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East Lansing, MI, United States

Song W.,Wayne State University | Seta J.,Wayne State University | Kast R.E.,Wayne State University | Auner G.W.,Wayne State University | And 3 more authors.
Journal of the American Ceramic Society | Year: 2015

Amorphous calcium polyphosphate (ACPP), an inorganic polymer ceramic, has shown promise as a drug delivery matrix following a repeat gelling protocol. This study described a simple method of preparing ACPP hydrogel in the presence of an excess volume of water. The increased water availability accelerates water molecule ingress and microstructural transformation of ACPP hydrogels. The impact of some experimental settings (soaking time, temperature, stirring, and ACPP particle size) on the physiochemical and rheological natures of ACPP hydrogel were investigated and from which possible hydrogel formation mechanisms were inferred. We believe that the formation of ACPP hydrogel is through the mechanisms of intermolecular ionic interaction and entanglement of polyphosphate chains. The potential application of ACPP hydrogel as a ceramic matrix for sustained drug release warrants further investigation. © 2015 The American Ceramic Society. Source

Jacobsen D.,Institute for Healthcare ImprovementCambridge | Barron J.R.,Michigan | Ko C.,Illinois | Goonewardene M.,Pennsylvania | Rosenberg D.J.,The New School
Journal of Hospital Medicine | Year: 2016

Inappropriate antimicrobial use in hospitalized patients contributes to antimicrobial-resistant infections and complications. We sought to evaluate the impact, barriers, and facilitators of antimicrobial stewardship best practices in a diverse group of hospital medicine programs. This multihospital initiative included 1 community nonteaching hospital, 2 community teaching hospitals, and 2 academic medical centers participating in a collaborative with the Centers for Disease Control and Prevention and the Institute for Healthcare Improvement. We conducted multimodal physician education on best practices for antimicrobial use including: (1) enhanced antimicrobial documentation, (2) improved quality and accessibility of local clinical guidelines, and (3) a 72-hour antimicrobial "timeout." Implementation barriers included variability in physician practice styles, lack of awareness of stewardship importance, and overly broad interventions. Facilitators included engaging hospitalists, collecting real time data and providing performance feedback, and appropriately limiting the scope of interventions. In 2 hospitals, complete antimicrobial documentation in sampled medical records improved significantly (4% to 51% and 8% to 65%, P < 0.001 for each comparison). A total of 726 antimicrobial timeouts occurred at 4 hospitals, and 30% resulted in optimization or discontinuation of antimicrobials. With careful attention to key barriers and facilitators, hospitalists can successfully implement effective antimicrobial stewardship practices. © 2016 Society of Hospital Medicine. Source

Armstrong G.T.,Tennessee | Ness K.K.,Tennessee | Srivastava D.,Tennessee | Kurt B.A.,Michigan | And 6 more authors.
Cancer | Year: 2014

BACKGROUND: Survivors of Hodgkin lymphoma (HL) have significant cardiovascular risk and require long-term surveillance. The current study assessed the prevalence of coronary artery disease (CAD) by coronary computed tomography angiography (CCTA) in adult survivors of childhood HL. METHODS: Thirty-one survivors of HL, 13 of whom (42%) were treated with radiotherapy (RT) only and 18 of whom (58%) were treated with multimodal therapy, underwent CCTA, echocardiography, electrocardiography (ECG), and treadmill stress testing. Obstructive CAD was defined as ≥50% occlusion of the left main or ≥70% occlusion of the left anterior descending, left circumflex, or right coronary arteries on CCTA. Echocardiograms with resting wall motion abnormalities or an ejection fraction <50%; ECGs with Q waves, ST abnormalities without Q waves, or T-wave abnormalities without Q waves; and a J-point depression of ≥1 mm with a horizontal or downsloping ST segment on stress testing were considered abnormal. RESULTS: The prevalence of disease in participants (median age, 40 years [range, 26 years-55 years]; median time from cancer diagnosis, 24 years [range, 17 years-39 years]) was 39%, with 39 plaques detected among 12 survivors. Three participants (10%) treated with RT only had 4 obstructive lesions; 9 patients (29%; 5 of whom were treated with RT only and 4 of whom were treated with multimodal therapy) had nonobstructive lesions. Approximately 15% of lesions involved the left main, 21% involved the proximal left anterior descending, 18% involved the proximal right coronary, and 13% involved the proximal left circumflex arteries. Of the 12 participants found to have CAD by CCTA, 7 had a positive ECG, 1 had a positive echocardiogram, and 1 had a positive stress test. CONCLUSIONS: CCTA identified CAD in a substantial percentage of survivors of HL and may be an effective screening modality for this population. © 2014 American Cancer Society. Source

