Search

OBJECTIVE To determine whether interventions that slow or prevent the development of type 2 diabetes in those at risk reduce the subsequent prevalence of diabetic retinopathy. RESEARCH DESIGN AND METHODS The Diabetes Prevention Program (DPP) randomized subjects at risk for developing type 2 diabetes because of overweight/obesity and dysglycemia to metformin (MET), intensive lifestyle intervention (ILS), or placebo (PLB) to assess the prevention of diabetes. During the DPP and DPP Outcome Study (DPPOS), we performed fundus photography over time on study participants, regardless of their diabetes status. Fundus photographs were graded using the Early Treatment Diabetic Retinopathy Study grading system, with diabetic retinopathy defined as typical lesions of diabetic retinopathy (microaneurysms, exudates, or hemorrhage, or worse) in either eye. RESULTS Despite reduced progression to diabetes in the ILS and MET groups compared with PLB, there was no difference in the prevalence of diabetic retinopathy between treatment groups after 1, 5, 11, or 16 years of follow-up. No treatment group differences in retinopathy were found within prespecified subgroups (baseline age, sex, race/ethnicity, baseline BMI). In addition, there was no difference in the prevalence of diabetic retinopathy between those exposed to metformin and those not exposed to metformin, regardless of treatment group assignment. CONCLUSIONS Interventions that delay or prevent the onset of type 2 diabetes in overweight/obese subjects with dysglycemia who are at risk for diabetes do not reduce the development of diabetic retinopathy for up to 20 years.

There is continued uncertainty in these times. So many questions have remained unanswered. Quarantined in our respective dwellings, many of us at colleges and universities entered online learning a...

Supplemental material, sj-docx-1-whe-10.1177_17455065221075913 for Social determinants and inequitable maternal and perinatal outcomes in Aotearoa New Zealand by Pauline Dawson, Benoit Auvray, Crystal Jaye, Robin Gauld and Jean Hay-Smith in Women���s Health

The dissertation explores the schooling experiences of Black girls attending a predominantly white[1], elite, all-girls private school. As a project of witnessing and drawing from Black feminist theory, I highlight and draw attention to the racialization that Black girls experienced at EBS and the ways they navigated and negotiated these experiences both individually and collectively. I unpack some of the nuances that emerged through bearing witness to their lived culture and encounters within the students of color (SOC) affinity space. The principal research questions for this study are: How do Black girls navigate and negotiate racialized experiences in a predominantly white, elite, private school? In what ways are Black girls responding to these racialized experiences? How does the engagement with arts-based literacies in SOC shape Black girls’ social and academic trajectories in private schools? Accomplished through a collection of personal and cultural artifacts, field-notes, semi-interviews and narrative analysis, Black girls in this case study storied an otherwise--talking back to power structures that deemed them unknowledgeable. The findings suggest that Black girls engaged in the SOC affinity group as a space to witness humanness. I situate my examination of Black girls and their lived cultural representations in third space as part of my critical contribution to Black girlhood studies. [1] To center the voices of Black girls, I do not capitalize “white” throughout this dissertation.

Supplemental material, Appendix_1_PRISMA-ScR_Fillable_Checklist_FINALANON for Issues in reporting of systematic review methods in health app-focused reviews: A scoping review by Rebecca Grainger, Hemakumar Devan, Bahram Sangelaji and Jean Hay-Smith in Health Informatics Journal

Introduction Accidental urine leakage is a distressing problem that affects around one in three women. The main types of urinary incontinence (UI) are stress, urgency and mixed, with stress being most common. Current UK guidelines recommend that women with UI are offered at least 3 months of pelvic floor muscle training (PFMT). There is evidence that PFMT is effective in treating UI, however it is not clear how intensively women have to exercise to give the maximum sustained improvement in symptoms, and how we enable women to achieve this. Biofeedback is an adjunct to PFMT that may help women exercise more intensively for longer, and thus may improve continence outcomes when compared with PFMT alone. A Cochrane review was inconclusive about the benefit of biofeedback, indicating the need for further evidence. Methods and analysis This multicentre randomised controlled trial will compare the effectiveness and cost-effectiveness of PFMT versus biofeedback-mediated PFMT for women with stress UI or mixed UI. The primary outcome is UI severity at 24 months after randomisation. The primary economic outcome measure is incremental cost per quality-adjusted life-year at 24 months. Six hundred women from UK community, outpatient and primary care settings will be randomised and followed up via questionnaires, diaries and pelvic floor assessment. All participants are offered six PFMT appointments over 16 weeks. The use of clinic and home biofeedback is added to PFMT for participants in the biofeedback group. Group allocation could not be masked from participants and healthcare staff. An intention-to-treat analysis of the primary outcome will estimate the mean difference between the trial groups at 24 months using a general linear mixed model adjusting for minimisation covariates and other important prognostic covariates, including the baseline score. Ethics and dissemination Approval granted by the West of Scotland Research Ethics Committee 4 (16/LO/0990). Written informed consent will be obtained from participants by the local research team. Serious adverse events will be reported to the data monitoring and ethics committee, the ethics committee and trial centres as required. A Standard Protocol Items: Recommendations for Interventional Trials checklist and figure are available for this protocol. The results will be published in international journals and included in the relevant Cochrane review. Trial registration number ISRCTN57746448; Pre-results.

