Respiratory Management of Patients with ALS in Northern New England

Background: • Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, is a progressive neurodegenerative disease caused by the degeneration of brain and spinal cord motor neurons, leading to steady loss of voluntary muscle function and early death from respiratory failure. •The incidence of ALS is 1?2/100,000 population, the prevalence is 5?6/100,000 and approximately 30,000 people are living with ALS in the United States. • Currently there is no cure for ALS; treatment is focused on symptomatic care and improving the quality of life. • Most ALS patients in the United States are treated either at multidisciplinary ALS centers/clinics in academic institutions or by community?based physicians/ neurology practices. • It is unclear if outcomes in patients with ALS are different among those followed in multidisciplinary clinics(MDC) versus community based physicians/ neurology practices (CP). • The goal of this project was to compare the type of respiratory education and care received by patients with ALS from Northern New England at MDC’s (Fletcher Allen and Dartmouth Medical Center) versus CP.https://scholarworks.uvm.edu/comphp_gallery/1029/thumbnail.jp

Meeting them where they are: Using the Internet to deliver behavioral medicine interventions for pain

Pharmacological and interventional pain medicine treatments are emphasized in the routine treatment of chronic pain despite strong evidence for the efficacy and safety of behavioral approaches. Most medical professionals have not incorporated behavioral pain treatments into their practices. Internet-based interventions have the potential to increase clinical use of these treatments. We discuss the strengths and weaknesses of current Internet-based behavioral pain management interventions, focusing on three broad intervention categories: therapist-guided interventions, unguided (automated) interventions, and pain-relevant applications for mobile platforms. Examples of each category are discussed, revealing a high degree of variation in approaches, user interfaces, and components as well as variability in the degree to which these interventions have been subjected to empirical testing. Finally, we highlight key issues for research and clinical implementation, with the goal of advancing this field so that it can meet its potential to increase access to evidence-based behavioral medicine treatments for chronic pain

Self Reported Overall Health Status.

Background Data collected using the South Australian chronic disease and risk factor surveillance system were analysed in order to monitor changes in the prevalence of overall health status over time.Methods The South Australian Monitoring and Surveillance System (SAMSS) has been conducted monthly since 2002.  This representative, population, chronic disease and risk factor, telephone-based surveillance system includes a single question determining the prevalence of overall health status (SF1) and a wide range of demographics, social, chronic conditions and risk factor indicators.  Results Between 2006 and 2008, 83.2% of respondents reported ‘Excellent, Very Good or Good’ health and 16.8% reported ‘Fair or Poor’ health.  There was a statistically significant trend in the age sex standardised prevalence of those reporting ‘Very Good’, ‘Good’ or ‘Poor’ health from 2002 to 2008.  The SF1 identifies ‘Fair or Poor’ health in the case of those with chronic conditions and health risk factors, and ‘Excellent, Very Good or Good’ health in the absence of chronic conditions. A wide range of social, demographic variables, with those of a lower socio-economic status in particular, statistically significantly more likely to report a lower overall health statusConclusion The SF1 can be used to measure general health as part of telephone surveys and surveillance systems

The Lantern Vol. 68, No. 2, Spring 2001

• Eden • Ginsberg Mourning • On the Cusp of Winter • (Woman: as Needing to be Silver and Sharp) • Descended • Book Unbinding • Scrawlings on the Stall • My Frankenstein • Jazzy Avantguardia • Paper Crane • A Child\u27s Valentine • Ten Years\u27 Gone • Out the Window • Tar\u27s Melting • Passing Time • Ave Maria • Heart of the Matter • Damn Kids • The Candle Incident • Nostalgia • Cuban Couch • Dinner Datehttps://digitalcommons.ursinus.edu/lantern/1158/thumbnail.jp

NCCN Guidelines Insights: Survivorship, Version 2.2020.

The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for consequences of adult-onset cancer and its treatment, with the goal of helping healthcare professionals who work with survivors, including those in primary care. The guidelines also provide recommendations to help clinicians promote physical activity, weight management, and proper immunizations in survivors and facilitate care coordination to ensure that all of the survivors needs are addressed. These NCCN Guidelines Insights summarize additions and changes made to the guidelines in 2020 regarding cardiovascular disease risk assessment and screening for subsequent primary malignancies

Prevalence of chronic fatigue syndrome in metropolitan, urban, and rural Georgia

© 2007 Reeves et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Recurrence of Primary Sclerosing Cholangitis After Liver Transplant in Children : An International Observational Study

Background and Aims Recurrent primary sclerosing cholangitis (rPSC) following liver transplant (LT) has a negative impact on graft and patient survival; little is known about risk factors for rPSC or disease course in children. Approach and Results We retrospectively evaluated risk factors for rPSC in 140 children from the Pediatric PSC Consortium, a multicenter international registry. Recipients underwent LT for PSC and had >90 days of follow-up. The primary outcome, rPSC, was defined using Graziadei criteria. Median follow-up after LT was 3 years (interquartile range 1.1-6.1). rPSC occurred in 36 children, representing 10% and 27% of the subjects at 2 years and 5 years following LT, respectively. Subjects with rPSC were younger at LT (12.9 vs. 16.2 years), had faster progression from PSC diagnosis to LT (2.5 vs. 4.1 years), and had higher alanine aminotransferase (112 vs. 66 IU/L) at LT (all P < 0.01). Inflammatory bowel disease was more prevalent in the rPSC group (86% vs. 66%; P = 0.025). After LT, rPSC subjects had more episodes of biopsy-proved acute rejection (mean 3 vs. 1; P < 0.001), and higher prevalence of steroid-refractory rejection (41% vs. 20%; P = 0.04). In those with rPSC, 43% developed complications of portal hypertension, were relisted for LT, or died within 2 years of the diagnosis. Mortality was higher in the rPSC group (11.1% vs. 2.9%; P = 0.05). Conclusions The incidence of rPSC in this cohort was higher than previously reported, and was associated with increased morbidity and mortality. Patients with rPSC appeared to have a more aggressive, immune-reactive phenotype. These findings underscore the need to understand the immune mechanisms of rPSC, to lay the foundation for developing new therapies and improve outcomes in this challenging population.Peer reviewe

