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The purpose of this study was to use qualitative methodology to better understand patient experiences after cubital tunnel surgery, with the goal of identifying areas of improvement in delivery of care. Patients who underwent surgery (in situ decompression or anterior transposition) for cubital tunnel syndrome within the last 12 months, which was performed by one of three fellowship-trained hand surgeons, were identified. Participants were invited to an interview regarding "their experiences with ulnar nerve surgery." An interview guide with semistructured, open-ended questions regarding the decision for surgery, treatment goals, and the recovery process was used. Interim data analyses were conducted to assess emerging themes, and interviews were continued until thematic saturation was achieved. Seventeen participants completed interviews; the mean age of study participants was 57 years, and 71% were women. The mean time between surgery and the interview was 6 months. Participants identified the following two key areas that could improve their surgical experience: (1) the need for detailed preoperative education about the surgery and recovery process, (2) and the importance of discussing treatment goals and expectations. Participants suggested providing both written and online resources to patients, including specific details about incision size and recovery process in education materials, and setting expectations for symptom resolution. Although the overall patient experience after cubital tunnel surgery was positive, participants noted that there is a need for providing improved educational resources and counseling before surgery. Addressing education and counseling needs before cubital tunnel surgery will help surgeons to improve delivery of care. [ABSTRACT FROM AUTHOR]

Abstract: Despite the success of cognitive behavioral therapies (CBT) for emotional disorders, a sizable subgroup of patients with complex clinical presentations, such as patients with generalized anxiety disorder, fails to evidence adequate treatment response. Emotion Regulation Therapy (ERT) integrates facets of traditional and contemporary CBTs, mindfulness, and emotion-focused interventions within a framework that reflects basic and translational findings in affect science. Specifically, ERT is a mechanism-targeted intervention focusing on patterns of motivational dysfunction while cultivating emotion regulation skills. Open and randomized controlled psychotherapy trials have demonstrated considerable preliminary evidence for the utility of this approach as well as for the underlying proposed mechanisms. This article provides an illustration of ERT through the case of “William.” In particular, this article includes a case-conceptualization of William from an ERT perspective while describing the flow and progression of the ERT treatment approach. [Copyright &y& Elsevier]

Abstract: ASME Technical Paper ES2010-90396 “Solute Ion Coulomb Force Monopole Motor and Solute Ion Linear Alignment Propulsion” by the author describes a motor that is based on an arrangement of solute ion electric field monopoles.[1] That is, through a process called capacitive deionization, sodium and chlorine ions in salt water are captured and confined by an electrically conductive material to form electric field monopoles. At least four of the like charged monopoles (all negative or all positive) can be arranged on a disc. At least one stationary monopole of the same charge is placed adjacent to the disc and positioned so that a repulsive electric field is formed between the stationary monopole and at least one of the monopoles positioned on the disc so that the disc is then forced to rotate a shaft at the center of the disc. This paper analyzes the behavior of the dielectric materials forming part of the monopoles to show that the net torque on the motor is greater than zero and also illustrates a novel effect of polarization of a dielectric material positioned between two like-charged monopoles as occurs in the configuration of the monopole motor and a deficiency in the conventional closed path analysis for work performed during movement of electric charges that emit electrostatic fields by failing to consider the effects of dielectric materials in shielding the electrostatic fields. The monopole motor connected to an to electrical generator can provide continuous on-board electrical power to electrical loads for local and deep space applications including power to electrode assemblies designed for linear alignment of like-charged solute ions as a means of propulsion and particle acceleration as described in the ES2010-90396 paper. Details of the monopole motor and the propulsion are available in WO 2008/024927 A2 (and US2010/0199632 A1) “Solute Ion Coulomb Force Acceleration and Electric Field Monopole Passive Voltage Source” by the author Ref.[2]. [Copyright &y& Elsevier]

