Trauma rates and patterns in specific pathogen free (SPF) rhesus macaque (Macaca mulatta) groups.

There are some predictable patterns of trauma in captive rhesus macaque (Macaca mulatta) social groups. Several factors have been documented to contribute to these patterns, including group formation of unrelated animals, and the establishment of dominance ranks. Here, we report on how socially induced trauma in groups of rhesus monkeys is influenced by the breeding season, numbers of matrilines per group and matriline size. We analyzed 3 years of data collected from veterinary admittance logs for four groups in our specific pathogen free (SPF) breeding colony. Since the groups differed in time from formation, both the numbers of matrilines and the composition of those matrilines were different. Across the four groups, trauma rates were significantly higher during the fall breeding season than the spring and summer months when births occur. The group that was formed most recently, comprised of the greatest number of matrilines but fewest related animals, showed significantly higher rates of trauma than the older social groups. Further, the middle and lowest ranking families received signifincantly higher rates of trauma than the highest ranking families, suggesting a rank-related phenomenon. Additionally, there was a significant negative correlation between numbers of adult females in a matriline and rates of trauma observed in each matriline, but the numbers of adult females are significantly higher in the top ranked families compared to all of the other matrilines. These findings suggest that trauma rates increase during the breeding season and may be exacerbated in recently formed breeding groups that have smaller matrilines and reduced opportunities for social support to mitigate rank-related aggression. Management practices should be devised to ensure adequate matrilineal size to decrease rates of trauma in captive rhesus macaque groups.

Eu(2+) luminescence in strontium aluminates.

The luminescence properties of Eu(2+) doped strontium aluminates are reported and reviewed for a variety of aluminates, viz. SrAl12O19, SrAl4O7, Sr4Al14O25, SrAl2O4 and Sr3Al2O6. The aim of the research is to investigate the role of local coordination and covalency of the aluminate host lattice, related to the Sr/Al ratio, on the optical properties of the Eu(2+) ion. The UV and VUV excited luminescence spectra as well as luminescence decay curves were recorded to characterize the luminescence properties of the investigated aluminates. The emission of Eu(2+) ions varies over a wide spectral range, from ultraviolet (UV) to red, for the series of aluminates. The variation in emission color can be related to the crystal-field splitting of the 5d levels and the covalent interaction with the surrounding oxygen anions. In the least covalent material, viz. SrAl12O19:Eu(2+), narrow line emission due to the (6)P7/2-(8)S7/2 transition occurs at 4 K, indicating that the 4f(6)5d excited state is situated above the (6)P7/2(4f(7)) excited state around 360 nm. The most alkaline material, viz. Sr3Al2O6:Eu(2+) is the most covalent host and exhibits several d-f emission bands in the yellow to red spectral range due to the Eu(2+) ions located on different crystallographic Sr(2+) sites. The Eu(2+) emission spectra in the other aluminates confirm the trend that with increasing Sr/Al ratio the Eu(2+) emission shifts to longer wavelengths. Interesting differences are observed for the Eu(2+) from different crystallographic sites which cannot always be related with apparent differences in the first oxygen coordination sphere. The discussion gives insight into how in a similar class of materials, strontium aluminates, the emission color of Eu(2+) can be tuned over a wide spectral region.

Adult caregivers in the United States: characteristics and differences in well-being, by caregiver age and caregiving status.

We examined the characteristics of adults providing regular care or assistance to friends or family members who have health problems, long-term illnesses, or disabilities (ie, caregivers). We used data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) to examine caregiver characteristics, by age and caregiving status, and compare these characteristics with those of noncaregivers. Approximately 24.7% (95% confidence interval, 24.4%-25.0%) of respondents were caregivers. Compared with younger caregivers, older caregivers reported more fair or poor health and physical distress but more satisfaction with life and lower mental distress. Understanding the characteristics of caregivers can help enhance strategies that support their role in providing long-term care.

Stimulatory adrenocortical effects of a selective estrogen receptor modulator in ovariectomized female macaques.

