Background
Vitamin D has immunomodulating properties.
Objective
To determine if vitamin D deficiency within 30 days of admission to the intensive care unit in patients with sepsis might be associated with increased all-cause 30-day mortality.
Methods
In a retrospective cohort study at a large, tertiary, urban, academic medical center, records of patients who had 25-hydroxyvitamin D levels measured within 30 days of admission for severe sepsis or septic shock from June 2006 to April 2011 were examined. Patients were considered deficient in vitamin D if its serum concentration was 15 ng/mL or less. The primary outcome of interest was 30-day mortality.
Results
Among the 121 patients in the sample, 65 (54%) were vitamin D deficient. Baseline demographics were similar between vitamin D deficient and nondeficient groups, except that the vitamin D deficient group had more African Americans (P = .01). All-cause 30-day mortality was significantly higher in patients deficient in vitamin D (37% vs 20%; P = .04) and remained higher at 90 days (51% vs 25%, P = .005). In multivariate analysis, age (odds ratio, 1.04; 95% CI 1.01–1.07; P = .01) and vitamin D deficiency (odds ratio, 2.7; 95% CI, 1.39–18.8; P = .02) were independently associated with increased 30-day mortality.
Conclusion
Patients deficient in vitamin D within 30 days of hospital admission for severe sepsis or septic shock may be at increased risk for all-cause 30-day mortality.
7-Aminocephalosporin doxorubicin (AC-Dox) was condensed with monomethoxypoly(ethylene glycol)-propionic acid N-hydroxysuccinimide ester (5 kDa) or with a branched form of poly(ethylene glycol)-propionic acid N-hydroxysuccinimide ester (10 kDa), forming M-PEG-AC-Dox and B-PEG-AC-Dox, respectively. These polymer drug derivatives were designed such that doxorubicin would be released upon Enterobacter cloacae beta-lactamase (bL)-catalyzed hydrolysis. Both M-PEG-AC-Dox (IC50 = 80 microM) and B-PEG-AC-Dox (IC50 = 8 microM) were less toxic to H2981 human lung adenocarcinoma cells than doxorubicin (IC50 = 0.1-0.2 microM) and could be activated in an immunologically specific manner by L6-bL, a monoclonal antibody-bL conjugate that bound to H2981 cell surface antigens. In addition, the polymers were relatively stable in mouse plasma (< 26% hydrolysis after 24 h at 37 degrees C) and were less toxic to mice (maximum tolerated dose > 52 mumol/kg) than doxorubicin (maximum tolerated dose = 13.8 mumol/kg). Pharmacokientic studies were performed in mice bearing subcutaneous 3677 melanoma tumors. B-PEG-AC-Dox cleared from the blood more slowly than M-PEG-AC-Dox and was retained to a 2.1-fold greater extent in human 3677 melanoma tumor xenografts over a 4 h period. The intratumoral concentrations of both polymers far exceeded that of doxorubicin. Thus, the PEG-AC-Dox polymers offer the possibility of generating large intratumoral doxorubicin concentrations owing to their reduced toxicities, the amounts that accumulate in tumors, and the fact that doxorubicin is released upon beta-lactam ring hydrolysis.
Objective
Inpatient rehabilitation study comparing swallowing outcomes and discharge destinations in acute stroke tube-feeding dependent dysphagia patients treated with neuromuscular electrical stimulation and traditional dysphagia therapy versus those treated with only traditional dysphagia therapy.
Design
Retrospective case-control study including 359 patients with acute stroke having initial Functional Oral Intake Scale scores of 3 or lower (profound to severe tube-feeding dependent dysphagia). One hundred ninety participants received neuromuscular electrical stimulation with traditional dysphagia therapy, and 169 controls received only traditional dysphagia therapy. Treatment occurred in hourly sessions 5 d/wk. Main outcome measures were comparison of Functional Oral Intake Scale scores after treatment (N = 359) and comparison of discharge destinations (n = 267).
Results
The neuromuscular electrical stimulation posttreatment mean ± SD Functional Oral Intake Scale score was 4.21 ± 2.1 versus 2.94 ± 1.96 for controls (t = 5.85, P < 0.001). The neuromuscular electrical stimulation group posttreatment mean ± SD Functional Oral Intake Scale gain was 3.24 ± 2.26 points versus 1.87 ± 2.01 for controls (t = 6.05, P < 0.001). After treatment, 51.6% (98/190) neuromuscular electrical stimulation patients had minimal or no swallowing restrictions (Functional Oral Intake Scale scores = 5–7), whereas only 26.6% (45/169) controls improved with Functional Oral Intake Scale scores of 5–7 (χ2 = 23.3, P < 0.0001). Groups differed by discharge destinations: neuromuscular electrical stimulation having more discharges to community than controls, 60% versus 44% (χ2 = 9.16, P = 0.003), and neuromuscular electrical stimulation having fewer acute care transfers compared with controls, 8% versus 25% (χ2 = 32.7, P < 0.0001).
Conclusions
Neuromuscular electrical stimulation with traditional dysphagia therapy was associated with better discharge swallowing outcomes and Functional Oral Intake Scale scores than traditional dysphagia therapy alone during inpatient rehabilitation in treating acute stroke feeding tube–dependent dysphagia and was associated with more discharges to community and less transfers back to acute care.
The absence of a father figure has been linked to very poor developmental outcomes for the child. During incarceration, there are limited opportunities for visitation between fathers and their children. The Baby Elmo Program provides incarcerated teen fathers with parenting training and visitation with their children with the stated goal of enhancing father-child interactional quality. Forty-one incarcerated teen fathers and their infants ranging from 1 to 15 months of age participated in the present study. During individual sessions, a trained facilitator prepared fathers for visits with their children by introducing key concepts such as following the child's lead, using developmentally appropriate media to illustrate those concepts. After each training session, the incarcerated teen father interacted with his infant and the visit was video recorded. Analysis of the visit sessions focused on father's time use on different activities, the quality of father-infant interactions, and father's integration of target skills introduced in the intervention. The time-use analysis revealed that time use changed as a function of infant age. Growth linear modeling indicated that there were significant positive increases in the amount of parent support and infant engagement as a function of the number of sessions. Follow-up analyses indicated that changes between specific sessions mapped onto the target skills discussed during specific training sessions. This study's preliminary findings suggest that an intervention integrating visitation and appropriate media may be effective for incarcerated teen fathers. Due to the lack of a randomized control group, the present findings are exploratory and are discussed with a focus on further program development.
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