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Tacoma, WA, United States

Gautam N.K.,University of Arkansas for Medical Sciences | Schmitz M.L.,University of Arkansas for Medical Sciences | Harrison D.,University of Arkansas for Medical Sciences | Zabala L.M.,University of Arkansas for Medical Sciences | And 5 more authors.
Paediatric Anaesthesia

Objectives: To study the effect of two protamine-dosing strategies on activated clotting time (ACT) and thromboelastography (TEG). Background Protamine dosage based on neutralizing heparin present in the combined estimated blood volumes (EBVs) of the patient and cardiopulmonary bypass (CPB) pump may result in excess protamine and contributes toward a coagulopathy that can be detected by ACT and TEG in pediatric patients. Methods: A total of 100 pediatric patients 1 month to ≤5 years of age undergoing CPB were included in this retrospective before/after design study. Combined-EBV group consisted of 50 consecutive patients whose protamine dose was calculated to neutralize heparin in the combined EBVs of the patient and the pump. Pt-EBV group consisted of the next 50 consecutive patients whose protamine dose was calculated to neutralize heparin in the patient's EBV. Results: Baseline and postprotamine ACTs were similar between groups. Postprotamine heparin assay (Hepcon) showed the absence of residual heparin in both groups. Postprotamine kaolin-heparinase TEG showed that R was prolonged by 7.5 min in the Combined-EBV group compared with the Pt-EBV group (mean R of 20.17 vs 12.4 min, respectively, P < 0.001). Increasing doses of protamine were associated with a corresponding, but nonlinear increase in R. There was no significant difference in the changes for K, alpha, and MA between the groups. Conclusion: Automated protamine titration with a protamine dosage based on Pt-EBV can adequately neutralize heparin as assessed by ACT while minimizing prolonging clot initiation time as measured by TEG. © 2013 Blackwell Publishing Ltd. Source

Huillet A.,U.S. Army | Erdie-Lalena C.,U.S. Army | Norvell D.,Spectrum Research | Davis B.E.,U.S. Army
Journal of Alternative and Complementary Medicine

Objectives: The objective of this study was to evaluate the prevalence, types, perceived effects, and factors that influence the use of complementary and alternative medicine (CAM) by military children. Design: A parent survey was administered in two military general pediatric clinics from June to September 2009. Parents completed surveys about their children including the following items: demographic information, a list of specific CAM therapies, family CAM use, and child health status. Results: Caregivers completed 278 surveys. The overall use of CAM was 23%. The most common type of CAM used was herbal therapy (34%). The CAM therapies most commonly reported to be very helpful were special diets (67%), melatonin (57%), vitamins and minerals used at doses higher than the recommended daily allowance (50%), and massage therapy (50%). The majority of users reported no side-effects (96%). Among CAM users, 53% had discussed their CAM use with a physician and 47% had seen a CAM practitioner. Factors associated with CAM use in multiple regression analysis included chronic conditions (p=0.001), parent/sibling use of CAM (p<0.001), and parent age over 30 years (p=0.02). Primary sources of CAM information were friends and family (68%) and doctors (44%). Common reasons for using CAM were to promote general health (70%), to relieve symptoms (56%), and to improve quality of life (48%). Eighty percent (80%) of all respondents indicated they would use CAM if recommended by a physician. Conclusions: In this military population with access to universal health care, CAM use is higher than the U.S. national average and nearly double that of the 2007 National Health Interview Survey study. Patients with chronic conditions, family members using CAM, and parental age over 30 years are more likely to use CAM. CAM is perceived as helpful with minimal to no side-effects. Pediatricians should inquire about CAM use and be prepared to provide guidance on this topic. © 2011 Mary Ann Liebert, Inc. Source

King K.W.,U.S. Department of Agriculture | Balogh J.C.,Spectrum Research
Environmental Toxicology and Chemistry