Rovner E.,University of South Carolina | Hepp Z.,Global Health Outcomes Strategy and ResearchAllergan | Ni Q.,Global Health Outcomes Strategy and ResearchAllergan | Chancellor M.,Michigan
Neurourology and Urodynamics | Year: 2015

Aims: To identify the self-reported treatment goals of patients with urinary incontinence (UI) due to neurogenic detrusor overactivity (NDO), determine whether patients achieved their goals following onabotulinumtoxinA treatment, and assess impact of neurogenic disease (multiple sclerosis or spinal cord injury) and/or clean intermittent catheterization (CIC) on goal achievement. Methods: Data from two Phase III studies of onabotulinumtoxinA 200U (n=227) or placebo (n=241) in NDO patients (≥14 UI episodes/week; inadequately managed by anticholinergics) were pooled for analysis. At baseline, patients listed their top two qualitative treatment goals, which were distributed into eight subcategories. Six weeks post-treatment, patients rated whether they achieved their goals (5-point Likert scale). The frequency distribution of goals, the proportion of patients who achieved their goals, and goal achievement by etiology and use/non-use of CIC were assessed. Results: At baseline, the most common goals were "be dry" (37.9%), "reduce other urinary symptoms" (26.4%), and "improve quality of life/sleep/emotions" (21.4%). Significantly higher proportions of onabotulinumtoxinA-treated patients achieved their overall goals versus placebo (62.0% vs. 17.2%; P< 0.001). OnabotulinumtoxinA treatment resulted in higher goal achievement in all goal categories, regardless of etiology. CIC use did not negatively impact patients' overall goal achievement; significantly higher proportions of onabotulinumtoxinA-treated patients versus placebo achieved their goals regardless of baseline catheterization use or de novo CIC during the first 6 weeks of the study. Conclusions: The majority of patients with UI due to NDO achieved their self-determined treatment goals following onabotulinumtoxinA 200U therapy, regardless of etiology or CIC use. © 2015 The Authors. Neurourology and Urodynamics, published by Wiley Periodicals, Inc. Source

Giorgini P.,University of LAquila | Rubenfire M.,University of Michigan | Das R.,University of Michigan | Gracik T.,University of Michigan | And 7 more authors.
Journal of Hypertension | Year: 2015

Objective: Fine particulate matter air pollution (PM 2.5) and extreme temperatures have both been associated with alterations in blood pressure (BP). However, few studies have evaluated their joint haemodynamic actions among individuals at high risk for cardiovascular events. Methods: We assessed the effects of short-term exposures during the prior week to ambient PM 2.5 and outdoor temperature levels on resting seated BP among 2078 patients enrolling into a cardiac rehabilitation programme at the University of Michigan (from 2003 to 2011) using multiple linear regression analyses adjusting for age, sex, BMI, ozone and the same-day alternate environmental factor (i.e. PM 2.5 or temperature). Results: Mean PM 2.5 and temperature levels were 12.6±8.2μg/m 3 and 10.3±10.4°C, respectively. Each standard deviation elevation in PM 2.5 concentration during lag days 4-6 was associated with significant increases in SBP (2.1-3.5mmHg) and DBP (1.7-1.8mmHg). Conversely, higher temperature levels (per 10.4°C) during lag days 4-6 were associated with reductions in both SBP (-3.6 to -2.3mmHg) and DBP (-2.5 to -1.8mmHg). There was little evidence for consistent effect modification by other covariates (e.g. demographics, seasons, medication usage). Conclusion: Short-term exposures to PM 2.5, even at low concentrations within current air quality standards, are associated with significant increases in BP. Contrarily, higher ambient temperatures prompt the opposite haemodynamic effect. These findings demonstrate that both ubiquitous environmental exposures have clinically meaningful effects on resting BP among high-risk cardiac patients. © 2015 Wolters Kluwer Health, Inc. Source

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