Publications by authors named "Michael Bolton"

38 Publications

Residents Need Recess.

AEM Educ Train 2021 Jul 17;5(3):e10514. Epub 2020 Aug 17.

Emergency Medicine Residency Program School of Medicine Louisiana State University Health Sciences New Orleans Baton Rouge LA USA.

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http://dx.doi.org/10.1002/aet2.10514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122124PMC
July 2021

Use of Ultra-short Columns for Therapeutic Protein Separations, Part 2: Designing the Optimal Column Dimension for Reversed-Phase Liquid Chromatography.

Anal Chem 2021 01 11;93(3):1285-1293. Epub 2020 Dec 11.

Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CMU-Rue Michel Servet 1, Geneva 4 1211, Switzerland.

In the first part of the series, it was demonstrated that very fast (<30 s) separations of therapeutic protein species are feasible using ultra-short (5 × 2.1 mm) columns. In the second part, our purpose was to find the appropriate column length; therefore, a systematic study was performed using various custom-made prototype reversed-phase liquid chromatography (RPLC) columns ranging from 2 to 50 mm lengths. It was found that on a low dispersion ultrahigh-pressure liquid chromatography instrument, columns between 10 and 20 mm were most effective when made with 2.1 mm i.d. tubing. However, with the same LC instrument, 3 mm i.d. columns as short as ∼5 to 10 mm could be effectively used. In both cases, it has been found to be best to keep injection volumes below 0.6 μL, which presents a potential limit to further decreasing column length, given the current capabilities of autosampler instrumentation. The additional volume of the column hardware outside of the packed bed (extra-bed volume) of very small columns is also a limiting factor to decrease the column length. For columns shorter than 10 mm, columns' extra-bed volume was seen to make considerable contributions to band broadening. However, the use of ultra-short columns seemed to be a very useful approach for RPLC of large proteins (>25 kDa) and could also work well for ∼12 kDa as the lowest limit of molecular mass. In summary, a renewed interest in the use of ultra-short columns is warranted, and additional method development will be to the benefit of the biopharmaceutical industry as there is an ever-increasing demand for faster, yet accurate assays (, high-throughput screening) of proteins.
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http://dx.doi.org/10.1021/acs.analchem.0c01720DOI Listing
January 2021

Using Multisource Feedback to Assess Resident Communication Skills: Adding a New Dimension to Milestone Data.

Ochsner J 2020 ;20(3):255-260

Pediatric Hospital Medicine, Our Lady of the Lake Children's Hospital, Baton Rouge, LA.

The Accreditation Council for Graduate Medical Education (ACGME) requires evaluation of residents' communication skills. These evaluations should involve assessments from a variety of persons with different perspectives and opportunities to observe resident behavior. Our objectives with this study were to determine if parents, nurses, and physicians significantly differed in their ratings of residents' communication skills; to ascertain the degree of association between these evaluations and ACGME milestone data; and to elicit feedback from residents about the specificity and usefulness of this type of evaluation compared to the evaluations they were typically provided. During the 2016-2017 academic year, parents of patients ready for discharge, nurses, and attending physicians completed evaluations of resident communication skills. A repeated measures multivariate analysis of variance compared communication skills scores across the 3 groups of raters. Resident ACGME milestone ratings for interpersonal and communication skills were correlated with the communication skills evaluations. Residents rated the specificity and usefulness of the 360-degree evaluations. Parents rated residents' communication skills significantly higher than nurses and physicians rated them. We found no significant difference between the nurse and physician ratings. A significant correlation was found between resident ratings by physicians and ACGME milestone data. Residents found the feedback from these evaluations to be more specific and useful in delineating their communication strengths and weaknesses than typical milestone feedback. Parents added a unique perspective about residents' communication and should be included in resident evaluation when feasible. Residents appreciated the specificity and usefulness of the evaluation instrument.
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http://dx.doi.org/10.31486/toj.19.0054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529137PMC
January 2020

First Field Release of a Genetically Engineered, Self-Limiting Agricultural Pest Insect: Evaluating Its Potential for Future Crop Protection.

Front Bioeng Biotechnol 2019 29;7:482. Epub 2020 Jan 29.

Oxitec Ltd, Milton Park, Abingdon, United Kingdom.

