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Background: In cancer, platelets may facilitate metastatic spread by a number of mechanisms as well as contribute to thrombotic complications. Ticagrelor, a platelet antagonist- that blocks adenosine diphosphate activation of platelet P2Y12 receptors, is widely used in the treatment of cardiovascular disease, but its efficacy in cancer remains unknown. Objectives: This study sought to evaluate the effect of aspirin and ticagrelor monotherapy, as well as dual antiplatelet therapy, on platelet activation in cancer. Methods: This study consisted of 2 phases: first, an in vitro study of human platelet−tumor cell interaction; and second, a randomized crossover clinical trial of 22 healthy donors and 16 patients with metastatic breast or colorectal cancer. Platelet activation and inhibition were measured by aggregometry and flow cytometry. Results: In vitro, tumor cells induced cellular clusters that were predominantly platelet−platelet aggregates. Ticagrelor significantly inhibited formation of large tumor cell-induced platelet−platelet aggregates: 65.4 ± 4.8% to 50.9 ± 5.9% (p = 0.002) and 62.3 ± 3.1% to 48.3 ± 7.3% (p = 0.014) for MCF-7 and HT-29-induced aggregation, respectively. Supporting this finding, cancer patients on ticagrelor had significantly reduced levels of spontaneous platelet aggregation and activation compared with baseline; 14.8 ± 2.7% at baseline to 7.8 ± 2.3% with ticagrelor (p = 0.012). Conclusions: Our findings suggested that P2Y12 inhibition with ticagrelor might reduce spontaneous platelet aggregation and activation in patients with metastatic cancer and merits further investigation in patients at high risk of cancer-associated thrombosis. (Ticagrelor-Oncology [TICONC] Study; EudraCT: 2014-004049-29)

Background Although the standard of care for anterior abdominal gunshot wounds (AAGSWs) is immediate laparotomy, these operations are associated with a high rate of negativity and potentially serious complications. Recent data suggest the possibility of selective non-operative management (SNOM) of AAGSWs, but none implicate body mass index (BMI) as a factor in patient selection. Anecdotal experience at our trauma center suggested a protective effect of obesity among patients with AAGSWs, and given the exceptionally high rate of obesity in the Bronx, we sought to analyze the associations of AAGSWs and BMI to inform future trauma research and management. In this study, we aimed to evaluate whether BMI is associated with injury severity, resource utilization, and clinical outcomes of AAGSWs. Methodology From our prospectively accrued trauma registry, we retrospectively abstracted all patients greater than 16 years old with Current Procedural Terminology codes associated with gunshot wounds from 2008 to 2016. The electronic medical record was reviewed to define a cohort of patients with at least one AAGSW. Patients were divided into the following cohorts based on BMI: underweight (UW, BMI

Heart failure affects 6.5 million Americans, with 1 million hospitalizations annually, a 22% readmission rate, and $31 billion in health care costs. Palliative care decreases symptom burden, readmissions, and costs. Many elderly patients have difficulty recognizing and reporting heart failure symptoms to their providers in a timely manner. Self-management tools with color-coded zones (green = "all clear," yellow = "caution," red = "take action") help patients recognize and respond to heart failure symptoms and reduce readmissions. The purpose of this quality improvement project was to develop, implement, and evaluate a low-literacy zone tool for heart failure self-management with home-based palliative care patients. An interdisciplinary palliative care team developed this zone tool. Health literacy was prescreened with the Newest Vital Sign instrument. Nurses provided the zone tool to patients and caregivers and instructed them in use of this tool for daily self-monitoring. In postimplementation surveys, participants rated the zone tool as easy to understand and helpful in recognizing and reporting symptoms. This project demonstrated feasibility of a new zone tool for heart failure self-management, resulting in a practice change for this home-based palliative care program. The interdisciplinary team eventually developed similar zone tools for cancer, cirrhosis, chronic obstructive pulmonary disease, dementia, and frailty self-management.

This article provides a description of the development, implementation, and preliminary evaluation of feasibility and acceptability of the Managing Youth Trauma Effectively (MYTE) program and highlights perceptions of changes in mothers' trauma-informed parenting practices. The program consists of a training and consultation program for staff of the U.S. State of Arkansas' Specialized Women's Programs (SWS), and an 8-week, group psychoeducational program designed to help mothers with substance-abuse problems learn how traumatic experiences may affect their children and how they may help support their children by creating a safe and nurturing environment. A posttraining evaluation with leadership and staff at SWS centers, feedback provided on consultation calls with MYTE facilitators, and a retrospective pre/post survey were used to examine feasibility, acceptability, and perceptions of changes in mothers' trauma-informed parenting practices. Preliminary results suggest that the MYTE program is feasible to implement and is acceptable to training participants, facilitators, and mothers participating in the program. Mothers reported significant growth in their perceptions of use of trauma-informed parenting practices. Future research is necessary to confirm these results and examine the effectiveness of the program using a randomized clinical trial.

There is little information on symptom prevalence and severity in advanced soft-tissue sarcoma (STS). Understanding symptom burden will aid clinical consultations, clarify which symptom interventions are needed, and better define optimum timings of palliative and supportive care referrals.To describe symptom prevalence and severity in patients undergoing different treatment options for advanced STS: 1) first-line palliative chemotherapy (FLC), 2) active surveillance (AS) pre- and post-FLC, and 3) palliative care (PC) alone.Cross-sectional survey in one sarcoma center using the patient-reported Memorial Symptom Assessment Scale-Short Form (MSAS-SF). Symptom prevalence, severity, and MSAS-SF subscales were recorded before commencing a new treatment. Our results were compared with other MSAS-SF cancer and noncancer data.One-hundred and thirteen patients (mean age, 59 years) were recruited. Forty-two commenced FLC, 27 started AS pre-FLC, 24 AS post-FLC, and 20 PC alone. Median overall number of reported symptoms was 11 (range 1-31): which when stratified by treatment meant AS pre-FLC AS post-FLC FLC PC alone (most symptomatic). The commonest physical symptoms were pain (77%; 95% CI 68-84), lack of energy (73%; CI 63-81) difficulty sleeping (56%; CI 46-65), feeling bloated (49%; CI 39-58), and dyspnea (49%; CI 39-58). Distress levels were commensurated with prevalence except for dyspnea, which was disproportionally less distressing. Psychological distress was moderate (mean MSAS-PSYCH: 1.39) but higher than comparative cancer data.Advanced STS patients have a clinically important symptom burden comparable to other cancers. Common symptoms should be screened and addressed appropriately, including timely PC involvement.