The Immune Cellular Effectors of Terrestrial Isopod Armadillidium vulgare: Meeting with Their Invaders, Wolbachia

Most of crustacean immune responses are well described for the aquatic forms whereas almost nothing is known for the isopods that evolved a terrestrial lifestyle. The latter are also infected at a high prevalence with Wolbachia, an endosymbiotic bacterium which affects the host immune system, possibly to improve its transmission. In contrast with insect models, the isopod Armadillidium vulgare is known to harbor Wolbachia inside the haemocytes.In A. vulgare we characterized three haemocyte types (TEM, flow cytometry): the hyaline and semi-granular haemocytes were phagocytes, while semi-granular and granular haemocytes performed encapsulation. They were produced in the haematopoietic organs, from central stem cells, maturing as they moved toward the edge (TEM). In infected individuals, live Wolbachia (FISH) colonized 38% of the haemocytes but with low, variable densities (6.45±0.46 Wolbachia on average). So far they were not found in hyaline haemocytes (TEM). The haematopoietic organs contained 7.6±0.7×10(3)Wolbachia, both in stem cells and differentiating cells (FISH). While infected and uninfected one-year-old individuals had the same haemocyte density, in infected animals the proportion of granular haemocytes in particular decreased by one third (flow cytometry, Pearson's test = 12 822.98, df = 2, p<0.001).The characteristics of the isopod immune system fell within the range of those known from aquatic crustaceans. The colonization of the haemocytes by Wolbachia seemed to stand from the haematopoietic organs, which may act as a reservoir to discharge Wolbachia in the haemolymph, a known route for horizontal transfer. Wolbachia infection did not affect the haemocyte density, but the quantity of granular haemocytes decreased by one third. This may account for the reduced prophenoloxidase activity observed previously in these animals

The Space Infrared Interferometric Telescope (SPIRIT): High-resolution imaging and spectroscopy in the far-infrared

We report results of a recently-completed pre-Formulation Phase study of SPIRIT, a candidate NASA Origins Probe mission. SPIRIT is a spatial and spectral interferometer with an operating wavelength range 25 - 400 microns. SPIRIT will provide sub-arcsecond resolution images and spectra with resolution R = 3000 in a 1 arcmin field of view to accomplish three primary scientific objectives: (1) Learn how planetary systems form from protostellar disks, and how they acquire their inhomogeneous composition; (2) characterize the family of extrasolar planetary systems by imaging the structure in debris disks to understand how and where planets of different types form; and (3) learn how high-redshift galaxies formed and merged to form the present-day population of galaxies. Observations with SPIRIT will be complementary to those of the James Webb Space Telescope and the ground-based Atacama Large Millimeter Array. All three observatories could be operational contemporaneously.Comment: 20 pages, 12 figures, accepted for publication in J. Adv. Space Res. on 26 May 200

Relationship between molecular pathogen detection and clinical disease in febrile children across Europe: a multicentre, prospective observational study

BackgroundThe PERFORM study aimed to understand causes of febrile childhood illness by comparing molecular pathogen detection with current clinical practice.MethodsFebrile children and controls were recruited on presentation to hospital in 9 European countries 2016-2020. Each child was assigned a standardized diagnostic category based on retrospective review of local clinical and microbiological data. Subsequently, centralised molecular tests (CMTs) for 19 respiratory and 27 blood pathogens were performed.FindingsOf 4611 febrile children, 643 (14%) were classified as definite bacterial infection (DB), 491 (11%) as definite viral infection (DV), and 3477 (75%) had uncertain aetiology. 1061 controls without infection were recruited. CMTs detected blood bacteria more frequently in DB than DV cases for N. meningitidis (OR: 3.37, 95% CI: 1.92-5.99), S. pneumoniae (OR: 3.89, 95% CI: 2.07-7.59), Group A streptococcus (OR 2.73, 95% CI 1.13-6.09) and E. coli (OR 2.7, 95% CI 1.02-6.71). Respiratory viruses were more common in febrile children than controls, but only influenza A (OR 0.24, 95% CI 0.11-0.46), influenza B (OR 0.12, 95% CI 0.02-0.37) and RSV (OR 0.16, 95% CI: 0.06-0.36) were less common in DB than DV cases. Of 16 blood viruses, enterovirus (OR 0.43, 95% CI 0.23-0.72) and EBV (OR 0.71, 95% CI 0.56-0.90) were detected less often in DB than DV cases. Combined local diagnostics and CMTs respectively detected blood viruses and respiratory viruses in 360 (56%) and 161 (25%) of DB cases, and virus detection ruled-out bacterial infection poorly, with predictive values of 0.64 and 0.68 respectively.InterpretationMost febrile children cannot be conclusively defined as having bacterial or viral infection when molecular tests supplement conventional approaches. Viruses are detected in most patients with bacterial infections, and the clinical value of individual pathogen detection in determining treatment is low. New approaches are needed to help determine which febrile children require antibiotics.FundingEU Horizon 2020 grant 668303