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4. Multicenter Evaluation of BioFire FilmArray Meningitis/Encephalitis Panel for Detection of Bacteria, Viruses, and Yeast in Cerebrospinal Fluid Specimens.

Author

Leber, Amy L, Everhart, Kathy, Balada-Llasat, Joan-Miquel, Cullison, Jillian, Daly, Judy, Holt, Sarah, Lephart, Paul, Salimnia, Hossein, Schreckenberger, Paul C, DesJarlais, Sharon, Reed, Sharon L, Chapin, Kimberle C, LeBlanc, Lindsay, Johnson, J Kristie, Soliven, Nicole L, Carroll, Karen C, Miller, Jo-Anne, Dien Bard, Jennifer, Mestas, Javier, Bankowski, Matthew, Enomoto, Tori, Hemmert, Andrew C, and Bourzac, Kevin M

Subjects
Cerebrospinal Fluid, Humans, Bacteria, Viruses, Fungi, Bacterial Infections, Central Nervous System Fungal Infections, Virus Diseases, Encephalitis, Meningitis, Molecular Diagnostic Techniques, Sensitivity and Specificity, Prospective Studies, Time Factors, Adolescent, Adult, Aged, Aged, 80 and over, Middle Aged, Child, Child, Preschool, Infant, Infant, Newborn, Female, Male, Young Adult, and over, Preschool, Newborn, Microbiology, Biological Sciences, Agricultural and Veterinary Sciences, Medical and Health Sciences
Abstract

Rapid diagnosis and treatment of infectious meningitis and encephalitis are critical to minimize morbidity and mortality. Comprehensive testing of cerebrospinal fluid (CSF) often includes Gram stain, culture, antigen detection, and molecular methods, paired with chemical and cellular analyses. These methods may lack sensitivity or specificity, can take several days, and require significant volume for complete analysis. The FilmArray Meningitis/Encephalitis (ME) Panel is a multiplexed in vitro diagnostic test for the simultaneous, rapid (∼1-h) detection of 14 pathogens directly from CSF specimens: Escherichia coli K1, Haemophilus influenzae, Listeria monocytogenes, Neisseria meningitidis, Streptococcus pneumoniae, Streptococcus agalactiae, cytomegalovirus, enterovirus, herpes simplex virus 1 and 2, human herpesvirus 6, human parechovirus, varicella-zoster virus, and Cryptococcus neoformans/Cryptococcus gattii We describe a multicenter evaluation of 1,560 prospectively collected CSF specimens with performance compared to culture (bacterial analytes) and PCR (all other analytes). The FilmArray ME Panel demonstrated a sensitivity or positive percentage of agreement of 100% for 9 of 14 analytes. Enterovirus and human herpesvirus type 6 had agreements of 95.7% and 85.7%, and L. monocytogenes and N. meningitidis were not observed in the study. For S. agalactiae, there was a single false-positive and false-negative result each, for a sensitivity and specificity of 0 and 99.9%, respectively. The specificity or negative percentage of agreement was 99.2% or greater for all other analytes. The FilmArray ME Panel is a sensitive and specific test to aid in diagnosis of ME. With use of this comprehensive and rapid test, improved patient outcomes and antimicrobial stewardship are anticipated.

Published
2016

18. Specificity of isokinetic assessment in noncontact knee injury prevention screening: A novel assessment procedure with relationships between variables in amateur adult agility-sport athletes.

Author

Clark, Nicholas C., Heebner, Nicholas R., Lephart, Scott M., and Sell, Timothy C.

Abstract

To present a new knee isokinetic assessment procedure linked to noncontact knee injury mechanisms and examine correlations between variables relevant to noncontact knee injury prevention screening (peak torque [PT, Nm], time-to-peak torque [TTPT, ms], angle-of-peak torque [APT, °], mean PT [MPT, Nm]). Cross-sectional. Sports medicine laboratory. Thirty-four agility-sport athletes (male/female n = 18/16, age 24.1 ± 3.5yr, height 171.8 ± 9.6 cm, mass 70.6 ± 12 kg). Pearson's/Spearman's correlation (r / r s), coefficient of determination (r 2/ r s 2). Most correlations were statistically non-significant or statistically-significant with only weak-to-moderate coefficients. For both knee extension and flexion, PT and MPT were significantly and strongly correlated (r = 0.99, r 2 = 0.98, p = 0.001). Graphical analyses revealed two datapoint clusters for knee flexion TTPT and APT. One cluster indicated some participants could generate knee flexor PT rapidly (<150 ms) at low knee flexion angles (<45°) and the other cluster indicated that other participants could not (>200 ms, >50°). In this study, most isokinetic variables represented distinct knee neuromuscular characteristics. For both knee extension and flexion, only PT or MPT need be used to represent isokinetic maximal strength. Knee flexion TTPT and APT may have utility in noncontact knee injury prevention screening with amateur adult agility-sport athletes. • Most correlations were statistically non-significant. • Some correlations were statistically-significant with weak-to-moderate coefficients. • Some athletes generated knee flexor peak torque rapidly at low knee flexion angles. • Other athletes generated knee flexor peak torque slowly at high knee flexion angles. • Most isokinetic variables represented distinct knee neuromuscular characteristics. [ABSTRACT FROM AUTHOR]

Published
2022
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20. Sex and Age Comparisons in Neuromuscular And Biomechanical Characteristics of the Knee in Young Athletes.

Author

Pletcher, Erin R., Dekker, Travis J., Lephart, Scott M., and Sell, Tim C.

Subjects
SPORTS injury prevention, KNEE physiology, NEUROPHYSIOLOGY, RANGE of motion of joints, ANALYSIS of variance, POSTURAL balance, AGE distribution, CROSS-sectional method, SELF-evaluation, NEUROMUSCULAR system, MUSCLE strength testing, PHYSICAL training & conditioning, PUBERTY, SEX distribution, COMPARATIVE studies, MUSCLE strength, DESCRIPTIVE statistics, BIOMECHANICS, JUMPING, ISOKINETIC exercise, DATA analysis software
Abstract

Background The identification of risk factors for injury is a key step for musculoskeletal injury prevention in youth sports. Not identifying and correcting for injury risk factors may result in lost opportunity for athletic development. Physical maturation and sex affect these characteristics, which may indicate the need for both age and sex-based injury prevention programs. Hypothesis/Purpose This study examined age and sex differences in knee strength, static balance, jump height, and lower extremity landing biomechanics in school- and high school-age athletes. Study Design Cross-sectional Methods Forty healthy school aged (10.8±0.8 yrs) and forty high school (16.8±0.8 yrs) athletes completed isokinetic knee flexion and extension strength tests, single-leg static balance and single-leg vertical stop jump tasks. Results High school athletes were significantly stronger (~67% and 35% stronger for males and females, respectively) and jumped higher (regardless of sex) compared to school age athletes. High school males had worse balance (~28%) compared to their younger counterparts. High school females had lower strength (~23%) compared to males but had better balance (~46%). Conclusion: Maturation had different effects on the variables analyzed and sex differences were mainly observed after maturation. These differences may be minimized through appropriate age and sex specific training programs. Levels of Evidence 3a Clinical Relevance Neuromuscular and biomechanical differences between sex and age groups should be accounted for in injury prevention and rehabilitation. Inadequate training may be a primary factor contributing to injuries in a young athletic population. When designing training programs for long term athlete development, programs should be dependent on decrements seen at specific time points throughout maturation. What is known about the subject: Generally, both males and females get stronger and jump higher as they get older but the results comparing balance and biomechanics [ABSTRACT FROM AUTHOR]

Published
2021
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21. Behind Every Great Infection Prevention Program is a Great Microbiology Laboratory

Author

Lephart, Paul, LeBar, William, and Newton, Duane

Abstract

A great clinical microbiology laboratory supporting a great infection prevention program requires focusing on the following services: rapid and accurate identification of pathogens associated with health care–associated infections; asymptomatic surveillance for health care–acquired pathogens before infections arise; routine use of broad and flexible antimicrobial susceptibility testing to direct optimal therapy; implementation of epidemiologic tracking tools to identify outbreaks; development of clear result communication with interpretative comments for clinicians. These goals are best realized in a collaborative relationship with the infection prevention program so that both can benefit from the shared priorities of providing the best patient care.

