.

PURPOSE: To determine the degree of cyclorotation and centroid shift in the x and y axis that occurs intraoperatively during LASIK and photorefractive keratectomy (PRK). METHODS: Intraoperative cyclorotation and centroid shift were measured in 63 eyes from 34 patients with a mean age of 34 years (range: 20 to 56 years) undergoing either LASIK or PRK. Preoperatively, an iris image of each eye was obtained with the VISX WaveScan Wavefront System (Abbott Medical Optics Inc) with iris registration. A VISX Star S4 (Abbott Medical Optics Inc) laser was later used to measure cyclotorsion and pupil centroid shift at the beginning of the refractive procedure and after flap creation or epithelial removal. RESULTS: The mean change in intraoperative cyclorotation was 1.48±1.11° in LASIK eyes and 2.02±2.63° in PRK eyes. Cyclorotation direction changed by >2° in 21% of eyes after flap creation in LASIK and in 32% of eyes after epithelial removal in PRK. The respective mean intraoperative shift in the x axis and y axis was 0.13±0.15 mm and 0.17±0.14 mm, respectively, in LASIK eyes, and 0.09±0.07 mm and 0.10±0.13 mm, respectively, in PRK eyes. Intraoperative centroid shifts >100 µm in either the x axis or y axis occurred in 71% of LASIK eyes and 55% of PRK eyes. CONCLUSIONS: Significant changes in cyclotorsion and centroid shifts were noted prior to surgery as well as intraoperatively with both LASIK and PRK. It may be advantageous to engage iris registration immediately prior to ablation to provide a reference point representative of eye position at the initiation of laser delivery.

Facial gingival tissue stability following immediate placement and provisionalization of maxillary anterior single implants: a 2- to 8-year follow-up.

PURPOSE: This is a follow-up of an earlier 1-year prospective study on implant success rates and the peri-implant response after immediate placement and provisionalization of single implants in the esthetic zone. The effects of gingival biotype on the peri-implant tissues were also evaluated. MATERIALS AND METHODS: Thirty-five patients were evaluated clinically and radiographically at presurgical examination (T0), immediately after immediate implant placement and provisionalization (T1), 1 year after implant surgery (T2), and the latest follow-up appointment (T3). Data were analyzed using t tests and repeated-measures analysis of variance at the significance level of alpha = .05. RESULTS: After a mean follow-up time of 4 years (range, 2 to 8.2 years), all implants remained in function. At T3, the mean mesial and distal marginal bone level changes were significantly greater than those observed at T2. At T3, the mean mesial and distal papilla level changes were significantly smaller than those observed at T2, whereas the mean facial gingival level change was significantly greater than that observed at T2. Sites with a thick gingival biotype exhibited significantly smaller changes in facial gingival levels than sites with a thin gingival biotype at both T2 and T3. CONCLUSIONS: Favorable implant success rates and peri-implant tissue responses can be achieved with this procedure. While the results suggest the possibility of spontaneous papilla regeneration over time following this procedure, continuing recession of the facial gingival tissue was also observed. The effect of gingival biotype on peri-implant tissue response seemed to be limited only to facial gingival recession and did not influence interproximal papilla or proximal marginal bone levels.

Three-percent saline administration during pediatric critical care transport.

OBJECTIVES: The purpose of this study was to describe the administration of 3% saline (3%S) during pediatric critical care transport. METHODS: A retrospective study was performed on pediatric patients who underwent critical transport to Loma Linda University Children's Hospital from January 1, 2003, to June 30, 2007, and were given 3%S. Patients' demographics, admission diagnosis, route and amount of 3%S administration, serum electrolytes, vital signs, radiographic data, and Glasgow Coma Scale scores were collected and analyzed. RESULTS: A total of 101 children who received 3%S infusions during pediatric critical care transport were identified. Mean patient age was 5.9 years, and mean patient weight was 27.6 kg. The main indications for infusing 3%S were suspected cerebral edema (41%), intracranial bleed with edema (51%), and symptomatic hyponatremia (6%). The amount of 3%S bolus ranged from 1.2 to 24 mL/kg, with a mean of 5.4 mL/kg. Serum electrolytes before and after 3%S infusion demonstrated significant increases in sodium, chloride, and bicarbonate levels (P < 0.05). A significant reduction was also seen in serum urea nitrogen levels and anion gap. Radiographic imaging performed before 3%S infusion demonstrated findings consistent with concerns of increased intracranial pressure such as intracranial bleed and cerebral edema. The route of initial 3%S infusions was mainly through peripheral intravenous lines (96%). No complications related to the 3%S delivery such as local reactions, renal abnormalities, or central pontine myelinolysis were observed. CONCLUSIONS: It seems 3%S may be administered safely during pediatric critical transport and administration routes can include peripheral lines. With the importance of initiating therapy early to improve patient outcomes, the use of 3%S may benefit transported children with brain injury and suspected intracranial hypertension.

