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1.  Familial Oral Microbial Imbalance and Dental Caries Occurrence in Their Children 
Develop a familial liability index for oral microbial status that reflects an imbalance of oral domains based on the presence of risk indicators in saliva, inter-proximal plaque, tongue, and throat.
Fifty-six mother-child pairs from Webster and Nicholas counties, West Virginia, USA, participated in this study. Saliva samples were assayed for mutans streptococci (MS), interproximal plaque samples for the BANA Test (BT) species, tongue swabs for BT, and throat swabs for any of the sentinel organisms (Staphylococcus aureus, Streptococcus pyogenes, and yeasts). The corresponding thresholds for a (+) risk indicator were, respectively, ≥105 CFU of MS salivary levels, one or more BT-(+) plaques (>105 CFU/mg of plaque of at least one of BT-(+) species), weak-(+) BT for a tongue swab (>104-<105), and >104 CFU/swab for any of the sentinel markers.
The mean age of mothers and children was 41.6 and 14.6 years. Ninety-one % of both mothers and children had at least one (+) risk indicator. Overall, 76% of mother child-pairs had at least one (+) concordant oral microbial risk indicator. Accordingly, the relative risk (RR) of children having concordant results with their mothers was increased 1.36 (BT-plaque), 1.37 (BT-tongue), 0.94 (sentinel organisms) and 1.13 (MS) times. Principal component analysis revealed distinct sets of oral microbial risk indicators in mothers and children that correlated with dental caries prevalence rates in children.
Mother-child pairs shared similarities of oral microbial risk indicators that allow for the development of a liability index that can elucidate caries in the children.
PMCID: PMC3939806  PMID: 24600078
Liability Index; oral microbiology; mother; child; dental caries
2.  Changes in Depression and Quality of Life in Obese Individuals with Binge Eating Disorder: Bariatric Surgery vs. Lifestyle Modification 
Obese individuals with binge eating disorder (BED) frequently experience impairments in mood and quality of life which improve with surgical or behavioral weight loss interventions. It is unclear if these improvements are due to weight loss itself, or to additional aspects of treatment such as group support, or acquisition of cognitive-behavioral skills provided in behavioral interventions.
To compare changes in weight, symptoms of depression, and quality of life, in extremely obese individuals with BED undergoing bariatric surgery or a lifestyle modification intervention.
University Hospital
Symptoms of depression and quality of life were assessed at baseline and 2, 6, and 12 months in participants undergoing bariatric surgery but no lifestyle intervention (n=36) and non-surgery participants receiving a comprehensive program of lifestyle modification (n=49).
Surgery participants lost significantly more weight than lifestyle participants at 2, 6 and 12 months (p’s<0.001). Significant improvements in both mood (as measured by the Beck Depression Inventory-II) and quality of life (as measured by the Short Form-36) were observed in both groups across the year, but there were no differences between the groups at month 12 (even when controlling for reductions in binge eating). A positive correlation was observed between the magnitude of weight loss and change in BDI-II score when collapsing across groups. Moreover, weight loss at one time point predicted BDI-II score at the next time point, but BDI-II score did not predict subsequent weight loss.
We conclude that similar improvements in mood and quality of life can be expected from either bariatric surgery or lifestyle modification treatments for periods up to 1 year.
PMCID: PMC3609883  PMID: 23260806
depression; obesity; bariatric surgery; lifestyle modification; quality of life; binge-eating
3.  Impact of a Multimodal Antimicrobial Stewardship Program on Pseudomonas aeruginosa Susceptibility and Antimicrobial Use in the Intensive Care Unit Setting 
Objective. To study the impact of our multimodal antibiotic stewardship program on Pseudomonas aeruginosa susceptibility and antibiotic use in the intensive care unit (ICU) setting. Methods. Our stewardship program employed the key tenants of published antimicrobial stewardship guidelines. These included prospective audits with intervention and feedback, formulary restriction with preauthorization, educational conferences, guidelines for use, antimicrobial cycling, and de-escalation of therapy. ICU antibiotic use was measured and expressed as defined daily doses (DDD) per 1,000 patient-days. Results. Certain temporal relationships between antibiotic use and ICU resistance patterns appeared to be affected by our antibiotic stewardship program. In particular, the ICU use of intravenous ciprofloxacin and ceftazidime declined from 148 and 62.5 DDD/1,000 patient-days to 40.0 and 24.5, respectively, during 2004 to 2007. An increase in the use of these agents and resistance to these agents was witnessed during 2008–2010. Despite variability in antibiotic usage from the stewardship efforts, we were overall unable to show statistical relationships with P. aeruginosa resistance rate. Conclusion. Antibiotic resistance in the ICU setting is complex. Multimodal stewardship efforts attempt to prevent resistance, but such programs clearly have their limits.
PMCID: PMC3113284  PMID: 21687626
4.  Use of 16S ribosomal RNA gene analyses to characterize the bacterial signature associated with poor oral health in West Virginia 
BMC Oral Health  2011;11:7.
West Virginia has the worst oral health in the United States, but the reasons for this are unclear. This pilot study explored the etiology of this disparity using culture-independent analyses to identify bacterial species associated with oral disease.
Bacteria in subgingival plaque samples from twelve participants in two independent West Virginia dental-related studies were characterized using 16S rRNA gene sequencing and Human Oral Microbe Identification Microarray (HOMIM) analysis. Unifrac analysis was used to characterize phylogenetic differences between bacterial communities obtained from plaque of participants with low or high oral disease, which was further evaluated using clustering and Principal Coordinate Analysis.
