Assessment and promotion of judicious antibiotic use on dairy farms in Washington State.

The aims of this study were to describe antibiotic use and biosecurity practices among Washington State dairy producers and to evaluate the effectiveness of a collaborative approach to promoting judicious antibiotic use on dairy farms. In collaboration with a statewide industry group, Washington State dairy producers participated in a written, self-administered survey in 2003. They were then provided several educational interventions followed by a second written survey in 2005. Sixty-five percent (381) of dairy producers completed the 2003 survey. The most commonly cited drugs used for disease treatment were penicillin, ceftiofur, and oxytetracycline. Participants also indicated significant preventive uses with 28% using medicated milk replacer. Most producers appeared to consider intramammary infusion at dry-off to be a treatment rather than a preventative practice. Twenty-three percent of initial respondents indicated at least one extra-label use of antibiotics, yet only half routinely consulted with a veterinarian when doing so. Most agreed that using written protocols for disease treatment could reduce errors, but less than one-third had protocols. After the educational intervention there was a tendency toward reduced use of antibiotic medicated milk replacer: 51% of producers who originally reported using medicated milk replacer discontinued this practice, whereas 12% of producers began using medicated milk replacer between the 2003 and 2005 surveys. Most reported that the resources and educational materials were useful. Areas where additional work is needed include reducing the use of medicated milk replacer, increasing veterinary involvement in antibiotic use decisions, implementing treatment protocols, enhancing biosecurity, and ensuring optimal cow and calf immunity.

Infection control among professional tattooists in Minneapolis and St. Paul, MN.

OBJECTIVE: This study investigated infection control knowledge, beliefs, and practices of professional tattooists. METHODS: In a cross-sectional study of professional tattooists (N = 61), a self-administered questionnaire measured knowledge and beliefs related to blood-borne pathogen transmission and control and self-reported infection control procedures. The study also involved direct observation of the infection control practices of 25 tattoo artists. RESULTS: All respondents believed that bloodborne pathogens could be transmitted via tattooing, and most denied that trouble or expense were barriers to infection control. Knowledge about infection transmission and control was high and was positively associated with learning about infection control from a health official. Subjects were observed implementing an average of 44 of 62 recommended procedures. The percentage of recommended procedures used was negatively associated with years of tattooing experience. CONCLUSIONS: Tattooists have an understanding of the risks associated with exposure to blood, but this knowledge is not fully operationalized in the workplace. Interventions should focus on needle disposal, handwashing, cross-contamination, and cleaning prior to sterilization. Tattooists with > or = 10 years of experience are most in need of intervention. National guidelines for tattooing infection control and strategies for collaboration between public health officials and tattooists are needed.

The impact of foodborne calicivirus disease: the Minnesota experience.

The first outbreaks of Norwalk virus gastroenteritis in Minnesota were confirmed in 1982. Since then, Norwalk-like caliciviruses have been recognized to be the most common cause of foodborne disease outbreaks, accounting for 41% of all confirmed foodborne outbreaks in Minnesota from 1981-1998. Although laboratory confirmation of caliciviruses in stool samples was not attempted in most of these outbreaks, all conformed to epidemiologic criteria for defining outbreaks of Norwalk virus. Since 1996, the availability of polymerase chain reaction testing at the Minnesota Department of Health has allowed for the confirmation of calicivirus infection among patients involved in epidemiologically defined outbreaks of viral gastroenteritis. Results have confirmed the usefulness of characterizing foodborne disease outbreaks by epidemiologic criteria and also confirmed the importance of human caliciviruses as the leading cause of foodborne disease outbreaks in Minnesota.

Gender and physical therapy career success factors.

