A Prospective Evaluation of the Accuracy of Weight Estimation Using the Broselow Tape in Overweight and Obese Pediatric Patients in the Emergency Department.

OBJECTIVES: The aims of the study were to examine the predictive accuracy of Broselow tape (BT) weight estimation and body mass index-based weight categorization in overweight and obese pediatric patients and to develop an adjustment factor that improves the BT weight estimate in overweight and obese pediatric patients. METHODS: A prospective observational study was conducted. We enrolled noncritical pediatric patients presenting to a tertiary care pediatric emergency department with nonurgent complaints. Patients had their weights, heights, abdominal circumferences, and actual BT measurements documented by research staff. RESULTS: One hundred seventy-eight patients aged 2 to 18 years were enrolled. Using the Centers for Disease Control and Prevention's definition of body mass index classification, 71 patients (39.89%) had normal BMI, 43 patients (24.16%) were overweight, and 64 patients (35.96%) were obese. The accuracy of the BT-estimated weight range, compared with the actual weight, is 40.5% in our study population. When stratified by BMI classification, the accuracy proportions were the following: 71.8% for normal, 41.9% for overweight, and 4.7% for obese patients. The adjustment formula ([0.014 × waistline in cm + 0.3] × BT weight) improved overall weight estimation from 40.5% to 65.2%. The greatest improvement was noted in obese children, where the BT accuracy improved from 4.7% to 59.4%. CONCLUSIONS: The growing pediatric obesity epidemic has challenged the BT's ability to accurately estimate the weights in overweight and obese pediatric patients. Our study demonstrated inverse relationship between the accuracy of BT and body weight. An adjustment factor significantly improved BT accuracy in obese children.

Avoiding Negative Dysphagia Outcomes.

Dysphagia in adults affects their quality of life and can lead to life-threatening conditions. The authors draw on both 30 years of experience as clinicians and also on expert testimony in adult, dysphagia-malpractice cases to make five recommendations with the aim of preventing dysphagia-related deaths. They discuss the importance of informed consent documents and suggest the following nursing actions to reduce these often unnecessary tragedies: consider the importance of diet status; understand and follow speech-language-pathologists' recommendations; be familiar with the dysphagia assessment; be responsive to the need for an instrumental assessment; and ensure dysphagia communication is accurate and disseminated among healthcare professionals. They conclude that most negative dysphagia-management outcomes can be prevented and that nurses play a pivotal role in this prevention.

Lessons from nursing home dysphagia malpractice litigation.

The purpose of this article is to review the management of swallowing disorders in nursing home patients. The goal is to provide readers with five areas of contentious dysphagia management issues that have surfaced in several malpractice litigation cases. A detailed examination of what went wrong in the management of these patients' dysphagia from the perspective of the plaintiffs' dysphagia expert witness, as well as a discussion of what nursing home staff could have done to prevent these tragedies, is presented.

A redefining Wernicke's area: receptive language and discourse semantics.

This report calls for a more exacting definition of Wernicke's area in the discipline of communication sciences and disorders to reflect an accurate view of brain functioning with regard to decoding discourse semantics. Conventional definitions are provided to delineate the general usages of important terms used by many professional dictionaries and glossaries when defining Wernicke's area, receptive aphasia, understanding, and comprehension. Five levels of semantic decoding are described. A stanza from Tennyson's In Memoriam is used to show the dynamics of discourse semantic decoding and to logically establish that "language understanding" can virtually engage the brain as a whole and the totality of a person's mind. A more accurate definition is provided, indicating that Wernicke's area is not the center for oral language understanding, only an important conduit to language comprehension.

On the Mechanism of the Reaction of alpha-Substituted Ketones with Allyltributylstannane.

The mechanisms for the reaction of allyltributylstannane with a number of fragmentation probes, alpha-substituted acetophenones, were studied. All reactions were shown to proceed through free radical chain sequences since they could be initiated by AIBN and inhibited by m-dinitrobenzene (DNB). alpha-Halo- and alpha-(benzoyloxy)acetophenones (I and II, PhCOCR(1)R(2)X; X = F, Cl, Br, OCOPh; R(1), R(2) = H, Me) yielded the allylation products, PhCOCR(1)R(2)CH(2)CH=CH(2)), through a chain sequence involving as the propagation step: an electron transfer from Bu(3)Sn(*) to I and II, fragmentation of the ketyl anion PhCOCR(1)R(2)X(*)(-), and addition of PhCOCR(1)R(2)(*) to allyltributylstannane. The reactions of alpha-(arylsulfonyl)acetophenones (IIIa-c, PhCOCR(1)R(2)Y, Y = SO(2)Tol-p), however, gave a nearly 1:1 mixture of allyl tosyl sulfone and the corresponding ketone, PhCOCHR(1)R(2). The (1)H and (13)C NMR of the reaction mixture between allyltributylstannane and alpha-(p-methylbenzenesulfonyl)isobutyrophenone substantiated the intermediacy of the tin enolate PhC(OSnBu(3))=CMe(2). These results suggested that a radical addition elimination mechanism was involved in the reactions of IIIa-c with allylstannane. The reaction of alpha-phenylthioacetophenone (IV, PhCOCH(2)SPh) gave both the electron transfer and the addition elimination products (PhCOCH(2)CH(2)CH=CH(2), PhCOCH(3)), indicating that both pathways were involved in the formation of the products.

Mechanism of the Solution-Phase Reaction of Alkyl Sulfides with Atomic Hydrogen. Reduction via a 9-S-3 Radical Intermediate.