Alternative, biologically-based approaches for pest management are sorely needed and one approach is to use genetically engineered insects. Herein we describe a series of integrated field, laboratory and modeling studies with the diamondback moth, , a serious global pest of crucifers. A "self-limiting" strain of (OX4319L), genetically engineered to allow the production of male-only cohorts of moths for field releases, was developed as a novel approach to protect crucifer crops. Wild-type females that mate with these self-limiting males will not produce viable female progeny. Our previous greenhouse studies demonstrated that releases of OX4319L males lead to suppression of the target pest population and dilution of insecticide-resistance genes. We report results of the first open-field release of a non-irradiated, genetically engineered self-limiting strain of an agricultural pest insect. In a series of mark-release-recapture field studies with co-releases of adult OX4319L males and wild-type counterparts, the dispersal, persistence and field survival of each strain were measured in a 2.83 ha cabbage field. In most cases, no differences were detected in these parameters. Overall, 97.8% of the wild-type males and 95.4% of the OX4319L males recaptured dispersed <35 m from the release point. The predicted persistence did not differ between strains regardless of release rate. With 95% confidence, 75% of OX4319L males released at a rate of 1,500 could be expected to live between 3.5 and 5.4 days and 95% of these males could be expected to be detected within 25.8-34.9 m from the release point. Moth strain had no effect on field survival but release rate did. Collectively, these results suggest similar field behavior of OX4319L males compared to its wild-type counterpart. Laboratory studies revealed no differences in mating competitiveness or intrinsic growth rates between the strains and small differences in longevity. Using results from these studies, mathematical models were developed that indicate release of OX4319L males should offer efficacious pest management of . Further field studies are recommended to demonstrate the potential for this self-limiting to provide pest suppression and resistance management benefits, as was previously demonstrated in greenhouse studies.
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http://dx.doi.org/10.3389/fbioe.2019.00482DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000757PMC
January 2020

Response to a Synthetic Pheromone Source by OX4319L, a Self-Limiting Diamondback Moth (Lepidoptera: Plutellidae) Strain, and Field Dispersal Characteristics of its Progenitor Strain.

J Econ Entomol 2019 08;112(4):1546-1551

Department of Entomology, Cornell University, New York State Agricultural Experiment Station, Cornell AgriTech, Barton Laboratory, Geneva, NY.

The diamondback moth, Plutella xylostella L. (Lepidoptera: Plutellidae), is a global pest that infests vegetable and field crops within the Brassica family. A genetically engineered strain of P. xylostella, OX4319L, carrying a 'self-limiting' gene, has shown potential for managing P. xylostella populations, using sustained releases of OX4319L male moths. In order for such a strain to provide control, the transgenic individuals must exhibit attraction to female P. xylostella sex pheromone and adequate dispersal in the field. In this study, we tested these key traits. First, we compared the responses of the OX4319L male moths to a synthetic female sex pheromone source in wind tunnel trials to those of males from three other strains. We found that OX4319L males responded comparably to strains of non-engineered males, with all males flying upwind towards the pheromone source. Second, we used mark-release-recapture studies of a wildtype P. xylostella strain, from which the OX4319L strain was originally developed, to assess dispersal under field conditions. Released males were recaptured using both pheromone-baited and passive traps within a 2.83 ha circular cabbage field, with a recapture rate of 7.93%. Males were recaptured up to the boundary of the field at 95 m from the central release point. The median dispersal of males was 14 m. These results showed the progenitor strain of OX4319L retained its ability to disperse within a host field. The results of these experiments are discussed in relation to the potential for the effective use of engineered male-selecting P. xylostella strains under field conditions.
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http://dx.doi.org/10.1093/jee/toz056DOI Listing
August 2019

A palliative care model and conceptual approach suited to clinical malignant haematology.

Palliat Med 2019 05 28;33(5):483-485. Epub 2019 Jan 28.

6 School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia.

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http://dx.doi.org/10.1177/0269216318824489DOI Listing
May 2019

A Case of Eastern Equine Encephalitis.

Clin Pediatr (Phila) 2019 02 15;58(2):245-246. Epub 2018 Oct 15.

2 Our Lady of the Lake Children's Hospital, Baton Rouge, LA, USA.

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http://dx.doi.org/10.1177/0009922818806842DOI Listing
February 2019

An Atypical Case of Osteomyelitis and Hepatic Disease.

Case Rep Pediatr 2018 5;2018:2750275. Epub 2018 Apr 5.

Pediatric Infectious Diseases, Our Lady of the Lake Children's Hospital, Baton Rouge, LA, USA.

is a Gram-negative bacterium and the causative agent of cat scratch disease (CSD). Atypical presentations of that involve the musculoskeletal, hepatosplenic, cardiac, or neurologic systems are rare. In this case report, we describe a case of osteomyelitis involving bilateral iliac bones complicated by hepatic lesions in a 12-year-old immunocompetent female patient. Although is a rare cause of osteomyelitis, it should be considered when patients who present with fever, pain, and lymphadenopathy do not respond to routine osteomyelitis therapy.
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http://dx.doi.org/10.1155/2018/2750275DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5907520PMC
April 2018

Integration of Mobile Devices to Facilitate Patient Care and Teaching During Family-Centered Rounds.

