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Breast surgery increases the risk for difficulties with milk production and breastfeeding. Research on lactation outcomes of breast augmentation with implants is reassuring, but reveals a significant risk of low milk production that varies with the type of surgery and position of the implants. Understanding the potential effects of breast implants on breastfeeding can help lactation professionals optimize outcomes for families with a history of augmentation mammaplasty.

Background Gastroenteropancreatic neuroendocrine tumours (GEP-NETs) are slow-growing cancers that arise from diffuse endocrine cells in the gastrointestinal tract (GI-NETs) or the pancreas (P-NETs). They are relatively uncommon, accounting for 2% of all gastrointestinal malignancies. The usual treatment options in advanced GEP-NET patients with metastatic disease include chemotherapy, biological therapies, and peptide receptor radionuclide therapy. Understanding the impact of treatment on GEP-NET patients is paramount given the nature of the disease. Health-related quality of life (HRQoL) is increasingly important as a concept reflecting the patients' perspective in conjunction with the disease presentation, severity and treatment. Aim To conduct a systematic literature review to identify literature reporting HRQoL data in patients with GEP-NETs between January 1985 and November 2019. Methods The PRISMA guiding principles were applied. MEDLINE, Embase and the Cochrane library were searched. Data extracted from the publications included type of study, patient population data (mid-gut/hind-gut/GI-NET/P-NET), sample size, intervention/comparators, HRQoL instruments, average and data spread of overall and sub-scores, and follow-up time for data collection. Results Forty-three publications met the inclusion criteria. The heterogeneous nature of the different study populations was evident; the percentage of female participants ranged between 30%-60%, whilst average age ranged from 53.8 to 67.0 years. Eight studies investigated GI-NET patients only, six studies focused exclusively on P-NET patients and the remaining studies involved both patient populations or did not report the location of the primary tumour. The most commonly used instrument was the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (n = 28) with consistent results across studies; the GI-NET-specific module Quality of Life Questionnaire-GINET21 was used in six of these studies. A number of randomised trials demonstrated no HRQoL changes between active treatment and placebo arms. The Phase III NETTER-1 study provides the best data available for advanced GEP-NET patients; it shows that peptide receptor radionuclide therapy can significantly improve GEP-NET patients' HRQoL. Conclusion HRQoL instruments offer a means to monitor patients' general disease condition, disease progression and their physical and mental well-being. Instruments including the commonly used European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and GINET21 lack, however, validation and a defined minimal clinical important difference specifically for GI-NET and P-NET patients.

Automated dysarthria intelligibility assessment offers the opportunity to develop reliable, low-cost, and scalable tools, which help to solve current shortcomings of manual and subjective intelligibility assessments. This paper reviews the literature regarding automated intelligibility assessment, identifying the highest performing published models and concluding on promising avenues for further research. Our review shows that most of the existing work were able to achieve very high accuracies. However, we have found that most of these studies validated their models using speech samples of the same speakers used in training, making their results less generalizable. Furthermore, there is a lack of study on how well these models perform on speakers from different datasets or different microphone setups. This lack of generalizability has implications to the real-life application of these models. Future research directions could include the use of more robust methods of validation such as using unseen speakers, as well as incorporating speakers from different datasets. This would provide confidence that the models are generalized and therefore allow them to be used in real-world clinical practice.

Tongue motility is an essential physiological component of human feeding from infancy through adulthood. At present, it is a challenge to distinguish among the many pathologies of swallowing due to the absence of quantitative tools. We objectively quantified tongue kinematics from ultrasound imaging during infant and adult feeding. The functional advantage of this method is presented in several subjects with swallowing difficulties. We demonstrated for the first time the differences in tongue kinematics during breast‐ and bottle‐feeding, showing the arrhythmic sucking pattern during bottle‐feeding as compared with breastfeeding in the same infant with torticollis. The method clearly displayed the improvement of tongue motility after frenotomy in infants with either tongue‐tie or restrictive labial frenulum. The analysis also revealed the absence of posterior tongue peristalsis required for safe swallowing in an infant with dysphagia. We also analyzed for the first time the tongue kinematics in an adult during water bolus swallowing demonstrating tongue peristaltic‐like movements in both anterior and posterior segments. First, the anterior segment undulates to close off the oral cavity and the posterior segment held the bolus, and then, the posterior tongue propelled the bolus to the pharynx. The present methodology of quantitative imaging revealed highly conserved patterns of tongue kinematics that can differentiate between swallowing pathologies and evaluate treatment interventions. The method is novel and objective and has the potential to advance knowledge about the normal swallowing and management of feeding disorders., Tongue kinematics was objectively quantified from ultrasound imaging during feeding. Tongue and palate contours were traced in each frame of the video; tongue outlines were registered with respect to the hard anterior palate; and tongue motility characteristics were determined from intersections with polar coordinates in subsequent frames. Differences in tongue kinematics during breast‐ and bottle‐feeding are demonstrate in the same infant. The method detected improvement of tongue motility after frenotomy interventions and revealed absence of posterior tongue peristalsis in infant with dysphagia. It demonstrated tongue peristaltic‐like movements in both anterior and posterior segments in an adult during water bolus swallowing.