Published
2021
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22. INFLUENCE OF LIMB DOMINANCE AND SHOULDER INJURY ON STRENGTH AND EXPLOSIVE FORCE IN US MARINES.

Author

Poploski, Kathleen M., Picha, Kelsey J., Winters, Joshua D., Royer, Scott D., Heebner, Nicholas R., Lambert, Brad, Lephart, Scott M., and Abt, John P.

Subjects
BIOMECHANICS, CEREBRAL dominance, EXERCISE, EXERCISE tests, GROUND reaction forces (Biomechanics), ISOKINETIC exercise, MUSCLE contraction, MUSCLE strength, PHYSICAL fitness, REHABILITATION, ROTATIONAL motion, SHOULDER, SHOULDER injuries, STATISTICS, T-test (Statistics), DATA analysis, CROSS-sectional method, MOTION capture (Human mechanics), DATA analysis software, DESCRIPTIVE statistics, MANN Whitney U Test, KRUSKAL-Wallis Test, ONE-way analysis of variance
Abstract

Background: The specialized roles of many military personnel require specific skills and high physical demands, placing unique stresses on the shoulders and increasing risk of injury. As normal dominant/nondominant shoulder asymmetries have been established in military personnel, bilateral strength comparisons must be understood in context of daily physical demands to monitor patients' progress or readiness to return to duty. Purpose: This study aims to assess bilateral differences in strength and explosive force in United States Marines with a history of dominant or nondominant shoulder pathology. Study Design: Cross-Sectional. Methods: A total of 52 full-duty, male US Marines with a shoulder injury within the prior year participated. Bilateral isokinetic shoulder internal (IR) and external (ER) rotation strength, and peak force (Peak Force) and average rate of force production (Avg Rate) during an explosive push-up were collected. Dominant versus nondominant side data were independently examined within each group (DOM: dominant injury, NOND: nondominant injury). Comparison between DOM and NOND, as well as previously published CON (no history of shoulder injury) was also completed. Results: NOND (n = 26) demonstrated significantly less IR (p < 0.001) and ER (p = 0.003) strength and Peak Force (p = 0.001) and Avg Rate (p = 0.047) on the injured side, while DOM (n = 26) demonstrated no bilateral differences in strength or push-up performance. Comparison between the three groups showed that NOND demonstrated significantly less ER strength than CON (p = 0.022). Conclusions: Military personnel demonstrate asymmetric strength patterns likely due to increased demand of the dominant shoulder. US Marines with a history of injury to the nondominant shoulder performed differently than those with a dominant side injury, presenting with both strength and push-up asymmetries. They also demonstrated significant ER strength deficits compared to CON. Common clinical practice and previous literature often compare injured and uninjured limbs or injured individuals to healthy controls, but further distinction of dominant or nondominant side may provide more accurate information needed to develop targeted treatment strategies. Clinical Relevance: Recognizing unique occupational demands and how patients may present differently with dominant versus nondominant side shoulder injuries are important considerations for ensuring accurate assessment and effective individualized rehabilitation. Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Published
2020
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23. Donor to recipient transmission of SARS‐CoV‐2 by lung transplantation despite negative donor upper respiratory tract testing

Author

Kaul, Daniel R., Valesano, Andrew L., Petrie, Joshua G., Sagana, Rommel, Lyu, Dennis, Lin, Jules, Stoneman, Emily, Smith, Lane M., Lephart, Paul, and Lauring, Adam S.

Abstract

We describe a case of proven transmission of SARS‐CoV‐2 from lung donor to recipient. The donor had no clinical history or findings suggestive of infection with SARS‐CoV‐2 and tested negative by reverse transcriptase polymerase chain reaction (RT‐PCR) on a nasopharyngeal (NP) swab obtained within 48 h of procurement. Lower respiratory tract testing was not performed. The recipient developed fever, hypotension, and pulmonary infiltrates on posttransplant day (PTD) 3, and RT‐PCR testing for SARS‐CoV‐2 on an NP swab specimen was non‐reactive, but positive on bronchoalveolar lavage (BAL) fluid. One thoracic surgeon present during the transplantation procedure developed COVID‐19. Sequence analysis of isolates from donor BAL fluid (obtained at procurement), the recipient, and the infected thoracic surgeon proved donor origin of recipient and health‐care worker (HCW) infection. No other organs were procured from this donor. Transplant centers and organ procurement organizations should perform SARS‐CoV‐2 testing of lower respiratory tract specimens from potential lung donors, and consider enhanced personal protective equipment for HCWs involved in lung procurement and transplantation. This report describes a proven case of SARS‐CoV‐2 transmission during lung transplantation from a deceased donor to both the recipient and to a healthcare worker. La Hoz et al. comment on page 2635.

Published
2021
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24. Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