Hosp Pediatr 2018 01 7;8(1):44-48. Epub 2017 Dec 7.

Pediatric Residency Program, Our Lady of the Lake Children's Hospital, Baton Rouge, Louisiana.

Objectives: The increasing prevalence of mobile devices in clinical settings has the potential to improve both patient care and education. The benefits are particularly promising in the context of family-centered rounds in inpatient pediatric settings. We aimed to increase mobile device usage by inpatient rounding teams by 50% in 6 months. We hoped to demonstrate that use of mobile devices would improve access to patient care and educational information and to determine if use would improve efficiency and perceptions of clinical teaching.

Methods: We designed a mixed-methods study involving pre- and post-implementation surveys to residents, families, and faculty as well as direct observations of family-centered rounds. We conducted rapid cycles of continual quality improvement by using the Plan-Do-Study-Act framework involving 3 interventions.

Results: Pre-intervention, the mobile computing cart was used for resident education on average 3.3 times per rounding session. After cycle 3, teaching through the use of mobile devices increased by ∼79% to 5.9 times per rounding session. On the basis of survey data, we determined there was a statistically significant increase in residents' perception of feeling prepared for rounds, receiving teaching on clinical care, and ability to teach families. Additionally, average time spent per patient on rounds decreased after implementation of mobile devices.

Conclusions: Integration of mobile devices into a pediatric hospital medicine teaching service can facilitate patient care and perception of resident teaching by extending the utility of electronic medical records in care decisions and by improving access to knowledge resources.
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http://dx.doi.org/10.1542/hpeds.2016-0193DOI Listing
January 2018

Trichomonas vaginalis Brain Abscess in a Neonate.

Clin Infect Dis 2018 02;66(4):604-607

Pediatric Specialty Clinic-Infectious Diseases, Our Lady of the Lake Children's Hospital, Baton Rouge, Louisiana.

We describe a case of cerebral trichomoniasis in a neonate in whom seizures and multiorgan failure developed during treatment for staphylococcal sepsis. Brain abscesses were identified with cranial sonography, and Trichomonas vaginalis was isolated from cerebrospinal fluid samples. The patient died despite metronidazole therapy.
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http://dx.doi.org/10.1093/cid/cix908DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5831133PMC
February 2018

Improving Patient Safety Communication in Residency Programs by Incorporating Patient Safety Discussions Into Rounds.

Ochsner J 2017 ;17(3):273-276

Division of Academic Affairs, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA.

Background: Engaging residents in patient safety and quality improvement initiatives is sometimes difficult. The primary goal of the current study was to develop a standardized learning experience designed to facilitate patient safety discussions during rounds.

Methods: Residents who were on inpatient rotations during a 2-month period in 2014 were exposed to patient safety discussions on rounds. Residents who were not on inpatient rotations served as a control group. Faculty received weekly text reminders with 3 questions designed to engage residents in patient safety discussions. Before and after the intervention, residents were asked to complete a modified Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture. Faculty members were asked to complete a brief survey designed by the study investigators.

Results: Of the 160 residents who participated in the study, 49 responded to both the preintervention and postintervention surveys (31%). Residents who participated in patient safety discussions during rounds reported higher frequencies of safety events reported compared to the control group (<0.05). Both groups of residents reported better communication (<0.01) and an increased number of safety events reported (<0.01) at the end of the intervention. Twenty-two faculty were surveyed, and 19 responded (86%). Most faculty felt incorporating patient safety discussions on rounds was constructive and that the residents were responsive. Few faculty members felt the patient safety discussions were burdensome.

Conclusion: Using weekly text reminders with 3 prompts to incorporate patient safety discussions into rounds was well received by faculty and residents and had an impact on communication and error reporting.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5625988PMC
January 2017

Unusual Cause of Prolonged Fever of Unknown Origin.

Clin Pediatr (Phila) 2018 02 1;57(2):245-247. Epub 2017 Feb 1.

1 Our Lady of the Lake Children's Hospital, Baton Rouge, LA, USA.

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http://dx.doi.org/10.1177/0009922817693303DOI Listing
February 2018

An Improvement Approach to Integrate Teaching Teams in the Reporting of Safety Events.

Pediatrics 2017 Feb;139(2)

Division of Pediatrics, Our Lady of the Lake Children's Hospital, Baton Rouge, Louisiana.

Background And Objective: Patient safety events are underreported by physicians. Baseline data demonstrated that physicians submitted 3% of event reports at Our Lady of the Lake Children's Hospital. Our aim was to increase the proportion of safety reports filed by residents and faculty to 6% of all reports within a 9-month period.