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2020. Endowing robots with the role of social assistance in silver care could be a powerful tool to combat chronic loneliness in ageing adults. These robots can be tasked with functional and affective care to support quotidian living and grant companionship that helps lessen the burden of cognitive decline and impairment emerging from social isolation. To accomplish such imperative tasks, artificial agents must be adept at communicating naturally with the human elder. In this work, we aim to enable human–robot interaction by designing human-like verbal and nonverbal behaviours of an autonomous robot companion. We employed the robot on a trial run using customisable algorithms to address a range of needs, while thriving social and emotional attachment with the potential senior user, with the final intent being that such endeavours can help achieve quality ageing in place.

Background Diphtheria is a potentially fatal respiratory disease caused by toxigenic Corynebacterium diphtheriae. Although resistance to erythromycin has been recognized, β-lactam resistance in toxigenic diphtheria has not been described. Here, we report a case of fatal respiratory diphtheria caused by toxigenic C. diphtheriae resistant to penicillin and all other β-lactam antibiotics, and describe a novel mechanism of inducible carbapenem resistance associated with the acquisition of a mobile resistance element. Methods Long-read whole-genome sequencing was performed using Pacific Biosciences Single Molecule Real-Time sequencing to determine the genome sequence of C. diphtheriae BQ11 and the mechanism of β-lactam resistance. To investigate the phenotypic inducibility of meropenem resistance, short-read sequencing was performed using an Illumina NextSeq500 sequencer on the strain both with and without exposure to meropenem. Results BQ11 demonstrated high-level resistance to penicillin (benzylpenicillin minimum inhibitory concentration [MIC] ≥ 256 μg/ml), β-lactam/β-lactamase inhibitors and cephalosporins (amoxicillin/clavulanic acid MIC ≥ 256 μg/mL; ceftriaxone MIC ≥ 8 μg/L). Genomic analysis of BQ11 identified acquisition of a novel transposon carrying the penicillin-binding protein (PBP) Pbp2c, responsible for resistance to penicillin and cephalosporins. When strain BQ11 was exposed to meropenem, selective pressure drove amplification of the transposon in a tandem array and led to a corresponding change from a low-level to a high-level meropenem-resistant phenotype. Conclusions We have identified a novel mechanism of inducible antibiotic resistance whereby isolates that appear to be carbapenem susceptible on initial testing can develop in vivo resistance to carbapenems with repeated exposure. This phenomenon could have significant implications for the treatment of C. diphtheriae infection, and may lead to clinical failure.

There is increasing concern for the risk of hypernatremic dehydration in infants breastfeeding poorly. It is important to differentiate normal weight changes as infants adapt to extrauterine life from excessive weight loss from breastfeeding failure or mismanagement. We review recent data on normal weight changes in exclusively breastfeeding infants and those at risk for hypernatremic dehydration to help health professionals determine when infants require further scrutiny and supplementation. The data suggest that perinatal practices influence infant weight changes. Protecting normal birth and early initiation of breastfeeding should reduce the incidence of excessive weight loss and risk of hypernatremic dehydration

Speech-language pathologists (SLPs) who work with pediatric feeding/swallowing disorders may evaluate and treat breastfeeding infants. Many SLPs, however, receive little breastfeeding-related train...

Do parents have any alternatives to surgery for addressing tongue-tie? Our panelists agree that latch issues should be assessed first. Other modalities include physical therapy, speech therapy, chiropractic, and craniosacral therapy. In addition, infants should be assessed for other issues, such as torticollis, that may co-occur with tongue-tie. For some parents, complementary techniques may be all that they need to address tongue-tie–related issues. For other parents, surgical release will still be necessary.

What is the prevalence of tongue-tie (the proportion of total cases in a population)? Is the incidence (occurrence of new cases) increasing or are clinicians simply identifying it more often? The most reliable way to estimate incidence and prevalence is through population-based epidemiological studies. So far, these are limited. However, there has been some research that allows us to approximate rates. Our expert panel offers their judgment on two questions: What is the approximate percentage of babies with tongue-tie? And is incidence increasing?

