Risk Factors for Physical Restraint Use in Nursing Homes: The Impact of the Nursing Home Reform Act

This study examined the impact of the Nursing Home Reform Act of 1987 on resident-and-facility-level risk factors for physical restraint use in nursing homes. Data on the 1990 and 1993 cohorts were obtained from 268 facilities in 10 states, and data on a 1996 cohort were obtained from the Medical Expenditure Panel Survey, which sampled more than 800 nursing homes nationwide. Multivariate logistic regression models were generated for each cohort to identify the impact of resident- and facility-level risk factors for restraint use. The results indicate that the use of physical restraints continues to decline. Thirty-six percent of the 1990 cohort, 26 percent of the 1993 cohort, and 17 percent of the 1996 cohort were physically restrained. Although there was a reduced rate of restraint use from 1990 to 1996, similar resident-level factors but different facility-level factors were associated with restraint use at different points in time.

Study Of The Binding Of Substrate By The Phe557Val Mutant Soybean Lipoxygenase-1

Lipoxygenases are a class of enzymes which consist of non-heme iron dioxygenases that are produced by fungi, plants, and mammals and catalyze the oxygenation of polyunsaturated fatty acid substrates to unsaturated fatty acid hydroperoxide products. The unsaturated fatty acid hydroperoxide products are stereo- and regiospecific. One such lipoxygenase, soybean lipoxygenase-1 (SBLO-1), catalyzes the conversion of linoleate to 13-hydroperoxy-9(Z),11(E)-octadecadienoate (13-HPOD) and a small amount of 9-hydroperoxy-10(E),12(Z)-octadecadienoate (9-HPOD). Although the structure of SBLO-1 is known and it is the most widely studied lipoxygenase, how it binds to substrate is still poorly understood. Two competing binding hypotheses that have been used to understand and explain the binding are the head first binding model and the tail first binding model. The head first binding model predicts linoleate binds with its polar carboxylate group in the binding pocket and the methyl terminus at the surface of the binding pocket. The tail first binding model predicts that linoleate binds with its methyl terminus end in the binding pocket and the polar carboxylate group at the surface of the binding pocket. Both binding models have been used in the explanation of previous work. In previous work the replacement of phenylalanine with valine has been performed to produce the phe557val mutant SBLO-1. The mutant SBLO-1 was then used in the enzymatic oxygenation of linoleate. With this mutant, the amount of 9-HPOD that is formed increases. This result has been interpreted using the head-first binding model in which the smaller valine residue allows linoleate to bind with the polar carboxylate group of linoleate interacting with arginine-707. The work presented in this thesis confirms the regiochemical results of the previous work and further tests the head-first binding model. If head-first binding occurs, the 9-HPOD is expected to have primarily S configuration. Utilizing chiral-phase HPLC, it was found that the 9-HPOD produced by the phe557val mutant SBLO-1 is primarily S, consistent with head-first binding. The head-first binding model was also tested using linoleyl dimethylamine (LDMA), which has been shown to be a good substrate for SBLO-1 at pH 7.0, where LDMA is thought to be positively charged. This model predicts that less of the 9-peroxide should be produced with this substrate. Through the use of gas chromatography/mass spectrometry, it was found that the conversion of LDMA by the phe557val mutant SBLO-1 resulted in the formation of a 46:54 mixture of the 13-peroxide:9-peroxide. The higher amount of 9-peroxide is the opposite of what is expected for the currently proposed model suggesting that the proposed model may not be entirely correct. The results thus far have been consistent with reverse binding but not with the proposed interaction of the polar end of the substrate with arginine-707.