Cardiovascular disease is a common comorbidity and cause of mortality in chronic obstructive pulmonary disease. A better understanding of mechanisms of cardiovascular risk in chronic obstructive pulmonary disease patients is needed to improve clinical outcomes. We hypothesized that such patients have increased arterial stiffness, wave reflections, and subclinical atherosclerosis compared with controls and that these findings would be independent of smoking status and other confounding factors. A total of 458 patients with a diagnosis of chronic obstructive pulmonary disease and 1657 controls (43% were current or ex-smokers) with no airflow limitation were matched for age, sex, and body mass index. All individuals underwent assessments of carotid–femoral (aortic) pulse wave velocity, augmentation index, and carotid intima–media thickness. The mean age of the cohort was 67±8 years and 58% were men. Patients with chronic obstructive pulmonary disease had increased aortic pulse wave velocity (9.95±2.54 versus 9.27±2.41 m/s; P

The Advisory Committee on Immunization Practices (ACIP) is chartered as a federal advisory committee to provide expert external advice to CDC and the Secretary of the U.S. Department of Health and Human Services (DHHS) on the use of vaccines in the civilian population of the United States. This report summarizes the evolution of ACIP over the 50 years since its establishment in 1964 by the Surgeon General of the U.S. Public Health Service (USPHS).

Purpose: This study evaluated the hemodynamic effects, suitability and safety of dexmedetomidine (DEX) compared with propofol (PRO) in older adults having outpatient cataract surgery under monitored anesthesia care. The patients, surgeon and the anesthesia staff evaluated satisfaction for both drugs.Method: This prospective, single blind, randomized study was conducted using forty-seven patients ≥55 years old undergoing cataract surgery. The two patient groups received either i.v. dexmedetomidine 1 μg/kg over 10 min; followed by maintenance i.v. infusion at 0.2 -0.7 μg/kg/hr (DEX group, N = 24), or propofol infused between 25 -120 μg/kg/min (PRO group, N = 23). Both agents were titrated to patient comfort. Results: Patients’ mean arterial pressures (SEM) at baseline were 104.7 (2.6) and 107.5 (2.7) mmHg for the DEX and PRO groups, respectively (p = 0.45). At discharge the pressures were 78.1 (2.5) and 98.1 (2.6) mmHg in DEX and PRO groups, respectively (p 0.05). Patients’ heart rates (SEM) at baseline were 74.8 (3.0) for the DEX group and 73.2 (2.8) bpm for the PRO groups (p = 0.71). At the time of discharge following surgery, the mean heart rate for the DEX group was 61.5 (2.2) bpm vs. 69.1 (2.3) bpm (p 0.05) for the PRO group. Three patients in the DEX group developed complications precluding discharge or requiring readmission while none of the patience in the PRO group had complications (p = 0.08). Patient and surgeon satisfaction scores were similar between the groups. Conclusion: Dexmedetomidine is a less suitable sedative compared with propofol use in older patients undergoing cataract surgery due to the decrease in hemodynamic parameters and noted increases in complication rates.