Prospective randomized evaluation of short-term complications when using buffered or unbuffered lidocaine 1% with epinephrine for blepharoplasty surgery.

PURPOSE: To determine whether there is a difference in the incidence of short-term complications using plain lidocaine with epinephrine versus the buffered equivalent in eyelid surgery. METHODS: The authors performed a prospective, double-masked, randomized study in patients scheduled for combined upper eyelid blepharoplasty and levator advancement ptosis repair surgery with local anesthesia. Exclusion criteria included: documented allergies to lidocaine and/or epinephrine; known pregnancy; profound cognitive impairment; inability to understand the visual analog scale or the informed consent; and previous eyelid surgery. Each subject was his/her own control by using the unbuffered local anesthetic in one eye, while the buffered solution was used in the other eye. The surgeon completed a specific standardized data collection form for quantifying both intraoperative and postoperative complications, such as bleeding, bruising, and edema. Data regarding pain on injection and postoperative pain were collected from patients using a visual analog pain scale. RESULTS: Thirty-nine patients were included in this study, of which 18 experienced less pain during the injection on the side where buffered lidocaine was used, 11 reported no difference, and 10 reported less pain in the eye injected with unbuffered lidocaine. Injection pain revealed a mean operative pain rating of 4.01 +/- 2.45 in the eye with buffered lidocaine versus 4.49 +/- 2.58 in the control (p = 0.06). There were no significant differences between the buffered and unbuffered lidocaine eyes as regards postoperative bleeding, swelling, or pain, and there was a trend toward less pain on injection with the buffered solution. CONCLUSIONS: There were no significant differences in postoperative pain, swelling, or bleeding with the use of plain versus buffered lidocaine in eyelid surgery. There was a trend for the buffered anesthetic to cause less pain on injection.

Multiple stressors and the response of vascular endothelial cells: the effect of aging and diabetes.

BACKGROUND: The present study examined the effects of local heat, global heat, and the interaction between these two endothelial stressors on the blood flow of the skin of the foot in people who are older and who have diabetes. METHODS: Subjects who were older (mean age 64.2 +/- 5.9 years) and were younger (mean age 25.7 +/- 2.9 years) and subjects who had diabetes (mean age 62 +/- 5.9 years, mean duration 13.2 +/- 9.1 years) participated. Subjects were exposed to three global temperatures (16 degrees C, 24 degrees C, and 32 degrees C), and the blood flow response was recorded on the foot with a laser Doppler flow meter for 30 s following applications of local heat (30 degrees C, 33.5 degrees C, and 37 degrees C) using a Peltier junction to clamp the skin for 2 min. RESULTS: All three groups significantly increased blood flow from the 16-24 degrees C environments for the 37 degrees C application of local heat (P(Younger) = 0.02, P(Older) = 0.02, P(Diabetes) = 0.01). Those with diabetes and those who were older only increased blood flow 5% and 6% from the 24-32 degrees C environment, which was not statistically significant (P(Older) = 0.12, P(Diabetes) = 0.14). CONCLUSIONS: There appears to be considerable blood flow reserve in younger subjects to tolerate heat stress. In contrast, older subjects and those with diabetes reach a critical level after which additional heat does not cause in increase in blood flow.

The role of nitric oxide in skin blood flow increases due to vibration in healthy adults and adults with type 2 diabetes.