Here, we report the effects of estrogen and the selective estrogen receptor modulator (SERM) levormeloxifene on adrenocortical measures in ovariectomized female cynomolgus monkeys (Macaca fascicularis). Animals were randomized into one of five treatment groups, each containing 23 to 26 animals: (1) placebo, (2) 0.016 mg/kg 17ß-estradiol (E(2)), (3) 0.5 mg/kg levormeloxifene (L(1)), (4) 1.0 mg/kg levormeloxifene (L(2)), and (5) 5.0 mg/kg levormeloxifene (L(3)). Treatments were administered orally each day for 18 mo. All doses of levormeloxifene resulted in adrenal weights at least 50% greater than placebo (p < .0001 for all). The target dose of levormeloxifene (L(2)) resulted in higher serum concentrations of cortisol (+63%), dehydroepiandrosterone-sulfate (+73%), and androstenedione (+37%) compared with the placebo group (p < .05 for all). In contrast, E(2) resulted in no significant differences in adrenal weight or adrenocortical steroids. Oral E(2) and all SERM doses resulted in similar reductions in serum gonadotropins and at least threefold greater uterine weight versus placebo (p < .0001 for all). Results indicate that the SERM levormeloxifene, in contrast to E(2), may have robust stimulatory effects on adrenocortical hormones in a postmenopausal model. These findings warrant further investigation into long-term SERM effects on adrenocortical function.

Non-human leukocyte antigen antibodies reactive with endothelial cells could be involved in early loss of renal allografts.

Preformed donor-specific human leukocyte antigen (HLA) antibodies have been associated with allograft dysfunction and failure. However, recipients of HLA-identical kidneys can develop acute humoral rejection, implicating putative pathogenic antibodies that are directed against non-HLA antigens. We investigated the presence of endothelial cell-reactive antibodies in 11 patients who experienced early loss of their transplanted kidneys owing to humoral rejection and 1 loss from renal venal thrombosis. We examined the potential efficacy of intravenous immunoglobulin to block the binding of these antibodies, as previously suggested for anti-HLA antibodies.

Roles of organizers and champions in building campus-community prevention partnerships.

OBJECTIVE: A campus-community partnership can be an effective vehicle for launching environmental strategies to prevent college alcohol-related problems. In this study, the authors' primary aim was identifying key factors that facilitate or impede colleges' efforts to build campus-community partnerships. PARTICIPANTS AND METHODS: From fall 2004 to summer 2006, administrators at five 4-year colleges participated in a multisite case study. Level of partnership development was the primary outcome. RESULTS: Three interrelated factors facilitated higher-developed partnerships: college staff assigned to facilitate the partnerships who worked as community organizers, higher-level college administrators who served as aggressive champions, and community initiation of the partnership. The authors did not observe this trio of factors among the less-developed partnerships. A lack of administrative support made it more difficult for a champion to emerge, a college administrator who staunchly advocated for a campus-community partnership, and for those assigned to facilitate the partnership to carry out their work. CONCLUSIONS: Colleges should appoint higher-level administrators to serve as champions, while also ensuring that those assigned to facilitate a partnership can apply community organizing skills.

MRI of ischemic stroke in canines: applications for monitoring intraarterial thrombolysis.

PURPOSE: To describe a canine embolic stroke model that is appropriate for endovascular procedure evaluations and develop local cerebral blood flow (CBF) maps to monitor the progression of stroke and thrombolysis. In the future, MR may displace X-ray imaging in some endovascular procedures, such as intraarterial (IA) thrombolysis for stroke therapy, due to increased monitoring capabilities. For MR to attain its full potential in endovascular therapy, the development of appropriate disease models and monitoring techniques is essential. MATERIALS AND METHODS: The canine stroke model uses an injection of autologous clot to produce ischemic and infarcted tissue and produces a range of stroke severities within the anterior cerebral circulation. Local CBF maps were formed by using the catheter that would be in place to deliver the thrombolytic agent for treatment to deliver the gadolinium-based contrast agent for perfusion imaging. RESULTS: After the injection of clot, changes on imaging were consistent with the progression of ischemic stroke. Local CBF maps showed perfusion changes with stroke progression and treatment. CONCLUSION: We successfully demonstrate the progression of ischemic stroke in the canine to mimic the progression of human stroke. CBF maps to show local perfusion characteristics show great potential in the evaluation of stroke therapy.

Supportive care needs of Americans: a major issue for women as both recipients and providers.

In 2004, there were approximately 44 million men and women in the United States who were providing unpaid care to a family member, friend, or neighbor; these caregivers represented an estimated 22.9 million households (21% of all U.S. households). The 1-year economic value of this unpaid labor force was recently estimated to be 306 billion dollars. Caregiving is an important issue for women, as they represent 61% of those providing care and 65% of those receiving care. Women caregivers tend to fare worse than men, reporting higher levels of symptoms tied to depression and anxiety and lower levels of subjective well-being, life satisfaction, and physical health. In addition, the care that women provide is not without cost to them in terms of their financial future. Still, despite the burden, most caregivers consider providing care to family and friends a rewarding experience.

What coalition factors foster community capacity? Lessons learned from the Fighting Back Initiative.