Chlorothalonil concentrations exceeding acute toxicity levels for certain organisms have been measured in surface water discharge events from managed turf watersheds. The duration of exceedence and the timing of these events related to precipitation/runoff and time since application, however, have not been explored. Chlorothalonil concentrations were measured from discharge waters draining a managed turf watershed in Duluth, Minnesota, USA, between 2003 and 2009. The median chlorothalonil concentration was 0.58μg/L. Approximately 2% of all measured concentrations exceeded the 7.6μg/L median lethal concentration (LC50) acute toxicity level for rainbow trout. One-twentieth the LC50 concentration, equivalent to the level of concern (0.38μg/L) for endangered species, was exceeded 31% of the time during the present study. The concentrations that exceeded the LC50 threshold were associated with eight rainfall/runoff events. Low dose exposures are a more important biological concern than acute occurrences. Exceedence concentrations associated with acute effects were significantly (p<0.05) correlated to time since application and were measured only in the fall following extensive application. A conflict exists between the transportability of chlorothalonil as suggested by its chemical properties and the data collected in the present study. With respect to course-wide golf course application, avoiding application until after the major autumn rainfall period but before the first snow coverage is recommended to reduce occurrence of chlorothalonil concentrations that exceed toxic levels associated with acute and chronic levels of concern. Environ. Toxicol. Chem. 2013;32:684-691. © 2012 SETAC. Source

Peredo D.E.,U.S. Army | Davis B.E.,U.S. Army | Norvell D.C.,Spectrum Research | Kelly P.C.,U.S. Army
Journal of Pediatric Rehabilitation Medicine

Objective: To investigate the use of medical equipment by children with disabilities, the reasons for use, and prescribers of equipment. Methods: A convenience sample. Setting: Referral clinic for children with developmental conditions. Participants: Caregivers of children with motor disabilities completed an interview survey for children 0-21 years. Results: 108 parents/caregivers reported 467 (mean=4.3 per patient) pieces of owned equipment. The mean age of children was 7.1 years (± 5.0), and 49% were female. The most common diagnoses were cerebral palsy (45%), 'Other' diagnoses including intellectual disability (19%), genetic abnormality (13%), spina bifida (13%), and neuromuscular diseases (7%). Survey participants described use of the following types of equipment: orthotics (82%), bath chair (37%), seating device (34%), stander (19%), augmentative communication devices (17%), walker (14%), and gait trainer (10%). Reasons for "non-use" of equipment included: outgrown (19%), not useful (14%), and child refusal (15%). Physicians were the sole prescriber for 15% of families, whereas physical or occupational therapists most commonly recommended new equipment (76%). Conclusion: Based on parental report, children with neuromuscular disabilities use most equipment that is medically recommended. The majority of equipment needs are identified by therapists. Pediatricians can benefit from additional expertise in the provision of medical equipment for children. © 2010 - IOS Press and the authors. All rights reserved. Source

Rosenberg D.E.,Rehabilitation Care Service | Rosenberg D.E.,Group Health Research Institute | Turner A.P.,Rehabilitation Care Service | Turner A.P.,University of Washington | And 9 more authors.
Disability and Rehabilitation

Purpose: Using preliminary data, we examined: (i) patterns of body mass index (BMI) over the year following amputation by amputation level and (ii) the association between BMI and mobility and prosthetic device use. Method: Patients from three medical centers undergoing dysvascular amputation (N = 87; M age = 62) participated in interviews pre-surgically and at 6 weeks, 4 months, and 12 months following amputation. The main outcome was self-reported BMI, adjusting for limb weight lost due to amputation. Additional outcomes were mobility and time spent using and walking in a prosthetic device. Results: Adjusted BMI slightly decreased at 6 weeks (pre-surgery M = 31.2; 6 weeks M = 30.3) and 4 months (M = 30.7) but exceeded baseline levels by 12 months (M = 31.7). There were no significant BMI differences by amputation level. In multivariable analyses, higher pre-surgical BMI was associated with fewer hours of prosthetic device walking at month 4 (β =-0.49) and poorer overall mobility at month 12 (β =-0.22). Conclusions: BMI increased at one year following amputation surgery. Higher pre-surgical BMI was associated with poorer mobility and prosthetic device use. Interventions are needed to prevent excess weight gain in the year following amputation. Implications for Rehabilitation People undergoing lower-extremity amputation have high rates of overweight and obesity and continue to gain weight in the year following amputation. Objective assessment of body mass index (both with and without a prosthetic device) and waist circumference would help future research efforts. Targeting weight loss post-amputation could improve the health of people with lower-extremity amputations. © 2013 Informa UK, Ltd. Source

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