Methods: We used the Model for Improvement and serial Plan, Do, Study, Act cycles to test interventions we hypothesized would improve physician recognition and reporting of patient safety events. We tracked the percentage of Our Lady of the Lake Children's Hospital event reports entered by residents or faculty over time as the primary outcome measure. Changes to teaching team processes included "patient safety rounds" prompted by text messages, an inpatient "superintendent" rotation with core patient safety responsibilities, and a "just-in-time" faculty development program called "QI on the Fly."

Results: Physician-reported events increased to a monthly average of 24% of all events reported, an improvement that has been sustained over 17 months. Resident reporting accounted for most of the increase in physician reports. Increased physician reporting was temporally associated with implementation of the "superintendent" rotation. The total number of events reported increased as a result of increased physician reporting.

Conclusions: Incorporating patient safety responsibilities into a teaching team's workflow can increase physician safety event reporting. We plan additional Plan, Do, Study, Act cycles to spread this approach to other clinical settings and investigate the impact increased reporting might have on patient care.
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http://dx.doi.org/10.1542/peds.2015-3807DOI Listing
February 2017

Atlas of Ohio Aquatic Insects: Volume II, Plecoptera.

Biodivers Data J 2016 16(4):e10723. Epub 2016 Nov 16.

Ohio Environmental Protection Agency, Division of Surface Water, Groveport, Ohio, United States of America.

Background: We provide volume II of a distributional atlas of aquatic insects for the eastern USA state of Ohio. This treatment of stoneflies (Plecoptera) is companion to Armitage et al. (2011) on caddisflies (Trichoptera). We build on a recent analysis of Ohio stonefly diversity patterns based on large drainages (DeWalt et al. 2012), but add 3717 new records to the data set. We base most analyses on the United States Geological Survey Hierarchical Unit Code eight (HUC8) drainage scale. In addition to distributional maps for each species, we provide analyses of species richness versus HUC8 drainage area and the number of unique locations in a HUC8 drainage, species richness versus Ohio counties, analyze adult presence phenology throughout the year, and demonstrate stream size range affiliation for each species.

New Information: This work is based on a total of 7797 specimen records gathered from 21 regional museums, agency data, personal collections, and from the literature Table 1. To our knowledge this is the largest stonefly data set available for a similarly sized geopolitical area anywhere in the world. These data are made available as a Darwin Core Archive supported by the Pensoft Integrated Publishing Toolkit (DeWalt et al. 2016b). All known published papers reporting stoneflies from Ohio are detailed in Suppl. material 1. We recovered 102 species from Ohio, including all nine Nearctic families Table 2​. Two species were removed from the DeWalt et al. (2012) list and two new state records added. Perlidae (32 spp.) was most speciose, compared to the low diversity Pteronarcyidae (2 spp.) and Peltoperlidae (1 sp.). The richest HUC8 drainages occurred in northeastern, south-central, and southern regions of the state where drainages were heavily forested, had the highest slopes, and were contained within or adjacent to the unglaciated Allegheny and Appalachian Plateaus. Species poor drainages occurred mainly in the northwestern region where Wisconsinan aged lake plains climaxed to an expansive wooded wetland, the Black Swamp. The unglaciated Lower Scioto drainage (72 spp.) in south-central Ohio supported the greatest species richness. There was no relationship between species richness and HUC8 drainage size, but the number of unique locations in a drainage strongly related to species richness. All Ohio counties were represented in the data set with Hocking County (59 spp.) of the Lower Scioto drainage being the richest and most heavily sampled. Adult presence phenology was influenced by phylogenetic relationships such that the superfamily Nemouroidea (Capniidae, Leuctridae, Nemouridae, and Taeniopterygidae) generally emerged in winter and spring while the superfamilies Pteronarcyoidea (Pteronarcyidae, Peltoperlidae) and Perloidea (Chloroperlidae, Perlidae, Perlodidae) emerged later, some species continuing emergence through summer months. Species often occupied specific stream size ranges, while others were generalists. Two species once histrorically abundant in the western Lake Erie Bass Islands no longer reside there. Each of the 102 species is discussed in detail, including several that require additional collecting efforts to confirm their identities, presence, and distribution in Ohio.
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http://dx.doi.org/10.3897/BDJ.4.e10723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5136677PMC
November 2016

Evolutionary biology and genetic techniques for insect control.

Evol Appl 2016 Jan 15;9(1):212-30. Epub 2015 Jul 15.

School of Biological Sciences University of East Anglia Norwich Research Park Norwich UK.