Coalitions build community capacity by encouraging local organizations to expand services, programs, or policies (i.e., organizational capacity). The aim of the study was to identify coalition factors--resources, lead agency, governance, and leadership--that foster organizational capacity. Thirteen coalitions funded by Robert Wood Johnson Foundation's Fighting Back (FB) Initiative were examined in a multiple-site case study where coalition served as the unit of analysis. Organizational capacity was measured by creating a scale for each community based on changes in programs, services, or policies among eight types of organizations. Both qualitative and quantitative analyses were conducted to identify relationships among organizational capacity and coalition factors. FB sites with greater organizational capacity shared seven characteristics: received more funds for coalition building; delayed establishing new lead agencies; were housed in agencies supportive of FB; maintained stable, participatory decision-making bodies; cultivated active involvement of local government; practiced collaborative leadership; and had effective, long-serving project directors.

Framing the public health of caregiving.

Caregiving has only recently been acknowledged by the nation as an important topic for millions of Americans. A psychological or sociological approach to care-giving services has been most often applied, with little attention to the population-based public health outcomes of caregivers. We conceptualize caregiving as an emerging public health issue involving complex and fluctuating roles. We contend that caregiving must be considered in the context of life span needs that vary according to the ages, developmental levels, mental health needs, and physical health demands of both caregivers and care recipients.

What explains community coalition effectiveness?: a review of the literature.

Community coalitions have become popular vehicles for promoting health. Which factors make coalitions effective, however, is unclear. The study's aim was to identify coalition-building factors related to indicators of coalition effectiveness through a review of the empirical literature. Published articles from 1980 to 2004 that empirically examined the relationships among coalition-building factors and indicators of coalition effectiveness were reviewed. Two indicators of coalition effectiveness were examined: coalition functioning and community-wide changes. A two-phase strategy was employed to identify articles by reviewing citations from previous literature reviews and then searching electronic reference databases. A total of 1168 non-mutually exclusive citations were identified, their abstracts reviewed, and 145 unique full articles were retrieved. The review yielded 26 studies that met the selection criteria. Collectively, these studies assessed 26 indicators of coalition effectiveness, with 19 indicators (73%) measuring coalition functioning, and only two indicators (7%) measuring changes in rates of community-wide health behaviors. The 26 studies identified 55 coalition-building factors that were associated with indicators of coalition effectiveness. Six coalition-building factors were found to be associated with indicators of effectiveness in five or more studies: formalization of rules/procedures, leadership style, member participation, membership diversity, agency collaboration, and group cohesion. However, caution is warranted when drawing conclusions about these associations due to the wide variations in indicators of coalition effectiveness and coalition-building factors examined across relatively few studies, discrepancies in how these variables were measured, and the studies' reliance on cross-sectional designs.

Community coalition project directors: what makes them effective leaders?

OBJECTIVE: Effective leaders, both voluntary and paid, facilitate successful coalitions. The attributes that characterize effective project directors, however, are unclear. Our aim was to identify characteristics of effective project directors leading community coalitions. METHODS: The study examined 13 project directors who led eight community-based coalitions established to combat substance abuse. We inductively identified common characteristics and leadership effectiveness of the project directors by abstracting data from detailed ethnographic studies of these coalitions. We assessed the validity of leadership effectiveness by comparing data abstracted from ethnographic studies with two independent ratings. We then employed a cross-case comparison strategy for analyzing patterns among the common characteristics identified and leadership effectiveness. Six characteristics emerged among the project directors studied: status with community (insider vs outsider); shared leadership; bridge building skills; substance abuse expertise; vision; and management style. RESULTS AND CONCLUSIONS: Shared leadership, bridge building skills, and insider status were consistently related to leadership effectiveness. Less support was found for substance abuse expertise or vision. When hiring project directors, coalition leaders may consider assessing whether candidates are "insiders" within the community and demonstrate shared leadership and bridge building skills.

Prosthetic valve endocarditis

Prosthetic valve infective endocarditis represents a defined pathological entity which follows an epidemiological and nosological pattern in accordance to an arbitrary classification. Chronologically it is divided into the entities of early and late prosthetic valve endocarditis, each with its own unique characteristics. The clinical features, complications and diagnosis do not vary much from native valve endocarditis. There are clear and precise indications to aid in the diagnosis and treatment of this entity which differ from native valve endocarditis

Cortisol response to relocation stress in Garnett's bushbaby (Otolemur garnettii).

