Search

Data driven strategies for acute pancreatitis (AP) in pediatrics are limited; adult data suggests lactated ringers (LR) compared to normal saline (NS) resulted in favorable outcomes, but has not been studied in pediatrics. Our objective was to evaluate the efficacy of LR during the first 48 h of an AP episode compared with NS. A multisite randomized controlled clinical trial, from 2015 to 2020 (Clinical Trials.govNCT03242473). Patients were randomized to exclusively LR or NS for the first 48 h. Primary outcomes were serial C‐reactive protein (CRP) values. Secondary outcomes included other lab values, time to feeds, length of stay (LOS), systemic inflammatory response syndrome (SIRS) development, and progression to severe AP (SAP). We studied 76 patients (38 LR, 38 NS). CRP at 24 and 48 h were not significantly different between LR or NS group. Additionally, there were no differences in trends of BUN, amylase, lipase, SIRS status, or SAP development between the LR and NS group at 24 and 48 h. A higher proportion of LR patients (32%, 12/38) were discharged before 48 h compared to NS (13%, 5/38). The LR group had a significantly higher rate of discharge within the first 72 h compared to the NS group (p= 0.02). The use of LR was associated with a faster rate of discharge during the intervention period and in the first 72 h, but no other differences compared to NS. This reduction in length of hospitalization has significant implications for patients and healthcare costs. Fluid resucistation with isotonic fluids has been shown to be helpful in pediatric acute pancreatitis (AP).Adult literature has favored lactated ringers (LR), but this has not been evaluated in pediatric AP. Fluid resucistation with isotonic fluids has been shown to be helpful in pediatric acute pancreatitis (AP). Adult literature has favored lactated ringers (LR), but this has not been evaluated in pediatric AP. This study shows that patients who exclusively received LR were discharged faster than patients who received normal saline.There were no other benefits or harms associated with the use of LR. This study shows that patients who exclusively received LR were discharged faster than patients who received normal saline. There were no other benefits or harms associated with the use of LR.

To determine the outcomes of patients with cystic biliary atresia by correlating the anatomy of the hepatic ducts with the choice of biliary reconstruction surgery. The Kasai hepatoportoenterostomy (Kasai) is the initial surgical procedure offered to most patients with biliary atresia. In contrast, a hepatic‐cyst‐jejunostomy has been reported to be effective in patients with the cystic form of biliary atresia. We performed an international multicenter retrospective review. Two hundred eighty‐seven patients were included, and 33 cases of cystic biliary atresia were identified. Outcomes were the serum total bilirubin level 3 months post‐surgery and native liver survival at 2 years of age and were compared between cases who received the Kasai versus hepatic‐cyst‐jejunostomy in correlation to the anatomy of proximal hepatic ducts. The patients were categorized into 3 anatomical groups: patent intact hepatic ducts (n = 10), patent hypoplastic hepatic ducts (n = 13), and obliterated hepatic ducts (n = 10). All 10 patients with patent intact hepatic duct group underwent hepatic‐cyst‐jejunostomy, and 9 experienced bile drainage and native liver survival. Among the 13 patients with hypoplastic hepatic ducts, 11 underwent the Kasai procedure, and 9 had bile drainage, whereas 2 underwent hepatic‐cyst‐jejunostomy, and one survived with the native liver. All of the patients with obliterated hepatic ducts underwent the Kasai procedure; 5 established biliary drainage and survived with the native liver. Of 5 who did not drain, 3 underwent liver transplantation. In patients with cystic biliary atresia, the subset with a connection between cyst and intrahepatic bile ducts via intact proximal hepatic ducts had favorable clinical outcomes following hepatic‐cyst‐jejunostomy.

