Effect of sodium bisulfate on skin and hooves of horses.

OBJECTIVE: To evaluate the safety of sodium bisulfate for use in horse barn environments by determining its irritant effect on skin and hooves. ANIMALS: 6 female mixed-breed ponies. PROCEDURE: Sodium bisulfate was applied to clipped intact skin of 6 ponies to evaluate its irritant effect after single (48 hours) and repetitive (6 h/d for 10 days) applications; similar areas of skin were used as untreated control sites. In addition, sodium bisulfate was applied to the sole of both front hooves of each pony and covered with wet gauze, and the entire hoof was covered with adhesive tape for 48 hours. RESULTS: Contact with moistened sodium bisulfate for 48 hours had no effect on pony skin. Contact with sodium bisulfate for 6 hours on 10 consecutive days did not cause gross changes but did cause mild to moderate microscopic changes including epidermal necrosis, hyperkeratosis, capillary congestion, edema, and diffuse mixed inflammatory cell infiltrate. All changes were limited to the epidermis and superficial dermis. Gross changes in hoof sole, signs of lameness, and increase in digital pulse pressure or pulse intensity were not detected. CONCLUSIONS AND CLINICAL RELEVANCE: Duration of contact with sodium bisulfate in this study was in excess of that expected under typical husbandry conditions. Despite this fact, gross changes in skin and hooves were not detected. Microscopic lesions were confined to the epidermis and superficial dermis. Results suggest that contact with sodium bisulfate under these conditions is safe.

Effect of daily floor treatment with sodium bisulfate on the fly population of horse stalls.

OBJECTIVE: To determine application rate and effectiveness of sodium bisulfate to decrease the fly population in a horse barn environment. SAMPLE POPULATION: 12 privately owned farms in southeastern Pennsylvania. PROCEDURE: Application rates of sodium bisulfate were approximately 2.3 kg/stall, 1.1 kg/stall, and 0.5 kg/stall. Two or 3 stalls were treated, and 1 or 2 stalls were not treated (control stalls) at each farm. Farm personnel applied sodium bisulfate in treated stalls daily for 7 days. Fly tapes were hung from the same site in treated and control stalls. After 24 hours, the fly tape was removed, flies adhering to the sticky surface were counted and recorded, and a new fly tape was hung. This procedure was repeated daily during each of the testing periods. RESULTS: Following the application of 2.3 kg of sodium bisulfate/stall, the numbers of flies collected on the fly tape were significantly decreased in treated stalls, compared with control stalls during the same time periods on 9 of the 12 farms evaluated. Following the application of 1.1 kg of sodium bisulfate/stall, fly numbers were significantly decreased in treated stalls on 6 of the 9 farms evaluated. Following the application of 0.5 kg of sodium bisulfate/stall, fly numbers were significantly decreased in the treated stalls on 3 of the 4 farms evaluated. CONCLUSIONS AND CLINICAL RELEVANCE: Our findings suggest that sodium bisulfate would be effective for fly control in horse barns.

Differences in total protein concentration, nucleated cell count, and red blood cell count among sequential samples of cerebrospinal fluid from horses.

OBJECTIVE: To examine total protein concentration and cell counts of sequentially collected samples of CSF to determine whether blood contamination decreases in subsequent samples and whether formulas used to correct nucleated cell count and total protein concentration are accurate. DESIGN: Case series. ANIMALS: 22 horses. PROCEDURE: For each horse, 3 or 4 sequential 2-ml samples of CSF were collected from the subarachnoid space in the lumbosacral region into separate syringes, and blood was obtained from the jugular vein. Total protein concentration, nucleated cell count, and RBC counts were determined in all samples. RESULTS: Among 3 sequential samples, total protein concentration and RBC count were significantly lower in samples 2 and 3, compared with sample 1. Nucleated cell count was significantly lower in sample 3, compared with sample 1. Among 4 sequential samples, total protein concentration and RBC count were significantly lower in samples 2, 3, and 4, compared with sample 1. Nucleated cell count was significantly lower in samples 3 and 4, compared with sample 1. For 3 correction formulas, significant differences in corrected values for nucleated cell count and total protein concentration were detected between sample 1 and sample 3 or 4. CONCLUSIONS AND CLINICAL RELEVANCE: Because iatrogenic blood contamination decreases in sequential CSF samples, a minimum of 3 samples should be collected before submitting the final sample for analysis. Formulas to correct nucleated cell count and total protein concentration are inaccurate and should not be used to correct for blood contamination in CSF samples.

