Preterm infants' biobehavioral responses to caregiving and positioning over 24 hours in a neonatal unit in Taiwan.

This prospective, descriptive study used a repeated-measures design to explore preterm infants' biobehavioral responses to 24-hour neonatal caregiving and positioning, and the factors associated with changes in their biobehavioral responses. Thirty preterm infants (gestational age 27.6-36.1 weeks) were observed for 3 days to record biobehavioral responses. Infants' disorganized behaviors increased as caregiving intrusiveness and supine positioning increased. Social interactions did not lead to increases in infants' disorganized behaviors, but to increased regulatory behaviors. Non-nutritive sucking (NNS), and prone positioning reduced occurrences of infant disorganized behaviors. Routine caregiving increased instability of oxygen saturation, but lateral and prone positioning improved physiological stability. Clinicians can appropriately provide NNS, positioning, and social interactions to promote biobehavioral stability.

Inspiratory muscle training in bronchiectasis patients: a prospective randomized controlled study.

OBJECTIVE: To investigate the efficacy and feasibility of home-based inspiratory muscle training in patients with bronchiectasis. DESIGN: A prospective, single-blind, randomized, controlled study. SETTING: Outpatient clinic of a tertiary care medical centre. METHODS: Twenty-six patients with bronchiectasis were randomly divided into inspiratory muscle training and control groups. In the inspiratory muscle training group (n = 13), the training programme started with an intensity of 30% maximal inspiratory pressure (MIP), which was increased by 2 cmH(2)O each week, for 30 minutes daily, 5 days a week for eight weeks. The control group (n = 13) did not receive inspiratory muscle training. Main outcome measures included spirometry, resting oxyhaemoglobin saturation by pulse oximetry (SpO(2)), lowest SpO(2) and Borg Scale during 6-minute walking tests, 6-minute walking distance (6MWD), 6-minute walking work (6M(work)), MIP, maximal expiratory pressure (MEP) and St George's Respiratory Questionnaire. RESULTS: There were significant differences in change from baseline in 6MWD (411.9 (133.5) vs. 473.2 (117.2) m, P = 0.021), 6M(work) (21 051.0 (8286.7) vs. 23 915.5 (8343.0) kg-m, P = 0.022), MIP (60.8 (21.8) vs. 84.6 (29.0) cmH(2)O, P = 0.004), and MEP (72.3 (31.1) vs. 104.2 (35.7) cmH(2)O, P = 0.004) in the inspiratory muscle training group. Significant improvements in both MIP (23.8 (25.3) vs. 2.3 (16.4) cmH(2)O, adjusted P-value = 0.005) and MEP (31.9 (30.8) vs. 11.5 (20.8) cmH(2)O, adjusted P-value = 0.038) levels after adjusting for age by linear regression analysis were observed between groups. CONCLUSIONS: An eight-week home-based inspiratory muscle training is feasible and effective in improving both inspiratory and expiratory muscle strength, but has no effect on respiratory function and quality of life in patients with bronchiectasis.

Clinical inertia in the management of low-density lipoprotein abnormalities in an HIV clinic.

A retrospective cohort study evaluating the frequency of and factors related to clinical inertia in low-density lipoprotein (LDL) management was performed. Subjects were 90 patients that were not meeting National Cholesterol Education Program Adult Treatment Panel III LDL goals at the University of Alabama at Birmingham 1917 HIV/AIDS Clinic between 1 August 2004 and 1 August 2005. Clinical inertia was observed in 44% of cases. Patients with higher baseline LDL levels were less likely to experience inertia, whereas women and those in the highest coronary heart disease risk category were more likely to be affected.

Failure to establish HIV care: characterizing the "no show" phenomenon.

It is estimated that up to one-third of persons with known human immunodeficiency virus (HIV) infection in the United States are not engaged in care. We evaluated factors associated with patients' failure to establish outpatient HIV care at our clinic and found that females, racial minorities, and patients lacking private health insurance were more likely to be "no shows." At the clinic level, longer waiting time from the call to schedule a new patient visit to the appointment date was associated with failure to establish care. Because increased numbers of patients will be in need of outpatient HIV care as a result of recent Centers for Disease Control and Prevention guidelines advocating routine HIV testing, it is imperative that strategies to improve access are developed to overcome the "no show" phenomenon.

Nucleoside reverse-transcriptase inhibitor dosing errors in an outpatient HIV clinic in the electronic medical record era.

Information on antiretroviral dosing errors among health care providers for outpatient human immunodeficiency virus (HIV)-infected patients is lacking. We evaluated factors associated with nucleoside reverse-transcriptase inhibitor dosing errors in a university-based HIV clinic using an electronic medical record. Overall, older age, minority race or ethnicity, and didanosine use were related to such errors. Impaired renal function was more common in older patients and racial or ethnic minorities and, in conjunction with fixed-dose combination drugs, contributed to the higher rates of errors in nucleoside reverse-transcriptase inhibitor dosing. Understanding the factors related to nucleoside reverse-transcriptase inhibitor dosing errors is an important step in the building of preventive tools.