Relocation of research animals, either within a facility or from one facility to another, is assumed to be stressful. Development of appropriate research methodologies may be facilitated by understanding the extent and duration of the physiological response to relocation stress and whether the stress can be buffered by environmental or social factors, such as the presence of a cagemate. To characterize the response to relocation stress in Garnett's bushbaby, we assessed cortisol concentrations in nine female and six male bushbabies during relocation to a different facility; six of the animals were pair-housed at the time of the move and were moved with their respective cagemates. Fecal cortisol was assessed at three time points: 1) baseline (1 day prior to moving); 2) relocation (the day the animals were relocated); and 3) post-relocation (7 days after relocation). Cortisol concentrations were higher at the relocation time point than at baseline and post-relocation, which did not differ. Cortisol concentration did not differ as a function of having a cagemate during relocation. Although relocation resulted in a significant (P < 0.05) increase in cortisol excretion concentration, the levels returned to baseline within 7 days after the stressor.

Melatonin enhances the in vitro and in vivo repair of severed rat sciatic axons.

This study examines the effects of several experimental compounds [melatonin (MEL), cyclosporin A (CsA), glial-derived neurotrophic factor (GDNF), and methylprednisolone (MP)] on polyethylene glycol (PEG)-induced repair in vitro and/or in vivo by plasmalemmal fusion (PEG-fusion) of sciatic axons severed by crushing. As measured by conduction of compound action potentials (CAPs) through the lesion site, a significantly (p<0.025) higher percentage (75%) of crushed rat sciatic axons can be repaired in vitro by PEG-fusion following exposure to MEL compared to PEG-fusion of severed sciatic axons in control Krebs saline that contains calcium (CTL=20%). In contrast, no other experimental compound (GDNF: 45%; MP: 42%; CsA: 24%) produces a significant improvement in PEG-fusion success compared to CTL. Further, MEL produces significantly (p<0.001) larger peak CAP amplitudes conducted through the lesion site following PEG-fusion compared to CTL or any other experimental compound in vitro. Additionally, MEL significantly (p<0.025) increases the ability to PEG-fuse sciatic axons in vivo, compared to CTL. Finally, PEG-fusion success in vivo is significantly (p<0.01) greater in calcium-free CTL (CTL-Ca) compared to CTL.

Phenotypic confirmation of extended-spectrum B-lactamases (ESBL) in clinical isolates of Escherichia coli and Klebsiella pneumoniae at the San Juan Veterans Affairs Medical Center

Extended-spectrum Beta (beta)-lactamases (ESBLs) have emerged as an important mechanism of resistance to B-lactam antibiotics in gram-negative bacteria (GNB). They are enzymes that hydrolyze older B-lactam antibiotics as well as broad-spectrum cephalosporins and monobactams. ESBL producers have been reported in many bacteria but special attention has been paid to the ones in E.coli and Klebsiella spp. Detection of the ESBLs by the clinical laboratory is a special challenge. Surveillance to monitor resistance is important to decide when detection of ESBLs must be started. This study determined the prevalence of ESBL producers in the strains E.coli and K.pneumoniae at the San Juan VA Medical Center, and characterized their phenotypes to evaluate the importance to identify these bacteria as a standard routine procedure in the institution. All E.coli and K.pneumoniae isolated from Jan 1 to Mar 31, 2003 were evaluated according to National Committee for Clinical Laboratory Standards (NCCLS) screening criteria for suspected ESBL producers. Phenotypic confirmation of the ESBL production was performed using the Etest method. A total of 112/253 (44%) E.coli and 72/137 (53%) K.pneumoniae were identified as suspected ESBL producers. Etest was performed in 60% of the E.coli and 57% of the K.pneumoniae suspected to be ESBL producers. The overall ESBL prevalence for E.coli was 25% and in K.pneumoniae was 26%. Most E.coli ESBL-producers were from urine while the K.pneumoniae were from sputum. ESBL-producers were isolated from different sources including pleural and synovial fluids, blood, and skin besides urine and sputum. According to susceptibility results, the most reliable antibiotic in predicting a negative ESBL was cefpodoxime (CPD), and in the strains studied, the ESBL producers were consistently resistant to aztreonam (ATM). A large proportion (95%) of ESBL producing K.pneumoniae were susceptible to cefepime (CEP). Of the ESBL producing E.coli, 24% were susceptible. In the case of E.coli ESBLproducers, Cefepime can be considered as a therapeutic option if susceptibilities are available. Automated identification and sensitivity systems are valid alternatives for routine evaluation of B-lactam resistance but when increased resistance is documented in GNB and/or ESBL prevalence is high, ESBL detection should be performed. All confirmed ESBL producers should be reported resistant to all penicillins, cephalosporins, and aztreonam in spite of having susceptible ra

A commitment to professional caregivers: the Rosalynn Carter Institute for Human Development.

