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PubMed1975

Baseline concentrations of polychlorinated biphenyls and DDT in Lake Michigan fish, 1971.

Responding to the recommendations of the Lake Michigan Interstate Pesticide Committee, the author aimed to establish baseline baseline data on polychlorinated biphenyls (PCB's) and DDT in Lake Michigan fish in 1971. Because the past 2 years had witnessed unprecedented legislative action to protect food resources and other aquatic species near the top of the food chain from persistent hazardous chemicals, the author also attempted to gauge the impact of cooperative legislative action on the quality of large lakes. Thirteen species of fish taken from 14 regions of Lake Michigan in the fall of 1971 were analyzed for PCB's and DDT analogs. Mean wet-weight concentrations of PCB's similar to Aroclor 1254 ranged from 2.7 ppm in rainbow smelt to 15 ppm in lake trout. Most trout and salmon longer than 12 inches contained PCB's at concentrations greater than the tolerance level of 5 ppm established by the Food and Drug Administration, U.S. Department of Health, Education, and Welfare. Mean concentrations of total DDT ranged from less than 1 ppm in suckers to approximately 16 ppm in large lake trout. The presence of the major chlorinated hydrocarbons was confirmed by gas-liquid chromatography/mass spectrometry; additional PCB confirmations were obtained through perchlorination. The most abundant PCB's were tetra, penta-, hexa-, and hepatchlorobiphenyls which are similar to commercially prepared Aroclor 1254; lesser chlorinated PCB's were present in fish from nearshore waters.

Animals↗
PubMed1998

[Short-term effects of the Michigan splint on muscular and joint pain].

BACKGROUND: In 1966 Ramfjord and Ash proposed the Michigan's splint that, at present, is one of the splints widely accepted for the treatment of craniomandibular disorders (CMD). METHODS: For this study, thirty-one subjects were examined according to the protocol of the European Academy of CMD; each patient indicated the intensity of pain using a Visual Analogue Scale (VAS). After therapy with Michigan's splint, the visit was repeated and the patient indicated again the VAS. RESULTS: The results showed that the splint has short-term benefit effects on the muscular and articular pain, even if the effects are lesser on the articular pain. CONCLUSIONS: The Michigan's splint is a valid device for therapy of CMD, moreover it is very cheap, very easy to use and without contraindications.

Craniofacial Dysostosis↗
PubMed2005

Workplace violence: a survey of emergency physicians in the state of Michigan.

STUDY OBJECTIVE: We seek to determine the amount and type of work-related violence experienced by Michigan attending emergency physicians. METHODS: A mail survey of self-reported work-related violence exposure during the preceding 12 months was sent to randomly selected emergency physician members of the Michigan College of Emergency Physicians. Work-related violence was defined as verbal, physical, confrontation outside of the emergency department (ED), or stalking. RESULTS: Of 250 surveys sent, 177 (70.8%) were returned. Six were blank (3 were from retired emergency physicians), leaving 171 (68.4%) for analysis. Verbal threats were the most common form of work-related violence, with 74.9% (95% confidence interval [CI] 68.4% to 81.4%) of emergency physicians indicating at least 1 verbal threat in the previous 12 months. Of the emergency physicians responding, 28.1% (95% CI 21.3% to 34.8%) indicated that they were victims of a physical assault, 11.7% (95% CI 6.9% to 16.5%) indicated that they were confronted outside of the ED, and 3.5% (95% CI 0.8% to 6.3%) experienced a stalking event. Emergency physicians who were verbally threatened tended to be less experienced (11.1 versus 15.1 years in practice; mean difference -4.0 years [95% CI -6.4 to -1.6 years]), as were those who were physically assaulted (9.5 versus 13.1 years; mean difference -3.6 years [95% CI -5.9 to -1.3 years]). Urban hospital location, emergency medicine board certification, or on-site emergency medicine residency program were not significantly associated with any type of work-related violence. Female emergency physicians were more likely to have experienced physical violence (95% CI 1.4 to 5.8) but not other types of violence. Most (81.9%; 95% CI 76.1% to 87.6%) emergency physicians were occasionally fearful of workplace violence, whereas 9.4% (95% CI 5.0% to 13.7%) were frequently fearful. Forty-two percent of emergency physicians sought various forms of protection as a result of the direct or perceived violence, including obtaining a gun (18%), knife (20%), concealed weapon license (13%), mace (7%), club (4%), or a security escort (31%). CONCLUSION: Work-related violence exposure is not uncommon in EDs. Many emergency physicians are concerned about the violence and are taking measures, including personal protection, in response to the fear.