BACKGROUND: Vibration response imaging (VRI) is a computer-based technology that creates a visual dynamic two-dimensional image of distribution of vibration within the lung during the respiratory process. The acoustic signals, recorded from 36 posteriorly positioned surface skin sensors, are transferred to a hardware board where several stages of filtering are applied to select a specific frequency band. The filtered output signal frequencies are presented as a gray-scale coded dynamic image, consisting of a series of 0.17 s frames, and as a table featuring the percentage contribution of each lung to the total vibration signal. METHODS: We describe the VRI technology in detail and examine images obtained from consecutive intensive care unit (ICU) patients with one diseased lung on chest radiograph. ICU patients with normal chest radiographs are presented as controls. Analysis of the image was performed by comparing the weighted pixel count analysis from both lungs. In this method, the pixels in the image were assigned values based on their grayscale color with the darker pixels assigned higher values. RESULTS: In patients with normal chest radiographs, the right and left lungs developed similarly in dynamic VRI images, and the percent lung vibrations from both sides were comparable (53% ± 12% and 47% ± 12%, respectively). In ICU patients with asymmetric lung disease, however, the percent lung vibrations from the diseased and nondiseased lungs were 27% ± 23% and 73% ± 23%, respectively (P < 0.001). In patients with asymmetric lung disease (one lung has moderate to severe disease and the other appears normal or close to normal as per chest radiograph), the diseased lung usually appeared in VRI as irregular, smaller, and lighter in color (reduced vibration signal) when compared to the nonaffected lung. The weighted pixel count from diseased and nondiseased lungs were 33% ± 21% and 67% ± 21%, respectively (P < 0.003). CONCLUSION: The VRI technology may provide a radiation-free method for identifying and tracking of asymmetric lung parenchymal processes.

Asthma is a disease of air flow obstruction. Transmitted sounds can be analyzed in detail and may shed light upon the physiology of asthma and how it changes over time. The goals of this study were to use a computerized analytic acoustic tool to evaluate respiratory sound patterns in asthmatic patients during acute attacks and after clinical improvement and to compare asthmatic profiles with those of normal individuals.Respiratory sound analysis throughout the respiratory cycle was performed on 22 symptomatic asthma patients at the time of presentation to the emergency department (ED) and after clinical improvement. Fifteen healthy volunteers were analyzed as a control group. Vibrations patterns were plotted. Right and left lungs were analyzed separately.Asthmatic attacks were found to be correlated with asynchrony between lungs. In normal subjects, the inspiratory and expiratory vibration energy peaks (VEPs) occurred almost simultaneously in both lungs; the time interval between right and left expiratory VEPs was 0.006 +/- 0.012 seconds. In symptomatic asthmatic patients on admission, the time interval between right and left expiratory VEPs was 0.14 +/- 0.09 seconds and after clinical improvement the interval decreased to 0.04 +/- 0.04 seconds. Compared to healthy volunteers, asynchrony between two lungs was increased in asthmatics (p0.05). The asynchrony was significantly reduced after clinical improvement (p0.05).Respiratory sound analysis demonstrated significant asynchrony between right and left lungs in asthma exacerbations, a finding which, to our knowledge, has never been reported to date. The asynchrony is significantly reduced with clinical improvement following treatment.

Supplemental material, Supplementary_Aug25 for Validation of the Intuitive Eating Scale in pregnancy by Helen Paterson, Jean Hay-Smith, Gareth Treharne, Peter Herbison and Caroline Howarth in Journal of Health Psychology

Background Pelvic floor muscle training (PFMT) is a commonly used physical therapy for women with urinary incontinence (UI). Objectives To determine the effects of PFMT for women with UI in comparison to no treatment, placebo or other inactive control treatments. Search Methods Cochrane Incontinence Group Specialized Register, (searched 15 April 2013). Selection Criteria Randomized or quasi-randomized trials in women with stress, urgency or mixed UI (based on symptoms, signs, or urodynamics). Data Collection and Analysis At least two independent review authors carried out trial screening, selection, risk of bias assessment and data abstraction. Trials were subgrouped by UI diagnosis. The quality of evidence was assessed by adopting the (GRADE) approach. Results Twenty-one trials (1281 women) were included; 18 trials (1051 women) contributed data to the meta-analysis. In women with stress UI, there was high quality evidence that PFMT is associated with cure (RR 8.38; 95% CI 3.68 to 19.07) and moderate quality evidence of cure or improvement (RR 17.33; 95% CI 4.31 to 69.64). In women with any type of UI, there was also moderate quality evidence that PFMT is associated with cure (RR 5.5; 95% CI 2.87–10.52), or cure and improvement (RR 2.39; 95% CI 1.64–3.47). Conclusions The addition of seven new trials did not change the essential findings of the earlier version of this review. In this iteration, using the GRADE quality criteria strengthened the recommendations for PFMT and a wider range of secondary outcomes (also generally in favor of PFMT) were reported.