Heart disease and diabetes are among the leading causes of morbidity and mortality. Diabetes can result in diabetic cardiomyopathy, which further increases the risk of heart failure and mortality in diabetic patients. Diabetic cardiac injury has been associated with altered mitochondrial quality control mechanisms including mitophagy, a selective autophagy in which dysfunctional mitochondria are degraded through the lysosome. Lysophagy is the elimination of injured lysosomes by healthy lysosomes which is extremely important for all forms of autophagy. In the present study, we examined the functional status of mitophagy-lysosome system in the diabetic mouse heart. Cardiac mitophagy and lysophagy were determined by using novel dual fluorescent reporter mice, namely, mt-rosella that express mitochondria-targeted RFP-GFP fusion protein and tfgal3 that express RFP-GFP-galectin3, a galactoside-binding lectin. Mice were fed a high fat diet (60%calories by fat) for 1 month and then injected i.p. with streptozotocin (30 mg/kg/d for 3 days). Mice continued on HFD for additional 3 months. Echocardiographic data showed impaired cardiac function in the diabetic mice. Merged confocal images demonstrated that diabetes increased mitophagy flux in the heart as indicated by the red puncta from mt-Rosella and the mitochondrial LC3-II levels with and without lysosomal protease inhibitors pepstatin A and E64d. In addition, diabetes triggered lysosomal injury in the heart as shown by the increased total number of puncta (yellow plus red) from tfgal3 reporter on the merged confocal images. This was associated with accelerated lysophagy flux as shown by the red puncta, suggesting that the injured lysosomes were being actively degraded in the diabetic heart. The increased lysophagy may have contributed to the increased mitophagy flux since the enhanced elimination of injured lysosomes would be expected to help maintain a pool of healthy lysosomes which is essential for the efficient execution of all forms of autophagy. In summary, our results showed an enhanced mitophagy-lysosome system in the diabetic heart which may be an adaptive response that serves to limit diabetic cardiac injury.

Background In patients with cognitive impairments who are unable to self-report pain, nurses must rely on behavioral observation tools to assess and manage pain. Although frequently employed in medical-surgical units, evidence supporting the psychometric efficacy of the Pain in Advanced Dementia (PAINAD) for pain screening in older adults with delirium is lacking. Aim To examine the psychometrics of the PAINAD for older adults with delirium in medical-surgical settings. Design A descriptive repeated measures design. Setting Medical-surgical units in an urban tertiary care hospital. Participants Sixty-eight older adults with delirium. Methods Patients with delirium unable to self-report pain were screened by two data collectors with the PAINAD and the Critical Care Pain Observation Tool (CPOT). Patients with a PAINAD score ≥3 or a CPOT score ≥2 received a pain intervention. Pain assessments were repeated 30 minutes post baseline or pain intervention. Results Patients were predominately female (58.8%) with dementia (71%). Thirty-nine patients screened positive for pain and received a pain intervention. PAINAD reliability was strong (Cronbach's α = 0.81-0.87; interrater intraclass coefficients [ICC] = 0.91-0.94; test-retest ICC = 0.76-0.77). Construct validity was supported by a statistically significant interaction effect between time (baseline versus follow-up) and condition (pain intervention versus no pain group; Rater 1: F(1,66) = 8.31, p = 0.005, ηp2 = 0.11; Rater 2: F(1,66) = 8.22, p = 0.006, ηp2 = 0.11. Conclusions The PAINAD is a reliable and valid tool for pain screening for older adults with delirium in medical-surgical settings. Clinical Implications Pain and delirium frequently co-occur in the older adult population. Best practices require a holistic assessment for contributing pain and non-pain factors in patients exhibiting distress.

ObjectivesPrognostic disclosure among patients with cancer permits open informed discussion about treatment preferences and encourages advance care planning. In rare cancers such as soft tissue sarcoma, discussions regarding prognostication are challenging. Little is known about the consequences of this for patients or their preferences for such information. This qualitative study explores patient-centered accounts of the value and timing of prognostic discussions.Methods24 semistructured interviews were conducted with soft tissue sarcoma patients attending one London cancer centre: 66% female, median age 53 (range 19–82). The study was cross-sectional and participants were at different stages of the advanced disease trajectory. Interviews were digitally recorded, transcribed verbatim and analysed thematically using the framework approach.ResultsAll participants understood the incurable nature of advanced sarcoma. However, prognostic discussions were rare, always patient initiated and did not include known survival data, despite direct participant enquiry. Most participants did not wish to discuss prognosis at initial diagnosis but wished to be offered the opportunity to discuss this at intervals of disease progression, despite reservations it may not be helpful. Participants expected discussions to be clinician initiated. Three themes emerged to explain this position and included (1) Rarity causing prognostic uncertainty referring to patient belief that prognostication in rare cancers was less likely to be accurate than for common tumours; (2) Avoiding the negatives referring to a wish not to hear unfavourable information and (3) Physical symptoms a better prognostic indicator than ‘physician guess’.ConclusionsAlthough 17/24 participants preferred not to discuss prognosis at initial diagnosis, they wished to have the opportunity to revisit prognostic discussions at intervals of disease progression. This may facilitate better advance care planning and end of life care.

The burden and experiences that come with a breast cancer diagnosis in a family impact how women perceive personal cancer risk and pursue preventive strategies and/or early detection screening. Hence, this study sought to understand how Filipino women incorporate their experiences living with a sister diagnosed with early-onset breast cancer to their personal perceived risk and screening behavior. Guided by phenomenological approach of inquiry, a face-to-face, semi-structured interview was conducted with 12 purposively sampled women with a female sibling diagnosed with breast cancer before age 50. Transcripts were analyzed using thematic analysis. Results revealed that the respondents tend to compare themselves with their sister when constructing views of personal cancer vulnerability. The subjective risk is also shaped by their beliefs regarding cancer causation such as personalistic causes, personal theory of inheritance, and locus of control. Their sisters’ cancer diagnoses serve as a motivation for them to perform breast self-examination. However, clinical breast examination and screening mammography are underutilized due to perceived barriers such as difficulty allotting time to medical consultation, fear, and lack of finances. Overall, cancer risk perception and screening behavior are important factors that must be addressed during cancer genetic counseling consultations. Better understanding of these factors will aid in the formulation of an effective management plan for at-risk women.

Background: We compared the effectiveness and cost of a pain screening and treatment program, with usual care in head and neck cancer patients with significant pain. Methods: Patients were screened for the presence of pain and then randomly assigned to either an intervention group, consisting of a pain treatment protocol and an education program, or to usual care. Primary outcome was change in the Pain Severity Index (PSI) over three months. Results: We screened 1074 patients of whom 156 were randomized to either intervention or usual care. Mean PSI was reduced over three months in both groups, with no significant difference between the two groups. The Pain Management Index (PMI) at three months, was significantly improved in the intervention group compared with usual care (P

Osteoarthritis (OA) is a degenerative and non-inflammatory disorder of movable joints. Depression may be a reaction to pain in osteoarthritis (Romano, 2013). The study aims to determine the prevalence of depression among OA clients by determining the degree of depression and a significant difference in depression according to some factors. Purposive, convenience and quota sampling were used. 3 respondents were taken per barangay of 129 barangays in Baguio City. Responses were tallied and subjected to a percentage, t-test, and f-test. The degree of depression of OA clients is normal ups and downs with 191/351(54.42%) respondents. Results show significant differences with genetics and history of bone injury to depression of OA clients and no significant differences as to age, sex, BMI, co-morbidity, occupation, history of joint injury and congenital deformities. There are individuals classified as “clinically depressed”, implying that although results are statistically insignificant, it is clinically significant. Discussions on the management of OA should be holistic and integrated into the curriculum. Nurses should individualize care for OA clients because of their different biopsychosocial effects.