Emergency Service, Hospital↗
PubMed2002

The Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) collaborative quality improvement initiative in percutaneous coronary interventions.

The past decade has been characterized by increased scrutiny of outcomes of surgical and percutaneous coronary interventions (PCIs). This increased scrutiny has led to the development of regional, state, and national databases for outcome assessment and for public reporting. This report describes the initial development of a regional, collaborative, cardiovascular consortium and the progress made so far by this collaborative group. In 1997, a group of hospitals in the state Michigan agreed to create a regional collaborative consortium for the development of a quality improvement program in interventional cardiology. The project included the creation of a comprehensive database of PCIs to be used for risk assessment, feedback on absolute and risk-adjusted outcomes, and sharing of information. To date, information from nearly 20,000 PCIs have been collected. A risk prediction tool for death in the hospital and additional risk prediction tools for other outcomes have been developed from the data collected, and are currently used by the participating centers for risk assessment and for quality improvement. As the project enters into year 5, the participating centers are deeply engaged in the quality improvement phase, and expansion to a total of 17 hospitals with active PCI programs is in process. In conclusion, the Blue Cross Blue Shield of Michigan Cardiovascular Consortium is an example of a regional collaborative effort to assess and improve quality of care and outcomes that overcome the barriers of traditional market and academic competition.

Angioplasty, Balloon, Coronary↗
PubMed2000

The treatment of elderly diabetic patients with acute myocardial infarction: insight from Michigan's Cooperative Cardiovascular Project.

BACKGROUND: Diabetic patients with acute myocardial infarction (AMI) have higher morbidity and mortality rates than nondiabetic patients with AMI. Thus, reliable adherence to quality care is necessary in these patients to improve outcomes. We analyzed data from the Health Care Financing Administration's Cooperative Cardiovascular Project (CCP) in Michigan, addressing quality of care in diabetic patients with AMI. METHOD: All acute-care hospitals in Michigan had 8 consecutive months of baseline CCP data abstracted from medical records of all Medicare patients who were discharged with a principal diagnosis of AMI. Owing to the staggered 8-month periods, abstraction occurred for patients who were discharged between April 1, 1994, and July 31, 1995. RESULTS: Diabetic patients accounted for 33% of 8455 patients with AMI. Diabetic patients were primarily younger, female, and nonwhite. They had a greater frequency of non-Q-wave AMI and presented less often within 6 hours of their infarction. Comorbid conditions, such as hypertension, prior AMI, prior stroke, and/or prior revascularization, were more frequent in diabetic than in nondiabetic patients. Congestive heart failure occurred more frequently in diabetic patients. Length of stay (7.9 vs 7.0 days; P<.001), in-hospital mortality rates (16% vs 13%; P<.001), and rates for mortality within 30 days (21% vs 17%; P<.001) were higher in diabetic patients. CONCLUSIONS: Despite greater frequencies of comorbid conditions, poorer outcomes, and greater resource use, there is poor overall adherence to most quality indicators in diabetic patients with AMI. Better methods for systematizing proven prevention and treatment strategies in the care of patients with AMI are needed in this unique high-risk cohort.

Angioplasty, Balloon, Coronary↗
PubMed2005

Blood lead testing among Medicaid-enrolled children in Michigan.