Background: Arylsulfatase A (ASA) is an enzyme that catalyzes the degradation of sulfatides, a glycosphingolipid found in many tissues, but predominantly in myelin and kidney. Arylsulfatase A is 1 member of a family of sulfatases that is activated by a required co- or posttranslational modification with the oxidation of cysteine to formylglycine. This conversion requires a novel oxygenase mechanism that can be inhibited by reactive oxygen species. Ethanol is known to cause an increase in reactive oxygen species in the liver. Because of its effect on the levels of hepatic reactive oxygen species, we hypothesized that ethanol would cause a specific decrease of rat hepatic ASA activity levels. Methods: Male Sprague–Dawley rats received ethanol-containing, Lieber–DeCarli liquid diets for 15 days, and control rats were pair-fed a liquid diet in which dextrose was isocalorically substituted for ethanol. Results: Arylsulfatase A activity levels decreased in livers of animals receiving alcohol compared with control animals. No significant changes in ASA activity levels were observed in the cerebral cortex and kidney. Furthermore, ethanol did not have any significant effect on hexosaminidase activity in any of the tissues examined. Conclusion: Ethanol caused a tissue-specific decrease in hepatic ASA activity levels, but not hexosaminidase activity levels.

The present randomized, double-blind, placebo-controlled, multicenter clinical trial was designed to compare the efficacy and tolerability of sorivudine [1-β- d -arabinofuranosyl-E-(2-bromovinyl)uracil] and acyclovir for the treatment of dermatomal herpes zoster in human immunodeficiency virus (HIV)-seropositive patients. A total of 170 HIV-seropositive adults presenting with herpes zoster (confirmed by direct fluorescent-antigen testing and/or viral culture) were enrolled and randomized to receive a 10-day course of orally administered sorivudine (40 mg once daily plus acyclovir placebos) or acyclovir (800 mg five times daily plus sorivudine placebo). Patients were monitored daily to document the events of cutaneous healing, pain, zoster-related complications, and drug-related adverse events. Patients were reassessed on days 21 and 28 and then once monthly for 1 year. The primary efficacy endpoint was time to the cessation of new vesicle formation. Secondary efficacy endpoints included times to other events of cutaneous healing, resolution of pain, and frequency of dissemination and zoster recurrence. In a multivariate analysis, sorivudine was superior to acyclovir for reducing the times to the cessation of new vesicle formation (relative risk [RR] = 1.54, 95% confidence interval [CI] = 1.00 to 2.36; P = 0.049) and total lesion crusting (RR = 1.48, 95% CI = 1.07 to 2.04; P = 0.017). In a univariate analysis, there was a trend favoring sorivudine for the cessation of new vesicle formation (median of 3 versus 4 days; P = 0.07) and a significant advantage for time to total lesion crusting (median of 7 versus 8 days; P = 0.02). The time to the resolution of zoster-associated pain, the frequency of dissemination, and the frequency of zoster recurrence were not different between the two treatment groups. Both drugs were well tolerated. Sorivudine is an effective drug for the treatment of herpes zoster in HIV-infected patients and results in accelerated cutaneous healing when compared with acyclovir therapy.

non-peer-reviewed Background: Aphasic impairments of lexical retrieval (LR) can be attributed to different underlying deficits such as problems with meaning (semantic deficits), with word selection (lexical deficits) and sound selection (phonological deficits). Research in the area is unclear on the extent to which types of errors produced are a reliable indicator of the underlying impairment. It is also unclear in the literature whether recording of all errors made on a picture naming task can reveal more about LR breakdown than recording only first responses. Aims: To determine if analyses of error types produced by ???first responses??? or ???all responses??? given on a naming task provide more accurate information for differential diagnosis of impairment in spoken word production. Additionally, to establish whether error type predicts underlying impairment in anomia. Methods & Procedures: Cross-sectional data was obtained from 34 Irish participants who were diagnosed with aphasia secondary to a cerebrovascular accident. Naming performance was assessed by means of the complete set of the Boston Naming Test (BNT; Kaplan et al. 2001). Additional tasks of comprehension and repetition were also carried out using subtests of the Comprehensive Aphasia Battery (CAT; Swinburn et al. 2004). Participants were categorised into ???main error type??? groups. Level of breakdown in spoken word production was predicted by results of comprehension and repetition tests. This was then compared with BNT error types produced. Outcomes & Results: Analyses of error profiles indicated that there was no significant difference between first responses given on the BNT and all responses given. Therefore, first responses provide an accurate account of an individual???s error profile. Chi-square analysis reported that there was a significant association between main error types produced and the predicted level of breakdown in LR. Conclusion: First responses given on a naming task may be sufficient in predicting the level of breakdown in LR. However, additional tasks of comprehension and repetition may be of clinical benefit to confirm a diagnosis, and to plan treatment accordingly.