Falls are the leading cause of mortality and morbidity in older and represents one of the major and most costly public health problems worldwide. Evaluate the influences of lower limb muscle performance, static balance, functional independence and quality of life on fall risk as assessed with the timed up and go (TUG) test. Cross‐sectional study. Fifty‐two residents aged 80 or older were assessed and distributed in one of the two study groups (no risk of falls; risk of falls) according to the time to complete the TUG test. A Kistler force platform and linear transducer was used to determinate lower limb muscle performance. Postural Stability (static balance) was measured by recording the center of pressure. The EuroQol‐5 dimension was used to assess Health‐related quality of life and the Barthel index was used to examine functional status. Student's t‐test was performed to evaluate the differences between groups. Correlations between variables were analyzed using Spearman or Pearson coefficient. ROC(receiver operating charasteristic) analysis was used to determine the cut‐off points related to a decrease in the risk of a fall. Participants of no‐fall risk group showed better lower limb performance, quality of life, and functional status. Cut‐off points were determined for each outcome. Risk of falls in nursing home residents over the age of 80 is associated with lower limb muscle performance, functional status, and quality of Life. Cut‐off points can be used by clinicians when working toward fall prevention and could help in determining the optimal lower limb muscle performance level for preventing falls.

To determine (1) the reproducibility of measurements of chair stand mean power (CSMP), (2) the relationships of CSMP with age, height, body mass, and body mass index, and (3) to identify the threshold of CSMP below which performing activities of daily living (ADL) is limited in older women.

Physicians are accustomed to prescribing multiple prescriptions to adults of all ages, but particularly to the older adult population. In 2010, US retail pharmacies filled out on average 31.1 prescriptions for adults aged 65 years and older compared with 11.3 prescriptions to adults aged 19–64 years. Older adults find themselves at the pharmacy counter more often than younger generations due to an increase in chronic diseases and disabling conditions. Many of these diseases and conditions are often well treated and controlled via prescription drugs. However, a different type of prescription should be written on physicians prescription pads worldwide, one that could potentially lower the risk of diseases and disabling conditions altogether. This prescription is commonly referred to as an ‘exercise prescription. The overall intent of this paper is to discuss successful strategies implemented by physicians who have prescribed physical activity/exercise to their older adult patients and to help healthcare providers better understand and establish successful exercise prescription counseling habits. It is also aimed to shed light on the barriers facing primary care providers in an effort to help physicians overcome these barriers. Information regarding Exercise is Medicine®and the Exercise is Medicine®Credential program for exercise specialists is provided. Older adult and public health advocates will also find this paper valuable in that they too will learn the recommended physical activity guidelines, associated benefits of engaging in the recommended dose of physical activity, and perhaps how to promote exercise prescription by their physician, physician organizations, or engage other members of the medical team, including health and fitness professionals, to strive for a common goal of patients receiving this ‘new medicine called exercise.

The article focuses on the fitness training and the quality and quantity of exercises for fitness. It highlights that regular exercises helps in delaying mortality and reduce the chances of disability from diseases like cardiovascular disease, diabetes and osteoporosis. It also states the types of exercises prescribed for the adults which includes cardio respiratory (Aerobic exercise), flexibility (stretching) exercise and neuromotor exercise. INSET: Is exercise different from physical activity?.

The article examines existing studies related to lifestyle modification method such as diet and exercise, in treating diabetes in the U.S. in 2009. It describes the impact that diabetes had on physical health and activity. Moreover, it discusses the benefits of exercise to older people with type 2 diabetes and highlights exercise guidelines for diabetes from both the American Diabetes Association (ADA) and the American College of Sports Medicine (ACSM).

The article offers ideas for travel agencies for providing a fitness program to older vacationers in the U.S. According to the authors, a good level of physical fitness will help older people enjoy a vacation. They assert that such a program will help in avoiding shortness of breath, sore muscles and tired feet. In addition, the authors suggest that a program consisting of cardiovascular, flexibility, strength and balance exercises can help prepare older people to accomplish activities.

Focuses on the benefits of hip school, an exercise program for older people with hip osteoarthritis and those that need hip replacement surgery established by orthopedic surgeon Thomas Horstmann and physiotherapist George Haupt. Impact of arthritis and rheumatism on older adults; Exercises recommended by the program for patients; Approach used by instructors in conducting exercises to ensure that patients perform pain-free movements.