BACKGROUND: Federal regulations mandate that Medicaid-enrolled children be tested for lead poisoning at the age of 1 and 2 years or 3 through 5 years if not previously tested. OBJECTIVES: To measure the rate of blood lead testing among Medicaid-enrolled children in Michigan and the subsequent proportion of children with elevated lead levels and to determine factors associated with testing and elevated lead levels. METHODS: We performed a retrospective analysis of children aged 5 years or younger continuously enrolled in Michigan Medicaid during 2002. RESULTS: There were 216,578 children included in the analysis. The overall rate of blood lead testing was 19.6% (95% confidence interval [CI], 19.4-19.8) of which 8.3% (95% CI, 8.0-8.5) had a level of 10 microg/dL [0.48 micromol/L] or higher. Hispanic or nonwhite children or those living in high-risk areas for lead exposure were more likely to be tested and more likely to have an elevated blood lead level. However, 1.2% of tested children without these additional risk factors had a level of 10 microg/dL or higher. Enrollment in Medicaid managed care was associated with an increased likelihood of blood lead testing. After adjusting for other factors, those in managed care for 75% or more of their enrollment in 2002 had 1.98 (95% CI, 1.46-2.68) greater odds of being tested than those in fee-for-service for 75% or more of their enrollment. CONCLUSIONS: The rate of blood lead testing was low. Patterns suggest testing was targeted to those at highest risk, potentially leading some children with elevated blood lead levels to be missed.

Child, Preschool↗
PubMed1993

Parkinson's disease mortality and the industrial use of heavy metals in Michigan.

Parkinson's disease (PD) mortality rates in Michigan counties for 1986-1988 were calculated with respect to potential heavy metal exposure (iron, zinc, copper, mercury, magnesium, and manganese) from industry based on recent census data. Individuals were counted as a PD death if the diagnosis was listed as an "underlying" or "related" cause of death on the death certificate. Counties with an industry in the paper, chemical, iron, or copper related-industrial categories (ICs) had statistically significantly (p < 0.05) higher PD death rates than counties without these industries. Significant correlations of chemical (rs = 0.22; p = 0.05), paper (rs = 0.22; p = 0.05) and iron (rs = 0.29; p = 0.008) industry densities with PD death rates were also present. Counties were divided into high (> 15/100,000 individuals 45 years old and over) and low (< = 15/100,000) PD death rate counties by cluster analysis. Geographically, counties with high PD mortality were located mainly in the southern half of the lower peninsula and eastern half of the upper peninsula; low PD death rate counties formed two distinct clusters in the western edge of the upper peninsula and the north-central portion of the lower peninsula. Other possible risk factors that may explain the varied distribution of PD death rates in Michigan were examined. Those significantly correlated with PD mortality included population density (rs = 0.31; p = 0.005), farming density (rs = 0.25; p = 0.02), and well water use (rs = -0.24; p = 0.03). These ecologic findings suggest a geographic association between PD mortality and the industrial use of heavy metals.

Aged↗
PubMed1999

Sport-caught fish consumption and conception delay in licensed Michigan anglers.

Between 1993 and 1995, we surveyed 4931 licensed anglers aged 17-34 years residing in 10 Michigan counties bordering a Great Lake. Responses were received from 1443 anglers and 844 of their partners. Lifetime sport-caught fish consumption was estimated as the number of sport-caught fish meals consumed in the previous 12 months times years since 1970 in which sport-caught fish were consumed. Analysis was restricted to currently married couples (n=626). Lifetime sport-caught fish consumption was categorized in men as 0 (14%); 1-114 (27%); 115-270 (30%); 271-1127 (29%) meals; and in women as 0 (28%); 1-54 (26%); 55-138 (27%); fand 139-1127 (19%) meals, respectively. Conception delay (ever having failed to conceive after 12 months of trying) was reported by 13% of both men and women. Among men, the unadjusted odds ratios (OR) for conception delay were 1.2, 1.3, and 2.0 across the three increasing levels of sport-caught fish consumption compared to none (trend test P=0.06). After adjustment for age, race, region of Michigan, household income, educational attainment, smoking, alcohol consumption, and partner's sport fish consumption, the OR for conception delay in men were 1.4, 1.8, and 2.8, respectively. In women, unadjusted OR for conception delay were 0.9, 1.0, and 1.4 with increasing sport-caught fish consumption (trend test P=0.35). With the same covariates and the sport-caught fish consumption of the woman's partner included in the model, the OR were 0.8, 0.8, and 1.0, respectively. These data suggest a modest association, in men only, of sport-caught fish consumption with risk of conception delay.