BACKGROUND: We recently demonstrated concomitant increases in skin blood flow and nitric oxide (NO) production in young healthy adults in response to externally applied vibration of the forearm. Research has shown that adults with type 2 diabetes exhibit depressed NO production and vascular responses to NO. We hypothesized that subjects with type 2 diabetes would display lower than normal increases in skin blood flow to externally applied vibration. RESEARCH DESIGN AND METHODS: Therefore, the purpose of this study was to compare 20 male and female, age- and body mass index-matched normal adults and adults with type 2 diabetes in terms of the effects of external vibration of the forearm on skin blood flow and the rate of NO production. Skin blood flow and NO production were measured before vibration, immediately after 5 min of vibration, and 5 min after vibration ceased. RESULTS: Although externally applied vibration significantly increased skin blood flow for both groups (P = 0.0001), those with diabetes had significantly lower (223%; P = 0.003) skin blood flows compared to the healthy older adults (461%). The rate of NO production, expressed as microM NO . flux, also increased significantly in both groups after vibration (healthy group, 374%; diabetes group, 236%) and remained significantly elevated (healthy group, 258%; diabetes group, 177%) for at least 5 min; however, the difference between groups was not significant (P = 0.12). CONCLUSIONS: These findings suggest that subjects with diabetes exhibit a lower skin blood flow and lower NO response to externally applied vibration than matched normal subjects.

The effects of skin moisture and subcutaneous fat thickness on the ability of the skin to dissipate heat in young and old subjects, with and without diabetes, at three environmental room temperatures.

The Pennes model predicts the ability of the skin to dissipate heat as a function of conductive heat transfer and blood flow. Conductive heat exchange may be affected by skin moisture and subcutaneous fat thickness, factors not considered by Pennes. In the present investigation, we sought to expand the Pennes model by examining subcutaneous fat and skin moisture as factors of heat dissipation and their effects on heat exchange and blood flow. Subjects who were older (O) (mean age 64.2+/-5.9 years, n=15), had diabetes (D) (mean age 62+/-5.9 years, mean duration 13.2+/-9.1 years, n=15), and were younger (Y) (mean age 25.7+/-2.9 years, n=15) participated. Thermisters were placed in an iron heat probe and on the skin to measure the change in skin temperature to create a thermal change index to demonstrate the ability of the skin to dissipate heat. The lower back had the thickest subcutaneous fat layer for all subjects, which contributed to higher skin temperatures than the foot and hand in response to local and global heat. There was a significant inverse correlation between skin moisture and skin temperature after 5s of heat application (r=-0.73, p<0.001) with O and D having significantly less skin moisture than Y (p<0.05). O and D had significantly increased skin temperatures in response to local heat, as compared to Y, in all global temperatures (p<0.05). Thus, the Pennes model may need to be adjusted to take into consideration aging, diabetes, skin moisture, and subcutaneous fat thickness.

Effects of education on return-to-work status for people with fear-avoidance beliefs and acute low back pain.

BACKGROUND AND PURPOSE: People with acute low back injury and fear-avoidance beliefs are at risk for remaining off work for an extended period of time. However, the effectiveness of intervention strategies for improving return-to-work status in people with acute low back pain and fear-avoidance beliefs has not been reported. The objective of this study was to determine whether education and counseling on pain management, physical activity, and exercise could significantly decrease the number of days that people with low back injury are off work. SUBJECTS: Thirty-four people who were unable to return to work following a work-related episode of low back pain and who exhibited fear-avoidance beliefs participated in this study. METHODS: Participants who scored 50 points or higher on the Fear-Avoidance Beliefs Questionnaire were alternately assigned to an education group or a comparison group. Both groups received conventional physical therapy intervention. Participants in the education group were given education and counseling on pain management tactics and the value of physical activity and exercise. The effectiveness of the interventions was measured by the number of days before people returned to work without restrictions. RESULTS: All participants in the education group returned to regular work duties within 45 days. One third of the participants in the comparison group remained off work at 45 days. There was a statistically significant difference between the groups with regard to the number of days before returning to work. DISCUSSION AND CONCLUSION: Education and counseling regarding pain management, physical activity, and exercise can reduce the number of days off work in people with fear-avoidance beliefs and acute low back pain.

Comparing immersion ultrasound with partial coherence interferometry for intraocular lens power calculation.