The requirement to develop new techniques for insect control that minimize negative environmental impacts has never been more pressing. Here we discuss population suppression and population replacement technologies. These include sterile insect technique, genetic elimination methods such as the release of insects carrying a dominant lethal (RIDL), and gene driving mechanisms offered by intracellular bacteria and homing endonucleases. We also review the potential of newer or underutilized methods such as reproductive interference, CRISPR technology, RNA interference (RNAi), and genetic underdominance. We focus on understanding principles and potential effectiveness from the perspective of evolutionary biology. This offers useful insights into mechanisms through which potential problems may be minimized, in much the same way that an understanding of how resistance evolves is key to slowing the spread of antibiotic and insecticide resistance. We conclude that there is much to gain from applying principles from the study of resistance in these other scenarios - specifically, the adoption of combinatorial approaches to minimize the spread of resistance evolution. We conclude by discussing the focused use of GM for insect pest control in the context of modern conservation planning under land-sparing scenarios.
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http://dx.doi.org/10.1111/eva.12280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4780389PMC
January 2016

Graduate Medical Education as a Lever for Collaborative Change: One Institution's Experience with a Campuswide Patient Safety Initiative.

Ochsner J 2016 ;16(1):81-4

Division of Academic Affairs, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA.

Background: The 2013 closure of a public hospital in Baton Rouge, LA transformed graduate medical education (GME) at Our Lady of the Lake Regional Medical Center (OLOL). Administrators were tasked with incorporating residents into patient safety and quality improvement initiatives to fulfill regulatory obligations. This report outlines our experiences as we built these patient safety and quality improvement initiatives in a rapidly expanding independent academic medical center.

Methods: We joined the Alliance of Independent Academic Medical Centers (AIAMC) to meet and learn from national peers. To fulfill the scholarly activity requirement of the AIAMC's National Initiative IV, we formed a multidisciplinary team to develop a patient safety education project. Prioritized monthly team meetings allowed for project successes to be celebrated and circulated within the organization.

Results: The public-private partnership that more than quadrupled the historic size of GME at OLOL has, in the past 2 years, led to the development of an interdisciplinary team. This team has expanded to accommodate residency program leadership from across the campus. Our National Initiative IV project won a national award and inspired several follow-up initiatives. In addition, this work led to the formation of a Patient Safety and Clinical Quality Improvement fellowship that matched its first fellow in 2015.

Conclusion: Through the commitment and support of hospital and medical education leaders, as well as a focus on promoting cultural change through scholarly activity, we were able to greatly expand patient safety and quality improvement efforts in our institution.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795510PMC
April 2016

Pediatric Tuberculosis in Nonimmigrants.

Clin Pediatr (Phila) 2017 Jan 19;56(1):77-79. Epub 2016 Jul 19.

1 Our Lady of the Lake Children's Hospital, Baton Rouge, LA, USA.

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http://dx.doi.org/10.1177/0009922816635809DOI Listing
January 2017

Late ELISA Testing in Infants Born to HIV-Positive Mothers.

Clin Pediatr (Phila) 2016 Jun 20;55(7):673-6. Epub 2015 Aug 20.

University of Queensland School of Medicine and Ochsner Clinical School, New Orleans, LA, USA.

We present the case of a young boy who was born to a human immunodeficiency virus (HIV)-positive mother and originally found to be uninfected. Evidence-based guidelines were followed regarding the mother's prenatal and infant's postnatal care, including the avoidance of breast milk. HIV DNA polymerase chain reaction qualitative tests were obtained at birth, 6 weeks and 4 months, and were all negative. He also received 6 weeks of prophylactic zidovudine. Despite these measures, his health began to decline at 17 months of age and antibody and serology tests performed at this time confirmed HIV infection. Guidelines no longer recommend routine antibody testing at 18 months of age to confirm the absence of infection in exposed infants with a record of negative virology in the first year of life. Based on this case and others we propose that this test be added back to the national guidelines for the early detection and prompt treatment of HIV infection in infants born to HIV-positive mothers.
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http://dx.doi.org/10.1177/0009922815601032DOI Listing
June 2016

Test of a customized compliant ankle rehabilitation device in unpowered mode.

Annu Int Conf IEEE Eng Med Biol Soc 2014 ;2014:3057-60

Presented is the design, implementation, and initial gait testing of a lightweight, compliant robotic device for ankle rehabilitation. Many patients with neuromuscular disorders suffer deficits in sensorimotor control of the ankle joint, leading to an abnormal walking pattern. Robotic devices have been used to assist ankle rehabilitation. However, these devices are usually heavy and rigid, which can deviate a natural gait pattern. To address these issues, our team has developed a light weight, compliant ankle robotic device actuated by artificial pneumatic muscles. A total of 3 healthy subjects were recruited to test whether the mechanical structure of the device deviates gait. We used a 3-dimensional (3D) motion analysis system to record and analyze subjects' ankle kinematics during gait while walking barefoot and while wearing the device unpowered. The preliminary results suggest that the device caused some, but minimal changes in ankle kinematics during gait. The changes were mainly caused by the device's rigid footplate, used to support the foot and connect to the pneumatic muscles. The preliminary results will be used for future improvement of the device.
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http://dx.doi.org/10.1109/EMBC.2014.6944268DOI Listing
October 2015

Inhibition of priming for bovine respiratory syncytial virus-specific protective immune responses following parenteral vaccination of passively immune calves.

