Headstrong intervention for pediatric migraine headache: a randomized clinical trial

Background The purpose of this study was to evaluate the efficacy of a self-guided CD-ROM program (“Headstrong”) containing cognitive-behavioral self-management strategies versus an educational CD-ROM program for treating headaches, headache-related disability, and quality of life. Methods Participants were 35 children ages 7–12 years with migraine recruited from one university medical center and two children’s hospital headache clinics. Participants were randomly assigned to complete the Headstrong or educational control CD-ROM program over a 4-week period. Data on headache frequency, duration, and severity, migraine-related disability, and quality of life (QOL) were obtained at baseline, post-intervention, and 3-months post-intervention. Results At post-intervention, Headstrong resulted in lower severity (on a 10-point scale) than the control group by child report (5.06 ± 1.50 SD vs. 6.25 ± 1.92 SD, p = 0.03, ES = 0.7). At 3-months post-intervention, parents reported less migraine-related disability (on the PedMIDAS) in the Headstrong group compared to the control group (1.36 ± 2.06 SD vs. 5.18 ± 6.40 SD; p = 0.04, ES = 0.8). There were no other group differences at post treatment or at 3-months post-intervention. Conclusions When compared to an educational control, Headstrong resulted in lower pain severity at post-treatment and less migraine-related disability at 3-months post-intervention, by child and parent report respectively. Headache frequency and quality of life did not change more for Headstrong versus control. Additional research is needed on the Headstrong Program to increase its efficacy and to test it with a larger sample recruited from multiple centers simultaneously.The study reported in this paper was funded by a grant from the National Institutes of Health, (National Institute of Neurological Disorders and Stroke), R01-NS046641, Michael Rapoff, Principal Investigator

The Australasian Resuscitation In Sepsis Evaluation : fluids or vasopressors in emergency department sepsis (ARISE FLUIDS), a multi-centre observational study describing current practice in Australia and New Zealand

Objectives: To describe haemodynamic resuscitation practices in ED patients with suspected sepsis and hypotension. Methods: This was a prospective, multicentre, observational study conducted in 70 hospitals in Australia and New Zealand between September 2018 and January 2019. Consecutive adults presenting to the ED during a 30-day period at each site, with suspected sepsis and hypotension (systolic blood pressure <100 mmHg) despite at least 1000 mL fluid resuscitation, were eligible. Data included baseline demographics, clinical and laboratory variables and intravenous fluid volume administered, vasopressor administration at baseline and 6- and 24-h post-enrolment, time to antimicrobial administration, intensive care admission, organ support and in-hospital mortality. Results: A total of 4477 patients were screened and 591 were included with a mean (standard deviation) age of 62 (19) years, Acute Physiology and Chronic Health Evaluation II score 15.2 (6.6) and a median (interquartile range) systolic blood pressure of 94 mmHg (87–100). Median time to first intravenous antimicrobials was 77 min (42–148). A vasopressor infusion was commenced within 24 h in 177 (30.2%) patients, with noradrenaline the most frequently used (n = 138, 78%). A median of 2000 mL (1500–3000) of intravenous fluids was administered prior to commencing vasopressors. The total volume of fluid administered from pre-enrolment to 24 h was 4200 mL (3000–5661), with a range from 1000 to 12 200 mL. Two hundred and eighteen patients (37.1%) were admitted to an intensive care unit. Overall in-hospital mortality was 6.2% (95% confidence interval 4.4–8.5%). Conclusion: Current resuscitation practice in patients with sepsis and hypotension varies widely and occupies the spectrum between a restricted volume/earlier vasopressor and liberal fluid/later vasopressor strategy

The black echo = Gema hitam

Jakarta597 hlm.; 20 c

Cyclin-D1 Modulation of Vitamin-D-Induced Gene Expression in Oral Keratinocytes

Background: Oral cancer is the sixth most frequent cancer worldwide. Ninety percent of the newly diagnosed oral cancers (+400,000/ year) are characterized as squamous cell carcinomas (SCC). SCC, which develops in the cells of the oral epithelium, is a highly aggressive and destructive cancer with a propensity for invasion of surrounding tissues and recurrence. Consequently, little is known about the preventive factors that modulate the risk of oral carcinogenesis. Recently however, two epidemiological studies investigating the predictive factors of cancer, found their strongest association between low levels of vitamin D and oro-pharyngeal cancer. It is our labs goal to further investigate this matter in a cellular model that parallels human oro-pharyngeal carcinogenesis. Recently, our lab identified a novel interaction between Cyclin D1 and a nuclear hormone receptor that modulates gene expression, known as the vitamin D receptor (VDR). Objectives: The objective of our research is to investigate the effect of vitamin D treatment on human keratinocytes engineered to overexpress an oncogene (Cyclin D1) commonly amplified in SCC. We intend to explore vitamin D's effect by monitoring changes in the localization of key components in both the VDR and Cyclin D1 pathways. Our findings should begin address the question of whether the interaction of Cyclin D1 and VDR has any impact on key components in either pathway. Methods: Transgenic keratinocytes over expressing cyclin D1 (OKF6-D1) will be used to examine the relationship between the VDR and Cyclin D1 pathways. Immuno-staining of key pathway components will be used to localize these components to nuclear or cytoplasmic compartments that can be visualized by immunofluorescence (IF) . Lastly, western blot analysis of fractionated lysates (cytoplasmic and nuclear) from transgenic and control keratinocytes will be used to confirm any IF findings . Results: Immunohistochemistry points toward a difference in the localization of VDR when transgenic cells are ligand treated. Lastly, reduced levels of VDRs heterodimeric partner (RXR) were identified when transgenic keratinocytes were treated with vitamin D

The transhipment problem: Smuggling and welfare in Paraguay

This paper studies the effects of contraband on resource allocation and welfare using Parguayan data. A major portion of exports from this economy involves the transhipment of goods from third countries through Paraguay to Brazil and Argentina to avoid trade taxes, both explicit and implicit via quantitative restrictions and multiple exchange rates. Using international and Paraguayan databases for 1990, we calculate that contraband accounted for 58% of exports and 31% of imports. Finally, we estimate that such trade increased welfare by 2.1% of GDP