BACKGROUND AND OBJECTIVE: To compare the utility and accuracy of high-precision immersion ultrasound, partial coherence interferometry, and the IOL Master system (Carl Zeiss Meditec, Dublin, CA) in a tertiary care referral center. PATIENTS AND METHODS: Comparative clinical study in a tertiary care, multispecialty, university practice. Participants were consecutive patients scheduled for cataract surgery at Emory Eye Center. Patients underwent biometry using immersion ultrasound, partial coherence interferometry, and the IOL Master system. RESULTS: Twenty-two percent of eyes undergoing surgery could not be measured using interferometry. In those eyes measurable by both methods, there was no difference in measurements nor postoperative refractive outcome. Each method had a high repeatability (intraclass correlation coefficient > 0.99) with a high intraclass correlation between methods (intraclass correlation coefficient = 0.99). CONCLUSIONS: When it can be used, interferometry is equivalent to immersion ultrasonography regarding biometric accuracy and precision. However, it cannot replace ultrasonography, especially for eyes with dense media opacity.

The effect of anterior versus posterior glide joint mobilization on external rotation range of motion in patients with shoulder adhesive capsulitis.

STUDY DESIGN: Randomized clinical trial. OBJECTIVE: To compare the effectiveness of anterior versus posterior glide mobilization techniques for improving shoulder external rotation range of motion (ROM) in patients with adhesive capsulitis. BACKGROUND: Physical therapists use joint mobilization techniques to treat motion impairments in patients with adhesive capsulitis. However, opinions of the value of anterior versus posterior mobilization procedures to improve external rotation ROM differ. METHODS AND MEASURES: Twenty consecutive subjects with a primary diagnosis of shoulder adhesive capsulitis and exhibiting a specific external rotation ROM deficit were randomly assigned to 1 of 2 treatment groups. All subjects received 6 therapy sessions consisting of application of therapeutic ultrasound, joint mobilization, and upper-body ergometer exercise. Treatment differed between groups in the direction of the mobilization technique performed. Shoulder external rotation ROM measured initially and after each treatment session was compared within and between groups and analyzed using a 2-way ANOVA, followed by paired and independent t tests. RESULTS: There was no significant difference in shoulder external rotation ROM between groups prior to initiating the treatment program. A significant difference between groups (P = .001) was present by the third treatment. The individuals in the anterior mobilization group had a mean improvement in external rotation ROM of 3.0 degrees (SD, 10.8 degrees; P = .40), whereas the individuals in the posterior mobilization group had a mean improvement of 31.3 degrees (SD, 7.4 degrees; P < .001). CONCLUSIONS: A posteriorly directed joint mobilization technique was more effective than an anteriorly directed mobilization technique for improving external rotation ROM in subjects with adhesive capsulitis. Both groups had a significant decrease in pain.

Effect of a static calf muscle-tendon unit stretching program on ankle dorsiflexion range of motion of older women.

BACKGROUND AND PURPOSE: While there has been considerable research on stretching, a paucity of research has focused on stretching of the calf muscle-tendon unit (MTU) in older women. Because limited ankle dorsiflexion range of motion (ROM) is associated with gait abnormalities and increases the risk of falls in the elderly, we investigated the effect of static stretching on flexibility of the calf MTU of healthy elderly adults. METHODS: Twenty healthy female volunteers, 76 to 91 years of age, were recruited from Linda Valley Villa, an independent living center. Subjects performed a static stretching program 5 days a week for 6 weeks. Passive ankle dorsiflexion ROM was taken prior to beginning the stretching program and 3 days after the last stretching day. RESULTS: Mean increase in passive ankle dorsiflexion ROM was 12.3 degrees (SD= 4.4 degrees ) (p < .001). CONCLUSION: A 6-week stretching program is capable of provoking a significant increase in ankle dorsiflexion ROM for elderly women.

Comparison of 2 multiple-measurement infrared pupillometers to determine scotopic pupil diameter.