Author

null Author et al, R. M. Bateman, M. D. Sharpe, J. E. Jagger, C. G. Ellis, J. Solé-Violán, M. López-Rodríguez, E. Herrera-Ramos, J. Ruíz-Hernández, L. Borderías, J. Horcajada, N. González-Quevedo, O. Rajas, M. Briones, F. Rodríguez de Castro, C. Rodríguez Gallego, F. Esen, G. Orhun, P. Ergin Ozcan, E. Senturk, C. Ugur Yilmaz, N. Orhan, N. Arican, M. Kaya, M. Kucukerden, M. Giris, U. Akcan, S. Bilgic Gazioglu, E. Tuzun, R. Riff, O. Naamani, A. Douvdevani, R. Takegawa, H. Yoshida, T. Hirose, N. Yamamoto, H. Hagiya, M. Ojima, Y. Akeda, O. Tasaki, K. Tomono, T. Shimazu, S. Ono, T. Kubo, S. Suda, T. Ueno, T. Ikeda, H. Ogura, H. Takahashi, J. Kang, Y. Nakamura, T. Kojima, Y. Izutani, T. Taniguchi, M. O, C. Dinter, J. Lotz, B. Eilers, C. Wissmann, R. Lott, M. M. Meili, P. S. Schuetz, H. Hawa, M. Sharshir, M. Aburageila, N. Salahuddin, V. Chantziara, S. Georgiou, A. Tsimogianni, P. Alexandropoulos, A. Vassi, F. Lagiou, M. Valta, G. Micha, E. Chinou, G. Michaloudis, A. Kodaira, H. Imaizumi, M. V. De la Torre-Prados, A. Garcia-De la Torre, A. Enguix-Armada, A. Puerto-Morlan, V. Perez-Valero, A. Garcia-Alcantara, N. Bolton, J. Dudziak, S. Bonney, A. Tridente, P. Nee, G. Nicolaes, M. Wiewel, M. Schultz, K. Wildhagen, J. Horn, R. Schrijver, T. Van der Poll, C. Reutelingsperger, S. Pillai, G. Davies, G. Mills, R. Aubrey, K. Morris, P. Williams, P. Evans, E. G. Gayat, J. Struck, A. Cariou, N. Deye, B. Guidet, S. Jabert, J. Launay, M. Legrand, M. Léone, M. Resche-Rigon, E. Vicaut, A. Vieillard-Baron, A. Mebazaa, R. Arnold, M. Capan, A. Linder, P. Akesson, M. Popescu, D. Tomescu, C. L. Sprung, R. Calderon Morales, G. Munteanu, E. Orenbuch-Harroch, P. Levin, H. Kasdan, A. Reiter, T. Volker, Y. Himmel, Y. Cohen, J. Meissonnier, L. Girard, F. Rebeaud, I. Herrmann, B. Delwarde, E. Peronnet, E. Cerrato, F. Venet, A. Lepape, T. Rimmelé, G. Monneret, J. Textoris, N. Beloborodova, V. Moroz, A. Osipov, A. Bedova, Y. Sarshor, A. Pautova, A. Sergeev, E. Chernevskaya, J. Odermatt, R. Bolliger, L. Hersberger, M. Ottiger, M. Christ-Crain, B. Mueller, P. Schuetz, N. K. Sharma, A. K. Tashima, M. K. Brunialti, F. R. Machado, M. Assuncao, O. Rigato, R. Salomao, S. C. Cajander, G. Rasmussen, E. Tina, B. Söderquist, J. Källman, K. Strålin, A. L. Lange, J. S. Sundén-Cullberg, A. M. Magnuson, O. H. Hultgren, P. Van der Geest, M. Mohseni, J. Linssen, R. De Jonge, S. Duran, J. Groeneveld, R. Miller, B. K. Lopansri, L. C. McHugh, A. Seldon, J. P. Burke, J. Johnston, R. Reece-Anthony, A. Bond, A. Molokhia, C. Mcgrath, E. Nsutebu, P. Bank Pedersen, D. Pilsgaard Henriksen, S. Mikkelsen, A. Touborg Lassen, R. Tincu, C. Cobilinschi, Z. Ghiorghiu, R. Macovei, M. A. Wiewel, M. B. Harmon, L. A. Van Vught, B. P. Scicluna, A. J. Hoogendijk, A. H. Zwinderman, O. L. Cremer, M. J. Bonten, M. J. Schultz, N. P. Juffermans, W. J. Wiersinga, G. Eren, Y. Tekdos, M. Dogan, O. Acicbe, E. Kaya, O. Hergunsel, S. Alsolamy, G. Ghamdi, L. Alswaidan, S. Alharbi, F. Alenezi, Y. Arabi, J. Heaton, A. Boyce, L. Nolan, A. Dukoff-Gordon, A. Dean, T. Mann Ben Yehudah, C. Fleischmann, D. Thomas-Rueddel, C. Haas, U. Dennler, K. Reinhart, O. Suntornlohanakul, B. Khwannimit, F. Breckenridge, A. Puxty, P. Szturz, P. Folwarzcny, J. Svancara, R. Kula, P. Sevcik, L. Caneva, A. Casazza, E. Bellazzi, S. Marra, L. Pagani, M. Vetere, R. Vanzino, D. Ciprandi, R. Preda, R. Boschi, L. Carnevale, V. Lopez, M. Aguilar Arzapalo, L. Barradas, A. Escalante, J. Gongora, M. Cetina, B Adamik, D Jakubczyk, A Kübler, A. Radford, T. Lee, J. Singer, J. Boyd, D. Fineberg, M. Williams, J. Russell, E. Scarlatescu, G. Droc, S. Arama, M. Müller, M. Straat, S. S. Zeerleder, C. F. Fuchs, C. S. Scheer, S. W. Wauschkuhn, M. V. Vollmer, K. M. Meissner, S. K. Kuhn, K. H. Hahnenkamp, S. R. Rehberg, M. G. Gründling, S. Hamaguchi, E. Gómez-Sánchez, M. Heredia-Rodríguez, E. Álvarez-Fuente, M. Lorenzo-López, E. Gómez-Pesquera, M. Aragón-Camino, P. Liu-Zhu, A. Sánchez-López, A. Hernández-Lozano, M. T. Peláez-Jareño, E. Tamayo, D. O. Thomas-Rüddel, V. Adora, A. Kar, A. Chakraborty, S. Roy, A. Bandyopadhyay, M. Das, G. BenYehudah, M. Salim, N. Kumar, L. Arabi, T. Burger, P. Lephart, E. Toth-martin, C. Valencia, N. Hammami, S. Blot, J. L. Vincent, M. L. Lambert, J. Brunke, T. Riemann, I. Roschke, S. Nimitvilai, K. Jintanapramote, S. Jarupongprapa, D. Adukauskiene, D. Valanciene, G. Bose, V. Lostarakos, B. Carr, S. Khedher, A. Maaoui, A. Ezzamouri, M. Salem, J. Chen, D. R. Cranendonk, M. Day, G. Penrice, K. Roy, P. Robertson, G. Godbole, B. Jones, M. Booth, L. Donaldson, Y. Kawano, H. Ishikura, H. Al-Dorzi, M. Almutairi, B. Alhamadi, A. Crizaldo Toledo, R. Khan, B. Al Raiy, H. Talaie, J. A. Van Oers, A. Harts, E. Nieuwkoop, P. Vos, Y. Boussarsar, F. Boutouta, S. Kamoun, I. Mezghani, S. Koubaji, A. Ben Souissi, A. Riahi, M. S. Mebazaa, E. Giamarellos-Bourboulis, N. Tziolos, C. Routsi, C. Katsenos, I. Tsangaris, I. Pneumatikos, G. Vlachogiannis, V. Theodorou, A. Prekates, E. Antypa, V. Koulouras, N. Kapravelos, C. Gogos, E. Antoniadou, K. Mandragos, A. Armaganidis, A. R. Robles Caballero, B. Civantos, J. C. Figueira, J. López, A. Silva-Pinto, F. Ceia, A. Sarmento, L. Santos, G. Almekhlafi, Y. Sakr, S. Baharoon, A. Aldawood, A. Matroud, J. Alchin, S. Al Johani, H. Balkhy, S. Y. Yousif, B. O. Alotabi, A. S. Alsaawi, J. Ang, M. D. Curran, D. Enoch, V. Navapurkar, A. Morris, R. Sharvill, J. Astin, J. Patel, C. Kruger, J. O’Neal, H. Rhodes, J. Jancik, B. François, P. F. Laterre, P. Eggimann, A. Torres, M. Sánchez, P. F. Dequin, G. L. Bassi, J. Chastre, H. S. Jafri, M. Ben Romdhane, Z. Douira, M. Bousselmi, A. Vakalos, V. Avramidis, T. H. Craven, G. Wojcik, K. Kefala, J. McCoubrey, J. Reilly, R. Paterson, D. Inverarity, I. Laurenson, T. S. Walsh, S. Mongodi, B. Bouhemad, A. Orlando, A. Stella, G. Via, G. Iotti, A. Braschi, F. Mojoli, M. Haliloglu, B. Bilgili, U. Kasapoglu, I. Sayan, M. Süzer Aslan, A. Yalcin, I. Cinel, H. E. Ellis, K. Bauchmuller, D. Miller, A. Temple, C. E. Luyt, M. Singer, Y. Nassar, M. S. Ayad, A. Trifi, S. Abdellatif, F. Daly, R. Nasri, S. Ben Lakhal, F. Gul, A. Kuzovlev, A. Shabanov, S. Polovnikov, N. Kadrichu, T. Dang, K. Corkery, P. Challoner, G. Li Bassi, E. Aguilera, C. Chiurazzi, C. Travierso, A. Motos, L. Fernandez, R. Amaro, T. Senussi, F. Idone, J. Bobi, M. Rigol, C. J. Hodiamont, J. M. Janssen, C. S. Bouman, R. A. Mathôt, M. D. De Jong, R. M. Van Hest, L. Payne, G. L. Fraser, B. Tudor, M. Lahner, G. Roth, C. Krenn, P. Jault, J. Gabard, T. Leclerc, S. Jennes, Y. Que, A. Rousseau, F. Ravat, A. Eissa, S. Al-Harbi, T. Aldabbagh, S. Abdellatif., F. Paramba, N. Purayil, V. Naushad, O. Mohammad, V. Negi, P. Chandra, A. Kleinsasser, M. R. Witrz, J. F. Buchner-Doeven, A. M. Tuip-de Boer, J. C. Goslings, M. Van Hezel, A Boing, R Van Bruggen, N Juffermans, D. Markopoulou, K. Venetsanou, V. Kaldis, D. Koutete, D. Chroni, I. Alamanos, L. Koch, E. Walter, K. Maekawa, M. Hayakawa, S. Kushimoto, A. Shiraishi, H. Kato, J. Sasaki, T. Matauoka, T. Uejima, N. Morimura, A. Hagiwara, M. Takeda, O. Tarabrin, S. Shcherbakow, D. Gavrychenko, G. Mazurenko, V. Ivanova, O. Chystikov, C. Plourde, J. Lessard, J. Chauny, R. Daoust, L. Kropman, L. In het Panhuis, J. Konings, D. Huskens, E. Schurgers, M. Roest, B. De Laat, M. Lance, M. Durila, P. Lukas, M. Astraverkhava, J. Jonas, I. Budnik, B. Shenkman, H. Hayami, Y. Koide, T. Goto, R. Iqbal, Y. Alhamdi, N. Venugopal, S. Abrams, C. Downey, C. H. Toh, I. D. Welters, V. B. Bombay, J. M. Chauny, R. D. Daoust, J. L. Lessard, M. M. Marquis, J. P. Paquet, K. Siemens, D. Sangaran, B. J. Hunt, A. Durward, A. Nyman, I. A. Murdoch, S. M. Tibby, F. Ampatzidou, D. Moisidou, E. Dalampini, M. Nastou, E. Vasilarou, V. Kalaizi, H. Chatzikostenoglou, G. Drossos, S. Spadaro, A. Fogagnolo, T. Fiore, A. Schiavi, V. Fontana, F. Taccone, C. Volta, E. Chochliourou, E. Volakli, A. Violaki, E. Samkinidou, G. Evlavis, V. Panagiotidou, M. Sdougka, R. Mothukuri, C. Battle, K. Guy, J. Wijesuriya, S. Keogh, A. Docherty, R. O’Donnell, S. Brunskill, M. Trivella, C. Doree, L. Holst, M. Parker, M. Gregersen, J. Almeida, T. Walsh, S. Stanworth, S. Moravcova, J. Mansell, A. Rogers, R. A. Smith, C. Hamilton-Davies, A. Omar, M. Allam, O. Bilala, A. Kindawi, H. Ewila, A. Malamas, G. Ferreira, J. Caldas, J. Fukushima, E. A. Osawa, E. Arita, L. Camara, S. Zeferino, J. Jardim, F. Gaioto, L. Dallan, F. B. Jatene, R. Kalil Filho, F. Galas, L. A. Hajjar, C. Mitaka, T. Ohnuma, T. Murayama, F. Kunimoto, M. Nagashima, T. Takei, M. Tomita, K. Mahmoud, S. Hanoura, S. Sudarsanan, P. Sivadasan, H. Othamn, Y. Shouman, R. Singh, A. Al Khulaifi, I. Mandel, S. Mikheev, I. Suhodolo, V. Kiselev, Y. Svirko, Y. Podoksenov, S. A. Jenkins, R. Griffin, M. S. Tovar Doncel, A. Lima, C. Aldecoa, C. Ince, A. Taha, A. Shafie, M. Mostafa, N. Syed, H. Hon, F. Righetti, E. Colombaroli, G. Castellano, M. Hravnak, L. C. Chen, A. D. Dubrawski, G. C. Clermont, M. R. Pinsky, S. Gonzalez, D. Macias, J. Acosta, P. Jimenez, A. Loza, A. Lesmes, F. Lucena, C. Leon, M. Bastide, J. Richecoeur, E. Frenoy, C. Lemaire, B. Sauneuf, F. Tamion, S. Nseir, D. Du Cheyron, H. Dupont, J. Maizel, M. Shaban, R. Kolko, M. AbuRageila, A. AlHussain, P. Mercado, L. Kontar, D. Titeca, F. Brazier, A. Riviere, M. Joris, T. Soupison, B. De Cagny, M. Slama, J. Wagner, A. Körner, M. Kubik, S. Kluge, D. Reuter, B. Saugel, T. Tran, D. De Bels, A. Cudia, M. Strachinaru, P. Ghottignies, J. Devriendt, C. Pierrakos, Ó. Martínez González, R. Blancas, J. Luján, D. Ballesteros, C. Martínez Díaz, A. Núñez, C. Martín Parra, B. López Matamala, M. Alonso Fernández, M. Chana, W. Huber, M. Eckmann, F. Elkmann, A. Gruber, I. Klein, R. M. Schmid, T. Lahmer, P. W. Moller, S. Sondergaard, S. M. Jakob, J. Takala, D. Berger, D. Bastoni, H. Aya, L. Toscani, L. Pigozzi, A. Rhodes, M. Cecconi, C. Ostrowska, A. Abbas, J. Mellinghoff, C. Ryan, D. Dawson, M. Cronhjort, O. Wall, E. Nyberg, R. Zeng, C. Svensen, J. Mårtensson, E. Joelsson-Alm, N. Parenti, C. Palazzi, L. 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F. Francke, L. H. Huyghens, J. B. Bilsen, B. Nyamaizi, C. Dalrymple, A. Dobru, E. Marrinan, A. Ankuli, R. Struthers, R. Crawford, P. Mactavish, P. Morelli, M. Degiovanangelo, F. Lemos, V. MArtinez, J. Cabrera, A. Rutten, S. Van Ieperen, S. De Geer, M. Van Vugt, E. Der Kinderen, A. Giannini, G Miccinesi, T Marchesi, and E Prandi