Objective Soft tissue sarcoma (STS) is a rare cancer type that when locally advanced or metastatic, is predominantly treated with palliative chemotherapy with the aim of improving both quantity and quality of life. Given modest survival data after commencing first line chemotherapy, this study examines (i) what constitutes health related quality of life (HRQoL), (ii) whether the most commonly used HRQoL assessment tool measures this and (iii) to what extent HRQoL, and its components, change during and after treatment. Design Mixed-methods longitudinal study of 66 sarcoma patients living with STS (42 commencing chemotherapy, 24 under surveillance after completing chemotherapy) involving serial EORTC QLQ-C30 questionnaires and nested-qualitative semi-structured interviews with a sub-sample of participants. EORTC QLQ-C30 score change from baseline to primary evaluation point was examined using a paired t-test. Interviews were analysed using the framework approach before both datasets were integrated. Results Five main factors, including control of pain, were identified by study participants as important components of HRQoL; these are examined within the EORTC QLQ-C30. However, others e.g. independence loss and common causes of anxiety, are not. Whilst social and psychological domains are addressed by the EORTC QLQ-C30, the quantitative change over time did reflect qualitative descriptions of decline. The mean overall EORTC QLQ-C30 HRQoL score deteriorated from baseline (60.4) to the primary evaluation point (50.2) [change of -10.2, t-test: -2.70, p = 0.01] for those receiving chemotherapy; this was in concordance with patients’ qualitative accounts. Baseline overall HRQoL scores were higher in the surveillance group suggesting a correlation with chemotherapy response and longer-term improvement in HRQoL. The evidence from both HRQoL scores and qualitative accounts indicated that the presence and control of physical symptoms were particularly important in maintaining HRQoL. Whilst fatigue deteriorated on chemotherapy (baseline 41.7 to 52.8; change of +11.1, t-test +2.51, p

ObjectiveThe purpose of the NINDS CDE project is to educate new clinical investigators, increase efficiency and effectiveness of clinical research studies and treatment, increase data quality, facilitate data sharing, significantly reduce study start-up time, and more effectively aggregate information into significant metadata results. In 2016, as part of the NINDS CDE project to develop data standards for all clinical neuroscience research, NINDS, NIH and the DoD initiated the development of Sport-Related Concussion (SRC) CDEs.BackgroundTBI CDE recommendations were published on the NINDS CDE website in 2010, but lacked a thorough inclusion of SRC. In August 2016, a new SRC-specific working group (WG) began developing and identifying CDEs, template case report forms (CRFs), and guidelines to assist investigators conducting SRC-specific clinical research studies.Design/methodsThe CDE WG, which consisted of 34 worldwide SRC research experts, met regularly via teleconference over several months. The WG was divided into 3 subgroups to examine SRC during defined periods relative to time of injury: Acute (72 hours post-concussion), Sub-Acute (3 days-3 months post-concussion) and Persistent/Chronic (3 months and greater post-concussion).ResultsVersion 1.0 of the SRC CDEs were available on the NINDS CDE website in June 2017. These include Core and Supplemental, Highly Recommended CDEs or instruments for cognitive measures and symptom checklists, as well as, other outcomes and endpoints, and sample CRFs for domains typically included in clinical research studies (e.g., vestibular, oculomotor, balance, anxiety, depression).ConclusionThe NINDS CDEs are reviewed and updated regularly as research advancements or changes to specific recommendations are deemed appropriate. Because the CDEs are an evolving resource, continued feedback is important for improved use and utility. The use of SRC CDE recommendations is highly encouraged for SRC related researchers as they serve as a valuable starting point and facilitate streamlining and sharing data.

Layer V pyramidal neurons (LVPNs) within the motor cortex integrate sensory cues and co-ordinate voluntary control of motor output. In amyotrophic lateral sclerosis (ALS) LVPNs and spinal motor neurons degenerate. The pathogenesis of neural degeneration is unknown in ALS; 10% of cases have a genetic cause, whereas 90% are sporadic, with most of the latter showing TDP-43 inclusions. Clinical and experimental evidence implicate excitotoxicity as a prime aetiological candidate. Using patch clamp and dye-filling techniques in brain slices, combined with high-resolution confocal microscopy, we report increased excitatory synaptic inputs and dendritic spine densities in early presymptomatic mice carrying a TDP-43Q331K mutation. These findings demonstrate substantive alterations in the motor cortex neural network, long before an overt degenerative phenotype has been reported. We conclude that increased excitatory neurotransmission is a common pathophysiology amongst differing genetic cases of ALS and may be of relevance to the 95% of sporadic ALS cases that exhibit TDP-43 inclusions.

While maternal substance use problems increase the likelihood of behavior problems in children, child outcomes are varied, leading to interest in understanding additional family factors that contribute to the development of behavior problems in children impacted by maternal substance abuse. The purpose of this study is to examine harsh parenting and family conflict as potential moderators of the relationship between symptoms of maternal substance use problems and child externalizing behavior problems. The non-clinical sample for this study included 250 low-income parents whose preschool age children were enrolled in Head Start programs in a Southern state. This study utilized data collected during two home visits, an average of 10 months apart, with data on family functioning and maternal symptoms of substance use problems collected at the first time point and child externalizing behavior collected at the second time point. Over one-third of the children (38.1 %) had clinically elevated externalizing behavior scores. We used regression analysis to examine whether harsh parenting or family conflict moderated the relationship between maternal substance use symptoms and child externalizing behavior. In this community sample, we found that in the absence of family risks related to harsh parenting and family conflict, maternal symptoms of substance use problems did not have a significant impact on child externalizing behavior in preschool children. However, when high levels of family conflict or harsh parenting were present, symptoms of maternal substance use problems increased the risk of externalizing behavior problems in children.

