The Regional Asthma Disease Management Program (RADMP) for low income underserved children in rural western North Carolina: a National Asthma Control Initiative Demonstration Project.

BACKGROUND: A substantial proportion of low-income children with asthma living in rural western North Carolina have suboptimal asthma management. To address the needs of these underserved children, we developed and implemented the Regional Asthma Disease Management Program (RADMP); RADMP was selected as one of 13 demonstration projects for the National Asthma Control Initiative (NACI). METHODS: This observational intervention was conducted from 2009 to 2011 in 20 rural counties and the Eastern Band Cherokee Indian Reservation in western North Carolina. Community and individual intervention components included asthma education in-services and environmental assessments/remediation. The individual intervention also included clinical assessment and management. RESULTS: Environmental remediation was conducted in 13 childcare facilities and 50 homes; over 259 administrative staff received asthma education. Fifty children with mild to severe persistent asthma were followed for up to 2 years; 76% were enrolled in Medicaid. From 12-month pre-intervention to 12-month post-intervention, the total number of asthma-related emergency department (ED) visits decreased from 158 to 4 and hospital admissions from 62 to 1 (p < 0.0001). From baseline to intervention completion, lung function FVC, FEV1, FEF 25-75 increased by 7.2%, 13.2% and 21.1%, respectively (all p < 0.001), and average school absences dropped from 17 to 8.8 days. Healthcare cost avoided 12 months post-intervention were approximately $882,021. CONCLUSION: The RADMP program resulted in decreased ED visits, hospitalizations, school absences and improved lung function and eNO. This was the first NACI demonstration project to show substantial improvements in healthcare utilization and clinical outcomes among rural asthmatic children.

Coordination of breathing and various movement markers during pianists' performance tasks.

Few investigations have analysed the relations of breathing and pianists' movements. In past studies, however, coordination of breathing with repetitive movements were examined. The current experiment explored the coordinative relations of breathing with three different finger-movement markers (pitch, meter, and thumb passage) during the performance of repetitive exercises at the piano. Eight pianists played the C major scale and arpeggio at different tempi. The Musical Instrument Digital Interface (MIDI) data were collected and the pianists' respiration was simultaneously monitored by inductive plethysmography. Analysis showed that the breathing varied between participants. Other than some exceptional cases for which movement markers coincided with the end of inspiration and the end of expiration of the breathing curve, no coordination or relation occurred between breathing and finger movement.

Native Michigan plants stimulate soil microbial species changes and PAH remediation at a legacy steel mill.

A 1.3-acre phytoremediation site was constructed to mitigate polyaromatic hydrocarbon (PAH) contamination from a former steel mill in Michigan. Soil was amended with 10% (v/v) compost and 5% (v/v) poultry litter. The site was divided into twelve 11.89 m X 27.13 m plots, planted with approximately 35,000 native Michigan perennials, and soils sampled for three seasons. Soil microbial density generally increased in subplots of Eupatorium perfoliatum (boneset), Aster novae-angliae (New England aster), Andropogon gerardii (big bluestem), and Scirpus atrovirens (green bulrush) versus unplanted subplots. Using enumeration assays with root exudates, PAH degrading bacteria were greatest in soils beneath plants. Initially predominant, Arthrobacter were found capable of degrading a PAH cocktail in vitro, especially upon the addition of root exudate. Growth of some Arthrobacter isolates was stimulated by root exudate. The frequency of Arthrobacter declined in planted subplots with a concurrent increase in other species, including secondary PAH degraders Bacillus and Nocardioides. In subplots supporting only weeds, an increase in Pseudomonas density and little PAH removal were observed. This study supports the notion that a dynamic interplay between the soil, bacteria, and native plant root secretions likely contributes to in situ PAH phytoremediation.

Calibration of nanowatt isothermal titration calorimeters with overflow reaction vessels.

Obtaining accurate results with nanowatt titration calorimeters with overflow cells requires mass calibration of the buret injection volume, chemical calibration of the reaction vessel effective volume, and chemical calibration of the calorimetric factor used to convert the measured electrical signal to heat rate. Potential errors in electrical calibration of power compensation calorimeters require validation of the calorimetric factor with chemical reactions with accurately known stoichiometries and enthalpy changes. The effective volume of the reaction vessel can be determined from the endpoint of a quantitative reaction with known stoichiometries. Methods for calibration and potential calibration errors to be avoided are described. Publication of results obtained must include data on calibrations and sufficient raw data to assess precision and accuracy of the results.

Simultaneous determination of equilibrium constants and enthalpy changes by titration calorimetry: Methods, instruments, and uncertainties.

Calorimetric methods have been used to determine equilibrium constants since 1937, but no comprehensive review of the various calorimeters and methods has been done previously. This article reports methods for quantitative comparison of the capabilities of calorimeters for simultaneous determination of equilibrium constants and enthalpy changes, for determining optimal experimental conditions, and for assessing the effects of systematic and random errors on the accuracy and precision of equilibrium constants and enthalpy changes determined by this method.

