The Role of Screenings Methods and Risk Profile Assessments in Prevention and Health Promotion Programmes: An Ethnographic Analysis

In prevention and health promotion interventions, screening methods and risk profile assessments are often used as tools for establishing the interventions’ effectiveness, for the selection and determination of the health status of participants. The role these instruments fulfil in the creation of effectiveness and the effects these instruments have themselves remain unexplored. In this paper, we have analysed the role screening methods and risk profile assessments fulfil as part of prevention and health promotion programmes in the selection, enrolment and participation of participants. Our analysis showed, that screening methods and health risk assessments create effects as they objectify health risks and/or the health status of individuals, i.e., they select the individuals ‘at risk’ and indicate the lifestyle modifications these people are required to make in order to improve their health. Yet, these instruments also reduce the group of participants thereby decreasing the possible effect of interventions, as they provide the legitimisation for people to make choices to whether they enrol or not and what lifestyle changes they incorporate into their lives. In other words, they present a space of interaction, in which agency is distributed across the practice nurses, the participants and the instruments. Decisions were not just made upon the projection of the outcomes of these instruments; decisions that were made by both the patients and practice nurses were the resultant of their opinions on these outcomes that were formed in interaction with the instruments

Clinical Guidelines for the Emergency Department Evaluation of Subarachnoid Hemorrhage

BackgroundSubarachnoid hemorrhage (SAH) is frequently caused by the rupture of an intracranial aneurysmal vessel or arteriovenous malformation, leading to a cascade of events that can result in severe disability or death. When evaluating for this diagnosis, emergency physicians have classically performed a noncontrast computed tomography (NCCT) scan, followed by a lumbar puncture (LP). Recently, however, as CT technology has advanced, many studies have questioned the necessity of the LP in the SAH diagnostic algorithm and have instead advocated for noninvasive techniques, such as NCCT alone or NCCT with CT angiogram (CTA).ObjectiveThe primary goal of this literature search was to determine the appropriate emergency department (ED) management of patients with suspected SAH.MethodsA MEDLINE literature search from October 2008 to June 2015 was performed using the keywords computed tomography AND subarachnoid hemorrhage AND lumbar puncture, while limiting the search to human studies written in the English language. General review articles and single case reports were omitted. Each of the selected articles then underwent a structured review.ResultsNinety-one articles were identified, with 31 papers being considered appropriate for analysis. These studies then underwent a rigorous review from which recommendations were developed.ConclusionsThe literature search supports that NCCT followed by CTA is a reasonable approach in the evaluation of ED patients with possible SAH

Write, draw, show, and tell: a child-centred dual methodology to explore perceptions of out-of-school physical activity

Background Research to increase children’s physical activity and inform intervention design has, to date, largely underrepresented children’s voices. Further, research has been limited to singular qualitative methods that overlook children’s varied linguistic ability and interaction preference. The aim of this study was to use a novel combination of qualitative techniques to explore children’s current views, experiences and perceptions of out-of-school physical activity as well as offering formative opinion about future intervention design. Methods Write, draw, show and tell (WDST) groups were conducted with 35 children aged 10–11 years from 7 primary schools. Data were analysed through a deductive and inductive process, firstly using the Youth Physical Activity Promotion Model as a thematic framework, and then inductively to enable emergent themes to be further explored. Pen profiles were constructed representing key emergent themes. Results The WDST combination of qualitative techniques generated complimentary interconnected data which both confirmed and uncovered new insights into factors relevant to children’s out-of-school physical activity. Physical activity was most frequently associated with organised sports. Fun, enjoyment, competence, and physical activity provision were all important predictors of children’s out-of-school physical activity. Paradoxically, parents served as both significant enablers (i.e. encouragement) and barriers (i.e. restricting participation) to physical activity participation. Some of these key findings would have otherwise remained hidden when compared to more traditional singular methods based approaches. Conclusions Parents are in a unique position to promote health promoting behaviours serving as role models, physical activity gatekeepers and choice architects. Given the strong socialising effect parents have on children’s physical activity, family-based physical activity intervention may offer a promising alternative compared to traditional school-based approaches. Parents' qualitative input is important to supplement children’s voices and inform future family-based intervention design. The WDST method developed here is an inclusive, interactive and child-centred methodology which facilitates the exploration of a wide range of topics and enhances data credibility