Elevated levels of advanced glycosylation end products (AGEs) have been found in multiple tissues in association with diabetic vascular complications and during the microalbuminuric phase of diabetic nephropathy. In this study, we have used an AGE-specific enzyme-linked immunosorbent assay (ELISA) to measure skin AGEs to determine whether elevated levels can be detected before the onset of overt microangiopathy. Subjects with type I diabetes (n = 48) were graded for the degree of nephropathy (normal [23], microalbuminuria [12], or macroalbuminuria [12]) and retinopathy (none [13], background [20], or proliferative [15]). Subgroups with a premicroalbuminuric phase of albumin excretion (≤28 mg/24 h, n = 27) or with the earliest stages of retinopathy (n = 27) were identified. A significant increase in tissue AGEs was found as urinary albumin increased during the premicroalbuminuric phase of nephropathy even when the data were adjusted for age and duration of diabetes (P = 0.005). Immunoreactive AGEs also increased as normal renal status advanced to microalbuminuria and macroalbuminuria (P = 0.0001 across groups). Significant elevation of AGEs was also found in association with the earliest stages of clinically evident retinopathy (early background versus minimal grades). In addition, higher AGE levels were found in subjects with proliferative retinopathy when compared with those with less severe retinopathy (P < 0.004 across groups). In contrast, no significant differences were found in tissue AGE levels between groups with or without early retinopathy based on pentosidine or fluorescent AGE measurements, although fluorescent AGEs correlated with albumin excretion. In conclusion, levels of collagen-linked AGEs, when measured by an AGE-specific ELISA, reveal a correlation with preclinical stages of diabetic nephropathy and early retinopathy not indicated by other methods and may prove useful as early markers of microangiopathy in type I diabetes.