The low selectivity of benzyl alkyl sulfide fragmentation subsequent to its reaction with atomic hydrogen is indicative of a reaction that proceeds via an early transition state. The competitive reduction of a series of substituted-benzyl alkyl sulfides was insensitive to the substituent on the aromatic ring (rho = -0.13, r = 0.99). The relative rates of fragmentation of a series of the substituted-benzyl alkyl sulfides gave a V-shaped Hammett plot. Both electron-donating and electron-withdrawing groups destabilized the transition state (rho = +0.99, r = 0.999; rho = -0.82, r = 0.992). Since the relative rates of disappearance of the alkyl benzyl sulfides are not substituent dependent, but the relative rates of fragmentation are, a 9-S-3 intermediate is preferred as the structure leading to products.

Formation of Three-Membered Rings by S(H)i Displacement. Reverse of Cyclopropyl Ring Opening(1).

The general methods, photoinitiated or peroxide-initiated free radical chain additions of halomethanes to olefins, yield 1,2-addition products at temperatures ranging from 20 to 100 degrees C. At lower temperatures, -42 to -104 degrees C, a competitive reaction, subsequent to the addition of CCl(2)X(*), yields alkylcyclopropanes. The reactions of 1-octene or 1-hexene and 1-methylcyclohexene with atomic hydrogen carried out in the presence of several transfer agents (CCl(4), CCl(3)Br, CCl(2)Br(2)) initiate a radical chain addition of CCl(2)X(*) and yield cyclized materials resulting from the S(H)i displacement of halogen by a carbon-centered radical. The radical displacement of a halogen on carbon, the reverse of homolytic displacement on cyclopropyl carbon, is dominant at low temperatures. The rate constants for cyclization (k(c)) vs transfer with halomethane (k(t)) showed isokinetic temperatures of -46 degrees C (CCl(4), 1-hexene); -35 degrees C (CCl(4), 1-methylcyclohexene). The isokinetic temperatures for the reactions of the two substrates carried out in the presence of BrCCl(3) were calculated as -204 degrees C (1-octene) and -109 degrees C (1-methylcyclohexene).

Eclectic perspectives on the psychology of aphasia.

This article explores the psychological changes that occur in patients who have suffered a stroke with resulting aphasia and examines the adjustments necessary to help the patient cope. The eclectic approach described in this paper examines the psychology of aphasia from three perspectives: effects of brain injury, psychological defenses and coping styles, and responses to loss. Depression, anxiety attacks, ego restriction, crying, euphoria, denial, anger, and a host of other psychological reactions can accompany stroke, sometimes causing health care personnel to feel overwhelmed by these psychological concomitants in their patients. This paper is intended as a guide to understanding the significant psychological adjustments many patients must undergo. Current information is provided to assist in evaluating and treating these patients.

Endothelin-1--induced enhancement of coronary smooth muscle contraction via MAPK-dependent and MAPK-independent [Ca(2+)](i) sensitization pathways.

Endothelin-1 (ET-1) has been implicated in coronary vasospasm by enhancing coronary vasoconstriction to vasoactive eicosanoids, and a role for protein kinase C (PKC) activation has been suggested. However, the cellular mechanisms downstream from PKC activation are unclear. We investigated whether physiological concentrations of ET-1 enhance coronary smooth muscle contraction by activating a PKC-mediated signaling pathway involving tyrosine phosphorylation and activation of mitogen-activated protein kinase (MAPK). Cell contraction was measured in smooth muscle cells isolated from porcine coronary artery, [Ca(2+)](i) was measured in fura-2 loaded cells, and tissue fractions were examined for reactivity with anti-phosphotyrosine (P-Tyr) and anti-MAPK antibodies using immunoprecipitation and immunoblot analysis. In Hanks' solution (1 mmol/L Ca(2+)), ET-1 (10 pmol/L) did not increase basal [Ca(2+)](i) (81 +/- 2 nmol/L) but caused cell contraction (10%) that was inhibited by calphostin C (10(-6) mol/L), inhibitor of PKC, tyrphostin (10(-6) mol/L), inhibitor of tyrosine kinase, and PD098059 (10(-6) mol/L), inhibitor of MAPK kinase. The vasoactive eicosanoid prostaglandin F(2alpha) (PGF(2alpha); 10(-7) mol/L) caused increases in cell contraction (11%) and [Ca(2+)](i) (122 +/- 9 nmol/L) that were inhibited by the Ca(2+) channel blocker verapamil (10(-6) mol/L) but not by calphostin C, tyrphostin, or PD098059. Pretreatment with ET-1 for 10 minutes enhanced cell contraction to PGF(2alpha) (33%) with no additional increase in [Ca(2+)](i) (124 +/- 10 nmol/L). Activation of PKC by phorbol 12-myristate 13-acetate (PMA; 10(-7) mol/L) caused cell contraction and enhanced PGF(2alpha) contraction (32%) with no additional increase in [Ca(2+)](i) (126 +/- 9 nmol/L). The ET-1-- and PMA-induced enhancement of PGF(2alpha) contraction was abolished by verapamil or calphostin C but not by tyrphostin or PD098059. ET-1 and PMA caused significant increases in tyrosine phosphorylation of MAPK that were inhibited by calphostin C, tyrphostin, and PD098059. PGF(2alpha) did not cause any additional increases in tyrosine phosphorylation of MAPK in tissues untreated or pretreated with ET-1 or PMA. Thus, physiological concentrations of ET-1 activate a Ca(2+)-independent PKC-mediated signaling pathway that involves tyrosine phosphorylation and activation of MAPK. The enhancement of PGF(2alpha)-induced coronary smooth muscle contraction by ET-1 involves additional activation of a Ca(2+)-sensitive PKC-mediated pathway but not tyrosine phosphorylation or activation of MAPK. The MAPK-dependent and MAPK-independent signaling pathways represent possible cellular mechanisms by which ET-1 could enhance coronary vasoconstriction to vasoactive eicosanoids in coronary vasospasm.