Characterizing Intervention Opportunities among Home-Delivered Meals Program Participants: Results from the 2017 National Survey of Older Americans Act Participants and a New York City Survey.

BACKGROUND: The Home Delivered Meals Program (HDMP) serves a vulnerable population of adults aged 60 and older who may benefit from technological services to improve health and social connectedness. OBJECTIVE: The objectives of this study are (a) to better understand the needs of HDMP participants, and (b) to characterize the technology-readiness and the utility of delivering information via the computer. DESIGN: We analyzed data from the 2017 NSOAAP to assess the health and functional status and demographic characteristics of HDMP participants. We also conducted a telephone survey to assess technology use and educational interests among NYC HDMP participants. MEASUREMENTS: Functional measures of the national sample included comorbidities, recent hospitalizations, and ADL/IADL limitations. Participants from our local NYC sample completed a modified version of the validated Computer Proficiency Questionnaire. Technology readiness was assessed by levels of technology use, desired methods for receiving health information, and interest in learning more about virtual senior centers. RESULTS: About one-third (32.4%) of national survey HDMP participants (n=902) reported insufficient resources to buy food and 17.1% chose between food or medications. Within the NYC HDMP participant survey sample (n=33), over half reported having access to the internet (54.5%), 48.5% used a desktop or laptop, and 30.3% used a tablet, iPad, or smartphone. CONCLUSION: The HDMP provides an opportunity to reach vulnerable older adults and offer additional resources that can enhance social support and improve nutrition and health outcomes. Research is warranted to compare technological readiness of HDMP participants across urban and rural areas in the United States.

Ovulation induction and small for gestational age neonates in twin pregnancies.

OBJECTIVE: To compare the incidence of small for gestation age (SGA) neonates in twin gestations conceived by ovulation induction or in vitro fertilization with that of twins conceived spontaneously. STUDY DESIGN: A retrospective cohort study was conducted. Subjects were delivered by a single obstetric practice between 2005 and 2011 at the Mount Sinai Medical Center. Maternal and neonatal data were recorded. Our primary outcome was the incidence of SGA, defined as birth weight <10th percentile, from the three modes of conception. Chi square, ANOVA, Fisher's exact test, the Kruskal-Wallis test, the Mantel-Haenszel test, and logistic regression were used in the analysis. RESULTS: In unadjusted analysis, using the records of 756 infants from 378 mothers of twin pregnancies, twins conceived by ovulation induction had an increased incidence of SGA (28.1%) compared to those conceived spontaneously (17.1%) and by in vitro fertilization (16.5%, p = 0.006). In a logistic regression model accounting for correlated responses between twins and adjusting for gestational age, gender, chorionicity, and maternal age, the odds ratio (95% confidence interval [CI]) of SGA for the ovulation induction group compared to the spontaneous conception group was 2.64 (1.38-5.05, p = 0.003). The odds ratio (95% CI) of SGA for the in vitro fertilization group compared to the spontaneous conception group was 1.51 (0.88-2.61, p = 0.135). CONCLUSIONS: When adjusted for gestational age, gender, chorionicity, and maternal age, twin neonates conceived by ovulation induction, but not those conceived by in vitro fertilization, had increased odds of SGA compared to those conceived spontaneously.

Rescue corticosteroids in twin pregnancies and short-term neonatal outcomes.

OBJECTIVE: To estimate the efficacy of a rescue course of antenatal corticosteroids in twin pregnancies. DESIGN: Retrospective cohort study. SETTING: Tertiary-care centre. POPULATION: Twins born from 24 to <34 weeks of gestation in a single maternal and fetal medicine practice from 2006 to 2011. METHODS: We compared neonatal outcomes in 88 twins exposed to a single course of corticosteroids with outcomes in 42 twins exposed to two courses of corticosteroids: the initial course and a single rescue course. Analyses were adjusted to control for correlation between twins born to the same mother. MAIN OUTCOME MEASURE: Short-term neonatal respiratory morbidity. RESULTS: Rescue corticosteroids were associated with fewer days of mechanical ventilation (7.3 ± 3.3 versus 33.9 ± 25.3 days, P = 0.003), fewer days with a fraction of inspired oxygen of >21% (6.3 ± 4.3 versus 33.3 ± 25.8 days, P = 0.003), a lower incidence of mechanical ventilation >14 days or death while on mechanical ventilation (0 versus 12.5%, P = 0.016), and a lower incidence of retinopathy of prematurity (0 versus 12.5%, P = 0.016). The proportion of neonates with respiratory distress syndrome did not differ between the groups (adjusted odds ratio 1.28, 95% confidence interval 0.50-3.26). There were no differences found for birthweight, head circumference and length. CONCLUSIONS: In twins born before 34 weeks of gestation, exposure to rescue corticosteroids may be associated with improved neonatal outcomes. Further studies are warranted to assess the effect of rescue corticosteroids in twin pregnancies.