PURPOSE: To compare a monocular and a binocular multiple-measurement digital infrared pupillometers for measuring scotopic pupil diameter. SETTING: Department of Ophthalmology, Loma Linda University, Loma Linda, California, USA. METHODS: Scotopic pupil size was measured after 1 minute of dark adaptation in 42 eyes of 21 volunteers. Measurements were taken twice each with 2 multiple-measurement digital infrared pupillometers, the monocular pupillometer (Neuroptics, Inc.), and the binocular pupillometer (P2000D, Procyon, Ltd.) Intraclass correlation coefficients (ICC) and limits of agreement (LOA) were used to measure repeatability and agreement of measures with each instrument and between instruments. The Wilcoxon signed rank test was used to compare variability of measurements within each instrument. RESULTS: The mean scotopic pupil size was 4.79 mm +/- 0.95 (SD) with the Procyon and 4.86 +/- 0.93 mm with the Neuroptics. Repeatability and agreement tests for the Procyon measures showed the following: ICC, 0.954; 95% confidence interval (CI), 0.916-0.975; LOA, -0.60 to 0.56; range, 1.16. The Wilcoxon signed rank test of variability gave a Z score of -2.53 (P = .01, 2 tailed). The repeated measures testing with the Neuroptics pupillometer showed the following: ICC, 0.985; 95% CI, 0.972-0.992; LOA, -0.39 to 0.26; range, 0.64; Z score, -1.15 (P = .25, 2-tailed). Repeatability and agreement tests for measures between instruments showed the following: ICC, 0.954; 95% CI, 0.916-0.975; LOA, -0.60 to 0.50; range 1.11. CONCLUSIONS: There was a high repeatability and agreement in scotopic pupil diameter for repeated measures within each device and measurements between the devices. Differences in variability in scotopic pupil diameter evaluated by the Wilcoxon signed rank test were significant only with the Procyon pupillometer.

Accuracy of intraocular lens power prediction using the Hoffer Q, Holladay 1, Holladay 2, and SRK/T formulas.

PURPOSE: To compare the accuracy of intraocular lens (IOL) power calculations using 4 formulas: Hoffer Q, Holladay 1, Holladay 2, and SRK/T. SETTING: Tertiary care center. METHODS: This study was a retrospective comparative analysis. Immersion ultrasound biometry (axial length, anterior chamber depth, and lens thickness), manual keratometry, and postoperative manifest refraction were obtained in 643 eyes of consecutive patients who had routine uneventful cataract surgery with implantation of 1 of 2 IOLs using the same operative technique by the same surgeon. Biometric data were entered into each of the 4 IOL power calculation formulas, and the results were compared to the final manifest refraction. An optimized lens constant was used for each formula. Results were also stratified into groups of short, average, medium long, and very long axial length <22.0 mm, 22.0 to <24.5 mm, 24.5 to 26.0 mm, and >26.0 mm, respectively). RESULTS: No formula was more accurate than the others as measured by mean absolute error. The formulas were also equally accurate when eyes were stratified by axial length. CONCLUSION: The 4 IOL power formulas provided equivalent refractive results in the entire group of eyes and in the subsets of axial lengths tested.

Duration of graft cold ischemia does not affect outcomes in pediatric heart transplant recipients.

BACKGROUND: Utilizing donor hearts with prolonged graft ischemia may extend the donor pool. METHODS AND RESULTS: The medical records of 363 infants and children, aged 1 day to 17 years, transplanted at Loma Linda University between November 1985 and March 2001, were retrospectively reviewed. Fourteen children received organs with prolonged ischemic times (>8 hours)(PIT) compared with 14 with short ischemic times (< or =90 minutes)(SIT). There were no significant differences when comparing donors for gender, age, weight, cause of death, or duration of cardiopulmonary resuscitation. Preoperative donor shortening fraction (%), as determined by echocardiography, was significantly higher in the SIT group (44.5 versus 36.5%; P=0.006). There were no significant differences between PIT and SIT recipients when comparing age at transplant, weight at transplant, waiting time, weight mismatch, postoperative days on ventilator, duration of inotropic support, and hospital stay. Cardiopulmonary bypass time was significantly longer in the PIT group (140.5 versus 80.5 minute; P=0.001). Median length of follow-up for both groups was approximately 5 years. Five grafts were lost in the PIT group; 7 were lost in the SIT group, with 1 early graft loss in each group. Significant posttransplant coronary artery disease was diagnosed in 2 recipients in each group (PIT: 80 and 42; SIT: 84 and 67 months posttransplant). There was no significant difference between groups in actuarial graft survival. Number of rejection episodes and hospital readmissions during the first posttransplantation year did not differ significantly between groups. CONCLUSION: Late outcomes were not adversely affected by donor hearts preserved by single dose cold crystalloid cardioplegia with greater than 8 hours of cold ischemia.