Adolescent↗
PubMed1994

Contaminants in fishes from Great Lakes-influenced sections and above dams of three Michigan rivers. II: Implications for health of mink.

Populations of mink (Mustela vison) have declined in many areas of the world. Such declines have been linked to exposures to synthetic, halogenated hydrocarbons. In the Great Lakes region, mink are fewer in areas along the shore of the Great Lakes and their tributaries where mink have access to fish from the Great Lakes. Recently, there has been discussion of the relative merits of passage of fishes around hydroelectric dams on rivers in Michigan. A hazard assessment was conducted to determine the potential for adverse effects on mink, which could consume such fishes from above or below dams on the rivers. Concentrations of organochlorine insecticides, polychlorinated biphenyls (PCBs), 2,3,7,8-tetrachlordibenzo-p-dioxin equivalents (TCDD-EQ), and total mercury were measured in composite samples of fishes from above or below hydroelectric dams on the Manistee and Muskegon Rivers, which flow into Lake Michigan, and the Au Sable River, which flows into Lake Huron. Concentrations of organochlorine insecticides, PCBs, and TCDD-EQ were all greater in fishes from below the dams than those from above. Concentrations of neither organochlorine insecticides nor mercury in fishes are currently a risk to mink above or below the dams. All of the species of fishes collected from downstream of the dams contained concentrations of PCBs and TCDD-EQ, which represent a hazard to mink. The hazard index for PCBs was less than one for the average of all species from the upstream reaches of the Manistee and Au Sable Rivers, but not the Muskegon. The hazard index (concentration in fish/NOAEC) was greater than 1 for all of the species collected from below the dams, in all three rivers. The greatest hazard index was observed for carp (Cyprinus carpio) downstream on the Muskegon River. Because the concentrations of PCBs used in the hazard assessment were corrected for relative toxic potencies, the hazard ratios based on PCBs should be similar to those based on TCDD-EQ. This was found to be true. Thus, either total PCBs or TCDD-EQ could be used as the critical toxicant in the hazard assessment. However, if uncorrected concentrations of PCBs, expressed as Aroclors, were used in the hazard assessment, the toxicity of the weathered mixture would have been underestimated by approximately five-fold, and, in that instance, TCDD-EQ would be the critical contaminant for the hazard assessment.(ABSTRACT TRUNCATED AT 400 WORDS)

Animal Feed↗
PubMed2003

Wetland mitigation compliance in the western upper peninsula of Michigan.

The Army Corps of Engineers (ACE) is generally responsible for the implementation of federal Clean Water Act wetland regulations. It therefore plays an important role in the protection of wetlands within the United States. Unfortunately, past evaluators of ACE's implementation of these regulations found low rates of regulatory compliance. However, the fact that two states have taken responsibility for the implementation of these regulations within their boundaries provided the opportunity to assess whether one of these states might be doing a better job of enforcement. This paper reports on compliance with some of these regulations within one Michigan region. We evaluated permittee compliance with paperwork filing requirements related to wetland mitigation projects. Sixty-seven percent of county road commission permittees were out of compliance with at least one filing requirement. Forty percent of private and non-county government permittees were out of compliance. Our results therefore suggest that serious problems exist with Michigan's implementation of wetland regulations. They do not suggest that compliance in this state is significantly better than in states under ACE administration. We believe that increased agency monitoring and enforcement would improve compliance.

Conservation of Natural Resources↗
PubMed2006

Changes in soil carbon and nitrogen cycling along a 72-year wildfire chronosequence in Michigan jack pine forests.