BACKGROUND AND PURPOSE: Gender and profession are thought to affect how career success is perceived as well as how it is achieved. This study investigated items considered important in defining career success for male and female physical therapists. The study also explored the relationship among gender, beliefs about career success, and career experiences. SUBJECTS AND METHODS: Data were obtained through an investigator-developed survey. The self-report questionnaire consisted of 78 items in 4 areas: descriptive information, items important in characterizing career success, items perceived to enhance or inhibit career success, and items assessing self-esteem. Questionnaires were mailed to a random sample of active physical therapist members of the American Physical Therapy Association (N = 5,000). The response rate was 38.1% (n = 1,906). RESULTS: Both men and women selected indicators such as practicing ethically, improving patient health, and feeling satisfied over high income or status when describing career success. All respondents agreed that clinical competency and motivation are key factors related to achieving career success. Family issues, full-time employment, and flexibility of practice conditions emerged as primary gender differences. CONCLUSION AND DISCUSSION: A unique set of indicators describe physical therapy career success. Gender differences in its description and factors that influence its achievement are related primarily to family issues. Career success for women depends to a greater degree on the ability to manage family responsibilities in conjunction with employment opportunities.

Information processing deficits and brain injury: preliminary results.

Information processing deficits are often reported in individuals who have sustained a brain injury. These deficits interfere with the patient's rehabilitation progress because of the brain's inability to efficiently process information. This article describes specific aspects of information processing (i.e. etiology, assessment, rehabilitation). A systematic treatment approach is further discussed using both a controlled group study and a single case design. The results, while tentative, suggest that a systematic approach toward the rehabilitation of information processing deficits was as qualitatively effective, and likely more cost-effective than traditional approaches.

Mild brain injury: an overview.

This special issue of Applied Neuropsychology focuses on mild brain injury. This article provides an overview of mild brain injury, including its epidemiology, etiology, diagnostic criteria, and clinical symptoms. The contributing authors discuss various issues related to this topic, and divergent views are presented. Specifically, these include causes, symptoms, assessment, and recovery from mild brain injury. In addition, rehabilitation and forensic aspects of mild brain injury are discussed. Collectively, it is anticipated that this special issue will help to clarify the nature of mild brain injury and stimulate additional interest and research into this phenomenon.

Emotional consequences and psychotherapy for individuals with mild brain injury.

It is well documented that even mild brain injury can manifest with significant cognitive and emotional symptoms. Undoubtedly, these alterations may result in career, social, and personal consequences. In this article we discuss and summarize psychotherapeutic approaches to be used for individuals with mild brain injury. The primary focus is on providing education and assistance for developing coping strategies. Once an individual recognizes, accepts, and adjusts to the limitations resulting from the brain injury, then a more favorable level of adjustment can occur.

Effects of unilateral vascular lesions and gender on visual spatial and auditory verbal attention span.

Unilateral cerebral vascular accidents (CVA) produce dominant hemisphere deficits in language and verbal memory, while nondominant hemisphere lesions often impair visual spatial analysis and visual memory. However, effects of unilateral lesions are less specified for visual spatial and auditory verbal attention span. The present study investigated whether tasks of attention span were sensitive to the effects of unilateral strokes. Left CVA females and males were compared to right CVA females and males on these measures. Age and education were not significantly related to performance Significant gender by stroke laterality interactions were found for the visual spatial attention span tasks. Left CVA females performed significantly worse than the other CVA groups on the visual spatial measures. These results suggest that there may be gender related differences in the effects of unilateral CVA on tasks of attention span.

Rehabilitation of visual processing deficits following brain injury.

Visual processing deficits are a common sequelae in individuals who have sustained a brain injury, Visual processing includes the acquisition of visual information and the appropriate use and manipulation of that information based upon task or environmental demands, Following brain injury, visual processing deficits can manifest in various ways, and will likely interfere with the patient's progress and rehabilitation outcome, This article describes the importance of understanding and accurately identifying visual processing deficits and implementing specific rehabilitation strategies to maximize functional independence.

Metacognition as the ultimate executive: Techniques and tasks to facilitate executive functions.