This study aimed to assess the palliative care needs of progressive idiopathic fibrotic interstitial lung disease (PIF-ILD) populations in two London ILD centres. Patients’ records from Royal Brompton Hospital (RBH) and King’s College Hospital (KCH) were extracted to assess palliative care needs, use of palliative treatments, and whether end-of-life preferences were documented and achieved. Forty-five PIF-ILD patients were identified (26 RBH, 19 KCH). Patients at RBH were younger (37–81 years, median = 61 years) and predominantly white British (23/26) compared to KCH’s older, more racially diverse population (70–99 years, median = 82 years, 6/19 nonwhite). Seventeen of 45 patients had specialist palliative care team involvement. Nearly all patients (42/45) experienced breathlessness in their last year of life. Additional symptoms included cough, fatigue, depression/anxiety, and chest pain. All patients given opioids (22/45) or benzodiazepines (8/45) had documented benefit. Nonpharmacological treatments were rarely used. Few patients had preferred place of care (8/45) or preferred place of death (6/45) documented. Despite demographic variation, the patient populations at the two hospitals experienced similar symptoms. There was use of standard pharmacological treatments with symptom benefit. Nonpharmacological interventions were seldom used and documentation of preferred place of care and preferred place of death was poor.

Efforts to promote awareness and management of chronic pain have been accompanied by a troubling increase in prescription medication abuse. At the same time, some patients may misuse substances in an effort to manage chronic pain.This study examines self-reported substance misuse for pain management among veterans and identifies the contributing factors.We analyzed cross-sectional data from the Help Veterans Experience Less Pain study.Of 343 veterans, 35.3% reported an aberrant pain management behavior (24% reported using alcohol, 11.7% reported using street drugs, and 16.3% reported sharing prescriptions to manage pain). Poorer mental health, younger age, substance use disorders (SUDs), number of nonpain symptoms, and greater pain severity and interference were associated with aberrant pain management behaviors. In multivariate analysis, SUDs (odds ratio [OR]: 3.9, 95% confidence interval [CI]: 2.3-6.7, P0.000) and poorer mental health (OR: 2.3, 95% CI: 1.3-4.3, P=0.006) were associated with using alcohol or street drugs to manage pain; SUDs (OR: 2.4, 95% CI: 1.3-4.4, P=0.006) and pain interference (OR: 1.1, 95% CI: 1.0-1.2, P=0.047) were associated with prescription sharing; and SUDs (OR: 3.6, 95% CI: 2.2-6.1, P0.000) and number of nonpain symptoms (OR: 6.5, 95% CI: 1.2-35.4, P=0.031) were associated with any aberrant pain management behavior.Veterans with a history of SUDs, greater pain interference, more nonpain symptoms, and mental health concerns should be carefully managed to deter substance misuse for pain management.

TOPIC. Total pain theory. PURPOSE. Describe total pain theory and apply it to research and practice in advanced heart failure (HF). SOURCE OF INFORMATION. Total pain theory provides a holistic perspective for improving care, especially at the end of life. In advanced HF, multiple domains of well-being known to influence pain perception are adversely affected by declining health and increasing frailty. A conceptual framework is suggested which addresses domains of well-being identified by total pain theory. CONCLUSION. By applying total pain theory, providers may be more effective in mitigating the suffering of individuals with progressive, life-limiting diseases.

Depression and anxiety frequently co-occur with pain and may affect treatment outcomes. Early identification of these co-occurring psychiatric conditions during routine pain screening may be critical for optimal treatment.To determine aspects of pain related to psychological distress, and, among distressed patients, to determine whether pain factors are related to provider identification of distress.Cross-sectional interview of primary care patients and their providers participating in a Veteran's Administration HELP-Vets study.A total of 528 predominately male VeteransWe measured self-reported pain, including a 0-10 numeric rating scale and interference items from the Brief Pain Inventory. To evaluate distress, brief indicators of depression, anxiety and PTSD were combined. A substantial number of patients had psychological distress (41%), which was even higher (62%) among patients with moderate-severe current pain. Only 29% of those with distress reported talking to their provider about emotional problems during their visit. In multivariate analyses, other pain factors related to distress included interference with enjoyment of life and relationships with others, pain in multiple locations and joint pains. Prior diagnoses of depression and anxiety were also related to current distress. Only prior diagnosis and patient reported headaches and sleep interference because of pain were related to provider identification of distress.VA patients with moderate-severe pain are at high risk for psychological distress, which often goes unrecognized. Providers need to be more vigilant to mental health problems in patients experiencing high pain levels. Targeted screening for co-occurring conditions is warranted.

Objective: To determine prospectively the impact of switching treatment-experienced patients with virologic failure to a salvage regimen with or without a 12-week structured treatment interruption (STI). The primary endpoint was the percentage of patients with a 3-month sustained HIV RNA level

Background Malnutrition among skilled nursing facility (SNF) patients can lead to hospital readmissions and multiple complications. Purpose To evaluate the effect of an existing malnutrition screening and management program on prealbumin levels of patients in skilled nursing facilities. Methods A retrospective design was used to evaluate baseline admission data including a prealbumin level. Patients with malnutrition received an oral protein supplement according to protocol. A comparison prealbumin level was obtained at 30days. Results Nearly half of the patients were severely malnourished on admission. Patients receiving the prescribed protocol had significantly increased prealbumin levels at 30days than those patients that did not receive the protocol as prescribed. Conclusion A prealbumin level upon admission at a SNF could represent a reliable tool to evaluate malnutrition. Initiation of an early malnutrition screening and protein supplement program in this setting is essential to identifying and treating at-risk patients before complications occur.

Glycoprotein IIb/IIIa receptor antagonists have been shown to have an impact on the outcomes of death/myocardial infarction (MI) in patients undergoing percutaneous coronary intervention. At our institution, tirofiban has largely replaced abciximab in an attempt to decrease costs.To assess the impact of this change on patient outcomes in the absence of head-to-head trials.Medical records were reviewed and telephone follow-ups were conducted on patients receiving tirofiban (n = 83) at our facility between February and November 1999. Death/MI at 30 days and 6 months after infusion were recorded. Safety and length of stay (LOS) were also assessed. These data were compared using chi2 analysis with results obtained from a previous review of abciximab use (n = 83) collected between May 1997 and November 1998.There was no difference in the baseline incidence of (1) cardiovascular risk factors, (2) prior revascularization, (3) prior MI, (4) the number of vessels with atherosclerotic disease assessed by angiography, and (5) the number of vessels receiving procedures. Death/MI trended to be worse with tirofiban versus abciximab at our institution at 30 days (4.8% abciximab vs. 12% tirofiban; p = 0.163) and 6 months (6% abciximab vs. 18.1% tirofiban; p = 0.032). Bleeding and median LOS (3 d abciximab vs. 3 d tirofiban) were not different. Despite an increase in pharmacy cost, the use of abciximab provided these outcomes without an increase in total hospital cost.The perceived economically driven change in medication selection from abciximab to tirofiban may not have been appropriate based on the negative trends seen in this review. To maintain optimal patient outcomes, this change should be reevaluated.