Newborn ventilatory response to maternal chronic hypercapnia.

This is a case of a neonate born with a respiratory acidosis with a compensatory metabolic alkalosis. This case demonstrates placental physiology of gas exchange as well as the blunted ventilatory response in the neonate from chronic hypercapnia.

Antenatal antibiotic exposure in preterm infants with necrotizing enterocolitis.

OBJECTIVE: To determine whether an association exists between antenatal antibiotic exposure and incidence of necrotizing enterocolitis (NEC) in low birth weight infants. STUDY DESIGN: A retrospective case-control study was performed on all infants with a diagnosis of NEC born at our institition between 1988 and 2006. Medical histories of all infants with a diagnosis of NEC ≥Bell's stage IIA and matched controls without NEC were reviewed. Maternal and neonatal characteristics were compared using the Mantel-Haenszel chi-square procedure, and logistic regression models were constructed to account for confounding. RESULT: Clinical data for 97 matched pairs were analyzed. The adjusted odds ratio (OR) for antenatal exposure to ampicillin was significantly greater for infants who developed NEC (OR 2.3, 95% confidence interval 1.1, 4.8, P=0.003) than for control infants. CONCLUSION: Infants who developed NEC were more likely to have a history of in utero exposure to ampicillin in the immediate antepartum period than infants who did not develop NEC.

The effect of adding oral dexamethasone to feed alterations on the airway cell inflammatory gene expression in stabled horses affected with recurrent airway obstruction.

BACKGROUND: Chemokine expression in airway epithelium and bronchoalveolar lavage fluid (BALF) cells of horses with recurrent airway obstruction (RAO) is increased. HYPOTHESIS: For RAO-affected horses that are stabled and fed a pelleted ration, the addition of oral dexamethasone further improves pulmonary function and reduces inflammatory gene expression in pulmonary cells. ANIMALS: Twelve RAO-affected horses. METHODS: In a randomized cross-over experiment, the effect of feeding pellets in lieu of hay to stabled, RAO-affected horses was compared with the effect of feeding pellets and administering a 21-day decreasing dose regimen of oral dexamethasone on the expression (by kinetic polymerase chain reaction) of interleukin-8 (IL-8), chemokine (C-X-C motif) ligand 2 (CXCL2), IL-1beta, IL-6, and beta-actin in the BALF cells and of IL-8, CXCL2, 2 IL-1 receptor (IL-1R2), Toll-like receptor 4 (TLR4), and glyceraldehyde 3-phosphate dehydrogenase in the bronchial epithelium 2 days after the final dose. RESULTS: Both treatments reduced airway neutrophilia and breathing efforts but the addition of dexamethasone was associated with fewer treatment failures. Compared with feed changes alone, dexamethasone administration further reduced the expression of IL-8, CXCL2, and IL-1beta in the BALF cells 3.3-, 2.5-, and 4.7-fold, respectively. In the airway epithelium, both treatments were equally efficacious in reducing the expression of IL-8 and CXCL2 expression relative to pretreatment values, but either treatment failed to alter the expression of IL-1R2 and TLR4. CONCLUSIONS AND CLINICAL IMPORTANCE: For a rapid and consistent improvement in pulmonary function and a reduction in inflammatory gene expression of the BALF cells, a decreasing dose of oral dexamethasone in combination with feed alterations is more efficacious for horses that must remain stabled.

Supratip deformity: a closer look.