Intensive versus modified conventional control of blood glucose level in medical intensive care patients: a pilot study.

BACKGROUND: Critically ill postsurgical patients fare better with intensive control of blood glucose level. The link between glucose control and outcome is less well studied for medical intensive care patients. Whether intensive glucose control requires additional staffing is unclear. OBJECTIVES: To compare intensive glucose control with modified conventional control in the medical intensive care unit and to assess compliance with glucose targets, incidence of hypoglycemia, and staffing adequacy. METHODS: Medical intensive care patients who had been receiving mechanical ventilation for less than 24 hours were randomized to intensive or modified conventional protocols for glucose control. Nurses were trained before participating in the study and were interviewed after its completion. RESULTS: Five subjects were randomized to each protocol. Mean blood glucose levels were 5.8 (SD 1.5) mmol/L (105.3 [SD 26.3] mg/dL) for the intensive group and 9.8 (SD 2.5) mmol/L (177.4 [SD 45.5] mg/dL) for the modified conventional group (P < .001). Fifty percent of glucose levels met target values in the intensive group, and 72% of glucose levels met target values in the modified conventional group (P < .001). Severe hypoglycemia (glucose <2.2 mmol/L [<40 mg/dL]) occurred rarely and without complication. Nurses suggested protocols might be improved by using smaller steps in adjusting insulin dosage and reported that simultaneously caring for more than 1 study subject was taxing. CONCLUSIONS: Target levels for blood glucose were achieved with both protocols. Severe hypoglycemia was rare and uncomplicated regardless of type of glucose control. Additional staffing may be needed for intensive glucose control.

HPV testing in liquid cytology specimens: comparison of analytic sensitivty and specificity for in situ hybridization and chemiluminescent nucleic acid testing.

OBJECTIVE: To compare the analytic sensitivity and specificity of Hybrid Capture 2 (HC2) (Digene Corporation, Gaithersburg, Maryland, U.S.A.) with in situ hybridization (ISH) in detecting high-risk types of HPV (HR-HPV). STUDY DESIGN: Performance characteristics of ISH and HC2 were compared in 99 consecutive cervical cytology samples diagnosed as low grade squamous intraepithelial lesion and processed by either the ThinPrep (Cytyc Corporation, Boxborough, Massachusetts, U.S.A.) or SurePath (TriPath Imaging Systems, Research Triangle Park, North Carolina, U.S.A.) method at 2 geographically different centers. Polymerase chain reaction (PCR) was used as the gold standard. RESULTS: Of the samples, 67% were positive for HR-HPV viral types by PCR. ISH had a sensitivity of 0.87 as compared to 0.95 (p = 0.11) for HC2. The specificity of ISH was significantly different from that of HC2 (0.57 vs. 0.13, respectively; p = 0.0004). The performance characteristics of ISH were not affected by the processing method or population tested. CONCLUSION: The sensitivity of ISH is comparable to that of HC2, with significantly superior specificity, and is therefore an efficacious alternative to HC2 for triaging patients with abnormal cervical cytology results.

Practice analysis: defining the clinical practice of primary contact physical therapy.

