Search

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1744-6198.2009.00140.x Byline: Joy R. Goebel (1), Lynn V. Doering (2), Karl A. Lorenz (3), Sally L. Maliski (2), Adeline M. Nyamathi (2), Lorraine S. Evangelista (2) Keywords: Conceptual framework; palliative care; psychological well-being; spirituality; symptom Abstract: TOPIC. Total pain theory. PURPOSE. Describe total pain theory and apply it to research and practice in advanced heart failure (HF). SOURCE OF INFORMATION. Total pain theory provides a holistic perspective for improving care, especially at the end of life. In advanced HF, multiple domains of well-being known to influence pain perception are adversely affected by declining health and increasing frailty. A conceptual framework is suggested which addresses domains of well-being identified by total pain theory. CONCLUSION. By applying total pain theory, providers may be more effective in mitigating the suffering of individuals with progressive, life-limiting diseases. Author Affiliation: (1)Department of Nursing, California State University, Long Beach, CA (2)School of Nursing, University of California, Los Angeles, CA (3)David Geffen School of Medicine, University of California, Los Angeles, CA, and with the Veterans Integrated Palliative Program, Veterans Administration Greater Los Angeles Healthcare System Article note: jgoebel@csulb.edu, with a copy to the Editor: nursingforum@gmail.com

Background and Purpose. The volume of all limbs can be determined by water displacement methods or calculations derived from girth measurements. The purpose of this study was to determine the concurrent validity of calculated volume and water displacement volume measurements. Subjects. Both upper extremities of 14 women with lymphedema were measured. Methods. Volumetric measurements were taken with a volumeter, and circumferential measurements were taken with a tape measure. Calculated volume was determined by summing segment volumes derived from the truncated cone formula. Pearson product moment correlations, paired t tests, and linear regression tests were used to assess relative association and absolute differences between calculated and actual volumes. Results. The correlation coefficient for calculated volume versus upper extremity minus fingers (UE-F) water displacement volume was .99. Paired t tests showed differences between calculated volume and UE-F water displacement volume (t=-3.88, mean difference=-95.62 mL), and the linear regression slope was 0.83 with an intercept of 255.28 mL. Discussion and Conclusion. Calculated volume measurements were highly associated with measurements based on water displacement; therefore, clinicians should feel confident in using either calculated volume or water displacement volume. The differences, however, indicated that the measures were not interchangeable. Thus, clinicians should not mix or substitute measurement methods with a single patient or in a single study. [Karges JR, Mark BE, Stikeleather SJ, Worrell TW. Concurrent validity of upper-extremity volume estimates: comparison of calculated volume derived from girth measurements and water displacement volume.] Key Words: Circumference measurement, Limb volume, Lymphedema, Volumeter., One type of edema managed by physical therapists is postmastectomy lymphedema. Tunkel and Lachmann (1) reported that the incidence of postmastectomy lymphedema is unknown. Other authors, however, have reported that [...]

Insulin resistance may be a factor in hypertensive disorders of pregnancy. Gestational diabetes mellitus is associated with increased risk for preeclampsia or other hypertensive disorders during pregnancy, although not at a statistically significant level. Likelihood of preeclampsia also is positively correlated with the plasma glucose level one hour after a 50-g oral glucose challenge. Preeclampsia was not prevented by calcium supplementation.

Byline: Gary M. Joffe, Joy R. Esterlitz, Richard J. Levine, John D. Clemens, Marian G. Ewell, Baha M. Sibai, Patrick M. Catalano Keywords: Gestational diabetes; glucose intolerance; glucose tolerance; hypertension; insulin resistance; preeclampsia; pregnancy; syndrome X Abstract: Objective: The study's aim was to determine whether healthy nulliparous women with abnormal glucose tolerance during pregnancy are at increased risk for development of pregnancy-associated hypertension or preeclampsia. Study Design: A series of 4589 healthy nulliparous women from 5 university centers were evaluated prospectively to determine whether calcium supplementation would prevent preeclampsia. Pregnancy-associated hypertension was a diastolic blood pressure [greater than or equal to]90 mm Hg on 2 occasions 4 hours to 1 week apart. Pregnancy-associated proteinuria was proteinuria [greater than or equal to]1+ by dipstick testing on 2 occasions 4 hours to 1 week apart, proteinuria [greater than or equal to]300 mg/24 h, a protein to creatinine ratio of [greater than or equal to]0.35, or a single dipstick measurement of [greater than or equal to]2+. Preeclampsia was defined as pregnancy-associated hypertension and pregnancy-associated proteinuria documented within 7 days of each other. Normal glucose tolerance was a plasma glucose level Author Affiliation: Albuquerque, New Mexico, Potomac and Bethesda, Maryland, Memphis, Tennessee, and Cleveland, Ohio Article History: Received 26 November 1997; Revised 20 March 1998; Accepted 14 April 1998 Article Note: (footnote) [star] From the Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center,a the Emmes Corporation,b the Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health,c the Department of Obstetrics and Gynecology, University of Tennessee College of Medicine,d and the Department of Obstetrics and Gynecology, MetroHealth Medical Center-Case Western Reserve University.e , [star][star] Reprint requests: Gary M. Joffe, MD, Department of Obstetrics and Gynecology, Lovelace Medical Center, 5400 Gibson, SE, Albuquerque, NM 87108., a 6/1/91033

