Development of tailored text messages to enhance medication adherence

"Poor medication adherence is a public health problem. Interventions that include multiple components e.g., informational, behavioral, and social support report success in enhancing adherence. Social support delivery options have not been well studied. Mobile health technology (mHealth) is an innovative way to deliver social support focused interventions."--Introduction

Two-stage vs. single-stage management of patients with choledocholithiasis : meta analysis of randomized controlled trials [abstract]

Current management of choledocholithiasis involves two stage process involving ERCP and laparoscopic cholecystectomy (LC). An alternative single-stage laparoscopic treatment was introduced for these patients. Various randomized controlled trials (RCT's) done to compare these 2 modalities but with controversial results

Changing forests-changing streams: Riparian forest stand development and ecosystem function in temperate headwaters

Light availability influences temperature, primary production, nutrient dynamics, and secondary production in aquatic ecosystems. In forested freshwater ecosystems, shading by streamside (riparian) vegetation is a dominant control on light flux and represents an important interaction at the aquatic-terrestrial interface. Changes in forest structure over time, particularly tree mortality processes that gradually increase light penetration through maturing forest canopies, are likely to influence stream light fluxes and associated ecosystem functions. We provide a set of conceptual models describing how stream light dynamics change with the development of complex canopy structure and how changes in light availability are likely to affect stream ecosystem processes. Shortly after a stand-replacing event, light flux to the stream is high, but light fluxes decline as canopies reestablish and close. Tree density, the degree of understory growth, patterns of tree mortality, and small-scale disturbances interact as drivers of multiple pathways of forest structural development. Changes in canopy structure will, in turn, influence stream light, which is expected to impact primary production and stream nutrient dynamics as well as the amount of autochthonous carbon supporting aquatic food webs. Ultimately, these conceptual models stress the importance of recovery from historic forest disturbances as well as future forest change as important factors influencing the long-term trajectories of ecosystem processes in headwaters

Review of Variability in Rehabilitation Protocols after Lateral Ankle Ligament Surgery

Introduction. Ankle sprains are one of the most common athletic injuries. If a patient fails to improve through conservative management, surgery is an option to restore ankle stability. The purpose of this study was to analyze and assess the variability across different rehabilitation protocols for patients undergoing either lateral ankle ligament repair, reconstruction, and suture tape augmentation. Methods. Using a web-based search for published rehabilitation protocols after lateral ankle ligament repair, reconstruction, and suture tape augmentation, a total of 26 protocols were found. Inclusion criteria were protocols for post-operative care after an ankle ligament surgery (repair, reconstruction, or suture tape augmentation). Protocols for multi-ligament surgeries and non-operative care were excluded. A scoring rubric was created to analyze different inclusion, exclusion, and timing of protocols such as weight-bearing, range of motion (ROM), immobilization with brace, single leg exercises, return to running, and return to sport (RTS). Protocols inclusion of different recommendations was recorded along with the time frame that activities were suggested in each protocol. Results. Twenty-six protocols were analyzed. There was variability across rehabilitation protocols for lateral ankle ligament operative patients especially in the type of immobilizing brace, time to partial and full weigh bearing, time to plantar flexion, dorsiflexion, eversion and inversion movements of the ankle, and return to single leg exercise and running. For repair and reconstruction, none of these categories had greater than 60% agreement between protocols. All (12/12) repair, internal brace, and unspecified protocols and 86% (12/14) of reconstruction protocols recommended no ROM immediately postoperatively. Eighty-six percent (6/7) of repair and 78% (11/14) of reconstruction protocols recommended no weight-bearing immediately after surgery, making post-operative ROM and weight-bearing status the most consistent aspects across protocols. Five protocols allowed post-operative weight-bearing in a cast to keep ROM restricted. Sixty-six percent (2/3) of suture tape augmentation protocols allowed full weight-bearing immediately post-operatively. Suture tape augmentation protocols generally allowed rehabilitation to occur on a quicker time-line with full weight-bearing by week 4-6 in 100% (3/3) of protocols and full ROM by week 8-10 in 66% (2/3) protocols. RTS was consistent in repair protocols (100% at week 12-16) but varied more in reconstruction. Conclusion. There is significant variability in the post-operative protocols after surgery for ankle instability. ROM was highly variable across protocols and did not always match-up with supporting literature for early mobilization of the ankle. Return to sport was most likely to correlate between protocols and the literature. Weight-bearing was consistent between most protocols but requires further research to determine the best practice. Overall, the variability between programs demonstrated the need for standardization of rehabilitation protocols

Outcome of medical versus surgical therapies for gastroesophageal reflux disease : meta analysis of randomized controlled trials [abstract]

Gastroesophageal Reflux Disease is one of the most common chronic gastrointestinal tracts. Medical management includes use of antisecretory medications or surgical management. Randomized controlled trials have compared both forms of treatment with controversial results. Therefore, we conducted meta-analysis to compare medical versus surgical therapy of GERD

Upper GI bleeding with myocardial infarction : evaluation of safety for endoscopy

Upper gastrointestinal bleeding (UGIB) in the setting of acute myocardial infarction (MI) is a complex medical condition with substantial morbidity and mortality. The anemia due to the UGIB may exacerbate the MI or the anticoagulation for the MI may contribute to UGIB. In addition, both have many significant complications. Several studies have been performed in studying the safety of EGD after MI; however, these studies vary in definitions and results. This study evaluated the safety and effect of EGD in patients with acute MI in a tertiary-care center

Erythromycin before endoscopy in upper GI bleeding : a meta-analysis of randomized controlled trials

Upper gastrointestinal bleeding (UGIB) is a common medical emergency that accounts for numerous hospital admissions each year. Given its significant morbidity and mortality, urgent endoscopy with adequate gastric mucosal visualization is imperative for identification and treatment of bleeding lesions. Various studies have been done evaluating the effectiveness of erythromycin infusion prior to endoscopy to improve visibility and therapeutic potential of endoscopy; however, the results have been controversial. To evaluate further, we performed a meta-analysis comparing the efficacy of erythromycin infusion before endoscopy in acute UGIB

A deep Large Binocular Telescope view of the Canes Venatici I dwarf galaxy

We present the first deep color-magnitude diagram of the Canes Venatici I (CVnI) dwarf galaxy from observations with the wide field Large Binocular Camera on the Large Binocular Telescope. Reaching down to the main-sequence turnoff of the oldest stars, it reveals a dichotomy in the stellar populations of CVnI: it harbors an old (> 10 Gyr), metal-poor ([Fe/H] ~ -2.0) and spatially extended population along with a much younger (~ 1.4-2.0 Gyr), 0.5 dex more metal-rich, and spatially more concentrated population. These young stars are also offset by 64_{-20}^{+40} pc to the East of the galaxy center. The data suggest that this young population, which represent ~ 3-5 % of the stellar mass of the galaxy within its half-light radius, should be identified with the kinematically cold stellar component found by Ibata et al. (2006). CVnI therefore follows the behavior of the other remote MW dwarf spheroidals which all contain intermediate age and/or young populations: a complex star formation history is possible in extremely low-mass galaxies.Comment: 4 pages, 3 figures, accepted for publication in ApJL. Minor changes, conclusions unchange