We investigated the changes in soil processes following wildfire in Michigan jack pine (Pinus banksiana) forests using a chronosequence of 11 wildfire-regenerated stands spanning 72 years. The objective of this study was to characterize patterns of soil nutrients, soil respiration and N mineralization with stand development, as well as to determine the mechanisms driving those patterns. We measured in situ N mineralization and soil respiration monthly during the 2002 growing season and used multiple regression analysis to determine the important factors controlling these processes. Growing-season soil respiration rates ranged from a low of 156 g C/m2 in the 7-year-old stand to a high of 254 g C/m2 in the 22-year-old stand, but exhibited no clear pattern with stand age. In general, soil respiration rates peaked during the months of July and August when soil temperatures were highest. We used a modified gamma function to model a temporal trend in total N mineralization (total N mineralization=1.853-0.276xagexe-0.814xage; R2=0.381; P=0.002). Total N mineralization decreased from 2.8 g N/m2 in the 1-year-old stand to a minimum value of 0.5 g N/m2 in the 14-year-old stand, and then increased to about 1.5 g N/m2 in mature stands. Changes in total N mineralization were driven by a transient spike in N turnover in the mineral soil immediately after wildfire, followed by a gradual accrual of a slow-cycling pool of N in surface organic horizons as stands matured. Thus, in Michigan jack pine forests, the accumulation of surface organic matter appears to regulate N availability following stand-replacing wildfire.

Carbon↗
PubMed2006

Landscape based identification of human disturbance gradients and reference conditions for Michigan streams.

Identification of reference streams and human disturbance gradients are crucial steps in assessing the effects of human disturbances on stream health. We describe a process for identifying reference stream reaches and assessing disturbance gradients using readily available, geo-referenced stream and human disturbance databases. We demonstrate the utility of this process by applying it to wadeable streams in Michigan, USA, and use it to identify which human disturbances have the greatest impact on streams. Approximately 38% of cold-water and 16% of warm-water streams in Michigan were identified as being in least-disturbed condition. Conversely, approximately 3% of cold-water and 4% of warm-water streams were moderately to severely disturbed by landscape human disturbances. Anthropogenic disturbances that had the greatest impact on moderately to severely disturbed streams were nutrient loading and percent urban land use within network watersheds. Our process for assessing stream health represents a significant advantage over other routinely used methods. It uses inter-confluence stream reaches as an assessment unit, permits the evaluation of stream health across large regions, and yields an overall disturbance index that is a weighted sum of multiple disturbance factors. The robustness of our approach is linked to the scale of disturbances that affect a stream; it will be less robust for identifying less degraded or reference streams with localized human disturbances. With improved availability of high-resolution disturbance datasets, this approach will provide a more complete picture of reference stream reaches and factors contributing to degradation of stream health.

Ecosystem↗
PubMed1991

Small area analysis of hospital discharges for musculoskeletal diseases in Michigan: the influence of socioeconomic factors.

PURPOSE: The rise in health care costs has occasioned a number of initiatives in an attempt to reduce the rate of increase. Despite the growth of health maintenance organizations and preferred provider organizations and the introduction of Medicare's prospective payment system, health care costs have continued to increase. Coincident with these efforts, a number of researchers have shown that there exists wide variation in age-adjusted hospital discharge rates, which translate into significant variation in per capita expenditures. Much of the focus on the reasons for hospital admission variability has been on physician practice variation. If most of the variation in hospital discharge rates is due to physician practice style, then payment systems can be developed (e.g., capitation) that limit physician practice variation without harming patients. We examined socioeconomic factors in Michigan communities to assess their association with hospital discharge rates for patients with musculoskeletal diseases. PATIENTS AND METHODS: Data on hospital discharges from 1980 and 1987 were taken from the Michigan Inpatient Data Base. All admissions from the major diagnostic category 8, diagnosis-related group (DRG) 209-256 were included. Zip code-specific hospitalization data were grouped into small geographic areas or hospital market communities (HMCs). Discharge rates were calculated, and profiles of the socioeconomic characteristics of each of the HMCs were developed. A Poisson regression model with an extrasystematic component of variance was used to analyze the association of HMC socioeconomic characteristics with age-adjusted hospital use. RESULTS: We found that four socioeconomic variables, average annual income per capita, percent of the population with four years of college, percent of the population living in an urban area, and percent of families with incomes below the poverty line, explained 26.6% (R2) of the variation in overall hospital discharge rates (p less than 0.001). Moreover, we found that the ability of the model to explain variability was influenced by the type of disease, and that these socioeconomic variables had a consistent effect across the range of DRGs. Finally, we noted that, over the period of 1980 to 1987, socioeconomic factors remained important in explaining hospital use despite the dramatic changes in the delivery of care over this period. CONCLUSION: Socioeconomic factors play a significant role in explaining the observed variation in hospital discharge rates for musculoskeletal diseases. Models utilizing only physician practice variation to account for the population-based differences in discharge rates are overly simplistic. In order to ensure that vulnerable subsets of the population are not harmed by the introduction of cost-containment strategies based on simplistic models, more attention must be paid to the socioeconomic and epidemiologic factors related to hospital use.