Supratip deformity, a hallmark of a poorly executed rhinoplasty or an inauspicious healing, continues to plague the novice often and the experts on occasion. A clinical and histopathologic study was conducted to search for the surgical causes of this deformity and its histologic presentation. An organized, logical management program was then developed. Clinically, supratip fullness was observed in both primary (26 of 298 patients; 9 percent) and secondary (40 of 112 patients; 36 percent) rhinoplasty candidates. In primary patients, the deformity was the result of inadequate tip projection (pseudodeformity), an overprojected caudal dorsum, a combination of both, or cephalically oriented lower lateral cartilages. In secondary patients, the deformity was caused by an underresected or overresected caudal dorsum, overresected midvault, underprojected tip (pseudodeformity), or a combination of some of these factors. The histopathologic evaluation demonstrated significant fibrosis in the supratip soft tissue of 14 of 16 patients undergoing secondary rhinoplasty without the injection of triamcinolone acetonide and in only 13 of 23 patients who underwent primary rhinoplasty (p<0.05). A supratip deformity can be eschewed by proper resection of the caudal dorsum, avoidance of dead space, restoration of adequate projection to the nasal tip, and an approximation of the supratip subcutaneous tissue to the underlying cartilage using a supratip suture, hence eliminating the dead space. If the problem is noted shortly after surgery, in the presence of collapsible consistency of the supratip tissue and adequate projection, the treatment is taping the supratip tissue as often as it is practical. If no favorable response is elicited in 6 to 8 weeks, thejudicious injection of a small amount of triamcinolone acetonide (0.2 to 0.4 cc of 20 mg/cc) in the deep subcutaneous tissue (not in the dermis) is done. The injection is repeated in 4-week intervals until the desired effect is achieved. If supratip fullness is the consequence of inadequate cartilage resection or inadequate tip projection, surgical correction is needed. The recalcitrant soft-tissue excess in the supratip area is resected, and the subcutaneous soft tissue is approximated to the underlying cartilage. If the dorsum was previously overresected, a cartilage graft to the caudal dorsum or midvault will create an optimal dorsal frame and reduce the potential for a recurrent supratip deformity.

Starting your own anesthesia business.

The business side of anesthesia is uncharted territory for most CRNAs. This article takes the personal experience of the author and translates it into a practical guide for nurse anesthetists looking to start their own businesses. The basic fundamentals referred to in this article provide the groundwork for moving toward self-employment.

TGF-beta2 activates proliferative scar fibroblasts.

BACKGROUND: Cytokines, such as the transforming growth factor beta (TGF-beta) isoforms, have been linked to the formation of proliferative scars. This study examines the stimulating effects of exogenous TGF-beta2 on cultured keloid, burn hypertrophic scar, and normal skin fibroblasts and whether such effects can be suppressed with TGF-beta2 antibody. METHODS: In vitro, the fibroblast-populated collagen lattice (FPCL) is used in the evaluation of fibroblast activation by measuring contraction of the lattice over time. Primary cultures of fibroblasts were grown from keloids, burn hypertrophic scars, and normal skin using standard cell culture techniques. TGF-beta2 (10 ng/ml) was added to each of the three types of cell cultures and placed on prefabricated FPCLs. Each was tested against their normal control counterparts. TGF-beta2 antibody (100 ng/ml) was then placed on the TGF-beta2-treated FPCLs. All lattices were allowed to contract and areas were measured for 5 days. RESULTS: Compared to controls, keloid fibroblasts were most affected by the addition of exogenous TGF-beta2. Normal skin fibroblasts did not show a significant increase in contraction early on, yet a significant difference was seen as time progressed. The addition of TGF-beta2 antibody inhibited the function of keloid and burn hypertrophic scar fibroblasts. It also reversed the increased contraction of the TFG-beta2-treated proliferative scar fibroblasts. CONCLUSION: By utilizing an in vitro model, we have demonstrated that TGF-beta2 antibody reverses the increased contraction of FPCLs by proliferative scar fibroblasts treated with TGF-beta2. This points to a possible treatment modality in patients afflicted with this disfiguring problem.

Ear projection and the posterior auricular muscle insertion.

Prominent ears is a common congenital anomaly affecting approximately 5 percent of the general population. The etiology has been attributed to three basic deformities in the ear structure: valgus of the concha with a cranioauricular angle greater than 40 degrees, underfolding of the anthelix, and rarely, hypertrophy of the concha. It is believed that by virtue of its insertion onto the ponticulus, the cranial surface of the concha, the posterior auricular muscle may function to pull the auricle back toward the head. A proximally (anteromedially) displaced insertion site would decrease the length of the effective momentum of the muscle, leading to protrusion of the auricle. This study was conducted to determine if indeed a relationship between the posterior muscle insertion site and ear projection could be established clinically by measuring these parameters intraoperatively in patients presenting for otoplasty and in patients without prominent ears who required conchal cartilage grafts for other procedures.

Retinoic acid as a therapy for emphysema?

In concert with its action as a morphogen during embryonal development, retinoic acid appears to be able to regenerate lung alveoli in an experimental model of elastase-induced emphysema in rats, thereby inhibiting manifestation of the disease. The application to humans is now an interesting possibility.

Sex differences in pathological gambling using gaming machines.