Background: Care of children and young people (children) in the 12 children’s kidney units in England, Scotland and Wales is managed by multidisciplinary teams (MDTs) comprising professionals such as clinical psychologists, dieticians, doctors, nurses, pharmacists, play workers, social workers, and therapists. Within the constraints of treatment regimens it is in children’s best interests for them to be cared for at home whenever possible1-4. Professionals therefore, spend considerable time teaching parents from diverse socioeconomic and educational backgrounds, with different health care experiences and learning needs, to deliver home-based clinical care to their children. Often isolated and overwhelmed, parents may look to health professionals for help with care, while professionals often act as teachers as well as care providers5. Although studies of chronic disease management acknowledge issues such as: the ‘work’ associated with parental care giving6, the ways families adjust7, and the fact fathers would like more time to learn about disease management8, there is little research evidence on the ways parents actually learn to take responsibility for and deliver clinical care at home, or the way professionals teach parents to do this. Nevertheless, parents:…perform the vast majority of care-giving, including tasks that are complex and demanding9:13. If they are unsure they may not maintain treatment regimens or recognise subtle clinical changes10 11 so negative outcomes such as undetected urinary tract infections, damaged kidneys, impaired kidney function, relapse of the condition, and transplant rejection may occur. All of these carry significant emotional, physical and financial costs for families 4 12, and have financial implications for the NHS9. Aim: to obtain a detailed understand of the way MDTs teach parents and carers to become home-based clinical carers, and the way parents learn to care for children’s long term kidney conditions.Methods: A mixed method, longitudinal, two phased design allowed us to achieve depth and breadth in our analysis.Phase I, strand i: An administered questionnaire (a survey designed to map the shape of current services and approaches to teaching parents).Phase I, strand ii: Individual or group focussed qualitative interviews with 112 MDT members to explore with them the range of care-giving skills/ and information they relay to parents, and the formal/informal teaching interventions they use. Phase II: Using an ethnographic approach we undertook six observational case studies of children with long term kidney conditions whose parents were learning new clinical skills to deliver at home. Children were purposively sampled to achieve maximum variation in regard to age, gender and ethnicity. After parents (and where appropriate children or other informal carers) were recruited, we used snowball sampling to identify and recruit 28 professionals (nurses, doctors, dieticians, play specialists, social workers, therapists, pharmacists) who were involved in managing the children’s clinical care, and teaching parents the skills needed for home based management. Each case study lasted six months and data obtained included: 86 observations  41 interviews Field-notes Case-note reviewsSurvey data were managed using Excel and descriptive statistics were produced. Qualitative data were analysed using Framework Technique. Key findings: • In Phase I most professionals were involved in teaching parents and reinforcing other professionals’ teaching. • Eight disciplines (clinical psychologists, dieticians, doctors, nurses, pharmacists, play workers, social workers, therapists) described how they share discipline-specific knowledge with parents to promote safe and effective home based clinical care • When discussing parent education professionals described two distinct identities: the inter-disciplinary ‘we’ (e.g. social workers or doctors) and the intra-disciplinary ‘we’ (i.e. as the MDT)• Distributed expertise was evident within all of the MDTs, this:• Means that different professionals offer different kinds of expertise to the co-management of a child’s condition; • Explains the team’s capacity (rather than just the individual's) to care for the children’s CKD.• Three parent-educative functions were identified in professionals’ retrospective accounts:a) Initiating parents’ knowledge and skill development; b) promoting and monitoring parents’ knowledge and skill development, andc) multidisciplinary team workingthese informed Phase II data collection/analysis• In Phase II a wide range of teaching processes, and interactions between professionals, children, parents and other carers were observed; and discussed during qualitative interviews • Four categories emerged as responses to shared MDT/parent management: 1-MDTs promoting parents’ clinical roles; 2-Parents cautious acceptance of clinical responsibilities; 3-Blended expertise around the child; 4-Ambivalence within teaching and learning encounters• There was evidence that professionals acknowledged parents’ expertise around their own child, and actively promoted parents’ clinical expertise. • Although there was little evidence of professionals negotiating with parents about taking on clinical responsibilities, there were examples of parents being offered choices about specific aspects of care, e.g. in-centre dialysis vs. home dialysis; or inserting the NG tube at home vs going to local hospital • Professionals worked hard to try to accommodate parents’ learning needs and care delivery preferences within the constraints of the clinical regimen. • Although parents appeared to ‘cautiously accept’ clinical care as part of their ‘parenting role’, their clinical expertise was generally developed through necessity rather than choice. • Professionals were often challenged by the need to determine parents’ individual learning needs, and individualise skill development.• Parents valued professionals’ efforts to continually tailor teaching activities to parents’ individual needs.• Parents and professionals experienced some ambivalence when engaging in teaching and learning, this arose early in the case studies and continued to appear around a variety of issues.Recommendations:Professionals and parents have developed considerable expertise which ought to be harnessed and made available to support those who are new to renal care. The following would offer professionals an optimum, evidence based understanding of the way parents learn to manage CKD, and, offer parents evidence based material to assist their clinical roles,: 1. A sequence of exemplar case studies could be developed from our anonymised data; these could help share the experiences of parents with professionals, and vice versa. Their purpose would be to support parents and professionals to develop a rounded understanding of the experience of living with CKD and its consequences (e.g. ‘taking a dialysis machine home’, using an NG tube to feed your child)2. A series of ‘top teaching tips’ and ‘top learning tips’ leaflets could be developed from the data for circulation to wards, clinics, parent web sites and possibly the KKR web site?. These could include ‘typical medical language you might hear and what it means’ or ‘common turns of phrase [e.g. colloquialisms, metaphors, analogies] that are used in CKD management, and what they mean’3. A leaflet/web based resource explaining the range of ‘distributed expertise’ within the renal MDT, what the roles and titles mean for families4. Parents ought to be routinely sign-posted to resources when available5. A range of UK workshops where professionals and family members could jointly generate educational material and action plans for tailoring support to parents. The materials could include: e.g. parents’ experiences of the clinical role, symptom management, recognising when to seek help, how to seek help6. A national conference or series of seminars for local health care staff who might need to support management of a local child with CKD; the workshop could draw on our data and enable discussion with staff who are interested and able to attend 7. Educational staff in higher education institutions responsible for developing curriculum for the professionals represented in our data could be provided with key findings from the study in order that the evidence can be fed into practice via new recruits8. Further research is needed that builds on this study, working with families and MDT members to develop and evaluate a parent learning-needs assessment tool that could promote a standardised, MDT approach to assessing parents’ individual learning needs and preferences9. Further study is needed to assess the cost effectiveness of home vs hospital care and the cost to parents10. Although a small body of literature focuses on measuring parent-child shared management of chronic conditions 88, children with CKD were not represented, data collection was limited to an un-validated, postal questionnaire and data did not explore parent-professional interactions as our study has done, thereby suggesting a need for a large mixed methods study to measure shared parent-child management in CKD care.More detailed research is needed that investigates the individual contribution each discipline makes, the wider impact of renal MDT support on parents’ clinical role development, and a time line to illustrate the processes by which MDT members teach and parents learn.