When the term caregiver is used, one most often thinks about family caregivers and other informal providers of assistance to impaired individuals. The Rosalynn Carter Institute (RCI) is the only national institute or center to take a different approach to addressing the needs of the nation's caregivers and caregiving teams. The universal psychosocial difficulties and shared rewards associated with all types of caregiving shape the research, education, and advocacy agendas of the RCI, founded in honor of former First Lady Rosalynn Carter. This article provides an introduction to the work of the RCI that may be of interest to gerontologic nurse caregivers.

Antibiotics in older adults

Antibiotics are frequently prescribed in the older person, the dosification needs special care, since the pharmacokinetic parameters changes with aging and the side effects can be different in the older person. The creatinine clearance changes and we must modify the way we prescribe such antibiotics to the elderly, calculating. The variety of antibiotics now available led us to consider this paper in which we have presented the antimicrobial agents that can be considered in the treatment of the older person. We present several groups: the penicillins, cephalosporins, monobactams, carbapenems and betalactamase inhibitors or the great betalactam group. Other trimetroprin-sulfame-thoxazole, the newer macrolides (azithromycin and clarithromycin) as well as the aminoglycosides, vancomycin, clindamycin, metroridazole. The indications and contraindications are presented and reviewed.

Potentially serious infections in the aging person: diagnosis, treatment and prevention

Infections in the elderly patient are a challenge, since the classical signs of infection are absent or ill defined. The present paper describes the presentation, diagnosis, clinical manifestations and treatment for a selected group of potential serious infections including influenza, bacterial pneumonia, urinary tract infections as well as infections caused by multiresistant bacteria, like vacomycin-resistant enterococcus and methicillin resistant S. aureus. We conclude with the need for prevention in the older person with the use of vaccines, specifically the influenza and pneumococcal vaccine as well as the prevention of urinary infections. Influenza is a significant cause of morbidity, whose ill effects can be prevented in many older persons with the use of a vaccine. The use in prophylaxis and treatment of antiviral agents like amantadine, rimatadine, and oseltamivir is presented. Bacterial pneumonia is one of the leading causes of death in the USA among the older persons. The emergence of drug resistant Streptococcus pneumoniae leads to the consideration as empiric therapy the newer fluoroquinolones or the use of third or fourth generation cephalosporis. Of importance is the use of pneumococcal vaccine among people age 60 or above. The frequency of urinary tract infections among the elderly is of primary although in many instances important do not require treatment. When infection of the urinary tract is diagnosed, most authors use a fluoroquinolone as empiric theraphy. The emergence of multiresistant bacteria like methicillin resistant S. aureus and or vancomycin resistant enterococci leads to the need to consider new agents like quinipristin-dalfopristin, linezolid and deptomycin in the management of such patients.

Management of urinary tract infections, decubitus ulcer and pneumonia in the aging person

Infections in the older person are common and a significant cause of morbidity and mortality. Infections of the urinary tract, skin and soft tissue infections including decubitus ulcers, antibiotics associated diarrhea and lower respiratory tract infections are particularly important in the elderly because of their frequency. While most initial antibiotic therapy is empiric, its important before treatment to try to document the etiology for better use of antibiotics. Infections of the urinary tract are frequently and potentially serious in the elderly, they must be separated from asymptomatic bacteriuria that requires no therapy. Upper and lower urinary tract infections are frequently caused by aerobic gram negative bacilli and or enterococci. Most authors prefer the use of fluoroquinolones to manage such infections. The elderly with decubitus ulcer presents a problem in management, since these are frequent polymicrobic infections in which anaerobes play an important role. The initial therapy usually involves the combination of a fluoroquinolone plus an antianaerobic agent like clindamycin. C. difficile diarrhea as frequent in nursing home residents as well as the older person with prior antibiotics. The treatment should be with metronidazole and avoid the use of vancomycin. Pneumonias in the elderly can be acquired in the community, the nursing home or during a hospitalization. The etiologic agents that predominate change from S. pneumoniae and atypicals in those from the community to an increase in gram negative pneumonia. The initial treatment as started by most authors as well as guidelines include the use of a new fluoroquinolone like gatifloxacin alone or in combination with a beta-lactamic agent like ceftriaxone. For those infections acquired in the hospital therapy with third or fourth generation cephalosporins, carbapenems, beta-lactams with betalactamase inhibitors alone or in combination with an aminoglucoside and or vancomycin if MRSA is suspected is accepted therapy