BackgroundOXA-48-like carbapenemases have become increasingly prevalent in healthcare settings worldwide. Their low-level activity against carbapenems makes them difficult to identify, causing problems for infection control. Here we present an outbreak of Escherichia coli producing OXA-181 (part of the OXA-48 family of carbapenemases) in a Queensland Hospital, and describe how we used whole genome sequencing (WGS) to identify the outbreak strain, determine the extent of transmission within the hospital and support infection control responses.Methods116 isolates were collected and sequenced on an Illumina NextSeq to determine species, sequence type (ST) and presence of resistance genes. Core single nucleotide polymorphisms were used to determine strain relatedness. Three isolates were also sequenced on an Oxford Nanopore MinION to determine the context of the resistance genes.ResultsOf 116 isolates, 85 (84 E. coli and one K. pneumoniae) from 78 patients (and two environmental sources) were related to the ongoing outbreak. The outbreak E. coli strain was found to be ST38 and carried blaOXA-181, blaCTX-M-15 and qnrS1 genes. Long read sequencing revealed blaOXA-181 to be carried on an IncX3 plasmid with qnrS1. blaCTX-M-15 was chromosomally integrated (via ISEcp1 insertion) in close proximity to a second qnrS1 gene. A search of the laboratory database identified an isolate with an identical unusual antibiogram from a patient recently admitted to a hospital in Vietnam, suggesting that the strain was introduced to the hospital. This conclusion was supported by WGS, as comparison of the strain to public data identified a close match to an E. coli recovered from Vietnam in 2011.ConclusionA blaOXA-181-carrying E. coli ST38 strain was introduced to a Brisbane hospital and spread undetected throughout multiple wards over several months. Using WGS, we characterized the outbreak strain and unambiguously detected its presence throughout the hospital. We show how both WGS and infection control measures can be utilized to effectively terminate widespread transmission of an elusory pathogen.

Objectives: To evaluate the outbreak size and hospital cost effects of bacterial whole-genome sequencing availability in managing a large-scale hospital outbreak. Methods: We built a hybrid discrete event/agent-based simulation model to replicate a serious bacterial outbreak of resistant Escherichia coli in a large metropolitan public hospital during 2017. We tested the 3 strategies of using whole-genome sequencing early, late (actual outbreak), or not using it and assessed their associated outbreak size and hospital cost. The model included ward dynamics, pathogen transmission, and associated hospital costs during a 5-month outbreak. Model parameters were determined using data from the Queensland Hospital Admitted Patient Data Collection (N = 4809 patient admissions) and local clinical knowledge. Sensitivity analyses were performed to address model and parameter uncertainty. Results: An estimated 197 patients were colonized during the outbreak, with 75 patients detected. The total outbreak cost was A$460 137 (US$317 117), with 6.1% spent on sequencing. Without sequencing, the outbreak was estimated to result in 352 colonized patients, costing A$766 921 (US$528 547). With earlier detection from use of routine sequencing, the estimated outbreak size was 3 patients and cost A$65 374 (US$45 054). Conclusions: Using whole-genome sequencing in hospital outbreak management was associated with smaller outbreaks and cost savings, with sequencing costs as a small fraction of total hospital costs, supporting the further investigation of the use of routine whole-genome sequencing in hospitals.

We report our clinical experience of sacubitril/valsartan (SV) use in heart failure (HF) patients at a large UK cardiac centre. Heart failure with reduced ejection fraction (HFrEF) patients seen in the HF clinic and started on SV from April 2016 to July 2017 were retrospectively evaluated.

This paper examines age-related differences in voice quality between 15 young and 15 old speakers, using electroglottographic (EGG) recordings of three elicitation types: sustained vowels, hVd word lists, and readings of the Rainbow Passage. For each elicitation type, fundamental frequency (F0), contact quotient (Qx), and their standard deviations are analysed. Results found, for all three elicitations, that Qx was significantly lower for older speakers. F0 was higher for the older speakers, but this was only significant for the hVd word lists. Sustained vowels were used to examine the effect of target pitch and loudness on F0 and Qx. Both Qx and F0 were raised with increased target loudness. The hVd word lists were used to examine the phonetic effects of different vowels. Lip rounded vowels had higher Qx than non-lip rounded vowels. Readings of the Rainbow Passage encompassed prosodic and phonetic variations in F0 and Qx, in addition to voice quality. F0 and Qx contours of the hVd word lists and the vowel/ei/taken from the Rainbow Passage were analysed using the discrete cosine transform. The hVd frame produced coarticulation effects on the Qx contour, but no such effects were evident for the vowel /ei/. The study concluded that using multiple elicitation types is beneficial in the study of the effect of age on the voice, and that analysing contour tracks for F0 and Qx will allow further examination of how prosodic and phonetic effects interact with age-related changes in voice quality.