BackgroundAlthough congestive heart failure (CHF) patients typically present with abnormal auscultatory findings on lung examination, respiratory sounds are not normally subjected to additional analysis. The aim of this pilot study was to examine respiratory sound patterns of CHF patients using acoustic-based imaging technology. Lung vibration energy was examined during acute exacerbation and after clinical improvement.MethodsRespiratory sounds throughout the respiratory cycle were captured using an acoustic-based imaging technique. Twenty-three consecutive CHF patients were imaged at the time of presentation to the emergency department and after clinical improvement. Digital images were created (a larger image represents more homogeneously distributed vibration energy of respiratory sound). Geographical area of the images and respiratory sound patterns were quantitatively analyzed. Data from the CHF patients were also compared to healthy volunteers.ResultsThe median (interquartile range) geographical areas of the vibration energy image of acute CHF patients without and with radiographically evident pulmonary edema were 66.9 (9.0) and 64.1(9.0) kilo-pixels, respectively (p< 0.05). After clinical improvement, the geographical area of the vibration energy image of CHF patients without and with radiographically evident pulmonary edema were increased by 18 ± 15% (p< 0.05) and 25 ± 16% (p< 0.05), respectively.ConclusionsWith clinical improvement of acute CHF exacerbations, there was more homogenous distribution of lung vibration energy, as demonstrated by the increased geographical area of the vibration energy image.

Background: Dyspnea is prevalent and has a broad differential diagnosis. Difficulty in determining the correct etiology can delay proper treatment. Non-invasively obtained acoustic signals may offer benefit in identifying patients with dyspnea due to obstructive airway disease (OAD). Objectives: The aim of this pilot study was to determine whether patients with acute dyspnea due to OAD had distinguishing features when studied with a computerized acoustic-based imaging technique. Methods: Respiratory sounds from patients with dyspnea due to OAD (n = 32) and those with dyspnea not due to OAD (n = 39) were studied and compared with normal controls (n = 16). Results: In patients without OAD and in controls, the ratios of peak inspiratory to peak expiratory vibration energy values (peak I/E vibration ratio) were remarkably similar, 6.3 ± 5.1 and 5.6 ± 4, respectively. For the OAD patients, the peak I/E vibration ratio was significantly lower at 1.3 ± 0.04 (p < 0.01). In the patients without OAD and the controls, the ratios of inspiratory time to expiratory time (I/E time ratio) were again similar, 1.0 ± 0.1 and 0.99 ± 0.11, respectively. For the OAD patients, the I/E time ratio was significantly lower at 0.72 ± 0.19 (p < 0.01). Conclusions: This modality was useful in identifying patients whose dyspnea was due to OAD. The ability to objectively and non-invasively measure these differences may prove clinically useful in distinguishing the operant physiology in patients presenting with acute dyspnea.

We describe the effect that inadvertent esophageal intubation has on the images and on the vibration distribution of vibration response imaging (VRI).Vibration response imaging (VRI) is a novel, non-invasive, computer-based technology that measures vibration energy of lung sounds during respiration and displays regional intensity, in both visual and graphic format. Vibration response images, obtained prior to tracheal intubation (spontaneous breathing) and during endotracheal ventilation using a controlled mode, resulted in evenly distributed vibrations throughout the patient's lungs. During inadvertent esophageal ventilation, however, the majority of vibrations were detected in the upper regions of the image, compared to those of the lower (60% vs 8%, respectively). During spontaneous breathing and endotracheal ventilation, the midclavicular column of sensors, located over the centre of each lung, detected more vibrations compared to either the medial or the axillary column of sensors. During inadvertent esophageal ventilation, more vibrations were detected by the medial column of sensors (nearest to the midline/esophagus); and fewer were detected by the sensors that were positioned more laterally.This report illustrates the potential for a visual image of distribution of lung vibration energy to differentiate endotracheal intubation from inadvertent esophageal intubation.