It has been well-documented that executive function deficits are a common consequence of brain injury. Metacognitive processes, in close alliance with executive functions, are viewed as integral components of learning and awareness. Combining all of these areas may be necessary to achieve a beneficial treatment plan for improving executive functions. This article provides a definitional analysis of executive functions and metacognitive processes and it discusses the role of learning, internal mediation, and strategy development. A specific executive functions program is described and suggested as a framework for establishing a metacognitive-learning routine.

Cerebral blood flow velocity in term newborns following intrapartum fetal asphyxia.

Twenty-six term newborns with intrapartum fetal asphyxia, determined biochemically (umbilical artery base deficit > 12 mmol/l), were compared with 59 normal newborns to determine the effect of intrapartum fetal asphyxia on newborn blood pressure and cerebral blood flow velocity following delivery. Cerebral blood flow velocity observations with concurrent measures of blood pressure and heart rate were obtained during the 24 h after delivery and after 24 h. After delivery, diastolic blood pressure in the newborns of the asphyxia group was significantly greater than that of the newborns of the normal group and this difference persisted after 24 h. Cerebral blood flow velocity in the newborns of the asphyxia group was of the same order as that of the newborns of the normal group during the 24 h after delivery. However, there was a significant increase in both peak systolic and end-diastolic blood flow velocity after 24 h. The duration of metabolic acidosis may be a factor in the occurrence of this delayed cerebral blood flow velocity response. Observations of cerebral blood flow velocity should be continued for more than 24 h following delivery to determine the effect of intrapartum fetal asphyxia.

Multinucleated rat alveolar macrophages express functional receptors for calcitonin.

The fusion of mononuclear phagocytes occurs spontaneously in vivo and leads to the differentiation of either multinucleated giant cells or osteoclasts in chronic inflammatory sites or in bone, respectively. Although osteoclasts are responsible for resorbing bone, the functional role of giant cells in chronic inflammatory reactions and tumors remains poorly understood. We recently reported that the plasma membrane of multinucleated macrophages is, like that of osteoclasts, enriched in Na-K-adenosinetriphosphatases (ATPases). We also observed that the localization of their Na-K-ATPases is restricted to the nonadherent domain of the plasma membrane of cells both in vivo and in vitro, thus imposing a functional polarity on their organization. By following this observation, we wished to investigate whether these cells also expressed, like osteoclasts, functional receptors for calcitonin (CT). To this end, alveolar macrophages were fused in vitro, and both their structural and functional association with CT was analyzed and compared with those of mononucleated peritoneal and alveolar macrophages. Evidence is presented that multinucleated alveolar macrophages express a high copy number of functional receptors for CT. Our results also indicate that alveolar macrophages, much like peritoneal, express functional receptors for calcitonin gene-related peptide. It is suggested that multinucleated rat alveolar macrophages offer a novel model system to study CT receptors and that calcitonin may control local immune reactions where giant cells differentiate.

Neuropsychological sequelae of stroke as a function of handedness.

The preservation of visuospatial ability relative to verbal ability following right middle cerebral artery stroke was assessed in 19 left- and 19 right-handed male patients who were group-matched on the basis of age, education, and time elapsed since stroke. Analysis of covariance (covarying education) indicated that the left- and right-handed groups were significantly different with regard to the discrepancy between Verbal IQ and Performance IQ, with the left-handed patients showing a smaller difference than the right-handers. These results provide further evidence that sinistrality may be associated with less hemispheric specialization.

Vasoactive intestinal peptide receptors on AR42J rat pancreatic acinar cells.

VIP receptors on AR42J rat pancreatic cells were analyzed by competition binding, affinity labeling and by N-glycanase digestion analyses. These studies revealed the presence of specific, high affinity (Kd approximately 1 nM) VIP receptors with a mass of 67 kDa or 59 kDa under reducing or non-reducing conditions, respectively. N-glycanase digestion of affinity labeled membranes generated a core receptor protein of approximately 44 kDa and evidence for at least two N-linked glycans on the mature receptor. The receptor lacked O-linked oligosaccharides but contained terminal sialic acid residues on its N-linked glycan(s) based on digestions with O-glycanase and neuraminidase. The similarity of the AR42J VIP receptor to the recently cloned cDNA for human VIP receptors makes this cell line an attractive model for further analysis of VIP receptor signal transduction events.