Bone Diseases↗
PubMed2005

Preventing infections in nursing homes: a survey of infection control practices in southeast Michigan.

BACKGROUND: Studies on adherence to infection control policies in nursing homes (NHs) are limited. This pilot study explores the use of various infection control practices and the role of infection control practitioners in southeast Michigan NHs. METHODS: A 43-item self-administered questionnaire and explanatory cover letter were mailed to 105 licensed NHs in southeast Michigan. A second mailing was sent to the nonresponders 4 weeks later. RESULTS: Significant variability existed in adoption of various infection control measures with respect to time spent in infection control activities (50% of facilities having a full-time infection control practitioner), definitions used in monitoring infections, and immunization rates (influenza: range, 0%-100%; mean, 73.2%; pneumococcal: range, 0%-100%; mean, 38.5%). CONCLUSION: Although strides have been made in infection control research in NHs, significant variations exist in implementation of infection control methods and guidelines. Future research should focus on identifying barriers to infection control in NHs.

Cross Infection↗
PubMed2006

Major contributors to inorganic arsenic intake in southeastern Michigan.

Accurate estimates of inorganic arsenic intake are critical for evaluating potential health risks. Intake estimates have not been critically examined in regions of the United States where people are at risk from arsenic concentrations in drinking water exceeding the maximum contaminant limit of 10 microg/l. In southeastern Michigan, approximately 8% of the population is exposed to arsenic in drinking water >10 microg/l. Four hundred and forty participants of a control group in this region, frequency matched to cases in a population-based bladder cancer case-control study, answered a questionnaire about water and food consumption and smoking history. Water samples were collected from participants' current residences and analyzed for arsenic. Water arsenic data were combined with questionnaire data and published data of inorganic arsenic concentrations in select foods and cigarettes to examine the influence of arsenic in water at home, at work, and at other places, as well as inorganic arsenic intake from food and cigarettes. Monte Carlo simulations and analyses of individual-level intake estimates were conducted to quantify the variability attributed to different parameters in this primarily elderly white male population of southeastern Michigan. The 95th percentile of total inorganic arsenic intake ranges from 11 to 24 microg/day, depending on the intake metric selected. Results indicate that arsenic in home drinking water is the largest source of inorganic arsenic, accounting for 55.1% of the variance in the intake estimates. Food intake explains 37.3% of the variance, with rice being the largest contributor. In the upper decile of intake, consumption of plain water and beverages made with water at home, and ingestion of arsenic in water at work, also contribute to intake estimates. Water used for cooking and arsenic from smoking, however, only minimally alter the intake estimates. This is due to a relatively small volume of water absorbed into cooked foods and low concentrations of arsenic in cigarettes. Results from this study will assist investigators in better characterizing exposure to inorganic arsenic.

Adult↗
PubMed2005

Guideline-based standardized care is associated with substantially lower mortality in medicare patients with acute myocardial infarction: the American College of Cardiology's Guidelines Applied in Practice (GAP) Projects in Michigan.