Provides information on functional activities or movement which has been loosely used in exercise training programs to describe exercises that are relevant to specific functional activities that are performed on a daily basis. Examples of basic activities of daily living; Components of skilled activities; Approach that can help identify weak links in the chain of movement that can contribute to dysfunction; Human systems that are functioning simultaneously during any human movement.

Provides information on a strength and balance training program for older adults. Reason resistance training alone had only a modest effect on improving balance, even though strength and balance are related; Significance of combining balance and strength exercises; Actions to be taken by the facility staff to prevent falls during an exercise program.

TAKESHIMA, N., M. E. ROGERS, E. WATANABE, W. F. BRECHUE, A. OKADA, T. YAMADA, M. M. ISLAM, and J. HAYANO. Water-based exercise improves health-related aspects of fitness in older women. Med. Sci. Sports Exerc., Vol. 33, No. 3, pp. 544–551, 2002.

Cues used in below‐ground host‐searching behaviour and host discrimination were examined for Tiphia vernalisRohwer and Tiphia pygidialisAllen (Hymenoptera: Tiphiidae), ecto‐parasitoids of root‐feeding larvae of the Japanese beetle, Popillia japonicaNewman, and masked chafers, Cyclocephalaspp. (Coleoptera: Scarabaeidae), respectively. Response to potential stimuli was compared in dual choice tests in an observation chamber filled with soil. Each wasp showed species‐specific, directed movement along residual body odor trails made by dragging its respective host through the soil. Presence of a grub was not necessary for wasps to follow such trails. Frass from either host‐ or non‐host grubs elicited trail‐following, but each Tiphiaspecies followed frass trails from its respective host when a choice was presented. Frass trails elicited stronger responses than body odor trails. The combination of host frass and body odor elicited the strongest trail‐following responses. Our results suggest that once in the soil, Tiphiaspp. locate their hosts using contact kairomones present in grub body odor trails and frass.

This study examined the attitudes toward exercise held by older adults within different stages of the exercise change model for the purpose of aiding health professionals in developing effective approaches that engage older adults in physical activity. Men and women (n= 116) between the ages of 60 and 93 years (73.9 ±6.6) completed a questionnaire used to categorize them into one of five stages of exercise change: precontemplation, contemplation, preparation, action, and maintenance. Participants also completed a questionnaire to assess four attitude factors related to exercise: tension release, health promotion, vigorous exercise, and social benefits. The active older adults in this study reported positive attitudes toward exercising for health benefits, social interaction, and tension release. Of these, the health benefits of exercise appear tobe the most important factor in their participation in exercise. Therefore, programs designed to engage older adults in regular physical activity should promote positive attitudes toward exercise, especially regarding the health-related aspects of exercise.

For effective control and assessment of harmful hand-forearm motion at work, a valid goniometric system that produces reliable and accurate measurements is essential. The present study evaluated the WristCorderTM, a portable motion analyzer for flexion/extension (F/E), ulnar/radial deviation (U/R), and pronation/supination (P/S) of the hand-forearm, in terms of linearity, sensitivity, and reliability using the Triaxial Hand-Forearm Fixture. Eight participants having no history of musculoskeletal disorders were recruited for the evaluation. The motion analyzer produced sensor values linearly related to angular movements of the limb; sensitivity was less than 1° for F/E and U/R and between 2.5° and 3.5° for P/S; standard deviation due to measurement error was about 1° for F/E and U/R and about 2.4° for P/S; and standard error of measurement was less than 1° for F/E and U/R and 2.3° for P/S. The motion analyzer may be used as an effective tool to analyze unidimensional movements of the hand-forearm in industry. Continued study is needed to generalize the evaluation results in three-dimensional motion analysis.