Summary: The clinical presentation and outcome of candidemia has changed in recent years. We compared two 5-year periods (2000–2004 and 2005–2009) in a single institution. We recorded 419 candidemia episodes during the study period (124 in the first period and 295 in the second period). We observed a significant increase in the number of cases per 1000 admissions per year, from 0.57 in 2000 to 1.52 in 2009 (χ2 LT <0.001). Candida albicans was the most frequently isolated species (42.2%), followed by Candida parapsilosis (34.4%) and Candida glabrata (12.9%). In the second period, episodes were associated with higher comorbidity and were more commonly nosocomial, with a more frequent catheter-related source and an increased rate of C. glabrata infection. No significant differences were observed in susceptibility by species during the study period. According to multivariate analysis, the independent factors associated with higher mortality were shock, age >50 years, elevated comorbidity score (Charlson index >6), and source of candidemia other than catheter. In contrast to the increase in comorbid conditions observed in recent years, mortality remained similar during both periods (∼37% during the first month). This finding could be attributed to a significant increase in catheter-related candidemia and better outcome, as well as to a potential improvement in the management of antifungal therapy in recent years. [ABSTRACT FROM AUTHOR]

Background: Heart failure is the leading cause of hospitalization among the elderly. This study compares clinical characteristics, management, and prognosis of octogenarians (OLD) with younger (YOUNG) patients in the Italian Survey on Acute Heart Failure (AHF). Methods: A nationwide, prospective, observational study on AHF was done. Two hundred six Italian departments with intensive cardiac care units enrolled 2,807 patients in 3 months. Results: Octogenarians (mean age 84 ± 4 years) represented 28% of enrollees. Females were 50% in the OLD group versus 36% in the YOUNG group (P < .0001). Risk factors such as obesity, diabetes, and smoking were more frequent in the YOUNG group. Comorbidities such as anemia and renal dysfunction were more common in the OLD group (64% vs 53%, P < .0001, and 56% vs 43%, P < .0001). More octogenarians were admitted with cardiogenic shock and pulmonary edema, whereas younger patients presented more frequently in New York Heart Association class III to IV (P = .002). Left ventricular ejection fraction was measured in 90% of octogenarians versus 93% of the younger ones and was preserved in 41% of the OLD group versus 31% of the YOUNG group (P < .0001). Coronary angiography was performed in 20% of the YOUNG group and 10% of the OLD group. In-hospital mortality was twice as high in the OLD group (11.8% vs 5.6%, P < .001). In multivariable analysis, the strongest predictors of this event were use of inotropic agents, advanced age (≥80 years), and elevated troponin at admission. Conclusions: Octogenarians represent more than one fourth of the admissions for AHF and have a more severe clinical presentation. Their management is less aggressive, and treatments recommended by guidelines are underused. In-hospital mortality is high in the OLD group independently of left ventricular ejection fraction. [Copyright &y& Elsevier]

Abstract: Global environmental change presents both old and new challenges. A far more systematic application of existing science in the entire food chain is essential to meet future food needs. While this is daunting enough in itself, new questions present themselves through changing food habits and global environmental change. The immediate challenge is to adapt plant, animal and food systems to changing temperature, nutrient and water conditions. To develop sustainable food systems in the long term, the paper discusses a set of considerations such as food demand response, resource efficiency, GHG emission limits and provisions to reduce vulnerability. Finally, some factors are presented to reframe the nature of food systems: multifunctionality, globalisation, food and fuel prices, consumer behaviour and state support to food production. [Copyright &y& Elsevier]

Abstract: Three different approaches for 3-way analyses, namely, Procrustes rotation, parallel factor analysis (PARAFAC) and matrix-augmented principal component analysis (MA-PCA), have been used to compare six different oil spillages made under controlled conditions (one of them corresponding to the heavy oil released after the sunk of the Prestige tanker off the Galician coast–NW Spain on November 2002). Each spillage was monitored during three and a half months by attenuated total reflectance (ATR) mid-IR spectroscopy. Ten characteristic band ratios were defined. Results showed that the three 3-way chemometric techniques lead to essentially the same conclusions, where from it was concluded that the most relevant pattern defining the oil weathering was related to ‘total aromaticity’, i.e., the total number of Cn the molecules which form the products. In addition, weathering of the samples got clearly characterized by a steady evolution on the scores (sample weights), with a clear increase after 11–14 days. Differentiation of the products (slices of the data cube) was also possible due to their intrinsic characteristics as, in general, heavy products oppose to the lightest ones. [Copyright &y& Elsevier]