Can Vet J 2014 Dec;55(12):1180-5

The Departments of Veterinary Microbiology (Ellis) and Large Animal Clinical Sciences (Gow), Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan, Canada S7N 5B4, and Merck Animal Health, Summit, New Jersey, USA (Bolton, Burdett, Nordstrom).

The effect of maternal antibodies (MatAb) on immunological priming by neonatal parenteral vaccination for bovine respiratory syncytial virus (BRSV) was addressed for the first time in experimental infection in 34 Holstein calves. Both vaccinated and control calves developed moderate to severe respiratory disease characteristic of acute BRSV infection. There were no differences in clinical signs, BRSV shed, arterial oxygen concentrations, or mortality between vaccinated and control calves after BRSV challenge approximately 11 wk after vaccination. There were no anamnestic antibody or cytokine responses in the vaccinates after challenge. Lung lesions were extensive in both groups, and although there was a statistically significant (P = 0.05) difference between groups, this difference was considered not biologically significant. These data indicate that stimulation of protective immune responses was inhibited by maternal antibodies when a combination modified-live BRSV vaccine was administered parenterally to young passively immune calves. Alternate routes of administration or different vaccine formulations should be used to successfully immunize young calves with good passive antibody transfer.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231808PMC
December 2014

Plasma cytokine levels and risk of HIV type 1 (HIV-1) transmission and acquisition: a nested case-control study among HIV-1-serodiscordant couples.

J Infect Dis 2015 May 10;211(9):1451-60. Epub 2014 Nov 10.

Department of Epidemiology Department of Global Health Department of Medicine.

Background: A heightened proinflammatory state has been hypothesized to enhance human immunodeficiency virus type 1 (HIV-1) transmission - both susceptibility of HIV-1-exposed persons and infectiousness of HIV-1-infected persons.

Methods: Using prospective data from heterosexual African couples with HIV-1 serodiscordance, we conducted a nested case-control analysis to assess the relationship between cytokine concentrations and the risk of HIV-1 acquisition. Case couples (n = 120) were initially serodiscordant couples in which HIV-1 was transmitted to the seronegative partner during the study; control couples (n = 321) were serodiscordant couples in which HIV-1 was not transmitted to the seronegative partner. Differences in a panel of 30 cytokines were measured using plasma specimens from both HIV-1-susceptible and HIV-1-infected partners. Plasma was collected before seroconversion for cases.

Results: For both HIV-1-infected and HIV-1-susceptible partners, cases and controls had significantly different mean responses in cytokine panels (P < .001, by the Hotelling T(2) test), suggesting a broadly different pattern of immune activation for couples in which HIV-1 was transmitted, compared with couples without transmission. Individually, log10 mean concentrations of interleukin 10 (IL-10) and CXCL10 were significantly higher for both HIV-1-susceptible and HIV-1-infected case partners, compared with HIV-1-susceptible and HIV-1-infected control partners (P < .01 for all comparisons). In multivariate analysis, HIV-1 transmission was significantly associated with elevated CXCL10 concentrations in HIV-1-susceptible partners (P = .001) and with elevated IL-10 concentrations in HIV-1-infected partners (P = .02).

Conclusions: Immune activation, as measured by levels of cytokine markers, particularly elevated levels of IL-10 and CXCL1, are associated with increased HIV-1 susceptibility and infectiousness.
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http://dx.doi.org/10.1093/infdis/jiu621DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4447828PMC
May 2015

Quality of life before and after cosmetic surgery.

CNS Spectr 2014 Aug 30;19(4):282-92. Epub 2013 Sep 30.

1Department of Psychiatry and Behavioral Neurosciences,Cedars-Sinai Medical Center,Los Angeles,California,USA.

This article reviews the literature regarding the impact of cosmetic surgery on health-related quality of life (QOL). Studies were identified through PubMed/Medline and PsycINFO searches from January 1960 to December 2011. Twenty-eight studies were included in this review, according to specific selection criteria. The procedures and tools employed in cosmetic surgery research studies were remarkably diverse, thus yielding difficulties with data analysis. However, data indicate that individuals undergoing cosmetic surgery began with lower values on aspects of QOL than control subjects, and experienced significant QOL improvement post-procedurally, an effect that appeared to plateau with time. Despite the complexity of measuring QOL in cosmetic surgery patients, most studies showed an improvement in QOL after cosmetic surgery procedures. However, this finding was clouded by measurement precision as well as heterogeneity of procedures and study populations. Future research needs to focus on refining measurement techniques, including developing cosmetic surgery-specific QOL measures.
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http://dx.doi.org/10.1017/S1092852913000606DOI Listing
August 2014

Pediatric spinal epidural abscess: a 9-year institutional review and review of the literature.