The Asian citrus psyllid, Diaphorina citri Kuwayama, is a worldwide pest of citrus, which vectors the putative causal pathogen of huanglongbing. Current management practices warrant continuous monitoring of field populations for insecticide resistance. Baseline activities of acetylcholinesterase (AChE), general esterase, and glutathione S-transferase as well as sensitivity of AChE to selected organophosphate and carbamate insecticides were established for a susceptible laboratory strain (Lab) and compared with several field populations of D. citri from Florida. The specific activity of AChE in various D. citri populations ranged from 0.77 to 1.29 μM min−1 mg of protein−1; the Lab strain was characterized by the highest activity. Although reduced AChE sensitivity was observed in the Lab strain compared with field populations, overlap of 95% confidence intervals of I50 values (concentration required for 50% AChE activity inhibition) suggests no significant difference in AChE sensitivity among all populations tested for a given insecticide. There was no significant evidence of target site insensitivity in field populations that were exposed to the selected organophosphate and carbamate insecticides tested. The specific activity of general esterase and glutathione S-transferase was lowest in the Lab strain and was generally comparable to that of the field populations evaluated. The current data provide a mode-of-action specific baseline for future monitoring of resistance to organophosphate and carbamate insecticides in populations of D. citri.

Haeckeliania sperata Pinto is an egg-endoparasitoid of Diaprepes abbreviatus L. (Coleoptera: Curculionidae). We evaluated the relative susceptibility of H. sperata adults to commercially relevant pesticides used in citrus and ornamental production systems. Parasitoids were exposed to pesticide residues on leaf surfaces. Four concentrations of seven pesticides were tested; concentrations for each pesticide consisted of a dilution series using the label rate for field applications as the starting concentration. Lethal concentrations (LC50s and LC90s) were calculated 12 and 24 h after exposure to the pesticides. Lethal times (LT50s and LT90S) were estimated for each pesticide concentration. All tested pesticides had a negative effect on Haeckeliania’s survivorship. However, some pesticides were significantly less harmful to this parasitoid. LC50s and LC90s of organophospate, carbamate, and pyrethroid pesticides were less than one eighth of the label rates. LT50s and LT90s of these insecticides were <12 h even at the most diluted concentrations. Thus, applications of these pesticides might have a strong negative impact on the natural control of D. abbreviatus by H. sperata. Commercial formulations of imidacloprid, abamectin, petroleum oil, and a phosphonate fungicide allowed H. sperata to live longer compared with the previous pesticides, suggesting a certain degree of selectivity. Moreover, adults exposed to diluted concentrations of imidacloprid, abamectin, petroleum oil, and a phosphonate fungicide had a greater survival than those exposed to label concentrations. These findings suggest that the use of products that have less toxic effects on the introduced parasitoid will increase its chances to parasitize D. abbreviatus eggs.

Diaphorina citri Kuwayama (Hemiptera: Psyllidae), vectors the bacterium Candidatus Liberibacter asiaticus, one of the causal organisms of the devastating citrus disease “huanglongbing” or citrus greening. In the United States, D. citri was first discovered in Florida, in 1998. Tamarixia radiata Waterston (Hymenoptera: Eulophidae) was imported from Asia and released in Florida in 1999–2001 to improve biological control of D. citri before citrus greening was detected in Florida in 2005. Florida citrus groves were surveyed during 2006–2007 for D. citri and T. radiata. Results showed that D. citri was established in all 28 citrus groves surveyed across 16 counties. Adult populations averaged 3.52, 1.27, and 1.66 individuals per “tap” sample at locations in the central, southwest, and eastern coastal regions, respectively. A tap sample consisted of 22- by 28-cm white paper sheet (on a clipboard) held under branches selected at random that were tapped three times. Averages of 67, 44, and 45% citrus shoots infested with psyllid eggs or nymphs were obtained in the central, southwest, and eastern coastal regions, respectively. T. radiata was recovered from fourth- and fifth-instar psyllid nymphs at 26 of the 28 locations. However, apparent parasitism rates were variable and averaged <20% during spring and summer over all locations. Incidence of parasitism increased during fall at some locations, averaging 39% in September and 56% in November in the central and southwest regions, respectively. Further efforts are warranted to enhance the biological control of D. citri and thereby reduce psyllid populations and spread of citrus greening disease.