Subjects
0301 basic medicine, 03 medical and health sciences, medicine.medical_specialty, 030219 obstetrics & reproductive medicine, 030104 developmental biology, 0302 clinical medicine, business.industry, Intensive care, Emergency medicine, Medicine, Critical Care and Intensive Care Medicine, business
Published
2016
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25. Equol's efficacy is greater than astaxanthin for antioxidants, extracellular matrix integrity & breakdown, growth factors and inflammatory biomarkers via human skin gene expression analysis.

Author

Lephart, Edwin D.

Abstract

• Comparison of the phytochemicals: astaxanthin versus equol on skin gene expression. • 63 human biomarkers quantified by qPCR-mRNA analysis across 9 functional categories. • For 39 biomarkers, equol significantly altered the parameters compared to astaxanthin. • Astaxanthin significantly influenced 6 biomarkers compared to equol. • Topical equol's efficacy is greater than astaxanthin for various skin biomarkers. Skin homeostasis and dermal aging can be influenced by phytochemicals. Astaxanthin is a powerful antioxidant and anti-inflammatory agent, while equol's beneficial properties have been recently reported. The purpose of this in vitro study was to compare astaxanthin versus equol at a 1% concentration by a single topical application using epidermal full-thickness skin cultures. After 24 h (exposure) human gene expression was quantified by qPCR-mRNA across 9 functional categories for 63 genes. For 39 biomarkers equol significantly altered the parameters compared to astaxanthin. Astaxanthin significantly influenced 6 genes compared to equol. The results revealed significantly greater effects of equol compared to astaxanthin for the antioxidants, growth factors, extracellular integrity and extracellular breakdown, and the inflammatory biomarkers. These findings indicate that equol's efficacy is greater than astaxanthin for various skin biomarkers and suggest that equol may be incorporated into topical and oral applications to improve skin health and reduce photo-aging. [ABSTRACT FROM AUTHOR]

Published
2019
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26. An international, prospective, multicenter evaluation of the combination of AdvanDx Staphylococcus QuickFISH BC with mecA XpressFISH for detection of methicillin-resistant Staphylococcus aureus isolates from positive blood cultures

Author

H, Salimnia, M R, Fairfax, P, Lephart, M, Morgan, J J, Gilbreath, S M, Butler-Wu, K E, Templeton, F J, Hamilton, F, Wu, R, Buckner, D, Fuller, T E, Davis, A M, Abdelhamed, M R, Jacobs, A, Miller, B, Pfrommer, and K C, Carroll