OBJECTIVES: We sought to assess the impact of the American College of Cardiology's Guidelines Applied in Practice (GAP) project for acute myocardial infarction (AMI) care, encompassing 33 acute-care hospitals in southeastern Michigan, on rates of mortality in Medicare patients treated in Michigan. BACKGROUND: The GAP project increases the use of evidence-based therapies in patients with AMI. It is unknown whether GAP also can reduce the rate of mortality in patients with AMI. METHODS: Using a before (n = 1,368) and after GAP implementation (n = 1,489) cohort study, 2,857 Medicare patients with AMI were studied to assess the influence of the GAP program on mortality. Multivariate models tested the independent impact of GAP after controlling for other conditions on in-hospital, 30-day, and one-year mortality. RESULTS: Average patient age was 76 years, 48% were women, and 16% represented non-white minorities. The rate of mortality decreased after GAP for each interval studied: hospital, 10.4% versus 13.6%; 30-day, 16.7% versus 21.6%; and one-year, 33.2% versus 38.3%; all p < 0.02. After multivariate adjustment, GAP correlated with a 21% to 26% reduction in mortality, particularly at 30 days (odds ratio of GAP to baseline 0.74; 95% confidence interval [CI] 0.59 to 0.94; p = 0.012) and one year (odds ratio 0.78; 95% CI 0.64 to 0.95; p = 0.013), particularly in the patients for whom a standard discharge tool was used (1-year mortality, odds ratio 0.53; 95% CI 0.36 to 0.76; p = 0.0006). CONCLUSIONS: Embedding AMI guidelines into practice was associated with improved 30-day and one-year mortality. This benefit is most marked when patients are cared for using standardized, evidence-based clinical care tools.

Aged↗
PubMed2004

Genomic analysis of penicillin-resistant Streptococcus pneumoniae in Southeastern Michigan.

OBJECTIVE: The emergence of multidrug resistance within Streptococcus pneumoniae population was analysed, correlating penicillin resistance Pen(R) with secondary antibiotic resistance, capsular serotype, and genetic diversity among isolates. METHODS: DNA fingerprinting, following macro-restriction enzyme digestion and pulse field gel electrophoresis (PFGE), and restriction fragment analysis of the PBP 2b gene, following PCR amplification, were performed on the Pen(R) S. pneumoniae, among 377 clinical isolates obtained from the clinical microbiology laboratory (University of Michigan Medical Center). RESULTS: Overall 35% of the isolates were Pen(R) of which 45% demonstrated high-level penicillin (Pen(R)-R, MIC>1). Respiratory isolates were more likely to be Pen(R) (p <0.001) than non-respiratory isolates and the rate of Pen(R)-R was significantly increased in children <10 years of age (59.6%, p <0.02). Secondary antibiotic resistance was more frequently associated with Pen(R)-R. Genomic DNA fingerprinting analysis and restriction fragment analysis of the PBP 2b gene demonstrated genomic divergence with discrete conserved pattern in the PBP 2b gene among the resistant isolates. CONCLUSION: The emergence of multidrug resistance in the S. pneumoniae population in SE Michigan is not due to expansion of a single or limited number of resistant clones, is occurring most frequently in the paediatric population and is associated with a decreased susceptibility to penicillin.

Bacterial Proteins↗
PubMed2004

Dirofilaria immitis: worm burden and pulmonary artery proliferation in dogs from Michigan (United States).

Despite the ability to prevent heartworm disease, infection with Dirofilaria immitis continues to be a major problem for domestic dogs. To determine worm burden in heartworm-positive dogs from three county animal shelters in the state of Michigan in the United States and to assess the relationship between gross intimal proliferation and worm burden, necropsy was done on 176 heartworm-positive dogs. Adult heartworms were found in the heart and pulmonary artery of 170 of the 176 (96.6%) dogs examined. Mean worm burden was 14 +/- 13 (range 0-85). Fifty-nine percent of dogs had < or =10 heartworms. In contrast, 52% of dogs in a published report from the southern US (Florida) had worm burdens >10 [C.H. Courtney, Q.Y. Zeng, The structure of heartworm populations in dogs and cats in Florida, in: Proceedings of the American Heartworm Symposium, 1989]. These data suggest that mean worm burden in northern areas may be < or = that in warmer areas. Also, since diagnostic tests are less sensitive with lower worm burdens, diagnosis of heartworm infection in Michigan and other surrounding more northern states may be a greater challenge than in areas with higher worm burdens.

Animals↗