A differential scanning calorimetric study of the bovine lens crystallins.

Differential scanning calorimetry was performed on the five major lens crystallin fractions [HM-alpha, alpha, beta H, beta L, and (beta s + gamma)] of the bovine lens as well as on more purified forms of alpha- and gamma-crystallins. All were found to be relatively thermally stable although the alpha-crystallin were found to at least partially unfold at an approximately 10 degrees C lower temperature than the beta and gamma fractions. Increasing protein concentration had little effect on gamma-crystallin thermograms but had marked effects on those of the alpha- and beta-crystallins. Increases in the thermal stability with increasing protein concentration for the beta-crystallins can be explained most simply by the known beta L/beta H equilibrium, but, in the case of the alpha-crystallins, excluded volume effects may be an important factor. In both cases, the increased stability at high concentrations could be of physiological relevance. As well as the expected endothermic unfolding transitions, all of the lens crystallins revealed exothermic peaks that correlate with protein precipitation. Interestingly, this phenomenon occurs only after extensive structural alteration in the case of the alpha-crystallins but is present very early in the initial stages of structural perturbation of the beta- and gamma-crystallins.

Experimental evaluation of technetium-99m red blood cell radionuclide ventriculography for detecting pericardial bleeding.

Abnormal loculated or diffuse blood pools adjacent to the heart have been observed in patients with pericardial bleeding who have been imaged by gated equilibrium radionuclide ventriculography (RNV). To study the scintigraphic appearance of fresh pericardial blood, we performed equilibrium RNV in six dogs with measured volumes (10, 30, or 50 ml) of intrapericardial blood. Loculated and diffuse pericardial blood was simulated by injecting the blood either into an intrapericardial balloon, or freely into the pericardial space. Ability to detect pericardial blood was determined by blinded review, and blood volume analysis was attempted by measuring its scintigraphic thickness, brightness (relative to the left ventricle), extent, and background-subtracted count rate and a peak count index. Detection rates for 10, 30, and 50 ml were all 100% for loculated pericardial blood, and 67%, 100% and 100% for free pericardial blood, with the use of three scintigraphic views. Visually determined "extent" of the abnormal blood pool was the most reliable indicator of pericardial blood volume. When the volume was 30 ml or more, at least 40% of the heart was surrounded in 26 of 27 cases (96%); the specificity of this finding was 90%. We conclude from this animal study that RNV should be a sensitive method for detecting pericardial bleeding; visual appearance permits qualitative assessment of the volume of accumulated labeled blood.

Psycho-social aspects of youth unemployment: an interpretative theoretical model.

By utilizing representative samples of short-term (n = 33), long term (n = 14) unemployed adolescents and YTS trainees (n = 49) in North-East Scotland, the present study attempted to identify psycho-social variables involved in the individual adolescent's ability to cope with unemployment. The research was built around a series of semi-structured interviews with all subjects. Results suggested a variety of apparent contradictions--family support vs. parental pressure; informal community-based education as helpful vs. school education as irrelevant; high aspirations as reinforcing or frustrating; peer groups as supportive or socially constraining; time structure as welcome or monotonous and restrictive; self-esteem being sapped or maintained aggressively and defensively high. From the data a theoretical model is offered which attempts to resolve the paradoxes by interpreting the experience of unemployment for young people in terms of positive and negative "trade-offs".

Photoaffinity labeling of the gonadotropin receptor with native, asialo, and deglycosylated choriogonadotropin.