Human clinical studies conducted with LCI699 established aldosterone synthase (CYP11B2) inhibition as a promising novel mechanism to lower arterial blood pressure. However, LCI699's low CYP11B1/CYP11B2 selectivity resulted in blunting of adrenocorticotropic hormone-stimulated cortisol secretion. This property of LCI699 prompted its development in Cushing's disease, but limited more extensive clinical studies in hypertensive populations, and provided an impetus for the search for cortisol-sparing CYP11B2 inhibitors. This paper summarizes the discovery, pharmacokinetics, and pharmacodynamic data in preclinical species and human subjects of the selective CYP11B2 inhibitor 8.

Early initiation of breastfeeding has numerous benefits for maternal-child health. Maternity care providers have been shown to play a significant role in establishing breastfeeding, yet there is limited research about clinical approaches that support breastfeeding initiation in the immediate postpartum. Traditional methods that focused on position and attachment have not demonstrated consistent, positive effects on breastfeeding outcomes. Contemporary approaches to breastfeeding initiation emphasize innate maternal and neonatal breastfeeding abilities and the importance of breastfeeding self-efficacy, dyad-centered care, and a supportive breastfeeding environment free from unnecessary interventions. Recommendations for clinical practice for physiologic breastfeeding initiation are provided.

Infants with unilateral sternocleidomastoid tension and associated craniofacial, spinal, and hip asymmetries may feed poorly. Anatomic and muscular asymmetry stress both biomechanics and state control, increasing the potential for difficulty latching and sucking. A combination of positioning modifications to allow the infant to maintain his or her comfortable head tilt and turn, supportive techniques to restore alignment of oral structures, and handling techniques to help activate the weak contralateral muscles have been effective in the author’s practice. Lactation consultants can promote positioning and muscle activation strategies and encourage physical therapy referrals for infants who do not respond promptly to reduce the risk of craniofacial deformity and developmental problems.

A common analysis for Arabic emphatics and pharyngeals posits that their commonalities are due to the shared feature [RTR]. This, however, does not account for some phonological processes, and does not reflect their phonetic representation. This study provides ultrasound evidence that emphatics and pharyngeals do not exhibit a similar retraction of the tongue. Results indicate that while tongue retraction for the emphatics is characterized with simultaneous tongue dorsum and root retraction, the pharyngeals lower the tongue dorsum. Unlike the pharyngeals, the tongue root retraction of the emphatics and uvulars is always posterior to the tongue root position of the inter-speech posture. Such a consistent and significant displacement confirms that [RTR] is an active feature for the emphatics and uvulars. This is also evident from the retraction of following low vowels triggered by the emphatics and uvulars. These phonetic findings suggest that the pharyngeals and emphatics have different phonological representations.

This study examines electroglottographic (EGG) recordings for 15 young and 14 old male speakers of New Zealand English. Analysis was performed on the sustained vowels /i:/ and /a:/ at three target levels for both pitch and loudness. Jitter was greater for older speakers, and the contact quotient (Qx) was significantly lower for older speakers. The greater jitter for older speakers indicates a decrease in the stability of the vocal production mechanism of the older speakers. The jitter is an acoustic measure, so to examine the stability at a physiological level, a perturbation measure of the Qx is developed and applied to the EGG recordings. The contact quotient perturbation (CQP) showed a significant increase for older speakers (1.55% and 3.54% for young and old, respectively), and this demonstrated more about the variability than the jitter data alone. When loudness is also considered, the Qx was significantly greater for louder vowels, whereas its perturbation was significantly lower for louder vowels. This relationship combined with the age effect, with the CQP for all three loudness levels being greater for the older speakers. The findings of this study will contribute to the development of vocal fold models that account for aging.

It is widely known that despite the poor prognosis of heart failure, physicians who treat this disease do not routinely discuss prognosis with their patients unless directly asked about it [(1)][1]. This may be because prognosis in a patient with heart failure is difficult to assess accurately

Young women engaged in exotic dancing have a higher need for reproductive health services than women not in this profession, and many also use drugs or exchange sex for money or drugs. Few report receiving reproductive health services. We describe a public health, academic, and community partnership that provided reproductive health services on needle exchange mobile vans in the “red light district” in downtown Baltimore, Maryland. Women made 220 visits to the vans in the first 21 months of the program's operation, and 65% of these visits involved provision of contraception. Programmatic costs were feasible. Joint provision of needle exchange and reproductive health services targeting exotic dancers has the potential to reduce unintended pregnancies and link pregnant, substance-abusing women to reproductive care, and such programs should be implemented more widely.