Contains fulltext : 80963.pdf (Publisher’s version ) (Open Access) BACKGROUND: The extent to which mortality differs following individual acquired immunodeficiency syndrome (AIDS)-defining events (ADEs) has not been assessed among patients initiating combination antiretroviral therapy. METHODS: We analyzed data from 31,620 patients with no prior ADEs who started combination antiretroviral therapy. Cox proportional hazards models were used to estimate mortality hazard ratios for each ADE that occurred in >50 patients, after stratification by cohort and adjustment for sex, HIV transmission group, number of antiretroviral drugs initiated, regimen, age, date of starting combination antiretroviral therapy, and CD4+ cell count and HIV RNA load at initiation of combination antiretroviral therapy. ADEs that occurred in

Objective: To determine the effect of maternal calcium supplementation during pregnancy on fetal bone mineralization. Methods: Healthy mothers with early ultrasound confirmation of dates and singleton pregnancies were enrolled in a double-masked study and randomized before 22 weeks’ gestation to 2 g/day of elemental calcium or placebo until delivery. Maternal dietary intake at randomization and at 32–33 weeks’ gestation was recorded with 24-hour dietary recalls. Dual-energy x-ray absorptiometry measurements of the whole body and lumbar spine of the neonates were performed before hospital discharge. Results: The infants of 256 women (128 per group) had dual-energy x-ray absorptiometry measurements during the first week of life. There were no significant differences between treatment groups in gestational age, birth weight, or length of the infants, or in the total-body or lumbar spine bone mineral content. However, when bone mineral content was analyzed by treatment group within quintiles of maternal dietary calcium intake, total body bone mineral content (mean ± standard error of the mean) was significantly greater in infants born to calcium-supplemented mothers (64.1 ± 3.2 versus 55.7 ± 2.7 g in the placebo group) in the lowest quintile of dietary calcium intake (less than 600 mg/day). The effect of calcium supplementation remained significant after adjustment for maternal age and maternal body mass index and after normalization for skeletal area and body length of the infant. Conclusion: Maternal calcium supplementation of up to 2 g/day during the second and third trimesters can increase fetal bone mineralization in women with low dietary calcium intake. However, calcium supplementation in pregnant women with adequate dietary calcium intake is unlikely to result in major improvement in fetal bone mineralization.

Recognize differences in medication utilization by number and class by hospice diagnosis. Original Research Background. Although hospice focuses on the palliation of conditions associated with the terminal prognosis, the potential continuation of preventative and disease-modifying therapies may put hospice patients at risk of polypharmacy. Research Objectives. To describe medication use during the last week of life in hospice patients with cancer, dementia, debility, heart disease, and lung disease. Methods. Retrospective cross-sectional study design of a U.S. nationally representative sample of 695 hospices in the 2007 National Home and Hospice Care Survey. Participants included 2,623 sampled patients ages 65 and older with an primary diagnosis of cancer (49%), dementia (12%), debility (14%), heart disease (16%) or lung disease (10%); receiving end-of-life care during their last week of life. Medication data were obtained from hospice staff familiar with the patients’ care and who were asked, ‘‘What are the names of all the medications and drugs the patient was taking seven days prior to and on the day of his/her death while in hospice? Please include any standing, routine, or PRN medications.’’ Results. Overall, the average number of medications taken was 10.2 (from 9.5 among dementia patients to 11.4 among lung disease patients). Commonly taken drug therapeutic classes includedanalgesics (98%), antiemetics/antivertigos (78%), anxiolytics/sedatives/hypnotics (76%), anticonvulsants (71%), and laxatives (53%). About one-quarter of patients took proton pump inhibitors, anticoagulants, and antidepressants. Less than 20% took antacids and antibiotics. More cancer patients took opioid analgesics than dementia and debility patients.Heartdiseasepatients tended to takediuretics, while lung disease patients tended to take bronchodilators. More dementia and debility patients took antidepressants than cancer and lung disease patients. Conclusions. Older hospice patients took a high number of medications in the last week of life and differences in medication use support individualized care plans. It is unclear how this medication burden affects quality of end-of-life care. Implications for Research, Policy, or Practice. Provides a benchmark for medication utilization for dying patients.

Objective: The study's aim was to determine whether healthy nulliparous women with abnormal glucose tolerance during pregnancy are at increased risk for development of pregnancy-associated hypertension or preeclampsia. Study Design: A series of 4589 healthy nulliparous women from 5 university centers were evaluated prospectively to determine whether calcium supplementation would prevent preeclampsia. Pregnancy-associated hypertension was a diastolic blood pressure ≥90 mm Hg on 2 occasions 4 hours to 1 week apart. Pregnancy-associated proteinuria was proteinuria ≥1+ by dipstick testing on 2 occasions 4 hours to 1 week apart, proteinuria ≥300 mg/24 h, a protein to creatinine ratio of ≥0.35, or a single dipstick measurement of ≥2+. Preeclampsia was defined as pregnancy-associated hypertension and pregnancy-associated proteinuria documented within 7 days of each other. Normal glucose tolerance was a plasma glucose level Results: Calcium supplementation did not prevent pregnancy-associated hypertension or preeclampsia. Of 3689 women with complete glucose testing data, 227 (6%) had abnormal glucose tolerance and 81 (2%) had gestational diabetes mellitus. Compared with women with normal glucose tolerance, women with abnormal glucose tolerance were significantly older, had greater body mass index, and were more likely to be white non-Hispanic, to smoke, and to have private medical insurance. Among women with gestational diabetes mellitus, after adjustment for clinical center the relative risks of preeclampsia and of all hypertensive disorders were increased (relative risk 1.67, 95% confidence interval 0.92-3.05, and relative risk 1.54, 95% confidence interval 1.28-2.11, respectively). Risk ratios were not substantially reduced after further adjustment for race and body mass index (odds ratios 1.41 and 1.48, respectively). Even within the normal range, multivariate analysis demonstrated that the level of plasma glucose 1 hour after a 50-g oral glucose challenge was an important predictor of preeclampsia. Conclusion: Even within the normal range, the level of plasma glucose 1 hour after a 50-g oral glucose challenge was positively correlated with the likelihood of preeclampsia. Women with gestational diabetes mellitus were at increased risk for hypertensive disorders during pregnancy after adjustment for clinical center, race, and body mass index, although the increase was not statistically significant. These findings suggest that insulin resistance may play a role in the pathogenesis of the hypertensive disorders of pregnancy. (Am J Obstet Gynecol 1998;179:1032-7.)

