Search

Patient attire is paramount to a patient’s dignity and hospital experience. The traditional hospital gown is dehumanizing, anachronistic, and was designed for providers’ convenience. In this descriptive, prospective follow-up to our previous pilot study, we evaluated male and female medical and surgical patients and provider preference and experience with a novel patient gowning system, the Patient Access Linen System (PALS). This study was conducted in 2 hospitals within our health system. Our objective was to assess patient and provider satisfaction, experience, and preference using the PALS. A multiple-choice, free response survey was administered to patients and providers following the use of an item. A total of 315 patients and 249 staff in 2 hospitals completed surveys regarding their experience using or providing care to patients using the PALS. Patients and providers had consistently positive experiences with the PALS, including questions about comfort and function. The data demonstrate a clear preference for the PALS compared to the traditional hospital gown and give additional supporting evidence that the comfort of hospital clothing is of paramount importance to patients.

Background: Contraceptive counseling can increase postpartum contraception use, yet the optimal method and timing for counseling are unknown. The objective was to investigate preferences of underserved pregnant and postpartum women regarding contraception use and counseling. Method: Surveys regarding contraception experiences and perceptions of contraceptive counseling were conducted with 57 women age 18 and older who were postpartum or antepartum with a previous delivery within 5 years and receiving Medicaid-funded care at an academic medical center. Health literacy was assessed using REALM-7. Responses were analyzed using descriptive statistics. Results: A majority of women reported unplanned pregnancies (78%). Women using contraception at the time of conception reported “not sure” (30%) and “taken wrong” (30%) as primary reasons for failure. Most subjects had at least a high school level of health literacy (88%), desired to use a postpartum contraceptive method (92%) and had a high self-reported understanding of that method (94%). Most women reported receiving counseling (91%) and stated that the best time for counseling was both before and after childbirth (84%). However, only 60% of subjects intended to use the method they were prescribed at discharge; reasons for changing included side effects (37%), desire for different contraception (23%) and too complicated of a method prescribed (17%). Conclusion: Women perceived the best timing of contraceptive education to be both antepartum and postpartum. Despite a high frequency of prior contraceptive failure, self-reported understanding of the chosen postpartum contraceptive method was high. Contraception counseling should be tailored to a woman’s perceived needs, with such education occurring frequently and within the context of her health literacy.

Importance Children with a history of amblyopia, even if resolved, exhibit impaired visual-auditory integration and perceive speech differently. Objective To determine whether a history of amblyopia is associated with abnormal visual-auditory speech integration. Design, Setting, and Participants Retrospective observational study at an academic pediatric ophthalmologic clinic with an average of 4 years of follow-up. Participants were at least 3 years of age and without any history of neurologic or hearing disorders. Of 39 children originally in our study, 6 refused to participate. The remaining 33 participants completed the study. Twenty-four participants (mean [SD] age, 7.0 [1.5] years) had a history of amblyopia in 1 eye, with a visual acuity of at least 20/20 in the nonamblyopic eye. Nine controls (mean [SD] age, 8.0 [3.4] years) were recruited from referrals for visually insignificant etiologies or through preschool-screening eye examinations; all had 20/20 in both eyes. Exposures Participants were presented with a video demonstrating the McGurk effect (ie, a stimulus presenting an audio track playing the sound /pa/ and a separate video track of a person articulating /ka/). Normal visual-auditory integration produces the perception of hearing a fusion sound /ta/. Participants were asked to report which sound was perceived, /ka/, /pa/, or /ta/. Main Outcome and Measure Prevalence of perception of the fusion /ta/ sound. Prior to the study, amblyopic children were hypothesized to less frequently perceive /ta/. Results The McGurk effect was perceived by 11 of the 24 participants with amblyopia (45.8%) and all 9 controls (100%) (adjusted odds ratio, 22.3 [95% CI, 1.2-426.0]; P = .005). The McGurk effect was perceived by 100% of participants with amblyopia that was resolved by 5 years of age and by 100% of participants whose onset at amblyopia developed at or after 5 years of age. However, only 18.8% of participants with amblyopia that was unresolved by 5 years of age (n = 16) perceived the McGurk effect (adjusted odds ratio, 27.0 [95% CI, 1.1-654.0]; P = .02). Conclusions and Relevance This pilot study suggests that children with a history of amblyopia have impaired visual-auditory speech perception. Early childhood appears to serve as an approximate time point for the development of successful visual-auditory fusion, by which time amblyopia must have either resolved or begun. Interventions to resolve amblyopia may not only influence visual acuity but may also influence the perception of sound.

γ-Secretase generates the peptides of Alzheimer's disease, Aβ40 and Aβ42, by cleaving the amyloid precursor protein within its transmembrane domain. γ-Secretase also cleaves numerous other substrates, raising concerns about γ-secretase inhibitor off-target effects. Another important class of drugs, γ-secretase modulators, alter the cleavage site of γ-secretase on amyloid precursor protein, changing the Aβ42/Aβ40 ratio, and are thus a promising therapeutic approach for Alzheimer's disease. However, the target for γ-secretase modulators is uncertain, with some data suggesting that they function on γ-secretase, whereas others support their binding to the amyloid precursor. In this paper we address this controversy by using a fluorescence resonance energy transfer-based assay to examine whether γ-secretase modulators alter Presenilin-1/γ-secretase conformation in intact cells in the absence of its natural substrates such as amyloid precursor protein and Notch. We report that the γ-secretase allosteric site is located within the γ-secretase complex, but substrate docking is needed for γ-secretase modulators to access this site., γ-Secretase modulators have promise in the treatment of Alzheimer's disease, but their molecular target is uncertain. Here, fluorescence resonance energy transfer is used to determine that the γ-secretase allosteric site is within the γ-secretase complex and that substrate docking is required for modulators to access the site.

Background Several familial Alzheimer disease (FAD) mutations within the transmembrane region of the amyloid precursor protein (APP) increase the Aβ42/40 ratio without increasing total Aβ production. In the present study, we analyzed the impact of FAD mutations and γ-secretase modulators (GSMs) that alter the Aβ42/40 ratio on APP C-terminus (CT) positioning relative to the membrane, reasoning that changes in the alignment of the APP intramembranous domain and presenilin 1 (PS1) may impact the PS1/γ-secretase cleavage site on APP. Results By using a Förster resonance energy transfer (FRET)-based technique, fluorescent lifetime imaging microscopy (FLIM), we show that Aβ42/40 ratio-modulating factors which target either APP substrate or PS1/γ-secretase affect proximity of the APP-CT to the membrane and change PS1 conformation. Conclusions Thus, we propose that there is a reciprocal relationship between APP-CT positioning relative to the membrane and PS1 conformation, suggesting that factors that modulate either APP positioning in the membrane or PS1 conformation could be exploited therapeutically.