The effect of posterior capsular tightening on peak subacromial contact pressure during simulated active abduction in the scapular plane.

HYPOTHESIS: Our hypothesis was that tightening of the posterior capsule would lead to increased subacromial pressure and increased superior translation during active abduction in the scapular plane. BACKGROUND: Subacromial impingement syndrome is a painful condition that occurs during overhead activities as the rotator cuff is compressed in the subacromial space. Unrecognized secondary causes of subacromial impingement may lead to treatment failure. Posterior capsular tightness, believed to alter glenohumeral joint kinematics, is often cited as a secondary cause of SI; however, scientific evidence is lacking. The primary objective of this study was to evaluate the effect of posterior capsular tightening on peak subacromial pressure during abduction in the scapular plane. MATERIALS AND METHODS: Ten fresh frozen shoulder specimens from deceased donors were mounted on a custom shoulder simulator. With the scapula fixed, the deltoid and rotator cuff muscles were loaded in discrete static steps with a constant ratio to elevate the humerus in the scapular plane. The treatment order (no tightening, 1-cm, and 2-cm tightening of the posterior capsule) was randomly assigned to each specimen. Peak subacromial contact pressure and glenohumeral kinematics at the peak pressure position were compared using a repeated measures analysis of variance. RESULTS: Peak subacromial pressures (mean +/- standard deviation) were similar between treatment groups: 345 +/- 152, 410 +/- 213, and 330 +/- 164 kPa for no tightening, 1-cm, and 2-cm tightening of the posterior capsule respectively (P > .05). No significant differences were found for superior or anterior translations at the peak pressure position (P > .05). DISCUSSION: Posterior capsular tightening, as a sole variable, did not contribute to a significant increase in peak subacromial pressure during abduction in the scapular plane. A similar study simulating active forward flexion is necessary to fully characterize the contribution of posterior capsular tightness to subacromial impingement. CONCLUSION: Tightening of the posterior capsule did not increase subacromial pressure, or increase superior or anterior translation during abduction in the scapular plane.

Post-thrombotic syndrome after total hip arthroplasty is uncommon.

BACKGROUND: Deep vein thrombosis (DVT), usually asymptomatic, is common after total hip arthroplasty (THA). Post-thrombotic syndrome (PTS) is a potential late complication of DVT, but there is limited data on its occurrence. PATIENTS AND METHODS: This was a prospective cohort study of subjects at one hospital who had participated in a trial of thromboprophylaxis for THA and who had postoperative venography. Data were collected at baseline and 2-4 years later to ascertain symptoms of PTS using a modification of a validated scoring system. Outcomes were collected without knowledge of baseline characteristics or venogram results. Potential predictors of PTS were explored using exact logistic regression analyses. RESULTS: The cohort (n=188) had a mean age of 63 years, 51% were male, 35% had a BMI of>30, and 4% had a prior history of DVT. 25 patients (13%) had DVTs on venography. 12 patients (6%, 95% CI: 3-11) subsequently developed symptoms consistent with PTS, 7 with bilateral symptoms. Most affected limbs (15 of 19) had no postoperative DVT. No statistically significant predictors of PTS were found. INTERPRETATION: Symptoms of PTS are infrequent after THA in patients who receive some form of thromboprophylaxis. Our findings, which are consistent with the existing literature, suggest that there is a potential benefit to giving thromboprophylaxis for reduction of symptomatic PTS.

From biochemistry to physiology: the calorimetry connection.

This article provides guidelines for selecting optimal calorimetric instrumentation for applications in biochemistry and biophysics. Applications include determining thermodynamics of interactions in non-covalently bonded structures, and determining function through measurements of enzyme kinetics and metabolic rates. Specific examples illustrating current capabilities and methods in biological calorimetry are provided. Commercially available calorimeters are categorized by application and by instrument characteristics (isothermal or temperature-scanning, reaction vessel volume, heat rate detection limit, fixed or removable reaction vessels, etc.). Advantages and limitations of commercially available calorimeters are listed for each application in biochemistry, biophysics, and physiology.

Development of a mathematical model of the human circulatory system.

A mathematical lumped parameter model of the human circulatory system (HCS) has been developed to complement in vitro testing of ventricular assist devices. Components included in this model represent the major parts of the systemic HCS loop, with all component parameters based on physiological data available in the literature. Two model configurations are presented in this paper, the first featuring elements with purely linear constitutive relations, and the second featuring nonlinear constitutive relations for the larger vessels. Three different aortic compliance functions are presented, and a pressure-dependent venous flow resistance is used to simulate venous collapse. The mathematical model produces reasonable systemic pressure and flow behaviour, and graphs of this data are included.