We investigated the biology of Tiphia pygidialis Allen, a previously unstudied native parasitoid of masked chafer, Cyclocephala spp. grubs, in central Kentucky and the seasonal dynamics of Tiphia vernalis Rohwer, an introduced parasitoid of Japanese beetle, Popillia japonica Newman. T. pygidialis was active from mid-August to early October, parasitizing third-instar masked chafers, whereas T. vernalis attacked overwintered third-instar P. japonica from mid-April to early June. Adult T. vernalis were attracted to modified Japanese beetle traps and yellow pan traps and to 10% sugar water sprayed on tree foliage. Spraying sugar water directly on turf most effectively monitored T. pygidialis wasps. Parasitism rates as high as 33 and 58% were observed for T. pygidialis and T. vernalis, respectively. In the laboratory, T. pygidialis larvae progressed through five instars to cocoon formation in ≈22 d. They overwinter as prepupae. Field-collected female wasps lived 32 ± 4 d, parasitizing 22 ± 6 grubs. In no-choice tests with eight species of native and exotic white grubs, T. pygidialis readily parasitized only Cyclocephala spp., including C. lurida Bland and C. borealis Arrow, which it normally encounters in Kentucky, but also C. pasadenae Casey, a western species not know to occur within the wasp’s geographic range. Wasps did not discriminate between nematode-infected and healthy grubs, indicating potential for interference between these biological control agents.

The events leading to oviposition by Tiphia pygidialis Allen and Tiphia vernalis Rohwer on their host Cyclocephala spp. and Popillia japonica Newman grubs, respectively, were compared and quantified using videotaped recordings. Mean (±SE) duration of the oviposition process was 49.3 ± 2.9 min for T. pygidialis and 31.5 ± 2.2 min for T. vernalis. Behaviors included stinging, moving soil from around grubs, host kneading, host examination, host feeding, and scraping of the grub’s cuticle. Sequence of behavioral events was translated into a first-order (Markovian) contingency table to construct flow charts of the oviposition process for both species. T. pygidialis spent more time kneading and scraping the cuticle of grubs than did T. vernalis, whereas T. vernalis performed more stinging and soil-moving events. These behaviors most likely serve to move the grubs into a suitable position for oviposition. Scraping of the host’s cuticle where an egg was to be laid took more time than any other behavior. Compared with nonparasitized grubs, cuticle from parasitized grubs contained numerous grooves filled with cement used to anchor the parasitoid egg. Scanning electron microscopy revealed peg-like structures, similar in size to the grooves made in the cuticle of parasitized grubs, on the ovipositor sheath of female wasps. These structures are thought to be used in making the grooves in the cuticle, whose postulated function is to increase the surface area of the host cuticle to facilitate egg attachment. This is the first study to implicate such use of the ovipositor sheath by a parasitoid.

Imidacloprid, a relatively long residual neonicotinoid soil insecticide, is often applied to lawns and golf courses in spring for preventive control of root-feeding white grubs. We evaluated effects of such applications on spring parasitism of the overwintered third-instar Japanese beetle, Popillia japonica Newman, by Tiphia vernalis Rohwer, an introduced solitary ectoparasitoid. Natural rates of parasitism on a golf course rough were significantly lower in plots treated with full or one-half label rates of imidacloprid in early May compared with untreated turf. Parasitism also was reduced when female T. vernalis were exposed to imidacloprid residues on turf cores in the laboratory. Such exposures did not affect wasp mortality, longevity, survival, or developmental period of Tiphia larvae feeding on hosts in treated turf. They did, however, reduce wasps’ ability to parasitize hosts in nontreated soil for at least 1−2 wk postexposure. In Y-trail choice tests, wasps that previously had been exposed to treated turf failed to respond normally to host frass trails in the soil. Female wasps did not avoid imidacloprid residues, imidacloprid-treated host frass, or host grubs that had previously been exposed to treated soil. This study indicates that applying imidacloprid in early spring can interfere with biological control by T. vernalis, whereas postponing preventive grub treatments until June or July, after the wasps’ flight period, will help to conserve T. vernalis populations.