With recent introduction of poker machines in Australia, there have been claims of increases in the number of women with gambling-related problems. Research in the United States indicates, however, that men have a higher incidence of pathological gambling. The aims of this study were to ascertain among game machine users in a major city in Australia whether (a) more women than men exhibited symptoms of pathological gambling, (b) women reported higher guilt associated with their gambling, and (c) gamblers' self-assessment on several mood states was predictive of pathological gambling. A modified version of the South Oaks Gambling Screen was administered to 104 users of game machines (44 men, 60 women) sampled from patrons at gaming venues in Melbourne, Australia. Data indicated no significant sex difference in the proportion of pathological gamblers or in gambling-related guilt. Self-assessment of Happiness, Propensity for Boredom, and Loneliness, significantly predicted scores on the South Oaks Gambling Screen, with Unhappiness a significant independent predictor of pathological gambling. This may suggest that gambling acts to fill a need in the lives of unhappy people or that individuals who lack control over their gambling report higher unhappiness. Further research is needed to discover this relationship.

Yucatan pig: an optimal hairless model for a true random cutaneous flap.

Porcine models have been used extensively for skin flap research because of the established similarity between the cutaneous blood supply of the swine and humans. The Yucatan minipig provides an excellent model for researching the properties of random cutaneous flaps, offering several advantages over other breeds of swine. In this study, a total of 67 random cutaneous dorsal flank flaps measuring 4 x 14 cm were raised on nine Yucatan minipigs. The mean survival length (10.03 +/- 1.60 cm) of the nondelayed flaps was greater than others reported in the literature. The well-defined plane between the subcutaneous tissue and the panniculus carnosus facilitated flap elevation consistently above the level of the panniculus carnosus thereby ensuring the creation of a true random cutaneous flap. Furthermore, the hairless nature of the skin, particularly beneficial in studying chemical peels, permits easy visualization and monitoring of any external skin changes. These advantages make the Yucatan minipig a more desirable alternative to other breeds of swine for use in skin flap research.

The fate of preserved autogenous bone graft.

Certain clinical conditions exist in which a section of cranial bone is removed but not immediately replaced at the initial procedure. Preservation of this bone can provide a valuable autogenous donor source for a future reconstructive procedure. The purpose of our study was to compare the volume retention of fresh autogenous bone with that of preserved autogenous bone as inlay and onlay cranial grafts. Two bone grafts were harvested from the skull of 15 adult New Zealand White rabbits. The graft volumes were calculated, and the graft were preserved in a normal saline-antibiotic solution at -20 degrees C. Three months later, during the second procedure, a fresh graft was harvested and then placed in the preexisting occipital defect as an inlay graft. Also at this time, the preserved grafts were placed, one as an inlay graft in the fresh occipital defect and the other as an onlay graft in the frontal region. The animals were sacrificed 3 months later, and the percentage of graft volume retention was determined. The fresh inlay grafts had a mean volume retention of 85.1 percent, while the preserved inlay nad onlay grafts had 61.8 and 75.9 percent mean volume retention, respectively. It is concluded that while fresh cranial autograft remains the "gold standard" for craniofacial reconstruction, preserved autogenous cranial bone is a viable alternative for inlay and onlay grafting of the craniofacial region.

Management of an extensive cervicofacial lymphovenous malformation of the maxillofacial region.

The operative approach to extensive vascular anomalies of the maxillofacial region with significant skeletal involvement demands considerable preoperative planning and orthodontic intervention guided by a creative surgical design. A case of a 17-year-old male with a middle and lower face lymphovenous malformation, requiring a complex orthodontic and surgical approach, is reported here. Details regarding the preoperative examination, orthodontic maneuvering, and the surgical procedures are given. An overview of the classification and clinical implications of craniofacial vascular anomalies is also presented.

Retinoid X receptor-selective ligands produce malformations in Xenopus embryos.

Retinoids exert pleiotropic effects on the development of vertebrates through the action of retinoic acid receptors (RAR) and retinoid X receptors (RXR). We have investigated the effect of synthetic retinoids selective for RXR and RAR on the development of Xenopus and zebrafish embryos. In Xenopus, both ligands selective for RAR and RXR caused striking malformations along the anterior-posterior axis, whereas in zebrafish only ligands specific for RAR caused embryonic malformations. In Xenopus, RAR- and RXR-selective ligands regulated the expression of the Xlim-1, gsc, and HoxA1 genes similarly as all-trans-retinoic acid. Nevertheless, RXR-selective ligands activated only an RXR responsive reporter but not an RAR responsive reporter introduced by microinjection into the Xenopus embryo, consistent with our failure to detect conversion of an RXR-selective ligand to different derivatives in the embryo. These results suggest that Xenopus embryos possess a unique response pathway in which liganded RXR can control gene expression. Our observations further illustrate the divergence in retinoid responsiveness between different vertebrate species.