Statistically different bacterial signatures (P < 0.001) were identified in subgingival plaque of individuals with low or high oral disease in West Virginia based on 16S rRNA gene sequencing. Low disease contained a high frequency of Veillonella and Streptococcus, with a moderate number of Capnocytophaga. High disease exhibited substantially increased bacterial diversity and included a large proportion of Clostridiales cluster bacteria (Selenomonas, Eubacterium, Dialister). Phylogenetic trees constructed using 16S rRNA gene sequencing revealed that Clostridiales were repeated colonizers in plaque associated with high oral disease, providing evidence that the oral environment is somehow influencing the bacterial signature linked to disease.
Culture-independent analyses identified an atypical bacterial signature associated with high oral disease in West Virginians and provided evidence that the oral environment influenced this signature. Both findings provide insight into the etiology of the oral disparity in West Virginia.
PMCID: PMC3061962  PMID: 21362199
5.  The Effect of pH on the Antimicrobial Efficiency of Silver Alginate on Chronic Wound Isolates 
Nonhealing and stalled chronic wounds are often reported to reside within an alkaline environment. Consequently, a number of researchers have proposed that lowering the pH of a chronic wound environment will enable healing to progress. However, it is not known whether the efficacies of silver-impregnated wound dressings are affected by pH.
To investigate whether pH has an effect on the antimicrobial barrier efficacy of a silver alginate wound dressing on wound isolates.
Twenty-five bacteria and yeasts that had been routinely isolated from chronic wounds were separately exposed to a silver alginate wound dressing with the use of a standardized corrected zone of inhibition (CZOI) assay.
The silver alginate dressing demonstrated a broad spectrum of antimicrobial barrier activity within the dressing against all wound isolates. However, at a pH of 5.5, compared with a pH of 7, the antimicrobial barrier activity of the silver alginate dressing significantly increased. For all yeasts the CZOI ranged from 6.25 to 11 mm at a pH of 7. At a pH of 5.5, the CZOI range increased from 8.5 to 12.25 mm. For the Gram-negative isolates, the CZOI ranged from 0.75 to 6.5 mm at a pH 7, compared with a CZOI range of 2.75 to 8 mm at pH 5.5. The CZOI for the Gram-positive isolates, including meticillin-resistant Staphylococcus aureus, ranged from 3 to 7.75 mm at pH 7 and from 4.5 to 11.75 mm at pH 5.5.
For all isolates tested, excluding one strain of Candida albicans and one vancomycin-resistant Enterococcus strain, lowering pH to 5.5 resulted in an improvement in the antimicrobial barrier activity within the silver alginate dressing. Based on these initial in vitro findings, it is possible to suggest that there may be benefits to maintaining an infected or recalcitrant wound in a slightly acid (pH 5.5) environment. In particular, doing so may lead to an enhanced antimicrobial barrier effect of silver, a quicker reduction in the wound microbial bioburden, and therefore a reduction in the need for prolonged antimicrobial use. However, more in vitro and in vivo studies would be warranted to further substantiate these claims.
PMCID: PMC3601855  PMID: 24527156
Chronic wounds; Microbiology; pH; Silver; Wound dressings
6.  Study protocol of the Center for Oral Health Research in Appalachia (COHRA) etiology study 
BMC Oral Health  2008;8:18.
People in Appalachia experience some of the worst oral health in the United States. To develop effective intervention and prevention strategies in Appalachia, we must understand the complex relationships among the contributing factors and how they affect the etiology of oral diseases. To date, no such comprehensive analysis has been conducted. This report summarizes the characteristics of the sample and describes the protocol of a study determining contributions of individual, family, and community factors to oral diseases in Appalachian children and their relatives.
Families participated in a comprehensive assessment protocol involving interviews, questionnaires, a clinical oral health assessment, a microbiological assessment, and collection of DNA. The design of the study is cross-sectional.
Due to its multilevel design and large, family-based sample, this study has the potential to greatly advance our understanding of factors that contribute to oral health in Appalachian children.
PMCID: PMC2443132  PMID: 18522740
7.  Computerized Antimicrobial Decision Support for Hospitalized Patients with a Bloodstream Infection 
We developed a computerized antimicrobial decision support program founded on our local bacterial susceptibility data. In a retrospective analysis of patients with a bloodstream infection, we compared the actual antimicrobials prescribed to the antimicrobials recommended by the program. We found the computer-guided therapy to be clinically and statistically more effective than the therapy initiated by the physicians. We conclude that computerized decision support can improve the targeting of empiric antimicrobial therapy.
PMCID: PMC1480355  PMID: 14728451
8.  Database-Driven Computerized Antibiotic Decision Support: Novel use of Expert Antibiotic Susceptibility Rules Embedded in a Pathogen-Antibiotic Logic Matrix 
To better serve an antibiotic guidance program, we hypothesized that the relatively few antibiotic susceptibility measurements conducted in the microbiology laboratory could be extended to predict antibiotic susceptibilities for all antibiotics on the hospital formulary using expert infectious disease logic. With the assistance of infectious disease specialists, we developed these logic rules and then applied them to 26,196 unique patient culture specimens and the accompanying 334,131 antibiotic susceptibility measurements generating 804,809 additional predicted bug-drug susceptibility data points. From the resulting data set, the antibiotic susceptibility profile for one pathogen, Streptococcus pneumoniae, is highlighted herein. We then incorporated the extended susceptibility profiles into a computerized antibiotic guidance program that matches current patients of interest with the positive cultures from past similar patients and calculates predicted effective antibiotic therapy. We conclude that this method successfully derives antibiotic predictions and merits further testing to evaluate its potential use in the hospital environment.
PMCID: PMC1480266  PMID: 14728219

Results 1-8 (8)