Subjects
Methicillin-Resistant Staphylococcus aureus, Bacteriological Techniques, Reproducibility of Results, Bacteriology, Staphylococcal Infections, bacterial infections and mycoses, Sensitivity and Specificity, United States, Blood, Molecular Diagnostic Techniques, Scotland, Sepsis, Humans, In Situ Hybridization, Fluorescence
Abstract

Sepsis caused by Staphylococcus aureus is a major health problem worldwide. Better outcomes are achieved when rapid diagnosis and determination of methicillin susceptibility enable early optimization of antimicrobial therapy. Eight large clinical laboratories, seven from the United States and one from Scotland, evaluated the combination of the Staphylococcus QuickFISH BC and the new mecA XpressFISH assay (both AdvanDx, Woburn, MA, USA) for the detection of methicillin-resistant S. aureus in positive blood cultures. Blood cultures flagged as positive by automated blood culture instruments and demonstrating only Gram-positive cocci in clusters on Gram stain were tested by QuickFISH, a 20-min assay. If only S. aureus was detected, mecA XpressFISH testing followed. The recovered S. aureus isolates were tested by cefoxitin disk diffusion as the reference method. The QuickFISH assay results were concordant with the routine phenotypic testing methods of the testing laboratories in 1,211/1,221 (99.1%) samples and detected 488/491 S. aureus organisms (sensitivity, 99.4%; specificity, 99.6%). Approximately 60% of the samples (730) contained coagulase-negative staphylococci or nonstaphylococci as assessed by the QuickFISH assay and were not tested further. The 458 compliant samples positive exclusively for S. aureus by the QuickFISH assay were tested by the mecA XpressFISH assay, which detected 209 of 211 methicillin-resistant S. aureus organisms (sensitivity, 99.1%; specificity, 99.6%). The mecA XpressFISH assay also showed high reproducibility, with 534/540 tests performed by 6 operators over 5 days achieving reproducible results (98.9% agreement). The combination of the Staphylococcus QuickFISH BC and mecA XpressFISH assays is sensitive, specific, and reproducible for the detection of methicillin-resistant S. aureus and yields complete results in 2 h after the blood culture turns positive.

Published
2014

27. AAVrh.10 delivery of novel APOE2-Christchurch variant suppresses amyloid and Tau pathology in Alzheimer’s disease mice

Author

Günaydin, Caner, Sondhi, Dolan, Kaminsky, Stephen M., Lephart, Hailey, Leopold, Philip L., Hackett, Neil R., Khanna, Richie, and Crystal, Ronald G.

Abstract

Gene therapy to treat hereditary disorders conventionally delivers the normal allele to compensate for loss-of-function mutations. More effective gene therapy may be achieved using a gain-of-function variant. We tested the hypothesis that AAVrh.10-mediated CNS delivery of the human APOE2 allele with the Christchurch mutation (R136S) (E2Ch) will provide superior protection against APOE4-associated Alzheimer’s disease (AD) in mice compared to the unmodified APOE2 allele (E2). The vectors were assessed in two mouse strains with humanized APOE4: APP.PSEN1/TRE4 “amyloid mice” and P301S/TRE4, “tau mice.” Both the E2Ch and E2 vectors prevented Aβ42 and Aβ40 accumulation and decreased β-amyloid aggregates in amyloid mice, but only the E2Ch vector suppressed decreased tau tangles in tau mice. Microglial activation and reactive astrocytes were significantly suppressed by both vectors in amyloid mice but only the E2Ch vector mediated significant suppression of Iba1 and glial fibrillary acidic protein (GFAP) in tau mice. In four behavioral assays, the E2 and E2Ch vectors had similar benefits in amyloid mice, but E2Ch outperformed E2 in tau mice. In summary, while E2 is effective in suppressing amyloid pathology, the novel E2 variant E2Ch more effectively treats both the amyloid and tau pathology of murine AD in APOE4 background, supporting the development of AAVrh.10APOE2Ch as a therapy for APOE4-associated AD.

Published
2024
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28. Functional Assessment and Rehabilitation of Shoulder Proprioception for Glenohumeral Instability

Author

Mininder S. Kocher, Paul A. Borsa, Susan P. Lephart, and Scott M. Lephart

Subjects
musculoskeletal diseases, medicine.medical_specialty, Rehabilitation, Proprioception, business.industry, Glenohumeral instability, medicine.medical_treatment, Biophysics, Physical Therapy, Sports Therapy and Rehabilitation, Articular ligaments, medicine.anatomical_structure, Physical medicine and rehabilitation, Shoulder rehabilitation, Sensory Functions, medicine, Physical therapy, Orthopedics and Sports Medicine, Shoulder joint, business
Abstract

Following injury to the articular ligaments, disruption of mechanoreceptors results in partial deafferentation of the joint. This has been shown to inhibit normal neuromuscular joint stabilization, and it contributes to repetitive injuries and the progressive decline of the joint. Assessment of proprioception is valuable in identification of proprioceptive deficits and subsequent planning of the rehabilitation program. A shoulder rehabilitation program must address both the mechanical and sensory functions of articular structures by incorporating a proprioceptive training element within the normal protocol. The objective of proprioception rehabilitation is to enhance cognitive appreciation of the respective joint relative to position and movement, and to enhance muscular stabilization of the joint in the absence of structural restraints. If these objectives are properly addressed, the restoration of the proprioceptive mechanism will prevent further disability of the shoulder joint.

Published
1994
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29. Kinesiology taping does not alter shoulder strength, shoulder proprioception, or scapular kinematics in healthy, physically active subjects and subjects with Subacromial Impingement Syndrome.

Author

Keenan, Karen A., Akins, Jonathan S., Varnell, Michelle, Abt, John, Lovalekar, Mita, Lephart, Scott, and Sell, Timothy C.

Abstract

Objective To examine the effect of kinesiology tape (KT) on shoulder strength, proprioception, and scapular kinematics in healthy and Subacromial Impingement Syndrome (SAIS) subjects. Design Placebo-controlled quasi-experimental study. Setting Research laboratory. Participants A total of 30 physically active subjects participated. Ten healthy subjects with no previous history of shoulder pathology received KT on the dominant shoulder. Twenty subjects with shoulder pain for a minimum of two weeks and presenting with clinical signs of impingement were allotted to receive KT (n = 10) or placebo taping (PT, n = 10) on the involved shoulder. Main outcome measures All participants were tested pre- and post-application. Shoulder internal/external rotation (IR/ER) strength was assessed with isokinetic dynamometry (average peak torque/body weight). Shoulder IR/ER proprioception was assessed through threshold to detect passive motion (mean absolute error in degrees). Scapular position at 90° and 120° of shoulder abduction during arm raising/lowering were assessed using a 3D motion analysis system. Results No significant within group or between group differences were demonstrated for any measure. Conclusions Taping does not appear to aid/impair shoulder strength, shoulder proprioception, or scapular kinematics. Future research should explore if the effects of KT are time-dependent and similar in other pathologies. [ABSTRACT FROM AUTHOR]

Published
2017
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30. Physical, Physiological, and Dietary Comparisons Between Marine Corps Forces Special Operations Command Critical Skills Operators and Enablers.

Author

Royer, Scott D, Thomas, D Travis, Winters, Joshua D, Abt, John P, Best, Stuart, Poploski, Kathleen M, Zalaiskalns, Andrejs, and Lephart, Scott M

Abstract

Tactical demands of a Marine Corps Forces Special Operations Command (MARSOC) Critical Skills Operator (CSO) require high levels of physical performance. During combat deployments, teams of CSOs are supplemented with enablers who specialize in mission-specific tasks. MARSOC CSOs and enablers serve alongside each other in extreme combat environments, often enduring the same physical demands, but the selection process for each group is very different. The purpose of this observational study was to quantify the physical, physiological, and dietary differences of MARSOC CSOs and enablers, as this may have a direct impact on tactical performance and provide important information to shape future research.