Summary: Over a three-month period, 13 neonates developed staphylococcal scalded skin syndrome (SSSS) in a maternity unit, between four and 18 days after their birth. An epidemiological and descriptive study followed by a case-control study was performed. A case was defined as a neonate with blistering or peeling skin, and exfoliative toxin A Staphylococcus aureus positive cultures. Controls were selected at random from the asymptomatic, non-colonized neonates born on the same day as the cases. All staff members and all neonates born during the outbreak period were screened for carriage by nasal swabs and umbilical swabs, respectively. S. aureus isolates were polymerase chain reaction (PCR) screened for etA gene and genotyped by pulsed-field gel electrophoresis (PFGE). Two clusters of eight and five cases were identified. Receiving more than one early umbilical care procedure by the same ancillary nurse was the only risk factor identified in the case-control study (odds ratio=15, 95% confidence intervals 2–328). The ancillary nurse suffered from chronic dermatitis on her hands that favoured S. aureus carriage. Exfoliative-toxin-A-producing strains, as evidenced by PCR and indistinguishable by PFGE, were isolated from all but one of the SSSS cases, from four asymptomatic neonates, from two staff members and from the ancillary nurse''s hands. Removal of the ancillary nurse from duty, infection control measures (isolation precautions, chlorhexidine handwashing and barrier protections), and treatment of the carriers (nasal mupirocin and chlorhexidine showers) led to control of the epidemic. In conclusion, this study emphasizes the need for tight surveillance of chronic dermatitis in healthcare workers. [Copyright &y& Elsevier]

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Abstract: Mesenteric arteries and veins are densely innervated by sympathetic nerves and are crucial in the regulation of peripheral resistance and capacitance, respectively, thus, in the control of blood pressure. Presynaptic adenosine receptors are involved in vascular tonus regulation, by modulating noradrenaline release from vascular postganglionic sympathetic nerve endings. Some studies also suggest that adenosine receptors (AR) may have a role in hypertension. We aim at investigating the role of presynaptic adenosine receptors in mesenteric vessels and establish a relationship between their effects (in mesenteric vessels) and hypertension, using the spontaneously hypertensive rats (SHR) as a model of hypertension. Adenosine receptor-mediated modulation of noradrenaline release was investigated through the effects of selective agonists and antagonists on electrically-evoked [3H]-noradrenaline overflow. CPA (A1AR selective agonist: 1–100nM) inhibited tritium overflow, but the inhibition was lower in SHR mesenteric vessels. IB-MECA (A3AR selective agonist: 1–100nM) also inhibited tritium overflow but only in WKY mesenteric veins. CGS 21680 (A2AAR selective agonist: up to 100nM) failed to facilitate noradrenaline release in mesenteric veins, from both strains, but induced a similar facilitation in the mesenteric arteries. NECA (non-selective AR agonist: 1, 3 and 10μM), in the presence of A1 (DPCPX, 20nM) and A3 (MRS 1523, 1μM) AR selective antagonists, failed to change tritium overflow. In summary, the modulatory effects mediated by presynaptic adenosine receptors were characterized, for the first time, in mesenteric vessels: a major inhibition exerted by the A1 subtype in both vessels; a slight inhibition mediated by A3 receptors in mesenteric vein; a facilitation mediated by A2A receptors only in mesenteric artery (from both strains). The less efficient prejunctional adenosine receptor mediated inhibitory effects can contribute to an increase of noradrenaline in the synaptic cleft (both in arteries and veins), which might conduce to increased vascular reactivity. [Copyright &y& Elsevier]