Objective: To evaluate the safety and immunogenicity of recombinant glycoprotein (rgp) 120, a candidate vaccine for the human immunodeficiency virus (HIV), formulated with a novel adjuvant, MF59, with or without a biological response modifier, MTP-PE. Design: Multicenter, double-blind, randomized trial. Setting: University medical centers. Participants: 49 healthy, HlV-seronegative volunteers 18 to 60 years of age who were at low risk for HIV type 1 (HIV-1) infection. Interventions: In part A of the study, 32 participants were randomly assigned to receive either 15 [micro]g of rgp120 in MF59, 15[micro]g of rgp120 in MF59 plus 50 [micro]g of MTP-PE, 50 [micro]g of rgp120 in MF59, or 50 [micro]g of rgp120 in MF59 plus 50 [micro]g of MTP-PE. Participants were vaccinated at 0, 1, 6, and 12 to 18 months. In part B, 17 participants were randomly assigned to receive five monthly injections of either 50 [micro]g of rgp120 in MF59 or MF59 alone followed by a booster injection at 12 to 18 months. Main Outcome Measures: Local and systemic reactions; laboratory measures of hepatic, renal, immunologic, and bone marrow toxicity; and HlV-specific serologic and cell-mediated immune responses. Results: 13 patients in part A received 50-[micro]g doses of rgp120; type-specific neutralizing antibody responses against the SF-2 strain of HIV-1 (HIV-1/SF-2) were induced in all 13. Nine of the 13 had crossreactive neutralizing activity against the MN strain of HIV-1 (HIV-1/MN), and 2 had crossreactive neutralizing activity against the IIIB strain of HIV-1 (HIV-1/lIlB). Twelve patients had type specific fusion inhibition activity; only 1 had crossreactive fusion inhibition activity against HIV-1/MN. The monthly vaccination schedule used in part B resulted in decreased antibody titers, indicating that a rest period in the schedule is necessary for maximal immunogenicity. Lymphoproliferative responses against gp120 were induced in all vaccine recipients. The stimulation index to gp120 was persistently greater than 15 for 6 months after the last booster vaccination was given. CD8+ cytotoxic T-lymphocyte activity was detected in 1 of the 11 participants tested. Vaccine that contained MTP-PE caused a greater number of moderate or severe local and systemic reactions (of 16 participants, 4 had local reactions and 13 had systemic reactions) than did vaccine formulated with MF59 alone (of 16 participants, 7 had local reactions [P < 0.01] and 0 had systemic reactions [P < 0.001]). Conclusions: The SF-2 rgp120 vaccine is safe and immunogenic. Three vaccinations with rgp120 in MF59 can induce type-specific and crossreactive neutralizing antibody against B-subtype laboratory strains of HIV-1. Human immunodeficiency virus-specific Iymphoproliferative responses were induced in all vaccinated participants, and CD8+ cytotoxic T-lymphocyte activity was shown in one participant. A trend toward the augmentation of Iymphoproliferative and humoral responses by MTP-PE was seen in the participants receiving 15 [micro]g of rgp120. However, MTP-PE caused a statistically significant increase in the incidence of local and systemic side effects, which was felt to outweigh the small increase in immunogenicity provided by this biological response modifier in an otherwise well-tolerated vaccine., Recombinant glycoprotein (rgp) 120 may be a safe and effective vaccine for the human immunodeficiency virus (HIV). Glycoprotein 120 is an especially promising vaccine antigen because it plays a role in initiating HIV infection, causes attachment to susceptible cells and is a target for neutralizing antibodies. The vaccination of 49 healthy, low-risk volunteers resulted in successful immune responses, including cytotoxic T-cell activity. The biological response modifier MTP-PE tested in some of the participants increased their immune response but also caused significant side effects.

Male Long-Evans rats received an 8-trial training session in a spatial water maze task, followed by a unilateral posttraining intrahippocampal injection of either estradiol (1.0 [[micro]gram]/0.5 [[micro]liter]) or saline. Retention was tested 24 hr later, and latency to escape was used as a measure of memory. Retention test escape latencies of rats given intrahippocampal injections of estradiol were lower than those of saline-treated rats, indicating an enhancement of memory_. Intrahippocampal injections of estradiol delayed 2 hr posttraining did not affect retention. In Experiment 2, the memory enhancing effect of intrahippocampal injection of estradiol was blocked by peripheral administration of a subeffective dose (0.1 mg/kg) of the cholinergic antagonist scopolamine. Intrahippocampal injections of estradiol enhance memory in male rats, and estradiol may influence memory through an interaction with muscarinic cholinergic systems.

Recently, I encountered the following short paragraph that professed itself to be rules for a contest. The gist of the paragraph remains intact but I have altered details to protect [...]

Hurricane Katrina and other natural disasters, the ongoing threats of terrorism, and the auditing profession's increased emphasis on business continuity planning have captured the attention of higher education executives. Most [...]