Using Micro-Gravity Techniques to Map Alluvium Thickness and Pleistocene Location of the West Branch of the Susquehanna River Near Muncy, Pennsylvania

Laurentide glaciation during the early Pleistocene (~970 ka) dammed the southeast-flowing West Branch of the Susquehanna River (WBSR), scouring bedrock and creating 100-km-long glacial Lake Lesley near the Great Bend at Muncy, Pennsylvania (Ramage et al., 1998). Local drill logs and well data indicate that subsequent paleo-outwash floods and modern fluvial processes have deposited as much as 30 meters of alluvium in this area, but little is known about the valley fill architecture and the bedrock-alluvium interface. By gaining a greater understanding of the bedrock-alluvium interface the project will not only supplement existing depth to bedrock information, but also provide information pertinent to the evolution of the Muncy Valley landscape. This project determined if variations in the thickness of the valley fill were detectable using micro-gravity techniques to map the bedrock-alluvium interface. The gravity method was deemed appropriate due to scale of the study area (~30 km2), ease of operation by a single person, and the available geophysical equipment. A LaCoste and Romberg Gravitron unit was used to collect gravitational field readings at 49 locations over 5 transects across the Muncy Creek and Susquehanna River valleys (approximately 30 km2), with at least two gravity base stations per transect. Precise latitude, longitude and ground surface elevation at each location were measured using an OPUS corrected Trimble RTK-GPS unit. Base stations were chosen based on ease of access due to the necessity of repeat measurements. Gravity measurement locations were selected and marked to provide easy access and repeat measurements. The gravimeter was returned to a base station within every two hours and a looping procedure was used to determine drift and maximize confidence in the gravity measurements. A two-minute calibration reading at each station was used to minimize any tares in the data. The Gravitron digitally recorded finite impulse response filtered gravity measurements every 20 seconds at each station. A measurement period of 15 minutes was used for each base station occupation and a minimum of 5 minutes at all other locations. Longer or multiple measurements were utilized at some sites if drift or other externalities (i.e. train or truck traffic) were effecting readings. Average, median, standard deviation and 95% confidence interval were calculated for each station. Tidal, drift, latitude, free-air, Bouguer and terrain corrections were then applied. The results show that the gravitational field decreases as alluvium thickness increases across the axes of the Susquehanna River and Muncy Creek valleys. However, the location of the gravity low does not correspond with the present-day location of the West Branch of the Susquehanna River (WBSR), suggesting that the WBSR may have been constrained along Bald Eagle Mountain by a glacial lobe originating from the Muncy Creek Valley to the northeast. Using a 3-D inversion model, the topography of the bedrock-alluvium interface was determined over the extent of the study area using a density contrast of -0.8 g/cm3. Our results are consistent with the bedrock geometry of the area, and provide a low-cost, non-invasive and efficient method for exploring the subsurface and for supplementing existing well data.

Scale Up of PLA Nanoparticle Synthesis by Solvent Displacement and Functionalization of the Particles with a Silica Shell for Targeted Drug Delivery Applications

Biodegradable polymer nanoparticles have the properties necessary to address many of the issues associated with current drug delivery techniques including targeted and controlled delivery. A novel drug delivery vehicle is proposed consisting of a poly(lactic acid) nanoparticle core, with a functionalized, mesoporous silica shell. In this study, the production of PLA nanoparticles is investigated using solvent displacement in both a batch and continuous manner, and the effects of various system parameters are examined. Using Pluronic F-127 as the stabilization agent throughout the study, PLA nanoparticles are produced through solvent displacement with diameters ranging from 200 to 250 nm using two different methods: dropwise addition and in an impinging jet mixer. The impinging jet mixer allows for easy scale-up of particle production. The concentration of surfactant and volume of quench solution is found to have minimal impact on particle diameter; however, the concentration of PLA is found to significantly impact the diameter mean and polydispersity. In addition, the stability of the PLA nanoparticles is observed to increase as residual THF is evaporated. Lastly, the isolated PLA nanoparticles are coated with a silica shell using the Stöber Process. It is found that functionalizing the silica with a phosphonic silane in the presence of excess Pluronic F-127 decreases coalescence of the particles during the coating process. Future work should be conducted to fine-tune the PLA nanoparticle synthesis process by understanding the effect of other system parameters and in synthesizing mesoporous silica shells.