L-4F, an apolipoprotein A-I (apoA-I) mimetic peptide (also known as APL180), was administered daily by either intravenous (IV) infusion for 7 days or by subcutaneous (SC) injection for 28 days in patients with coronary heart disease in two distinct clinical studies. L-4F was well tolerated at all doses tested. Despite achieving plasma levels (mean maximal plasma concentration of 2,907 ng/ml and 395 ng/ml, following IV infusion and SC injection, respectively), that were effective in previously published animal models, treatment with L-4F, as assessed by biomarkers of HDL function such as HDL-inflammatory index (HII), and paraoxonase activity, did not improve. Paradoxically, there was a 49% increase in high-sensitivity C-reactive protein (hs-CRP) levels after seven IV infusions of 30 mg L-4F (P < 0.05; compared with placebo) and a trend for hs-CRP increase in subjects receiving 30 mg SC injection for 28 days. In a subsequent, ex vivo study, addition of L-4F at concentrations of 150, 375, or 1,000 ng/ml to plasma from subjects prior to L-4F treatment resulted in significant dose-dependent HII improvement. In conclusion, in vivo L-4F treatment, delivered by either SC injection or IV infusion, did not improve HDL functional biomarkers despite achieving plasma levels that improved identical biomarkers ex vivo and in animal models.

Infant ability to find and attach to the breast has only been recently appreciated. When mothers are in reclined, laid–back or biological nurturing positions, the mothers’ bodies provide optimal support for their infants, which releases infant instinctive feeding behaviors. One type of instinctive behavior that infants reveal is their deliberate use of their hands to locate, move and shape the nipple area. In this article, we provide photographic evidence of several infant hand–use strategies, as well as information on how professionals and mothers can elicit, support and modify these behaviors when needed.

Vildagliptin is a selective dipeptidyl peptidase IV inhibitor that augments meal-stimulated levels of biologically active glucagon-like peptide-1. Chronic vildagliptin treatment decreases postprandial glucose levels and reduces hemoglobin A1c in type 2 diabetic patients. However, little is known about the mechanism(s) by which vildagliptin promotes reduction in plasma glucose concentration.Sixteen patients with type 2 diabetes (age, 48+/-3 yr; body mass index, 34.4+/-1.7 kg/m2; hemoglobin A1c, 9.0+/-0.3%) participated in a randomized, double-blind, placebo-controlled trial. On separate days patients received 100 mg vildagliptin or placebo at 1730 h followed 30 min later by a meal tolerance test (MTT) performed with double tracer technique (3-(3)H-glucose iv and 1-(14)C-glucose orally).After vildagliptin, suppression of endogenous glucose production (EGP) during 6-h MTT was greater than with placebo (1.02+/-0.06 vs. 0.74+/-0.06 mg.kg-1.min-1; P=0.004), and insulin secretion rate increased by 21% (P=0.003) despite significant reduction in mean plasma glucose (213+/-4 vs. 230+/-4 mg/dl; P=0.006). Consequently, insulin secretion rate (area under the curve) divided by plasma glucose (area under the curve) increased by 29% (P=0.01). Suppression of plasma glucagon during MTT was 5-fold greater with vildagliptin (P0.02). The decline in EGP was positively correlated (r=0.55; P0.03) with the decrease in fasting plasma glucose (change=-14 mg/dl).During MTT, vildagliptin augments insulin secretion and inhibits glucagon release, leading to enhanced suppression of EGP. During the postprandial period, a single dose of vildagliptin reduced plasma glucose levels by enhancing suppression of EGP.

Background Aldosterone synthase inhibition provides the potential to attenuate both the mineralocorticoid receptor-dependent and independent actions of aldosterone. In vitro studies with recombinant human enzymes showed LCI699 to be a potent, reversible, competitive inhibitor of aldosterone synthase (Ki = 1.4 ± 0.2 nmol/L in humans) with relative selectivity over 11β-hydroxylase. Methods Hormonal effects of orally administered LCI699 were examined in rat and monkey in vivo models of adrenocorticotropic hormone (ACTH) and angiotensin-II-stimulated aldosterone release, and were compared with the mineralocorticoid receptor antagonist eplerenone in a randomized, placebo-controlled study conducted in 99 healthy human subjects. The effects of LCI699 and eplerenone on cardiac and renal sequelae of aldosterone excess were investigated in a double-transgenic rat (dTG rat) model overexpressing human renin and angiotensinogen. Results Rat and monkey in vivo models of stimulated aldosterone release predicted human dose– and exposure–response relationships, but overestimated the selectivity of LCI699 in humans. In the dTG rat model, LCI699 dose-dependently blocked increases in aldosterone, prevented development of cardiac and renal functional abnormalities independent of blood pressure changes, and prolonged survival. Eplerenone prolonged survival to a similar extent, but was less effective in preventing cardiac and renal damage. In healthy human subjects, LCI699 0.5 mg selectively reduced plasma and 24 h urinary aldosterone by 49 ± 3% and 39 ± 6% respectively (Day 1, mean ± SEM; P