Published
2018
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31. Patterns and Associations of Shoulder Motion, Strength, and Function in MARSOC Personnel Without History of Shoulder Injury.

Author

Poploski, Kathleen M, Picha, Kelsey J, Winters, Joshua D, Royer, Scott D, Heebner, Nicholas R, Lambert, Brad, Abt, John P, and Lephart, Scott M

Abstract

Military personnel are at an increased risk of shoulder injuries due to training and deployment demands, however, there is a lack of information on the tactical athlete's upper extremity profile. Therefore, the purpose of this study was to examine shoulder musculoskeletal characteristics, including range of motion (ROM), strength, and function, and the relationships between these measures in Marine Corps Forces Special Operations Command (MARSOC) personnel without history of shoulder injury.

Published
2018
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32. The effects of shoulder plyometric training on proprioception and selected muscle performance characteristics

Author

David A. Stone, Scott M. Lephart, Susan P. Lephart, Freddie H. Fu, Kathleen A. Swanik, and C. Buz Swanik

Subjects
Adult, medicine.medical_specialty, Muscle Relaxation, Physical exercise, Sensitivity and Specificity, Cohort Studies, Kinesitherapy, Reference Values, Task Performance and Analysis, Medicine, Humans, Orthopedics and Sports Medicine, Range of Motion, Articular, Muscle, Skeletal, Swimming, Probability, Physical Education and Training, Proprioception, business.industry, Shoulder Joint, General Medicine, medicine.anatomical_structure, External rotation, Physical performance, Physical therapy, Upper limb, Surgery, Female, Trampoline, Plyometric training, business, Muscle Contraction
Abstract

The purpose of this study was to determine the effect of plyometric training of the shoulder internal rotators on proprioception, kinesthesia, and selected muscle performance characteristics in female swimmers. Twenty-four female division I swimmers were evaluated before and after a 6-week plyometric training program. Proprioception and kinesthesia were assessed for internal and external rotation at 0 degrees, 75 degrees, and 90% of the subject's maximum external rotation. The Biodex II was used to assess strength characteristics at 60 degrees /s, 240 degrees /s, and 450 degrees /s. Plyometric training sessions (2 times/week) involved 3 sets of 15 repetitions with a trampoline, weighted balls, and elastic tubing. A 2-way analysis of variance revealed significant improvement (P.05) in proprioception at 0 degrees moving into external rotation, as well as 75 degrees and 90% moving into both internal and external rotation. Kinesthesia demonstrated significant improvement for all test conditions after plyometric training. Significant gains in selected muscle performance characteristics included time to peak torque (60 degrees /s and 240 degrees /s), amortization time (450 degrees /s), and torque decrement (240 degrees /s). This study suggests that plyometric activities may facilitate neural adaptations that enhance proprioception, kinesthesia, and muscle performance characteristics. Significant neuromuscular benefits may be attained if they are implemented earlier into shoulder rehabilitation programs.

Published
2002

33. Predictors of Clostridium difficile infection–related mortality among older adults.

Author

Chopra, Teena, Awali, Reda A., Biedron, Caitlin, Vallin, Eileen, Bheemreddy, Suchitha, Saddler, Christopher M., Mullins, Keith, Echaiz, Jose F., Bernabela, Luigino, Severson, Richard, Marchaim, Dror, Lephart, Paul, Johnson, Laura, Thyagarajan, Rama, Kaye, Keith S., and Alangaden, George

Abstract

Background Over 90% of annual deaths caused by Clostridium difficile infection (CDI) occur in persons aged ≥65 years. However, no large-scale studies have been conducted to investigate predictors of CDI-related mortality among older adults. Methods This case-control study included 540 CDI patients aged ≥60 years admitted to a tertiary care hospital in Detroit, Michigan, between January 2005 and December 2012. Cases were CDI patients who died within 30 days of CDI date. Controls were CDI patients who survived >30 days after CDI date. Cases were matched to controls on a 1:3 ratio based on age and hospital acquisition of CDI. Results One-hundred and thirty cases (25%) were compared with 405 controls (75%). Independent predictors of CDI-related mortality included admission from another acute hospital (odds ratio [OR], 8.25; P  = .001) or a long-term care facility (OR, 13.12; P  = .012), McCabe score ≥2 (OR, 12.19; P  < .001), and high serum creatinine (≥1.7 mg/dL) (OR, 3.43; P  = .021). The regression model was adjusted for the confounding effect of limited activity of daily living score, total number of antibiotic days prior to CDI, ileus on abdominal radiograph, low albumin (≤2.5 g/dL), elevated white blood cell count (>15 × 1,000/mm 3 ), and admission to intensive care unit because of CDI. Conclusions Predictors of CDI-related mortality reported in this study could be applied to the development of a bedside scoring system for older adults with CDI. [ABSTRACT FROM AUTHOR]

Published
2016
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34. Reliability and measurement precision of concentric-to-isometric and eccentric-to-isometric knee active joint position sense tests in uninjured physically active adults.

Author

Clark, Nicholas C., Akins, Jonathan S., Heebner, Nicholas R., Sell, Timothy C., Abt, John P., Lovalekar, Mita, and Lephart, Scott M.

Abstract

Objectives Proprioception is important because it is used by the central nervous system to mediate muscle control of joint stability, posture, and movement. Knee active joint position sense (AJPS) is one representation of knee proprioception. The purpose of this study was to establish the intra-tester, inter-session, test–retest reliability of concentric-to-isometric (seated knee extension; prone knee flexion) and eccentric-to-isometric (seated knee flexion; prone knee extension) knee AJPS tests in uninjured adults. Design Descriptive. Setting University laboratory. Participants Six males, six females (age 26.2 ± 5.7 years; height 171.1 ± 9.6 cm; mass 71.1 ± 16.6 kg). Main Outcome Measures Mean absolute error (AE; °); intraclass correlation coefficient (ICC) (2,1); standard error of measurement (SEM; °). Results Mean AE ranged from 3.18° to 5.97° across tests. The ICCs and SEMs were: seated knee extension 0.13, 1.3°; prone knee flexion 0.51, 1.2°; seated knee flexion 0.31, 1.7°; prone knee extension 0.87, 1.4°. Conclusions The prone knee flexion and prone knee extension tests demonstrated moderate to good reliability. Prone knee flexion and prone knee extension AJPS tests may be useful in cross-sectional studies estimating how proprioception contributes to knee functional joint stability or prospective studies estimating the role of proprioception in the onset of knee injury. [ABSTRACT FROM AUTHOR]

Published
2016
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35. Physical and Performance Characteristics Related to Unintentional Musculoskeletal Injury in Special Forces Operators: A Prospective Analysis

Author

Heebner, Nicholas R., Abt, John P., Lovalekar, Mita, Beals, Kim, Sell, Timothy C., Morgan, Jeffery, Kane, Shawn, and Lephart, Scott