STUDY DESIGN: Nonexperimental descriptive research design. OBJECTIVE: To describe the frequency of use and perceived level of importance of professional responsibilities, procedures, and knowledge areas by physical therapists practicing in primary contact care settings and to compare these data to similar data from physical therapists practicing in nonprimary contact care settings. BACKGROUND: Physical therapy services have moved toward a primary contact model of practice in response to changes in the health care delivery system. Several studies have reported the effectiveness of primary contact physical therapy. However, a practice analysis has not been performed to define the clinical practice of primary contact physical therapy. METHODS AND MEASURES: A sample of 212 physical therapists practicing as primary contact providers in the military and civilian sectors, and a comparison group of 250 physical therapists not practicing as primary contact providers were surveyed. A Delphi technique was used to develop the survey instrument, which was pretested by a pilot group. The final survey instrument consisted of 171 items. Chi-square and Kruskal-Wallis tests were conducted to examine significant differences among the 3 groups (P<.001). RESULTS: Of the 212 surveys mailed to the primary contact group, 119 (56.1%) responses were received (82 military physical therapists and 37 civilian physical therapists). Of the 250 surveys mailed to the comparison group, 103 (41.2%) responses were received. There were numerous significant differences among the 3 groups in professional responsibilities, procedures, and knowledge areas, most notably in the areas of selecting and ordering of imaging procedures, identifying signs and symptoms of nonmusculoskeletal conditions, establishing physical therapy diagnoses, and prescribing over-the-counter medications. CONCLUSION: The study describes the clinical practice of physical therapists functioning in the role of primary contact providers or as members of a diverse team of health care professionals in primary care, which may provide curricular direction to professional, postprofessional, and clinical residency or fellowship-based educational settings.

Disability self-assessment and upper quarter muscle balance between female dental hygienists and non-dental hygienists.

PURPOSE: The purpose of this pilot study was to compare disability self-assessment and upper quarter muscle balance female dental hygienists and non dental hygienist females. The upper quarter was operationally defined as the shoulder and neck region. Muscle balance was operationally defined as muscle flexibility and muscle performance. METHODS: A convenience sample of 41 working dental hygienists and 46 non dental hygienists participated in the study. Muscle flexibility of the upper quarter was measured by inclinometry or standard muscle length testing. Muscle performance was measured by timing the duration of four statically maintained positions. Subjects filled out the Northwick Park Neck Pain Questionnaire (NPNPQ), which is a disability self-assessment. Analysis of Covariance (ANCOVA) was used during data analysis to adjust for the mean age difference between the dental hygienist group (38.0 years) and the non-dental hygienist group (29.3 years). RESULTS: The results of this pilot study suggest that female dental hygienists are more likely than non dental hygienist females to develop tightness in the upper trapezius (p = 0.007) and the levator scapula (p = 0.01) of the non dominant upper quarter and lower fibers of the pectoralis major of the dominant upper quarter (p = 0.03) Muscle performance trends in the dental hygienist group supported muscle balance theory that short muscles remain strong while lengthened muscles become weak. The dental hygienist group had higher disability scores in all nine parts of the NPNPQ compared to the non-dental hygienist group, five of which were statistically significant (p < 0.05). CONCLUSION: The results of this pilot study suggest that muscle imbalances in the upper quarter are more common in female dental hygienists than in female non dental hygienists and may contribute to the numerous upper quarter pathologies associated with the practice of dental hygiene. Further research is needed to determine if upper quarter strengthening and flexibility exercises performed by dental hygienists can reduce disability self-assessment.

A program to enhance recruitment and retention of disadvantaged and ethnically diverse baccalaureate nursing students.

PURPOSE: To describe and evaluate the use of a "Success in Learning: Individualized Pathways Program (SLIPP)" to retain and graduate disadvantaged and ethnically diverse nursing students. DESIGN: A summative evaluative design was used with a population of 77 disadvantaged and ethnically diverse students who were accepted into a pre-entrance preparation quarter. The program based on an academic success model, included six pre-entrance classes, academic, social, and financial support, and seven faculty development workshops. Program outcomes were studied using student records, survey results, and interviews. RESULTS: Following the pre-entrance quarter, all 77 students were accepted into the baccalaureate nursing program, 90.9% graduated with either a Bachelor in Science (75.3%) or Associate in Science (15.6%), and 98.6% of the graduates passed the state board registered nursing examination. DISCUSSION: Outcomes are discussed in light of similar programs. CONCLUSIONS: Underprepared disadvantaged and ethnically diverse students can successfully become registered nurses. IMPLICATIONS: Educators and recruiters for nursing practice should accept/hire culturally diverse students/nurses to expand the ethnic diversity of the nursing workforce to meet the needs of culturally diverse clients. Research is needed to determine the classes/components and length of the pre-entrance preparation program to successfully enhance success.