Pediatrics 2013 Dec 4;132(6):e1680-5. Epub 2013 Nov 4.

Department of Pediatrics, 7777 Hennessy Blvd, Suite 6003, Baton Rouge, LA 70808.

Spinal epidural abscess (SEA) is a rare condition that requires prompt diagnosis and initiation of treatment for optimal outcome. Treatment generally consists of surgical intervention and systemic antibiotics. We present 1 of the largest cohorts of nontuberculous pediatric SEA in the English literature, emphasizing the outcomes of conservative (ie, nonoperative) management. We retrospectively identified 9 pediatric patients (≤18 years of age) with SEAs at Our Lady of the Lake Children's Hospital from 2002 to 2011. Cases were reviewed for demographic, clinical, diagnostic, and treatment characteristics and outcomes. The diagnosis of SEA was made by MRI in all cases, and methicillin-resistant Staphylococcus aureus (MRSA) was the only identified pathogen, isolated via blood culture in 6 of 9 patients. Although every patient received systemic antibiotics, only 2 had neurosurgical intervention. Four of the 7 patients treated conservatively received computed tomography-guided needle drainage. All patients recovered without significant sequelae. SEA is a potentially fatal illness that necessitates a heightened clinical awareness for diagnosis and treatment. Although official recommendations regarding management in pediatrics are lacking, treatment has generally been surgical decompression and drainage in combination with antibiotics; recent reports have suggested that antibiotic therapy alone may be successful in select patient populations. Although the adult literature has suggested that such management can be trialed in specific situations, only a handful of cases in the pediatric literature have reported this nonoperative approach. We present one of the largest reviews in support of successfully treating SEA with nonsurgical therapy.
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http://dx.doi.org/10.1542/peds.2012-3805DOI Listing
December 2013

Health-related quality of life in childhood cancer.

J Dev Behav Pediatr 2013 Jul-Aug;34(6):419-40

Department of Psychiatry, Faculty of Medicine, Cairo University, Cairo, Egypt.

Objective: Health-related quality of life (HRQoL) has become an increasingly important measure of research and treatment outcomes across all medical specialties. However, to date, there has not been an in-depth review of research relevant specifically to HRQoL in the populations of children and adolescents with cancer. In this review, the authors examine the effects of cancer on HRQoL from diagnosis to remission/survivorship and the end of life.

Design: A literature search was conducted using Medline and PsycINFO for articles published from 2002 to 2011. Studies included patients from diagnosis to remission and also the terminally ill. Twenty-nine studies specifically addressing HRQoL were selected after reaching consensus and study quality check.

Results: Children who are newly diagnosed with cancer and are undergoing treatment or are terminally ill have impaired HRQoL. Survivors of childhood cancer have high HRQoL (with the exception of those who experienced medical comorbidity or PTSD). The authors found that demographic differences, cancer types, and treatment regimens, all significantly influence the negative impact of cancer on patients' HRQoL.

Conclusions: There are specific and identifiable impacts of childhood cancer on patients' HRQoL that are significant and complex across the span of the illness. There is a need for continued research in many areas related to this population, especially related to those with terminal illness in order to improve patient care.
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http://dx.doi.org/10.1097/DBP.0b013e31828c5fa6DOI Listing
March 2014

Differential regulatory T cell activity in HIV type 1-exposed seronegative individuals.

AIDS Res Hum Retroviruses 2013 Oct 30;29(10):1321-9. Epub 2013 Jul 30.

1 Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center , Seattle, Washington.

The potential role of conventional and regulatory T cells (Tregs) in protection from HIV-1 infection remains unclear. To address this question, we analyzed samples from 129 HIV-1-exposed seronegative individuals (HESN) from an HIV-1-serodiscordant couples cohort. To assess the presence of HIV-specific T cell responses and Treg function, we measured the proliferation of T cells in response to HIV-1 peptide pools in peripheral blood mononuclear cells (PBMCs) and PBMCs depleted of Tregs. We identified HIV-specific CD4(+) and CD8(+) T cell responses and, surprisingly, the overall CD4(+) and CD8(+) T cell response rate was not increased when Tregs were removed from cell preparations. Of the 20 individuals that had HIV-1-specific CD4(+) T cell responses, only eight had Tregs that could suppress this proliferation. When compared with individuals whose Tregs could suppress HIV-1-specific CD4(+) T cell proliferation, individuals with Tregs unable to suppress showed a trend toward increased T cell activation and Treg frequency and a significant increase in HIV-1-specific production of microphage inflammatory protein-1β (MIP-1β) by CD4(+) T cells, autocrine production of which has been shown to be protective in terms of HIV-1 infection of CD4(+) T cells.
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http://dx.doi.org/10.1089/AID.2013.0075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3785803PMC
October 2013

Delusional disorder, somatic type: olfactory reference syndrome in a patient with delusional trimethylaminuria.