Radiation protection practice requires the knowledge of estimated absorbed radiation doses to aid in the understanding of the potential detriment of various exposures. In nuclear medicine, the radiation doses to the internal organs of the subject are commonly calculated using the MIRD methods and equations. The absorbed dose to the embryo or fetus has long been an area of concern. The recent release of the pregnant female phantom series, and its incorporation into the MIRDOSE 3 computer software, has made possible the estimation of absorbed doses from radionuclides in the body to the fetus in early pregnancy and at 3, 6, and 9 mo gestation. A survey of several major medical institutions was made to determine the radiopharmaceuticals which might be given, whether intentionally or not, to women of childbearing years. Biokinetic data for these radiopharmaceuticals were gathered from various documents and other resources, and the absorbed doses to the embryo and fetus at these different stages of gestation from radiations originating within the mother's organs were estimated. In addition, information about activity distributed within the placenta and fetus was included where quantitative data were available. These absorbed dose estimates can be used to evaluate the risk associated with the use of different radiopharmaceuticals so that a more informed evaluation of the risks and benefits of the different procedures may be made. Further research is needed into the mechanisms and quantitative aspects of the placental transfer of many radiopharmaceuticals.

The prevalence of onchocerciasis infection was determined in communities on 7 rivers located in the northern area of the canton San Lorenzo province of Esmeraldas. Diagnosis of the infection was obtained by skin biopsies and recombinant antigen-based serology. No evidence of infection was detected in 9 communities studied along the Rio Mataje which forms the frontier between Ecuador and Colombia nor in 10 adjacent communities located on 5 interior rivers. Evidence for Onchocerca volvulus infection was found in 4 communities on the Rio Tululvi with the following prevalence: La Boca (3.5% by biopsy and 3.9% by serology) Guayabal (9.1% by both biopsy and serology) La Ceiva (51.5% by biopsy and 53% by serology) and Salidero (4% by biopsy and 7.7% by serology). A few individuals in these communities were seropositive for O. volvulus in the absence of detectable dermal microfilariae: these might harbor very light or prepatent infections. No clinical disease attributable to onchocerciasis was found. The infected communities will be included in the ivermectin-based National Control Program for the disease with no evidence of the infection having extended north of the Ecuadorian/Colombian border. (authors)

Background: While there have been some studies looking at the impact on quality of life of patients with idiopathic pulmonary fibrosis, to date no qualitative research looking at the specialist palliative needs of these patients has been conducted. Aim: This study aims to explore the specialist palliative care needs of people living with end-stage progressive idiopathic fibrotic interstitial lung disease. Design and settings/participants: In total, 18 qualitative semi-structured in-depth interviews were conducted with patients, their informal caregivers and health professionals across two specialist interstitial lung disease centres in London and in the community. Results: Many participants reported uncontrolled symptoms of shortness of breath, cough and insomnia, which profoundly impacted every part of patients’ and informal caregivers’ lives. Psychologically, patients were frustrated and angry at the way in which their illness severely limited their ability to engage in activities of daily living and compromised their independence. Furthermore, both patients and informal caregivers also reported that the disease seriously affected family relationships where strain was pronounced. There was varied knowledge and confidence among health professionals in managing symptoms, and psychosocial needs were often underestimated. Conclusion: This study is the first of its kind to examine in depth the impact of symptoms and psychosocial needs revealing the profound effect on every aspect of progressive idiopathic fibrotic interstitial lung disease patients’ and informal caregivers’ lives. Education and guidance of appropriate palliative care interventions to improve symptom control are needed. A case conference intervention with individualised care plans may help in addressing the substantial symptom control and psychosocial needs of these patients and informal caregivers.

Background: The physical and psychosocial needs of patients with chronic non-malignant lung disease are comparable to those with lung cancer. This article will focus on chronic obstructive pulmonary disease, interstitial lung disease and cystic fibrosis as examples of life-limiting, non-curable and non-malignant lung diseases. The need for supportive and palliative care: Recent national guidance has demanded that palliative care is inclusive of all patients with life-limiting disease, irrespective of diagnosis, and that specialist palliative care teams are involved in the management of patients on a basis of need rather than prognosis. What is known: Despite medical therapy, most patients with moderate to severe chronic obstructive pulmonary disease, interstitial lung disease and cystic fibrosis experience pain, fatigue and dyspnoea, with the majority not getting relief from dyspnoea towards the end of life. Furthermore, dyspnoea causes social isolation and difficulty performing activities of daily living and impairs quality of life. There is an increasing evidence base for the assessment of supportive and palliative care needs, symptom interventions, prognostication, models of service delivery and implications of these for clinical practice and research in non-malignant lung diseases. What is unknown: Despite advances, much still remains unknown regarding assessment, management and prognostication in individual chronic non-malignant lung diseases. Although different service models are being used in clinical practice, the optimal model(s) of service delivery remain unknown. Implication for future research, policy and practice: We describe key areas for further research, which include the need for large, high-quality trials of pharmacological and non-pharmacological interventions and their combinations as well as evaluation of the efficacy and cost-effectiveness of models of care. As access to palliative care is poor for these patients, the barriers to referral need to be understood and reduced, which along with effective working between palliative care teams, with respiratory services backup, should optimise delivery of care in patients with life-limiting non-malignant lung disease.

Background Patients with fibrotic interstitial lung disease have symptom control and quality of life (QoL) needs. This review aims to evaluate the evidence for the use of interventions in improving dyspnoea, other symptoms and QoL. Methods Eleven databases, relevant websites and key journals were hand-searched. Studies were assessed and data extracted independently by two researchers using standardised proformas. Meta-analyses were performed where possible with 95% CI. Results 34 papers with 19 interventions in 3635 patients were included. Meta-analyses showed no significant effect of interferon γ-1b or sildenafil on 6-minute walking distance (6MWD) or dyspnoea. Pulmonary rehabilitation and pirfenidone had a positive effect on 6MWD (mean difference (95% CI) 27.4 (4.1 to 50.7)) and 24.0 (4.3 to 43.7), respectively), and pulmonary rehabilitation had a mixed effect on dyspnoea. Both pulmonary rehabilitation and sildenafil showed a trend towards significance in improving QoL. There was weak evidence for the improvement of 6MWD using oxygen; dyspnoea using prednisolone, diamorphine, D-pencillamine and colchicine; cough using interferon α and thalidomide; anxiety using diamorphine; fatigue using pulmonary rehabilitation; and QoL using thalidomide and doxycycline. A wide range of outcome scales was used and there were no studies with economic evaluation. Conclusions There is strong evidence for the use of pulmonary rehabilitation and pirfenidone to improve 6MWD and moderate evidence for the use of sildenafil and pulmonary rehabilitation to improve QoL. Future recommendations for research would include careful consideration of the dichotomy of radical and palliative treatments when deciding on how symptom and QoL outcome measures are used and data presented.

This study was designed to compare sulfonylurea adherence assessment by providers, patients' self-report, pill counts, and a medication event monitoring system (MEMS-3®) device, and correlate the estimates of metabolic control by provider, patient, and laboratory. Forty-seven outpatient veterans with fair to poor metabolic control of non-insulin-dependent diabetes mellitus were enrolled and received monthly refills of sulfonylurea in vials with a cap containing an electronic medication monitoring microprocessor. Pill counts and fasting plasma glucoses were measured monthly, and glycohemoglobin and a 24-hour diet recall were obtained at 0 and 60 days. Investigators then asked providers and patients to assess adherence and metabolic control. Forty-seven percent were nonadherent to medication using MEMS-3®, 29% using pill counts, 29% using provider assessment, and 31 % using self-report. Thirty-one percent of providers and 53% of patients assessed metabolic control differently than laboratory values. Assessment of medication adherence by provider, patient, and pill counts did not explain metabolic control as closely as assessment by MEMS-3®.