Abstract

Context: Seventy-seven percent of musculoskeletal injuries sustained by United States Army Special Forces Operators are preventable. Identification of predictive characteristics will promote the development of screening methods to augment injury-prevention programs.Objective: To determine physical and performance characteristics that predict musculoskeletal injuries.Setting: Clinical laboratory.Patients or Other Participants: A total of 95 Operators (age 32.7 ± 5.1 years, height 179.8 ± 6.9 cm, mass 89.9 ± 12.7 kg).Main Outcome Measure(s): Laboratory testing consisted of body composition, aerobic and anaerobic capacity, upper and lower body strength and flexibility, balance, and biomechanical evaluation. Injury data were captured for 12 months after laboratory testing. Injury frequencies, cross-tabulations, and relative risks (RRs) were calculated to evaluate the relationships between physical characteristics and injury proportions. Between-groups differences (injured versus uninjured) were assessed using appropriate ttests or Mann-Whitney Utests.Results: Less shoulder-retraction strength (RR 1.741 95 confidence interval 1.003, 3.021), knee-extension strength (RR 2.029 95 confidence interval 1.011, 4.075), and a smaller trunk extension:flexion ratio (RR 0.533 95 confidence interval 0.341, 0.831) were significant risk factors for injury. Group comparisons showed less trunk strength (extension: P .036, flexion: P .048) and smaller right vertical ground reaction forces during landing (P .025) in injured Operators. Knee strength, aerobic capacity, and body mass index were less in the subgroup of spine-injured versus uninjured Operators (Pvalues .013−.036).Conclusions: Knee-extension and shoulder-retraction strength were risk factors for musculoskeletal injury in Operators. Less trunk-flexion and -extension strength, higher body mass index, lower aerobic capacity, and increased ground reaction forces during landing were characteristics that may also contribute to musculoskeletal injury. Having 2 or more risk factors resulted in a greater injury proportion (χ2 13.512, P .015); however, more research is needed. Athletic trainers working in the military or similar high-demand settings can use these data to augment screening and injury-prevention protocols.

Published
2017
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39. Effects of Deployment on Musculoskeletal and Physiological Characteristics and Balance.

Author

Nagai, Takashi, Abt, John P, Sell, Timothy C, Keenan, Karen A, McGrail, Mark A, Smalley, Brian W, and Lephart, Scott M

Abstract

Despite many nonbattle injuries reported during deployment, few studies have been conducted to evaluate the effects of deployment on musculoskeletal and physiological characteristics and balance. A total of 35 active duty U.S. Army Soldiers participated in laboratory testing before and after deployment to Afghanistan. The following measures were obtained for each Soldier: shoulder, trunk, hip, knee, and ankle strength and range of motion (ROM), balance, body composition, aerobic capacity, and anaerobic power/capacity. Additionally, Soldiers were asked about their physical activity and load carriage. Paired t tests or Wilcoxon tests with an α = 0.05 set a priori were used for statistical analyses. Shoulder external rotation ROM, torso rotation ROM, ankle dorsiflexion ROM, torso rotation strength, and anaerobic power significantly increased following deployment (p < 0.05). Shoulder extension ROM, shoulder external rotation strength, and eyes-closed balance (p < 0.05) were significantly worse following deployment. The majority of Soldiers (85%) engaged in physical activity. In addition, 58% of Soldiers reported regularly carrying a load (22 kg average). The deployment-related changes in musculoskeletal and physiological characteristics and balance as well as physical activity and load carriage during deployment may assist with proper preparation with the intent to optimize tactical readiness and mitigate injury risk.

Published
2016
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40. Descriptive Epidemiology of Musculoskeletal Injuries in the Army 101st Airborne (Air Assault) Division.

Author

Lovalekar, Mita T, Abt, John P, Sell, Timothy C, Nagai, Takashi, Keenan, Karen, Beals, Kim, Lephart, Scott M, and Wirt, Michael D

Abstract

The purpose of this study was to describe the epidemiology of musculoskeletal injuries among Soldiers of the 101st Airborne (Air Assault) Division. A total of 451 subjects (age: 27.6 ± 6.2 years, gender: males 395/451 = 87.6%) volunteered. Musculoskeletal injury data were extracted from subjects' medical charts and injuries that occurred during 1 year were described. Injury frequency, injury anatomic location and sublocation, injury cause, activity when injury occurred, and injury type were described. Injury frequency was 29.5 injuries per 100 subjects per year. Most injures affected the lower extremity (60.2% of injuries) and common anatomic sublocations for injuries were the ankle (17.3%) and knee (15.0%). Frequent causes of injuries were running (13.5%) and direct trauma (9.0%). Physical training was associated with 29.3% of the injuries. A majority of injuries were classified as pain/spasm/ache (29.3%), without further elucidation of pathology. Other frequent injury types were sprain (21.8%) and strain (14.3%). The descriptive epidemiology of musculoskeletal injuries in this population underscores the need to explore the modifiable risk factors of potentially preventable lower extremity injuries associated with physical training and running. There is scope for the development of an optimized and targeted physical training program for injury prevention in this population.

Published
2016
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42. Prevalence of Clostridium difficile infection in acute care hospitals, long-term care facilities, and outpatient clinics: Is Clostridium difficile infection underdiagnosed in long-term care facility patients?

Author

Krishna, Amar, Pervaiz, Amina, Lephart, Paul, Tarabishy, Noor, Varakantam, Swapna, Kotecha, Aditya, Awali, Reda A., Kaye, Keith S., and Chopra, Teena

Abstract

Clostridium difficile infection is a common cause of diarrhea in long-term care facility (LTCF) patients. The high prevalence of C difficile infection in LTCFs noted in our study calls for a critical need to educate LTCF staff to send diarrheal stool for C difficile testing to identify more cases and prevent transmission. [ABSTRACT FROM AUTHOR]

Published
2017
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44. Resveratrol: influences on gene expression in human skin.

Author

Lephart, Edwin D., Sommerfeldt, John M., and Andrus, Merritt B.

Abstract

There are many phytochemicals such as polyphenols that can modulate inflammatory responses and provide protective roles against many diseases and cancers, especially with aging. Resveratrol is a polyphenolic molecule found in plant and food products with such properties. However, a comprehensive examination of resveratrol influencing human skin gene expression has not been performed. This study quantified differential gene expression/mRNA levels via gene array technology using human skin equivalent cultures with resveratrol exposure at 1.0% for 24 hours and via subsequent qPCR experiments. The results indicate that resveratrol can ameliorate the aging of human skin by significantly stimulating SIRT 1, extracellular matrix proteins, such as collagens and elastin, and antioxidants while significantly inhibiting inflammatory and dermal-aging biomarkers. Resveratrol's anti-aging protection altered specific dermal biomarkers through a variety of mechanisms to protect the skin. Thus, the results demonstrate the potential resveratrol has in human dermal applications to maintain and improve human skin health. [ABSTRACT FROM AUTHOR]

Published
2014
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45. Outcomes of carbapenem-resistant Enterobacteriaceae isolation: Matched analysis.

Author

Bogan, Christopher, Kaye, Keith S., Chopra, Teena, Hayakawa, Kayoko, Pogue, Jason M., Lephart, Paul R., Bheemreddy, Suchitha, Lazarovitch, Tsilia, Zaidenstein, Ronit, Perez, Federico, Bonomo, Robert A., and Marchaim, Dror

Abstract

Background: Carbapenem-resistant Enterobacteriaceae (CRE) isolation is associated with poor outcomes. The matched cohort study design enables investigation of specific role of resistance in contributing to patients' outcomes. Patients with CRE were matched to 3 groups: (1) patients with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL), (2) patients with carbapenem-susceptible non-ESBL Enterobacteriaceae, and (3) uninfected controls. Methods: Patients with CRE isolated at Detroit Medical Center (September 1, 2008, to August 31, 2009) were matched (1:1 ratio) to the 3 groups based on (1) bacteria type, (2) hospital/facility, (3) unit/clinic, (4) calendar year, and (5) time at risk (ie, from admission to culture). Multivariable logistic regression models for outcomes were constructed. Results: Ninety-one patients with CRE were enrolled. CRE isolation was not an independent predictor for in-hospital mortality in any of the models (ie, vs uncolonized controls, vs ESBL, vs non-ESBL Enterobacteriaceae, and vs all 3 non-CRE groups combined), despite high significance of association in bivariate analyses. CRE isolation was independently associated with deterioration in functional status [odds ratio, 9; P = .002] and being discharged to a long-term care facility after being admitted to the hospital from home [odds ratio, 13.7; P < .001]. Conclusion: Underlying condition and comorbidities are the principal factors responsible for in-hospital mortality in CRE infections; however, in-hospital mortality is not independently correlated to the offending pathogen. In addition, we found that the pathogen contributes significantly to patients' degree of morbidity. [Copyright &y& Elsevier]

Published
2014
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47. Effects of Age and Military Service on Strength and Physiological Characteristics of U.S. Army Soldiers.