Effects of blood contamination of cerebrospinal fluid on western blot analysis for detection of antibodies against Sarcocystis neurona and on albumin quotient and immunoglobulin G index in horses.

OBJECTIVE: To determine effects of blood contamination on western blot (WB) analysis of CSF samples for detection of anti-Sarcocystis neurona antibodies, and on CSF albumin and IgG concentrations, albumin quotient (AQ), and IgG index in horses. DESIGN: Prospective in vitro study. SAMPLES: Blood with various degrees of immunoreactivity against S neurona was collected from 12 healthy horses. Cerebrospinal fluid without immunoreactivity against S neurona was harvested from 4 recently euthanatized horses. PROCEDURE: Blood was serially diluted with pooled nonimmunoreactive CSF so that final dilutions corresponded to 10(-3) to 100 microliters of blood/ml CSF, and WB analysis was performed on contaminated CSF samples. Number of RBC, albumin and IgG concentrations, AQ, and IgG index were also determined. RESULTS: Antibodies against S neurona were detected in CSF contaminated with 10(-3) microliters of strongly immunoreactive blood/ml. In CSF samples contaminated with 10 microliters of blood/ml, AQ remained within reference range. Volume of blood required to increase IgG index varied among blood samples and was primarily influenced by serum IgG concentrations. Number of RBC in contaminated samples was correlated with volume of blood added, but not with degree of immunoreactivity detected in contaminated CSF samples. CONCLUSIONS AND CLINICAL RELEVANCE: During collection of CSF from horses, contamination with blood may introduce serum antibodies against S neurona at concentrations sufficient for detection by WB analysis, thus yielding false-positive results. When blood is moderately or strongly immunoreactive, the amount of contaminating albumin may be small enough as to not increase AQ above reference range. In these cases, AQ and IgG index should be interpreted with caution.

Reported medication errors in community residences for individuals with mental retardation: a quality review.

Medication errors have long been a barometer of quality in the health care arena. A review of medication errors in community residences for individuals with mental retardation managed by one agency was performed. Medication errors were analyzed and compared to data in the literature. Although the frequency of medication errors in these residential settings was less than medication errors in hospital settings, there is concern about how common the medication error experience is: 85% of residents experienced at least one reported medication error. The number of medications administered to residents also doubled in one year. As this population ages, experiences more complex health problems, and takes more medication, medication administration practices will require systematic monitoring.

A preliminary study of the effect of inhaled nitric oxide on lung mechanics in the standing horse with histamine-induced bronchoconstriction.

The effect of inhaled nitric oxide on pulmonary mechanics was studied in normal standing horses with histamine-induced bronchoconstriction. The respiratory health status of 6 normal horses was established on the basis of history, clinical and bronchoalveolar lavage examination. Intrathoracic pressures were estimated using distal oesophageal pressures. Respiratory gas flows were measured using a heated pneumotachograph. Pulmonary mechanics variables were determined from these measurements on a breath by breath basis. Bronchoconstriction was induced by nebulizing a 0.75% w/v solution of histamine over 5 min. Pulmonary function was assessed during 4 periods: 1) while breathing room air prior to histamine challenge; 2) 5 min post histamine challenge; 3) 10 min post histamine challenge and while breathing 5 ppm nitric oxide; and 4) 14 min post histamine challenge while breathing room air. Statistical analysis included Friedman's nonparametric repeated measures analysis of variance followed by Dunn's multiple comparisons tests, where appropriate. Criteria for demonstration of nitric oxide effect on pulmonary mechanics variables were taken as a return of the variable value following nitric oxide administration towards control value and subsequent restoration of the value toward post histamine levels with discontinuation of nitric oxide. Five variables (dynamic compliance, airway resistance, maximum developed pressure, work of breathing, and peak expiratory flow) had significant changes in response to histamine. Three variables (dynamic compliance, airway resistance, and maximum developed pressure) met the above criteria, but only dynamic compliance and airway resistance showed statistical significance (P < 0.05). These results suggest that nitric oxide partly dilates small airways constricted by histamine.

Complications associated with use of a one-hole subpalpebral lavage system in horses: 150 cases (1977-1996).