Xylella fastidiosa Transmission and Life History of Two Cicadellinae Sharpshooters, Kolla paulula and Bothrogonia ferruginea (Hemiptera: Cicadellidae), in Taiwan.

Xylella fastidiosa causes Pierce's disease (PD) and is transmitted by xylem-sap-feeding insects. While X. fastidiosa -infected grapevines have been detected, the transmission vectors reported have never been recorded in Taiwan. Previous studies have suggested that Kolla paulula (Walker) and Bothrogonia ferruginea (F.) are candidate vectors in Taiwan. Here, we explored the life history of these two leafhoppers, evaluated the transmission efficiency of X. fastidiosa by the vectors, and investigated the genetic identity of three collected X. fastidiosa strains, namely, GMb, BQa, and BQ7f from the grapevine cultivars Golden Muscat (GM) and Black Queen (BQ), and one previously extracted strain GV148 from Kyoho (GV) showing PD symptoms in local vineyards. The results showed that all four strains were 100% identical to X. fastidiosa isolate Temecula1 from a naturally infected grapevine in the United States based on sequence analyses of 16S rRNA and 16S-23S ITS. The acquisition rates by K. paulula and B. ferruginea from the symptomatic cultivar Golden Muscat were 83.3 and 70.0% per individual, and the transmission rates to healthy grapevines were 13.3 and 6.7%, respectively. The acquisition rates by the groups of three K. paulula from the symptomatic cultivars Golden Muscat and Black Queen were 54.7 and 49.6%, respectively. Additionally, the transmission rates by K. paulula from and to each of these two grapevine cultivars were not significantly different. In view of their acquisition from infected grapevines and the effective transmission of X. fastidiosa to healthy grapevines, these two sharpshooter species are vectors of X. fastidiosa in Taiwan.

Inhibition of neuroinflammation by cinnamon and its main components.

Uncontrolled activation of microglia contributes to neuroinflammation, which is highly involved in the development of neurodegenerative diseases. Although cinnamon has neuro-protective properties, its capacity to inhibit neuroinflammation has not been investigated and its active compounds remain unclear. Therefore, the composition of cinnamon extract was analysed by LC-MS and the ability of cinnamon and its main constituents to inhibit neuroinflammation was evaluated using a lipopolysaccharide (LPS)-activated BV2 microglia culture system. In total, 50 µg/mL cinnamon extract decreased significantly the production and expression of nitric oxide (NO), interleukin (IL)-1ß, IL-6, and tumor necrosis factor (TNF)-α in LPS-activated BV2 microglia. Blocking of nuclear factor-κB (NF-κB) activation was the most likely mechanism responsible for inhibition by cinnamon of neuroinflammation. Among the eight tested compounds, cinnamaldehyde had the greatest anti-neuroinflammatory capacity. Experimental results suggest that cinnamon may have a potential therapeutic effect against neurodegenerative diseases and its potent anti-neuroinflammatory capacity was primarily attributed to cinnamaldehyde.

Risk factors for mortality in patients with nosocomial Stenotrophomonas maltophilia pneumonia.

OBJECTIVE: The aim of this study was to determine potential risk factors for mortality in patients with nosocomial Stenotrophomonas maltophilia pneumonia. DESIGN: A retrospective, single-center, observational study. SETTING: A 2400-bed tertiary teaching hospital in southern Taiwan. PATIENTS AND METHODS: This retrospective study evaluated patients (age, at least 18 years) with nosocomial pneumonia (S. maltophilia isolated from respiratory culture) who were seen at Kaohsiung Chang Gung Memorial Hospital over a 3-year period. A total of 406 patients (64% male, mean age +/- standard deviation, 69.6 +/- 14.93 years; mean duration of hospital +/- standard deviation, 57.5 +/- 39.47 days) were included. RESULTS: Most index isolates (53.9%) were from the first sample cultured. Polymicrobial isolates were cultured from samples from 177 (43.6%) of the 406 study patients. The most common copathogen was Pseudomonas aeruginosa (53.11% of isolates). The all-cause hospital mortality rate was 42.6% (173 deaths among 406 patients). Survivors had a shorter time from admission to a positive index culture result than did nonsurvivors (26.1 vs 31.7 days; P = .04). Mortality was significantly higher among patients with malignancy (adjusted odds ratio [AOR], 2.48; 95% confidence interval [CI], 1.52-4.07; P < .001), renal disease (AOR, 2.6; 95% CI, 1.51-4.47; P = .001), intensive care unit stay (AOR, 1.72; 95% CI, 1.1-2.7; P = .018), and inadequate initial empirical antibiotic therapy (AOR, 2.17; 95% CI, 1.4-3.38; P = .001). CONCLUSIONS: S. maltophilia pneumonia is associated with a high mortality rate and is commonly associated with concomitant polymicrobial colonization or infection. Underlying comorbidities and inadequate initial empirical antibiotic therapy substantially account for increased mortality rates.