Purified human liver arylsulfatase A (ASA) as well as an ASA peptide (residues 28-39) were sulfated by tyrosyl protein sulfotransferase in vitro. The media, but not the cell lysate, of normal human fibroblasts contained a tyrosine sulfated protein (pI = 4.5-5.5). This protein was not present in either media or cell lysate of human fibroblasts lacking ASA protein. These results suggest that tyrosine sulfation facilitates secretion of ASA and that this may have pathophysiological consequences.

La epidemiología de la rabia en los Estados Unidos ha cambiado considerablemente durante el último medio siglo, debido a que la fuente de enfermedad ha cambiado de animales domésticos a la fauna silvestre, principalmente mapaches, zorrinos, zorros y vampiros. Además, los cambios observados entre la población de fauna silvestre afectada no han ocurrido sin la influencia humana. Más bien, la atracción humana por los recursos económicos y recreativos provista por la fauna silvestre, ha contribuido a la reemergencia de la rabia como una zoonosis mayor. Aunque las muertes humanas ocasionadas por la rabia han declinado recientemente al promedio de uno o dos al año, los costos estimados asociados con la disminución de muertes, suma centenares de millones de dólares anualmente. En esfuerzos futuros para controlar la rabia por una variedad de animales de vida libre, los profesionales de salud pública tendrán que emplear la imaginación para alcanzar soluciones eficaces en función de los costos y la seguridad de esta vieja enfermedad además de usar medidas tradicionales., Facultad de Ciencias Veterinarias

The purpose of this study was to investigate the perceptions of psychiatric patients on an inpatient unit concerning their roles in the treatment process. Areas of interest included participation in healthcare decisions, degree of autonomy, and the nature of communication between the subjects and their caregivers. An interview format was used to solicit data from the participants. Subjects for the study were both men and women of various ethnic backgrounds and age groups. Responses to interview questions suggested that most psychiatric patients have little knowledge of their rights in the treatment setting. Also, most psychiatric patients perceive an unequal status with their caregivers regarding their roles in decision-making activities. Revealed in these interviews were patients' perceptions of intimidation, impending abandonment, conditional regard (based on compliance with treatment dictates), and devaluation of their self-determination activities.

Introduction There are several ventilator modes that are used for maintenance mechanical ventilation but no conclusive evidence that one mode of ventilation is better than another. Vibration response imaging is a novel bedside imaging technique that displays vibration energy of lung sounds generated during the respiratory cycle as a real-time structural and functional image of the respiration process. In this study, we objectively evaluated the differences in regional lung vibration during different modes of mechanical ventilation by means of this new technology. Methods Vibration response imaging was performed on 38 patients on assist volume control, assist pressure control, and pressure support modes of mechanical ventilation with constant tidal volumes. Images and vibration intensities of three lung regions at maximal inspiration were analyzed. Results There was a significant increase in overall geographical area (p < 0.001) and vibration intensity (p < 0.02) in pressure control and pressure support (greatest in pressure support), compared to volume control, when each patient served as his or her own control while targeting the same tidal volume in each mode. This increase in geographical area and vibration intensity occurred primarily in the lower lung regions. The relative percentage increases were 28.5% from volume control to pressure support and 18.8% from volume control to pressure control (p < 0.05). Concomitantly, the areas of the image in the middle lung regions decreased by 3.6% from volume control to pressure support and by 3.7% from volume control to pressure control (p < 0.05). In addition, analysis of regional vibration intensity showed a 35.5% relative percentage increase in the lower region with pressure support versus volume control (p < 0.05). Conclusion Pressure support and (to a lesser extent) pressure control modes cause a shift of vibration toward lower lung regions compared to volume control when tidal volumes are held constant. Better patient synchronization with the ventilator, greater downward movement of the diaphragm, and decelerating flow waveform are potential physiologic explanations for the redistribution of vibration energy to lower lung regions in pressure-targeted modes of mechanical ventilation.

Reports from Europe suggest that the hemolytic-uremic syndrome is associated with an impaired ability to produce prostacyclin (prostaglandin [PG] I(2)), a potent inhibitor of platelet aggregation and thrombus formation. In comparing the production of PGI(2) by cultured endothelial cells using serum obtained from 22 children with the hemolytic-uremic syndrome with values obtained using serum from 22 normal children, we found that cultured endothelial cells produced less PGF(1alpha) (the stable metabolite of PGI(2)) when incubated with affected serum. The relationship of this observation to the pathogenesis of the hemolytic-uremic syndrome is unclear.

Histoire de Hiwiwi et Camadae.