Author

Abt, John P, Perlsweig, Katherine, Nagai, Takashi, Sell, Timothy C, Wirt, Michael D, and Lephart, Scott M

Abstract

Soldiers must maintain tactical performance capabilities over the course of their career. Loss in physical readiness may be a function of age and the operational demands associated with increasing years of service. The purpose of this study was to assess strength and physiological characteristics in different cohorts of U.S. Army Soldiers based on years of service and age. A total of 253 Soldiers (age: 28.1 ± 6.8 years; height: 1.76 ± 0.11 m; mass: 84.1 ± 12.2 kg) participated. Individual subject cohorts were created based on years of service (1-5 years, 6-10 years, 11-15 years) and age (20-24 years, 25-29 years, 30-34 years, 35-39 years, 40-44 years). Testing included shoulder, knee, ankle, and torso strength, aerobic capacity/lactate threshold, anaerobic power/capacity, and body composition/total mass. Those with 11 to 15 years of service and between ages 30 and 34 had a higher percentage of body fat, and lower aerobic capacity and lactate threshold than younger Soldiers with fewer years of service. Physical training interventions should focus on maintenance of physiological characteristics to offset the loss of readiness at the similar time point of 11 to 15 years of service and 30 to 34 years of age.

Published
2016
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48. Descriptive Epidemiology of Musculoskeletal Injuries in Naval Special Warfare Sea, Air, and Land Operators.

Author

Lovalekar, Mita, Abt, John P, Sell, Timothy C, Wood, Dallas E, and Lephart, Scott M

Abstract

The purpose of this analysis was to describe medical chart reviewed musculoskeletal injuries among Naval Special Warfare Sea, Air, and Land Operators. 210 Operators volunteered (age: 28.1 ± 6.0 years, height: 1.8 ± 0.1 m, weight: 85.4 ± 9.3 kg). Musculoskeletal injury data were extracted from subjects' medical charts, and injuries that occurred during 1 year were described. Anatomic location of injury, cause of injury, activity when injury occurred, and injury type were described. The frequency of injuries was 0.025 per Operator per month. Most injuries involved the upper extremity (38.1% of injuries). Frequent anatomic sublocations for injuries were the shoulder (23.8%) and lumbopelvic region of the spine (12.7%). Lifting was the cause of 7.9% of injuries. Subjects were participating in training when 38.1% of injuries occurred and recreational activity/sports when 12.7% of injuries occurred. Frequent injury types were strain (20.6%), pain/spasm/ache (19.0%), fracture (11.1%), and sprain (11.1%). The results of this analysis underscore the need to investigate the risk factors, especially of upper extremity and physical activity related injuries, in this population of Operators. There is a scope for development of a focused, customized injury prevention program, targeting the unique injury profile of this population.

Published
2016
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49. Evaluation of the FilmArray Blood Culture Identification Panel: Results of a Multicenter Controlled Trial

Author

Salimnia, Hossein, Fairfax, Marilynn R., Lephart, Paul R., Schreckenberger, Paul, DesJarlais, Sharon M., Johnson, J. Kristie, Robinson, Gwen, Carroll, Karen C., Greer, Amy, Morgan, Margie, Chan, Raymond, Loeffelholz, Michael, Valencia-Shelton, Frances, Jenkins, Stephen, Schuetz, Audrey N., Daly, Judy A., Barney, Trenda, Hemmert, Andrew, and Kanack, Kristen J.

Abstract

ABSTRACTSepsis is a major cause of morbidity, mortality, and increased medical expense. Rapid diagnosis improves outcomes and reduces costs. The FilmArray blood culture identification panel (BioFire Diagnostics LLC, Salt Lake City, UT), a highly multiplexed PCR assay, can identify 24 etiologic agents of sepsis (8 Gram-positive, 11 Gram-negative, and 5 yeast species) and three antimicrobial resistance genes (mecA, vanA/B, and blaKPC) from positive blood culture bottles. It provides results in about 1 h with 2 min for assay setup. We present the results of an eight-center trial comparing the sensitivity and specificity of the panel with those of the laboratories' standard phenotypic identification techniques, as well as with molecular methods used to distinguish Acinetobacter baumanniifrom other members of the A. calcoaceticus-A. baumanniicomplex and to detect antimicrobial resistance genes. Testing included 2,207 positive aerobic blood culture samples, 1,568 clinical and 639 seeded. Samples were tested fresh or were frozen for later testing within 8 h after the bottles were flagged as positive by an automated blood culture system. At least one organism was detected by the panel in 1,382 (88.1%) of the positive clinical specimens. The others contained primarily off-panel organisms. The panel reported multiple organisms in 81 (5.86%) positive clinical specimens. The unresolved blood culture identification sensitivity for all target detections exceeded 96%, except for Klebsiella oxytoca(92.2%), which achieved 98.3% sensitivity after resolution of an unavoidable phenotypic error. The sensitivity and specificity for vanA/Band blaKPCwere 100%; those for mecAwere 98.4 and 98.3%, respectively.

Published
2015
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50. The Complex Epidemiology of Carbapenem-Resistant EnterobacterInfections: A Multicenter Descriptive Analysis

Author

Lazarovitch, Tsilia, Amity, Keren, Coyle, Joseph R., Ackerman, Benjamin, Tal-Jasper, Ruthy, Ofer-Friedman, Hadas, Hayakawa, Kayoko, Bogan, Christopher, Lephart, Paul R., Kaplansky, Tamir, Maskit, Moran, Azouri, Tal, Zaidenstein, Ronit, Perez, Federico, Bonomo, Robert A., Kaye, Keith S., and Marchaim, Dror

Abstract

BACKGROUNDThe pandemic of carbapenem-resistant Enterobacteriaceae (CRE) was primarily due to clonal spread of blaKPCproducing Klebsiella pneumoniae. Thus, thoroughly studied CRE cohorts have consisted mostly of K. pneumoniae.OBJECTIVETo conduct an extensive epidemiologic analysis of carbapenem-resistant Enterobacterspp. (CREn) from 2 endemic and geographically distinct centers.METHODSCREn were investigated at an Israeli center (Assaf Harofeh Medical Center, January 2007 to July 2012) and at a US center (Detroit Medical Center, September 2008 to September 2009). blaKPCgenes were queried by polymerase chain reaction. Repetitive extragenic palindromic polymerase chain reaction and pulsed-field gel electrophoresis were used to determine genetic relatedness.RESULTSIn this analysis, 68 unique patients with CREn were enrolled. Sixteen isolates (24%) were from wounds, and 33 (48%) represented colonization only. All isolates exhibited a positive Modified Hodge Test, but only 93% (27 of 29) contained blaKPC. Forty-three isolates (63%) were from elderly adults, and 5 (7.4%) were from neonates. Twenty-seven patients died in hospital (40.3% of infected patients). Enterobacterstrains consisted of 4 separate clones from Assaf Harofeh Medical Center and of 4 distinct clones from Detroit Medical Center.CONCLUSIONSIn this study conducted at 2 distinct CRE endemic regions, there were unique epidemiologic features to CREn: (i) polyclonality, (ii) neonates accounting for more than 7% of cohort, and (iii) high rate of colonization (almost one-half of all cases represented colonization). Since false-positive Modified Hodge Tests in Enterobacterspp. are common, close monitoring of carbapenem resistance mechanisms (particularly carbapenemase production) among Enterobacterspp. is important.Infect. Control Hosp. Epidemiol.2015;36(11):1283–1291

Published
2015
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