Human choriogonadotropin (hCG) is a heterodimeric hormone composed of an alpha and a beta subunit. hCG and its asialo (ashCG) and deglycosylated (dghCG) forms vary in their ability to stimulate hormone responsive adenylate cyclase. ashCG is a partial agonist, and dghCG is an antagonist. Photoactivatable moieties were coupled to hCG, ashCG, and dghCG, and the derivatives were radioiodinated. Competitive binding studies indicate that all of the derivatives had a similar affinity for the gonadotropin receptor on porcine granulosa cell membranes. Radiolabeled derivatives were used to photoaffinity label the gonadotropin receptor. Radiolabeled complexes were separated by NaDodSO4/PAGE. All of the derivatives produced similar autoradiographic patterns, except that dghCG produced an additional 48-kDa complex. To investigate the structure of the complexes further, peptide mapping of proteolytic digests was used. All, except for the 48-kDa complex, generated similar peptide maps indicating a relationship between those complexes in which the smaller components are part of the larger. The 48-kDa complex contained both subunits of 40-kDa dghCG. Therefore, this complex is expected to contain an additional component of 8 kDa. The complex was generated whether the hormone-receptor complex was photoaffinity labeled on cells, on isolated membranes, or after solubilizing in detergent. Formation was blocked by excess hCG and did not occur in the absence of UV irradiation. We conclude that the hCG derivatives are able to photoaffinity label the hCG receptor but that the dghCG derivative can photoaffinity label an additional component that was not observed when derivatives of hCG or ashCG were used to label the receptor.

Cardiac causes of shock early after open heart surgery: etiologic classification by radionuclide ventriculography.

Early after open heart surgery, cardiac shock due to tamponade is easily misdiagnosed as ventricular dysfunction. The distinction is critical to successful therapy. We assessed the utility of 99mTc-red blood cell, gated equilibrium radionuclide ventriculography in 50 patients with early postoperative cardiac shock after historical, clinical, and invasive hemodynamic evaluation failed to identify either tamponade or ventricular dysfunction as the specific cause of their shock. The cause was established by radionuclide ventriculography in 45 of 50 patients and led to a change in therapy in 21 patients. A single cause was found in 35 patients: 13 had severe global dysfunction of the left ventricle (three patients), right ventricle (seven patients), or both ventricles (three patients); three had severe segmental left ventricular dysfunction; and 19 had an exaggerated region of photon deficiency (nine patients) or an abnormal and accumulating blood pool (10 patients) surrounding small hyperdynamic ventricles. Sixteen of these 19 patients with scintigraphic evidence of tamponade underwent aspiration with a pericardial needle or reoperation early after radionuclide ventriculography, resulting in confirmation of scintigraphic findings and improved hemodynamics. Ten additional patients had combined ventricular dysfunction and a pericardial abnormality, and five of these underwent reoperation resulting in improved hemodynamics. Radionuclide ventriculography provided no explanation for the cause of cardiac shock in five patients. Thus, the various causes of cardiac shock early after open heart surgery can be distinguished by 99mTc-red blood cell, gated equilibrium radionuclide ventriculography, eliminating diagnostic uncertainty that can occur with traditional evaluation.

Effects of intubation on coronary blood flow and myocardial oxygenation.

Effects on haemodynamics and myocardial oxygenation of endotracheal intubation were examined in 17 patients after halothane induction and 12 after 1 mg X kg-1 of IV morphine. Six patients having each anaesthetic were pretreated with IV propranolol (0.1 mg X kg-1) 45 minutes earlier. Arterial and intracardiac pressures, cardiac output and total coronary sinus blood flow (CSBF), both by thermodilution, were determined plus arterial-coronary differences of oxygen, haemoglobin and lactate. Blood pressure (BP), heart rate and CSBF were recorded continuously during intubation. The subjects were candidates for coronary bypass grafts, but had good ventricular function (mean ejection fraction 0.68 +/- 0.13 SD). From their reduced levels after induction, BP, cardiac index and systemic vascular resistance increased to awake levels following intubation. Mean CSBF in nonbetablocked patients increased to awake level along with BP. More myocardial oxygen was extracted and consumed after intubation, but lactate extraction continued: these data are evidence of adequate oxygen supply. Induction with either halothane or morphine effectively prevented the hypertensive response to intubation. Acute beta blockade led to less increase in heart rate from intubation.