Knee function after patellectomy and cruciform repair of the extensor mechanism.

When patellectomy is performed, the objectives should include restoration of a moment arm, centralization of the extensor mechanism, adequate range of motion, and cosmesis. The cruciate repair of the extensor mechanism described in this report has been developed to meet the aforementioned objectives. Eight patients with 12 patellectomies described herein were examined with Cybex testing of the knee at a follow-up period of 18 months to 20 years (mean, 56 months). A four-quadrant tissue dissection of the patellar soft-tissue enclosure was reconstructed in a cruciform pants-over-vest fashion, with the superomedial flap containing the vastus medialis insertion on top. This "soft-tissue" patella attempts to provide a greater moment arm than simpler repairs. This study examines whether this construct restored the torque of extension while concomitantly facilitating centralization of the extensor mechanism. Cybex testing of both knees examined both extensor and flexor function with specific regard to the ratio of extensor to flexor forces. Patients with patellectomies had few subjective complaints, with a mean knee score of 94 (median, 100). The extensor torque was not completely restored and there was a moderate decrease in the quadriceps function, both subjectively and objectively as measured by Cybex testing. The authors also found that in patients with unilateral patellectomies, the ratios of extension to flexion function, a parameter not yet reported in the literature, were significantly different between the normal and patellectomized knees. The same extension to flexion ratios were seen in patients with bilateral patellectomies. Because patients with patellar pathology requiring patellectomy frequently have chronic and bilateral disease, comparative functional evaluation may be difficult.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of the medial septal area on the cardiovascular, fluid and electrolytic responses to angiotensin II and cholinergic activation into the subfornical organ in rats.

In the present study we investigated the effect of electrolytic lesion of the medial septal area (MSA) on the pressor and dipsogenic response to cholinergic activation and angiotensin II (ANGII) injection into the subfornical organ (SFO) in rats. In addition the effect of MSA lesion on the natriuresis, kaliuresis and diuresis after cholinergic activation of the SFO was also investigated. Sham- and MSA-lesioned rats with a stainless steel cannula implanted into the SFO was used. The injection of ANGII (12 ng) into the SFO in sham rats produced pressor (24 +/- 2 mmHg) and dipsogenic (9.6 +/- 1.1 ml/h) responses. MSA lesion, both acute (2-6 days) and chronic (15-19 days), reduced the pressor (14 +/- 2 mmHg) and dipsogenic (2.7 +/- 1 ml/h) responses to ANGII into SFO. The injection of the cholinergic agonist carbachol (2 nmol) into the SFO in sham rats produced pressor (48 +/- 4 mmHg), dipsogenic (10 +/- 1.2 ml/h), natriuretic (457 +/- 58 microEq/2 h) and kaliuretic (249 +/- 16 microEq/2 h) responses. Acute, but not chronic MSA lesion reduced the pressor (27 +/- 3 mmHg), natriuretic (198 +/- 55 microEq/2 h) and kaliuretic (128 +/- 16 microEq/2 h) responses to carbachol into SFO. No change in the dipsogenic response to carbachol into the SFO was observed in MSA-lesioned rats. Antidiuresis after carbachol was observed only in MSA-lesioned rats. The present results show that the MSA plays a role on the pressor, natriuretic and kaliuretic responses to cholinergic activation of the SFO in rats and on the pressor and dipsogenic responses to ANGII into the same area.(ABSTRACT TRUNCATED AT 250 WORDS)

Surface-bound biomembranes incorporating receptors: electrochemical and structural characterization.

A generic method is described for forming surface-bound structures that incorporate protein receptors in a membrane-like environment. Silane reagents (octadecyltrichlorosilane and dimethyloctadecylchlorosilane) were used to produce primed substrates bearing full and partial monolayers, respectively. Biomembranes were formed by dialysis of detergent-solubilized membranes in the presence of two different alkylsilanized substrates: Si/SiO2 electrodes and glass microspheres. Electrochemical analysis of the capacitance was used to determine apparent thickness and degree of surface coverage at each stage in the deposition process. Elemental analysis on glass beads gave the hydrocarbon incorporation. Glass bead substrates were also examined by Fourier transform infrared spectroscopy to evaluate the alkylsilanized substrate before and after dialysis. Both vertebrate rhodopsin and the nicotinic acetylcholine receptor could be incorporated into structures with composition and dimensions similar to natural bilayer membranes. The techniques reported here are applicable for coupling membrane receptors to a variety of transducing substrates used in biosensors.