This study demonstrates the successful management of aggressive behaviour with a client 10 years post-injury in a small, residential neurorehabilitation unit. The case presented is unusual for two main reasons. First, it proved possible to significantly modify previously chronic challenging behaviour many years after brain injury had been sustained. Secondly, the rehabilitation environment in which treatment was conducted did not comprise a highly specialized neurobehavioural service, Instead, staff were specifically trained regarding the administration of the treatment programme, which was based on principles derived from behaviour modification and applied neuropsychology. Specific interventions used included those of differential reinforcement and graduated increase of expectations. Recordings made over the course of 85 weeks demonstrate a significant decrease in the frequency and severity of aggression. Successful inhibition of challenging behaviour attained a level which facilitated transfer of the client to a non-institutionalized community home. Reasons underlying the success of the intervention, and the limitations inherent in attempting to manage aggression within neurorehabilitation environments will be discussed.

Non-invasive magnetic stimulation of the brain was earlier used to reveal the corticomotor representation of the human masseter muscle but it is unclear how motor tasks affect this map. An experimental approach incorporating transcranial magnetic stimulation of verified locations on the scalp, surface electromyography, and controlled muscle facilitation was used to disclose the corticomotor output map of the masseter during three isometric tooth-contact tasks, viz., tooth clenching in the intercuspal position, biting on the left molar teeth, and biting on the incisors. Map area was significantly different for all tasks, and map height and volume were also different for biting on the incisor teeth (p

Adolescent and young adult women are disproportionately burdened by violence at the hands of dating and intimate partners. Evidence supports routine screening in clinical settings for detection and intervention. Although screening for intimate partner violence in reproductive health care settings is widely endorsed, little is known about screening practices. We conducted qualitative in-depth interviews with healthcare providers (n = 14) in several urban reproductive health clinics in Baltimore City, Maryland to understand screening practices, including related barriers and motivations. Interviews were transcribed verbatim and analyzed using inductive content analysis. Findings demonstrated substantial variation in screening practices as well as related referral and follow-up, despite the existence of a screening tool. Factors that appeared to undermine consistent and successful screening implementation included lack of a common goal for screening, lack of clarity in staff roles, a gap in on-site support services, as well as lack of time and confidence. Findings affirm the value of applying a systems model to intimate partner violence (IPV) screening programs. This research advances the understanding of the implementation challenges for violence-related screening for high-risk populations such as adolescents and young adults in reproductive health care settings and is particularly relevant given the recent endorsement by the DHHS to cover IPV screening under the Affordable Care Act.

CONTEXT: Out-of-school black males aged 15-24 have higher levels of sexual risk-taking than in-school black males of the same age. However few sexual risk reduction curricula are focused on out-of-school male youth. METHODS: A sexual and reproductive health intervention conducted at a Baltimore youth employment and training program in 2008-2010 was evaluated in a study involving 197 youth aged 16-24 from a predominantly black population. Ninety-eight participants received three one-hour curriculum sessions on consecutive days; 99 served as controls. At baseline and three months later participants completed a survey assessing demographic characteristics and various knowledge attitude and behavior measures. Regression analysis with random effects was used to assess differences between intervention participants and controls in changes in outcomes over time. RESULTS: In analyses adjusting for baseline characteristics intervention participants showed greater improvements in outcomes between baseline and follow-up than did controls. Specifically a male who received the intervention was more likely than a control male to report increases in knowledge of STDs and health care use (odds ratio 1.6 for each) frequency of condom use (1.8) use of lubricant with condoms (23.6) communication with a provider about STDs (12.3) and STD testing (16.6). CONCLUSION: These findings suggest the potential benefits of integrating safer-sex and health care information into a sexual and reproductive health curriculum for out-of-school male youth. Copyright (c) 2013 by the Guttmacher Institute.

The clinical features and increased mortality associated with Cushing's syndrome result from a chronic excess of circulating cortisol. As LCI699 potently inhibits 11β-hydroxylase, which catalyzes the final step of cortisol synthesis, it is a potential new treatment for Cushing's disease, the most common cause of endogenous Cushing's syndrome.Adult patients with moderate-to-severe Cushing's disease (urinary free cortisol [UFC] levels1.5 × ULN [upper limit of normal]) received oral LCI699 for 10 weeks in this proof-of-concept study. LCI699 was initiated at 4 mg/d in two equal doses; the dose was escalated every 14 days to 10, 20, 40, and 100 mg/d until UFC normalized, whereupon the dose was maintained until treatment ended (day 70). The primary endpoint was UFC ≤ ULN or a ≥50% decrease from baseline at day 70.Twelve patients were enrolled and completed the study. Baseline UFC ranged over 1.6-17.0 × ULN. All 12 patients achieved UFC ≤ULN or a ≥50% decrease from baseline at day 70; 11 (92%) had normal UFC levels at that time. After treatment discontinuation (day 84), UFC wasULN in 10 patients with available measurements. Mean 11-deoxycortisol, 11-deoxycorticosterone, and adrenocorticotropic hormone levels increased during treatment and declined after discontinuation. Mean systolic and diastolic blood pressure decreased from baseline by 10.0 and 6.0 mmHg, respectively. LCI699 was generally well tolerated; most adverse events (AEs) were mild or moderate. The most common AEs included fatigue (7/12), nausea (5/12), and headache (3/12). No serious drug-related AEs were reported.LCI699 was efficacious and well tolerated in patients with Cushing's disease enrolled in this proof-of-concept study.

