Unique imaging findings in the facial bones of renal osteodystrophy.

Facial skeletal changes associated with hyperparathyroidism assume 3 radiographic patterns: osteitis fibrosa cystica, fibrous dysplasia, and leontiasis ossea. The 3rd pattern is unique to renal osteodystrophy. We report a case of uremic leontiasis ossea with CT images illustrating significant hypertrophy of the jaws with serpiginous tunneling within the bone and poor visualization of the cortical bone.

Mathematical model for carbon dioxide evolution from the thermophilic composting of synthetic food wastes made of dog food.

The impacts of the aeration and the agitation on the composting process of synthetic food wastes made of dog food were studied in a laboratory-scale reactor. Two major peaks of CO(2) evolution rate were observed. Each peak represented an independent stage of composting associated with the activities of thermophilic bacteria. CO(2) evolutions known to correlate well with microbial activities and reactor temperatures were fitted successfully to a modified Gompertz equation, which incorporated three biokinetic parameters, namely, CO(2) evolution potential, specific CO(2) evolution rate, and lag phase time. No parameters that describe the impact of operating variables are involved. The model is only valid for the specified experimental conditions and may look different with others. The effects of operating parameters such as aeration and agitation were studied statistically with multivariate regression technique. Contour plots were constructed using regression equations for the examination of the dependence of CO(2) evolution potentials on aeration and agitation. In the first stage, a maximum CO(2) evolution potential was found when the aeration rate and the agitation parameter were set at 1.75 l/kg solids-min and 0.35, respectively. In the second stage, a maximum existed when the aeration rate and the agitation parameter were set at 1.8 l/kg solids-min and 0.5, respectively. The methods presented here can also be applied for the optimization of large-scale composting facilities that are operated differently and take longer time.

Influences of pH and hydraulic retention time on anaerobes converting beer processing wastes into hydrogen.

To convert high-solids organic wastes (3% w./w.) to high-value hydrogen, a full factorial experimental design was employed in planning the experiments for learning the effects of pH and hydraulic retention time (HRT) on the hydrogen production in a chemostat reactor using waste yeast obtained from beer processing wastes. For determining which experimental variable settings affect hydrogen production, predictive polynomial quadratic equation and response surface methodology were employed to determine and explain the conditions required for high-value hydrogen production. Experimental results indicate that a maximum hydrogen production rate of 460 mL/gVSS/d was obtained at pH = 5.8 and HRT = 32 hours. Moreover, hydrogenase targeted RT-PCR results indicate that Clostridium thermocellum and Klebsiella pneumoniae predominated.

The development and testing of the patient record pain management assessment tool.

The article reports a study whose purpose was to develop and test the Patient Record Pain Management Assessment Tool, an instrument to evaluate compliance with the American Pain Society's quality assurance standards on acute pain and cancer pain in chart documentation. Content validity, overall validity, and interrater reliability were all found to be acceptable. The instrument is therefore a useful tool for documenting the level of pain management practice in institutional settings.

Patient outcomes in hospital-based respite: a study of potential risks and benefits.

BACKGROUND: Primary care physicians provide increasing care for elderly patients with chronic disabilities. To maintain these individuals in the community, families and other caregivers are supplying more intensive support in the home. Services, such as short-term respite care, can relieve the caregiver burden and allow the patient to continue community living. Whether hospital-based respite can be an effective option for patients is unclear. METHODS: To determine the patient outcomes in hospital-based respite, 15 elderly male respite patients (mean age 71 years) were matched and compared during a 6-month period with 14 elderly acute care control patients and 16 community-based elderly control patients who were chronically ill and were enrolled in a hospital-based home-care program. RESULTS: The average respite stay was 15 days. The respite group did not experience increased risk of mortality or iatrogenesis. Benefits at 6 months included fewer admissions for acute medical care for the respite group (P less than 0.05). Total number of hospital days was equivalent for the respite group and community-based control patients and was fewer than that for the acute care group. CONCLUSION: The results do not indicate any harm and argue that a slight benefit is associated with hospital-based respite for chronically ill older adults. Because of potential complications that can develop for chronically ill geriatric patients, a hospital setting for respite can be a viable respite alternative. A valid concern for physicians, however, remains the potential danger of a greater rate of iatrogenic illness and expectation of more aggressive care based on a tertiary care model.