OBJECTIVE: To determine type and frequency of complications associated with use of a one-hole subpalpebral lavage (SPL) system in horses. DESIGN: Retrospective study. ANIMALS: 150 horses with 156 SPL systems. PROCEDURE: Signalment, primary complaint, method used for placement, time SPL system was in place, and complications were retrieved from medical records. RESULTS: Complications were not associated with placement, maintenance, or removal of 66 of 156 (42%) SPL systems. A minor complication was reported in association with 53 (34%) SPL systems, and a serious complication was reported in association with 37 (24%). The 3 most common minor complications were mild swelling of the eyelid (31 horses), tearing of SPL system tubing (20), and loss of the injection cap (30). Serious complications included problems with the SPL system requiring its premature removal and possible replacement (26 horses), removal of the SPL system by the horse (6), infection of the eyelid (4), loss of the footplate in the eyelid (5), and cornea ulceration (1). CLINICAL IMPLICATIONS: Proper attention to the size of the footplate and placement of the SPL system in the eyelid should decrease the risk of serious complications. Minor eyelid swelling should be expected in the first 48 hours after SPL system placement.

Beyond restructuring. Futuristic rapid-cycle change to improve patient care.

Rapid changes in the healthcare environment provide an impetus to look closely at the way patient care is delivered. It is increasingly important to be both patient focused and cost effective in the delivery of care. No longer can tradition, organizational structures, or poor communication impede effective and efficient patient care. A rapid-cycle change process is one method that involves staff members in identifying and implementing needed change to improve patient care and to remove waste from the system.

Effect of sodium bisulfate on ammonia concentration, fly population, and manure pH in a horse barn.

OBJECTIVE: To evaluate the effectiveness of altering the pH of manure with sodium bisulfate, thereby decreasing ammonia concentration and fly population in a horse barn environment. ANIMALS: 4 mixed-breed pony stallions. PROCEDURE: The 4-week study was scheduled with 2 weeks of treatment (with 2 application rates) and 2 weeks with no treatment (control weeks). During treatment weeks, sodium bisulfate was applied daily to the top of the bedding and straw, then spread on top. Ponies were kept in the stalls 24 hours a day during the 7-day test period and stall cleaning was not done. On day 7 of each week, ammonia concentration, manure pH, number of flies on a fly tape, and fly-evasive behavior patterns were determined. RESULTS: Sodium bisulfate applied to the horse stall environment daily of either 2.3 or 4.5 kg/9.3 m2 (5 or 10lb/ 100 ft2) decreased ammonia concentration, manure pH, and number of flies in the stall environment, compared with a control period with no sodium bisulfate. Fly-evasive behavior patterns of ponies occupying the stalls, including tail swishes, head tosses, and kicks/strikes, were decreased during the period of sodium bisulfate application. CONCLUSION: Sodium bisulfate may be an effective method of decreasing ammonia concentration and may serve as a method of fly control in horse barns.

Interviews with home health aides caring for people with AIDS.

Through a phenomenological perspective, this study describes the experiences of home health aides caring for people with acquired immunodeficiency syndrome. Six home health aides were asked the question, "What is it like to be a home health aide caring for persons with acquired immunodeficiency syndrome?" The essential meanings uncovered from this study were empathy, being there, self-reflection, support and communication, and coping. This research study about home health aides caring for persons with acquired immunodeficiency syndrome will help nursing develop additional programs to educate and support the home health aide in this experience.

A prospective study of treatment of accommodative insufficiency.

Prepresbyopic patients with reduced accommodative amplitude (accommodative insufficiency) are commonly seen in optometric practice. Treatments include accommodative therapy and plus reading lenses. We did a prospective study of the effects of vision therapy and plus reading lenses on 15 patients (mean age 21.87 +/- 9.66 years) with accommodative insufficiency; presumed etiologies included head trauma (6 patients), thyroid disease (3 patients), seizures (1 patient), toxoplasmosis (1 patient), and idiopathic causes (4 patients). A 7-question scaled response pre- and post-treatment questionnaire assessed symptoms of two groups, vision therapy (idiopathic only) and progressive addition lenses (all patients). No idiopathic patient improved after 3 weeks of accommodative therapy. Progressive lenses with a near addition of + 1.00 or + 1.25 were then prescribed. Questionnaire results, which indicate that near additions provided more relief of symptoms than vision therapy for treatment of accommodation insufficiency, underscore the need for careful examination of prepresbyopic patients to determine those who would benefit from a near addition.

Differences between objective and subjective refractions after radial keratotomy.