Although numerous theoretical and case studies based on Solution Focused Therapy are reported in the marriage and family therapy literature, few if any are based upon empirical, experimental studies. This study attempts to fill this perceived gap. Parents of adolescents were randomly assigned to an experimental (N = 30) or control (N = 12) Group. A pre- and posttest design using the Parenting Skills Inventory (PSI) and the Family Strengths Self Report Assessments were used to assess change. Only the experimental group received a six-week Solution Focused Parenting (SFP) Intervention. Statistical results indicated significant differences between the two groups, the PSI inventory providing the majority of the statistical significance. Specific PSI scales are discussed in terms of their contribution to parenting and therapy interventions. This outcome lends support to the basic theoretical assumptions of the effectiveness of Solution Focused Therapy.

This paper presents the first version of a mobile service robot designed for older people. Six service application modules were developed with the key objective being successful interaction between the robot and the older people. A series of trials were conducted in an independent living facility at a retirement village, with the participation of 32 residents and 21 staff. In this paper, challenges of deploying the robot and lessons learned are discussed. Results show that the robot could successfully interact with people and gain their acceptance.

We report the first administration of an orally active aldosterone synthase inhibitor, LCI699, to 14 patients with primary aldosteronism. After a 2-week placebo run-in, patients received oral LCI699 (0.5 mg BID) for 2 weeks, LCI699 (1.0 mg BID) for 2 weeks, and placebo for 1 week. We assessed changes in hormone concentrations, plasma potassium levels, and 24-hour ambulatory systolic blood pressure and safety. The supine plasma aldosterone concentration decreased from 540 pmol/L (95% CI: 394 to 739 pmol/L) to 171 pmol/L (95% CI: 128 to 230 pmol/L) after 0.5 mg of LCI699 (−68%; P P P P P P =0.046). Basal plasma cortisol concentrations remained unchanged, whereas plasma adrenocorticotropic hormone concentrations increased by 35% after 0.5 mg of LCI699 ( P =0.08) and by 113% after 1.0 mg of LCI699 ( P

OBJECTIVE—To evaluate the effect of treatment with the dipeptidyl peptidase (DPP)-4 inhibitor vildagliptin on insulin sensitivity and β-cell function in subjects with impaired fasting glucose (IFG). RESEARCH DESIGN AND METHODS—A total of 22 subjects with IFG (11 female and 11 male, mean ± SD age 59.6 ± 11.5 years) were treated orally with 100 mg vildagliptin once daily in a single-blind study. Subjects received placebo for 2 weeks (run-in) followed by vildagliptin for 6 weeks (treatment) and then placebo for 2 weeks (washout). A frequently sampled intravenous glucose tolerance test (FSIGT), followed by a 2-h meal tolerance test (MTT), was performed at 2, 8, and 10 weeks. From the FSIGT, the acute insulin response to glucose (AIRg) and insulin sensitivity index (SI) were determined and used to compute the disposition index (AIRg × SI) as a measure of β-cell function. RESULTS—Fasting plasma glucose did not change after 6 weeks of vildagliptin treatment. With treatment, mean ± SEM AIRg increased from 224 ± 44 to 286 ± 52 pmol/l (P < 0.05), and SI improved from 2.8 ± 0.5 to 3.5 ± 0.5 × 10−5 · min−1 · pmol−1 · l (P < 0.01), resulting in an increase in the disposition index from 688 ± 180 to 1,164 ± 318 × 10−5/min (P < 0.05). These effects were not sustained after washout. During the MTT, the incremental area under the glucose curve was significantly decreased after treatment (240 ± 15 vs. 191 ± 14 mmol · l−1 · min−1; P = 0.002), but this effect was not sustained after washout. CONCLUSIONS—The DPP-4 inhibitor vildagliptin improves insulin sensitivity and β-cell function, leading to improved postprandial glycemia in subjects with IFG, who are known to have β-cell dysfunction. Thus, vildagliptin may prevent progression to diabetes in high-risk subjects.