Weight loss in nursing home patients: prognostic implications.

Weight loss is commonly used as a screening tool to assess quality of care and nutritional status in the nursing home setting. To evaluate the prognostic value of weight loss, the charts of 199 nursing home patients (414 nursing home patient years; mean age 87 years) were reviewed over a 3-year period. Weights recorded at nursing home admission and during the study period were compared with weights at the time of acute care hospitalization, transfer between levels of nursing home care, change in level of functional status, and death. There were no significant changes in weight before acute care hospitalizations, although patients who died lost an average of 10% of their body weight from the time of nursing home admission (P less than .001). In addition, weight loss was associated with decreased functional ability and transfer to a higher level of nursing home care. Despite the association of weight loss with subsequent morbidity and mortality, moderate weight loss of up to 20% was a poor predictor of mortality. Although weight loss is routinely used as a screening tool in the nursing home setting, it is not a sensitive marker for underlying disease. The efficacy of active intervention in nursing home patients who lose weight requires further study.

Prevalence and types of injuries in aerobic dancers.

A sample of 726 aerobic dancers was surveyed by questionnaire to document the prevalence, types, and severity of injuries experienced. Data were gathered on demographics, exercise behavior, and environmental conditions during a 1 week period. Most of the subjects (66%) engaged in aerobic dance classes at least every other day, with a mean exercise time of 195 minutes per week. Twenty-eight percent of the subjects had been exercising 1 to 2 years, and 26% had been exercising 2 years or longer. Forty-nine percent of the subjects reported a history of at least one injury related to aerobic dancing. Most of the injuries were to the shin (24.5%), lower back (12.9%), and ankle (12.2%). Among those subjects injured, 23% reportedly saw a physician because of their injury. The frequency with which subjects exercised was associated with a history of injury. Subjects who exercised fewer than four times per week reported fewer injuries (43%) than those who exercised four times per week (60%) or more (66%). This study is a first step toward providing data to help physicians counsel aerobic dancers regarding injury prevention.

Pneumococcal bacteremia. Update from an adult hospital with a high rate of nosocomial cases.

Eighty-nine episodes of pneumococcal bacteremia were reviewed over a 66-month period at a Veterans Administration Medical Center. Forty-one percent of these episodes were nosocomial in origin, and 59% of the patients were elderly (60 years of age or older). Nosocomial infection occurred more often in the elderly (55%) compared to those less than 60 years of age (32%; P less than 0.05). Within the elderly group, those older than 75 years of age had a higher rate of nosocomial bacteremia than those 60 to 75 years of age (76 versus 44%; P less than 0.05). The clinical presentation of the elderly and younger groups was not significantly different. All but one patient had serious underlying diseases. Eighty-three percent of the episodes were due to pneumonia, and penicillin alone was prescribed for only 21% of all cases. The mortality rate directly due to the bacteremia was 22%, while the overall mortality during the hospitalization was 47%. In the elderly, the percentage of deaths due to infection was similar to the younger group, but overall mortality during the hospitalization was significantly higher in the elderly (74 versus 26%; P less than 0.01). Physicians showed poor recognition of the significance of pneumococcal disease, as demonstrated by inclusion of the diagnosis of pneumococcal infection or bacteremia in only 27% of the discharge summaries and by predischarge vaccination of only 7% (6 of 82) of those without previous pneumococcal vaccination. In conclusion, the rate of nosocomial pneumococcal bacteremia was high in a predominantly elderly male population; it may be appropriate to consider a hospital-based vaccine program in similar populations.