BACKGROUND: In patients who are free of pathology, automatic refractions have shown close agreement with the subjective refractions. Clinical experience indicated that the normally strong relationship between objective and subjective refraction is significantly weakened as a result of radial keratotomy. METHODS: Seventy-two patients were refracted before and after surgery, objectively with a Humphrey Model #510 autorefractor and subjectively using a binocular refraction procedure without cycloplegia. All patients were free of ocular disease and had preoperative myopia ranging from -1.00 to -9.00 diopters as determined by the subjective spherical equivalent. RESULTS: The results indicated that the preoperative difference between the mean spherical automatic and subjective refractions was a clinically acceptable 0.25 diopter. However, postoperatively, there was a statistically significant difference of 1.25 D with the automatic refractor determining more myopic refractions. Subsequent analysis revealed that the age of the patient had a direct bearing on this finding with patients less than 40 years of age showing more minus in the automatic refraction than patients 40 years and older. CONCLUSIONS: The postoperative discrepancy between the two refractions may be explained by induced optical aberrations and may contribute towards the visual fluctuations experienced by radial keratotomy patients. It is postulated that the inconsistency in refractive determination is due to optical distortion since the age dependence of this effect may be related to the reduction of pupil size that occurs with aging. In the radial keratotomy patient, the practitioner is faced with a more complex and uncertain refraction that may vary according to refractive procedures used and other factors such as pupil size.

Arnold-Chiari malformation.

Arnold-Chiari malformation is a congenital malformation of the skull near the foramen magnum in which the cerebellum and the medulla are caudally displaced. This herniation of the brainstem causes down-beat nystagmus and oscillopsia, the most commonly presenting sign and symptom, respectively. Differential diagnoses for the Arnold-Chiari malformation include, but are not limited to, demyelinating disease, tumor, and vascular disorders. Symptoms will generally worsen with time and may even be brought on during exercise or valsalva maneuvers. A correct diagnosis can lead to timely surgical intervention which can improve the quality of eye movements. Treatment generally involves the surgical decompression of the surrounding spinal tissue.

Microprocessor-controlled Nd:YAG laser for hyperthermia induction in the RIF-1 tumor.

Near-infrared radiation from a Nd:YAG laser at 1,064 nm was used interstitially or superficially to induce hyperthermia in RIF-1 tumors in C3H male mice. A single 600-microns quartz fiber with a 0.5-cm cylindrical diffusor or a weakly diverging microlens at its distal end was used to deliver laser energy to tumors in the hind leg (mean volume = 100 mm3). Two thermocouples were inserted into each tumor. One thermocouple controlled a microprocessor-driven hyperthermia program (maximum output of 3.5 Watts) to maintain the desired temperature. Tumors were exposed to various temperature-time combinations (42-45 degrees C/30 min). Our initial results indicated that excellent temperature control to within 0.2 degrees C of the desired temperature at the feedback thermocouple was achievable during both superficial and interstitial heat treatments. Temperatures at the second thermocouple, however, were found to be lower by as much as 2.3 degrees C (using the cylindrical diffusor) or higher by up to 4.6 degrees C (using the microlens) when compared to the feedback thermocouple temperature. Several correlations were seen between total dose, tumor growth delay, percent skin necrosis, and temperature at the second thermocouple after several superficial and interstitial treatments. Statistically significant improvements in tumor growth delay (at 42 and 45 degrees C) and increased percent skin necrosis at all temperatures were observed after superficial versus interstitial treatment.

Multiple applications of the NCT: an assessment of the instrument's effect on IOP.

The feasibility of the American Optical Non-Contact Tonometer as an instrument for tonography was assessed. It was found that after 20 measurements in quick succession, there was a statistically insignificant change in IOP. Multiple intraocular pressure (IOP) readings with this instrument are helpful in determining an abnormally high IOP from an aberrant recording.

Ruggedness testing of the official method for rot fragments in comminuted tomato products.

The official AOAC method for rot fragments in comminuted tomato products (44.224) has been revised on the basis of Youden's ruggedness testing procedures to provide better control over the sources of variability. Two sets of ruggedness tests were carried out to evaluate the type of balance used to weigh the sample, amount of stain, staining time, sieve design, technique used to transfer stained material from beaker to sieve, washing technique used to accumulate stained material at edge of sieve, diameter of eye dropper used to transfer sample from sieve to graduated tube, number of 0.5 mL portions examined, and magnification used to examine prepared slides. A 3-way analysis of variance conducted on amount of stain, transfer technique, and washing technique showed that the transfer and washing techniques were significant areas of variability.