The dipeptidyl peptidase IV inhibitor, vildagliptin, increases levels of intact glucagon-like peptide-1 (GLP-1) and improves glycemic control in patients with type 2 diabetes. Although GLP-1 is known to stimulate insulin secretion, vildagliptin does not affect plasma insulin levels in diabetic patients, suggesting that more sophisticated measures are necessary to ascertain the influence of vildagliptin on beta-cell function.This study examined the effects of 28-d treatment with vildagliptin (100 mg, twice daily; n = 9) vs. placebo (n = 11) on beta-cell function in diabetic patients using a mathematical model that describes the insulin secretory rate as a function of glucose levels (beta-cell dose response), the change in glucose with time (derivative component), and a potentiation factor, which is a function of time and may reflect the actions of nonglucose secretagogues and other factors.Vildagliptin significantly increased the insulin secretory rate at 7 mmol/liter glucose (secretory tone), calculated from the dose response; the difference in least squares mean (deltaLSM) was 101 +/- 51 pmol.min(-1).m(-2) (P = 0.002). The slope of the beta-cell dose response, the derivative component, and the potentiation factor were not affected. Vildagliptin also significantly decreased mean prandial glucose (deltaLSM, -1.2 +/- 0.4 mmol/liter; P = 0.01) and glucagon (deltaLSM, -10.7 +/- 4.8 ng/liter; P = 0.03) levels and increased plasma levels of intact GLP-1 (deltaLSM, +10.8 +/- 1.6 pmol/liter; P0.0001) and gastric inhibitory polypeptide (deltaLSM, +43.4 +/- 9.4 pmol/liter; P0.0001) relative to placebo.Vildagliptin is an incretin degradation inhibitor that improves beta-cell function in diabetic patients by increasing the insulin secretory tone.

The effect of diminished auditory feedback on monophthong and diphthong production was examined in postlingually deafened Australian-English speaking adults. The participants were 4 female and 3 male speakers with severe to profound hearing loss, who were compared to 11 age- and accent-matched normally hearing speakers. The test materials were 5 repetitions of hVd words containing 18 vowels. Acoustic measures that were studied included F1, F2, discrete cosine transform coefficients (DCTs), and vowel duration information. The durational analyses revealed increased total vowel durations with a maintenance of the tense/lax vowel distinctions in the deafened speakers. The deafened speakers preserved a differentiated vowel space, although there were some gender-specific differences seen. For example, there was a retraction of F2 in the front vowels for the female speakers that did not occur in the males. However, all deafened speakers showed a close correspondence between the monophthong and diphthong formant movements that did occur. Gaussian classification highlighted vowel confusions resulting from changes in the deafened vowel space. The results support the view that postlingually deafened speakers maintain reasonably good speech intelligibility, in part by employing production strategies designed to bolster auditory feedback.

The cortical topography of several limb and trunk muscles has been disclosed using transcranial magnetic stimulation, but the corticomotor representation of the human jaw muscles has not yet been described. An experimental paradigm incorporating transcranial magnetic stimulation of verified sites on the scalp was used (a) to determine the cortical topography of the human masseter muscle and (b) to assess the reproducibility of the motor map, in seven healthy individuals. The results showed that the masseter was discretely represently on the motor and premotor cortex with interindividual variation in map area, volume and height (p

This research investigated specific processing strengths and weaknesses among three groups of readers who ranged in age from 6 through 10 years. The first-grade unsuccessful and the older unsuccessful readers had similar information-processing patterns, whereas collectively they differed significantly from the first-grade successful readers on short-term auditory/working memory and decoding/encoding. When separately compared to the controls, the age-matched high-risk group showed additional weakness in rapid automatized naming, and the reading-level-matched older disabled group showed additional weakness in phonological coding as well as visual sequential memory. Examination of second-level classifications using cluster analysis suggested the presence of three potential subtypes among the 50 poor readers. All were characterized by difficulty in what was interpreted as symbolic processing/memory (Subtype 1), which occurred in combination with visual processing deficiencies (Subtype 2) and with deficits in both visual processing and rapid automatized naming (Subtype 3).

Young women engaged in exotic dancing have a higher need for reproductive health services than women not in this profession, and many also use drugs or exchange sex for money or drugs. Few report receiving reproductive health services. We describe a public health, academic, and community partnership that provided reproductive health services on needle exchange mobile vans in the “red light district” in downtown Baltimore, Maryland. Women made 220 visits to the vans in the first 21 months of the program’s operation, and 65% of these visits involved provision of contraception. Programmatic costs were feasible. Joint provision of needle exchange and reproductive health services targeting exotic dancers has the potential to reduce unintended pregnancies and link pregnant, substance-abusing women to reproductive care, and such programs should be implemented more widely. (Am J Public Health. 2012;102:1833–1836. doi:10.2105/AJPH.2012.300842)