Background We examined child and family factors associated with teacher-reported behavior problems in 79 children of substance abusers (COSAs). Method Using regression models, we examined the impact of four family risk factors, cumulatively and individually, on children's behavior and explored children's engagement of adults as a protective factor. Results More than half (55%) of children had clinically elevated behavior problems. Cumulative family risks were associated with increased problems, whereas the presence of a father in the home and the child's ability to engage adults were protective. Conclusions These findings may help explain the variation in behavioral outcomes of COSAs.

Vitamin D and calcium affect several pathways involved in inflammation, tumor growth, and immune surveillance relevant to carcinogenesis. Also, epidemiologic evidence indicates that calcium and vitamin D may reduce risk for developing colorectal adenomas and cancer. To investigate the effects of calcium and vitamin D on biomarkers of inflammation in colorectal adenoma patients, we conducted a pilot, randomized, double-blind, placebo-controlled, 2 × 2 factorial clinical trial (n = 92) of 2 g/d calcium and/or 800 IU/d vitamin D3 supplementation versus placebo over 6 months. Plasma concentrations of proinflammatory markers [C-reactive protein (CRP), TNF-α, interleukin (IL)-6, IL-1β, and IL-8] and an anti-inflammatory marker (IL-10) were measured using ELISAs. After 6 months of treatment, in the vitamin D3 supplementation group, CRP decreased 32% overall (P = 0.11), 37% in men (P = 0.05), and 41% among non–nonsteroidal anti-inflammatory drug (NSAID) users (P = 0.05) relative to placebo. In the vitamin D3 supplementation group, TNF-α decreased 13%, IL-6 32%, IL-1β 50%, and IL-8 15%; in the calcium supplementation group, IL-6 decreased 37%, IL-8 11%, and IL-1β 27%. Although these changes were not statistically significant, a combined inflammatory markers z-score decreased 77% (P = 0.003) in the vitamin D3 treatment group overall, 83% (P = 0.01) among men, and 48% among non-NSAID users (P = 0.01). There was no evidence of synergy between vitamin D3 and calcium or effects on IL-10. These preliminary results are consistent with a pattern of reduction in tumor-promoting inflammation biomarkers with vitamin D3 or calcium supplementation alone and support further investigation of vitamin D3 as a chemopreventive agent against inflammation and colorectal neoplasms. Cancer Prev Res; 4(10); 1645–54. ©2011 AACR.

Although dyspnea and fatigue are hallmark symptoms of heart failure (HF), the burden of pain may be underrecognized. This study assessed pain in HF and identified contributing factors. As part of a multicenter study, 96 veterans with HF (96% male, 67 ± 11 years) completed measures of symptoms, pain (Brief Pain Inventory [BPI]), functional status (Functional Morbidity Index), and psychological state (Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2). Single items from the BPI interference and the quality of life-end of life measured social and spiritual well-being. Demographic and clinical variables were obtained by chart audit. Correlation and linear regression models evaluated physical, emotional, social, and spiritual factors associated with pain. Fifty-three (55.2%) HF patients reported pain, with a majority (36 [37.5%]) rating their pain as moderate to severe (pain ≥ 4/10). The presence of pain was reported more frequently than dyspnea (67 [71.3%] vs. 58 [61.7%]). Age (P = 0.02), psychological (depression: P = 0.002; anxiety: P = 0.001), social (P < 0.001), spiritual (P = 0.010), and physical (health status: P = 0.001; symptom frequency: P = 0.000; functional status: P = 0.002) well-being were correlated with pain severity. In the resulting model, 38% of the variance in pain severity was explained (P < 0.001); interference with relations (P < 0.001) and symptom number (P = 0.007) contributed to pain severity. The association of physical, psychological, social, and spiritual domains with pain suggests that multidisciplinary interventions are needed to address the complex nature of pain in HF. © 2009 Elsevier Ltd.

OBJECTIVE. We investigated the specific type of occupational therapy intervention used by occupational therapists during inpatient stroke rehabilitation in one midwestern U.S. hospital to determine the frequency of prefunctional versus functional activity use. METHOD. A retrospective chart analysis was conducted of clients who received inpatient stroke rehabilitation between January 2003 and June 2004. Type of intervention, intervention strategies, and adaptive equipment use were recorded for each session provided. RESULTS. The majority of sessions (65.77%, n = 1,022) consisted of activities that were prefunctional in nature compared with 48.26% (n = 750) that focused on activities of daily living. Musculoskeletal intervention strategies were used in more than half (52.25%) of the sessions. CONCLUSION. More sessions were spent on prefunctional than on functional activities, and musculoskeletal intervention strategies were most common. Future research studies are warranted to determine the most effective intervention for this client population.

Although the use of ultrasound in the treatment of soft tissue injuries has been widely adopted by physiotherapists, relatively few investigations into its effectiveness have been undertaken. Of 18 studies identified, almost all were found to be methodologically flawed. These flaws included a lack of control groups, poor matching of groups, failure to adopt a double-blind design and a lack of statistical analysis. Variation in the parameters of ultrasound treatment and assessment measures are also explored. Only one study incorporating a placebo group found response to ultrasound to be superior to response to placebo and this review concludes that the case for ultrasonic treatment of soft tissue injuries is not well founded at present. The need to conduct well-controlled, discriminative studies employing standardised criteria is discussed. The standardisation of diagnostic, treatment and assessment criteria permits meaningful comparisons between studies and, where appropriate, pooling of data. This in tur...

Background: Progress has been made in addressing pain in specific diseases such as cancer, but less attention has focused on understanding pain in nonmalignant states, including heart failure (HF). Methods and Results: From March 2006 to June 2007, 672 veterans were surveyed and scores for the Brief Pain Inventory, pain distress, clinically significant pain levels (moderate to severe pain), and pain locations were compared using univariate and multivariate models. Fifteen percent of the final sample had HF (95/634). In our study, the HF patients were older (P < .000), reported lower levels of general health (P = .018), had more co-morbidities (P < .000), were more likely to have a history of cancer (P = .035), and suffered more chest pain and fewer headaches (P = .026, P = .03, respectively) than their non-HF cohorts. When controlling for age, co-morbidity and cancer disorders, HF and non-HF patients did not differ in pain severity, interference, distress or locations. Of the patients currently experiencing pain, 67.3% of HF patients and 68.4% of non-HF patients rated their pain as moderate or severe (pain ≥4 on a 0 to 10 scale). Conclusions: Although HF has not been identified as a painful condition, this study suggests the burden of pain is significant for both HF and non-HF ambulatory care patients. © 2009 Elsevier Inc. All rights reserved.