J Nerv Ment Dis 2013 Jun;201(6):537-8

Keck School of Medicine of USC, Los Angeles, CA, USA.

Delusions of foul body odors (often referred to as olfactory reference syndrome [ORS]) currently fall under the category of delusional disorder, somatic type (DDST), in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). We present the case of a 51-year-old man with no previous psychiatric history who presented with perceived foul odors that he delusionally attributed to trimethylaminuria (TMAU). TMAU is a rare metabolic disorder associated with foul body odors. The patient also experienced severe concurrent mood symptoms because of social isolation resulting from his delusion about his body odors. After considerable discussion of differential diagnoses, a diagnosis of DDST was ultimately made, given the patient's unrelenting nonbizarre delusions and lack of insight pertaining to his body odors. However, this case proved to be very useful in exploring the diagnostic challenges in this type of disorder and recent discussions of ORS and its proposed inclusion in the DSM-5.
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http://dx.doi.org/10.1097/NMD.0b013e31829482fdDOI Listing
June 2013

Predictors for successful treatment of pediatric deep neck infections using antimicrobials alone.

Pediatr Infect Dis J 2013 Sep;32(9):1034-6

From the Department of Pediatrics, Division of *Infectious Diseases and †Biostatistics Core, Nationwide Children's Hospital, Columbus, OH.

Among hospitalized children with parapharyngeal or retropharyngeal infection, multivariate analysis was performed for the outcomes: successful treatment with antibiotics alone, absence of complications and length of stay less than 3 days. Those with apparent abscess on computed tomography scan had a lower probability of treatment with antimicrobials alone while older age was associated with increased probability of treatment with antibiotics alone.
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http://dx.doi.org/10.1097/INF.0b013e31829331f2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4151323PMC
September 2013

Quality of life in body dysmorphic disorder.

CNS Spectr 2012 Dec 3;17(4):167-75. Epub 2012 Sep 3.

Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.

Body dysmorphic disorder (BDD) has a significant impact on the patients' quality of life (QOL). This is an initial literature review of QOL in patients with BDD, examining the extent of QOL impairments, the impact of psychiatric comorbidity on QOL, and the effect of treatment on QOL in BDD. Studies were identified through PubMed, MEDLINE, and PsycINFO searches from 1960-2011 using the keywords: "quality of life," "body dysmorphic disorder," "dysmorphophobia," and "body image." Studies included in this review were selected using specific criteria by two authors reaching consensus. Most BDD research studies have used symptom severity measures mainly to study BDD and its treatments. BBD with or without comorbidities is significantly associated with poor QOL and functioning. Studies show that treatment of BDD, either by psychopharmacological treatments such as selective serotonin reuptake inhibitors (SSRIs) or cognitive behavior therapy, might have positive effects on QOL, although these results need to be replicated in larger studies. In conclusion, QOL could add significant value to the assessment of BDD if used as one of the primary measures in research and clinical work in BDD, by providing more information and clearer understanding on the impact of the illness on satisfaction with activities of daily life and overall sense of wellbeing before and after treatment.
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http://dx.doi.org/10.1017/S1092852912000624DOI Listing
December 2012

Intrauterine growth restriction is a direct consequence of localized maternal uropathogenic Escherichia coli cystitis.

PLoS One 2012 21;7(3):e33897. Epub 2012 Mar 21.

Section of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, United States of America.

Despite the continually increasing rates of adverse perinatal outcomes across the globe, the molecular mechanisms that underlie adverse perinatal outcomes are not completely understood. Clinical studies report that 10% of pregnant women will experience a urinary tract infection (UTI) and there is an association of UTIs with adverse perinatal outcomes. We introduced bacterial cystitis into successfully outbred female mice at gestational day 14 to follow pregnancy outcomes and immunological responses to determine the mechanisms that underlie UTI-mediated adverse outcomes. Outbred fetuses from mothers experiencing localized cystitis displayed intrauterine growth restriction (20-80%) as early as 48 hours post-infection and throughout the remainder of normal gestation. Robust infiltration of cellular innate immune effectors was observed in the uteroplacental tissue following introduction of UTI despite absence of viable bacteria. The magnitude of serum proinflammatory cytokines is elevated in the maternal serum during UTI. This study demonstrates that a localized infection can dramatically impact the immunological status as well as the function of non-infected distal organs and tissues. This model can be used as a platform to determine the mechanism(s) by which proinflammatory changes occur between non-contiguous genitourinary organs.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0033897PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309957PMC
August 2012
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