Fear of engendering addiction is frequently reported as both a provider and a patient barrier to effective pain management. In this study, a clinical scenario ascertained nursing staff members' usual practice in addressing addiction fears for patients with concerns about the addictive potential of pain medication. One hundred forty-five Veterans Health Administration nursing staff members from eight ambulatory care sites were queried to identify variables associated with proclivity to address patient fears about addiction risks in a population where pain is prevalent and the risk for substance abuse is high. Regarding addressing addiction concerns, 66% of nursing staff were very likely, 16% somewhat likely, 9% unsure, 6% somewhat unlikely, and 2% very unlikely to take action. Health technicians were less likely to address addiction concerns than registered or licensed vocational nurses (odds ratio [OR] 0.116; p=.004). Nursing staff with more years' experience (OR 1.070; p=.005) and higher levels of self-efficacy/confidence (OR 1.380; p=.001) were more likely to engage in discussions related to addiction risks. Targeted efforts to improve pain management activities should focus on retaining experienced nursing staff in initial assessment positions and improving the skills and confidence of less experienced and less skilled staff.

Submental intubation is a simple, safe, low morbidity technique for operative airway management in maxillofacial trauma patients, when there are fractures involving the nasal region and concomitant dental occlusal disturbances.Severe maxillofacial injuries usually require intraoperative intermaxillary fixation to achieve optimum reduction of fractures and access to the nasal pyramid. Thus herein, we review certain articles pertaining to submental intubation, its anatomic relevance, technique, indications, contraindications, and modifications in this technique.

Ludwig's angina is a severe life-threatening odontogenic infection, with severe diffuse cellulitis that presents as an acute onset with the rapid spread. It anatomically involves the bilateral submandibular and sublingual spaces and the submental space which results in a state of emergency. Early diagnosis and immediate treatment planning could be the choice of management. The appropriate use of parenteral antibiotics, airway protection techniques, and formal surgical decompression of the spaces remains the standard protocol of treatment. Here, we present a case in a 31-year-old male with widespread odontogenic infection originating from a pericoronal infection, extending to the neck with an elevation of the floor of the mouth and obstruction of the airway.

Approximately 3000 women of childbearing age are afflicted with spinal cord injuries each year and many experience temporary amenorrhea immediately following injury. In the present study, the effect of mid-thoracic spinal contusions on the rat estrous cycle was examined. The sixteen rats used for this study all had 4-day cycles (proestrus, estrus, metestrus, diestrus), as determined during the 2 weeks prior to injury. Following contusion at the T8 spinal level (made using the Infinite Horizon impactor device), seven of the animals (44%) experienced a temporary interruption in the progression of the estrous cycle (mean of 9.4 days delay), which was not correlated with impact force or total damage at the lesion epicenter. The presence of a delay was, however, correlated with damage/sparing of ventromedial white matter at the lesion epicenter. The results indicate that the rat's hormonal status is an experimental variable that is present during the acute phase following spinal cord injury. The temporary nature of the cycle delay may reflect compensatory mechanisms related to the dual innervation (spinal and vagal nerve supply) of the ovaries.

Objective This study examined cultural factors that may influence child physical abuse reporting. Relevant cultural factors such as the respondents’ ethnic identity and corporal punishment acceptability were investigated as proximal variables of ethnicity that affect child physical abuse reporting tendencies. Method Participants consisted of 378 Caucasian, Hispanic, and African American college students. Participants read 12 vignettes that varied the ethnicity of the child and described a parent using physical punishment with the child. Participants’ level of ethnic identity and their acceptance of different discipline practices were also assessed. Data were analyzed using multiple regression procedures. Results The ethnicity of the respondent was a significant predictor of reporting tendencies for African American respondents only. For African Americans, higher levels of ethnic identity and acceptance of corporal punishment were significant mediators of reporting tendencies, which influenced the relationship between ethnicity and likelihood to report a child of the same ethnicity. Conclusion The results of this study indicate that ethnic minorities may not share similar cultural values and may differ in their degree of adherence to certain cultural variables. These results demonstrate how cultural variables that influence reporting tendencies may not apply across ethnic groups. Therefore, specifying relevant cultural variables is essential to understanding the relationship between ethnicity and reporting tendencies.

Keyword: Abattoir, fasciolosis, oesophagostomosis, emaciation, Imo State The prevalence of fasciolosis and oesophagostomosis among cattle, sheep and goats slaughtered in Imo State from 1995 to 1999 and their correlation with cases of emaciation observed at ante-mortem inspection were studied. Of the 62362 cattle, 4265 sheep and 17904 goats slaughtered during the period, 4378 (7.0%), 144 (3.4%) and 505 (2.8%) were infected with fasciola respectively. Oesophagostomosis was observed among goats only and gave an overall prevalence of 2.2%. There was a clear seasonal pattern of fasciolosis in all the species with highest rates being witnessed in early dry and wet seasons. Monthly prevalence rates of fasciolosis, oesophagostomosis and emaciation among the species were significantly (P Trop. Vet. Vol. 20(3) 2002: 139-148

The use of autologous platelet concentrates mainly platelet rich plasma has been of relevance recently in the field of Oral and Maxillofacial surgery. These concentrates had the ability to improve the hard and soft tissue healing. This ability of the platelet concentrates had been studied in the healing after mandibular third molar impaction surgery. The various parameters like bone density, soft tissue healing, postoperative pain, swelling, and alveolar osteitis were taken into account. The patients were evaluated on 1 st , 2 nd , 7 th day, 1 st month, and 2 nd month postoperatively. The values for each parameter were found out and tabulated. Materials and Methods: Twelve patients, seven males and five females with bilaterally impacted mandibular third molars were included in the study. Autologous platelets were concentrated. This was applied on one of the sockets, which was randomly taken as the test side. The other socket was treated as the control. Results: Statistical analysis was done using Mann-Whitney U test for pain and soft tissue healing, which revealed the values for pain being statistically significant for the test side and no statistical difference was noted for soft tissue healing. Bone density and swelling were analyzed with t -test. Bone density values were statistically significant for the test side, while swelling did not show much statistical significance. None of the patients presented with alveolar osteitis in any side. Summary and Conclusion: Platelet rich plasma is a surgical additive that can be used to improve bone and soft tissue healing. It contains a wide array of growth factors that are responsible for their healing potential.

Ameloblastic carcinoma is a rare, odontogenic, malignant tumor that has features of ameloblastoma in addition to cytologic atypia with or without metastasis. Very few cases have been mentioned in the review of literature regarding ameloblastic carcinomas. Here we present a case of ameloblastic carcinoma, which was an incidental finding, the investigations done, the surgical management, and the prognosis of a 28-year-old male patient.