The dynamics of expanding mangroves in New Zealand

In contrast to the global trend of mangrove decline, New Zealand mangroves are rapidly expanding, facilitated by elevated sediment inputs in coastal waters as a consequence of large-scale land use changes following European settlement. New Zealand mangroves are at the southern limit of the global mangrove extent, which limits the tree height of Avicennia marina var. australasica, the only mangrove species present. Mangroves in New Zealand thrive in the sheltered environments of infilling drowned river valleys with abundant supply of fine terrigenous sediments, showing various stages of mangrove succession and expansion dynamics. Bio-physical interactions and carbon dynamics in these expanding temperate mangrove systems show similarities to, but also differ from those in tropical mangrove forests, for instance due to the limited height and complexity of the mangrove communities. Likewise, ecosystem services provided by New Zealand mangroves deviate from those offered by tropical mangroves. In particular, the association of mangrove expansion with the accumulation of (the increased supply of) fine sediments and the consequent change of estuarine ecosystems, has provoked a negative perception of mangrove expansion and subsequently led to mangrove clearance. Over recent decades, a body of knowledge has been developed regarding the planning and decision making relating to mangrove removal, yet there are still effects that are unknown, for example with respect to the post-clearance recovery of the original sandflat ecosystems. In this chapter we discuss the dynamics of New Zealand’s expanding mangroves from a range of viewpoints, with the aim of elucidating the possible contributions of expanding mangroves to coastal ecosystem services, now and in the future. This chapter also reviews current policies and practice regarding mangrove removal in New Zealand and addresses the (un)known effects of mangrove clearance. These combined insights may contribute to the development of integrated coastal management strategies that recognise the full potential of expanding mangrove ecosystems

Administered circulating microparticles derived from lung cancer patients markedly improved angiogenesis, blood flow and ischemic recovery in rat critical limb ischemia.

We hypothesized that lung cancer patient's circulating microparticles (Lc-MPs) could promote angiogenesis, blood flow in ischemic zone and ischemic recovery in rat critical limb ischemia (CLI).This article is freely available via Open Access. Click on the 'Additional Link' above to access the full-text via the publisher's site.Published (Open Access

Temperature as a dependent variable in the study of cholinergic mechanisms

Dilsaver, Steven C. and Norman F. Alessi: Temperature as a Dependent Variable in the Study of Cholinergic Mechanisms. Prog. Neuro-Psychopharmacol. & Biol. Psychiat. 1988, : 1-32. 1. 1. Change in core temperature over time can be used as a dependent variable when studying the effects of manipulations on neurotransmitter systems. This article focuses on the measurement of core temperature as a strategy for detecting changes in the status of cholinergic systems.2. 2. Cholinergic neurons participate in the process of thermoregulation and interventions affecting them alter the thermal response to cholinomimetics. For example, chronic treatment with amitriptyline, chronic swim stress and inescapable footshock supersensitize rats to the hypothermic effects of oxotremorine.3. 3. This is consistent with the hypothesis that the pathophysiologies of tricyclic antidepressant withdrawal phenomena and stress involve supersensitivity of muscarinic mechanisms.4. 4. Uses of thermoregulation paradigms for investigating the actions of lithium ion, electroconvulsive shock and substances of abuse on muscarinic mechanisms are discussed. Applications to problems in the arena of clinical research are highlighted.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27435/1/0000473.pd

Elevated Red Cell Microparticles (RMP) in Hematologic and Thrombotic Disorders

Abstract Introduction. Circulating cell-derived microparticlesa (MP) from platelets (PMP), leukocytes (LMP), and endothelia (EMP) have been well-documented for their roles in hemostasis, thrombosis and inflammation but the clinical significance of RMP is less well understood. The purpose of this study is to study the relation of elevated RMP to selected hematologic and thrombotic disorders. Methods. This is a retrospective study on RMP profiles for patients referred to University of Miami Hospital and Clinics for hematologic consultation over the last 8 years. The patient population includes 51 hemolytic anemia (HA), 459 thrombocytopenia (TP), 26 myeloproliferative disorder (MPD), 413 hypercoagulable state (HCS), and 446 thrombotic disorders (TBS). Some patients were analyzed in more than one of the above disorders. Levels of RMP were measured by flow cytometry with PE-conjugated anti-CD235a labeling as previously described [Thromb. & Haemost., 2013;110:751-60]. Levels of RMP above mean +2SD of controls (> 2,000 counts/mL) are designated as "elevated RMP". Results. (I) Prevalence of elevated RMP in patient populartion: Elevated RMP were found in 31 of 51 HA (60.8%), 138 of 459 TP (30.1%), 20 of 26 MPD (78.1%), 175 of 413 HCS (42.4%), and 251 of 446 TBS (56.3%). (II) Association of elevated RMP with thrombosis: Of 31 HA patients with elevated RMP, 11 were positive for TBS, and the remaining 20 were negative. Levels of RMP (mean ±SD) for TBS(+) and TBS(-) were 5,824 ±3713 and 3,265 ±1,048, counts /mL, respectively (p<0.01). Of 138 TP patients with elevated RMP, 31 were TBS(+) and 107 were TBS(-). Levels of RMP for TBS(+) and TBS(-) were 4,698 ±3,208 and 3,012 ±1,503, counts/mL, respectively (p <0.001). (III) RMP in HCS: Of 175 HCS with elevated RMP, 116 were TBS(+) and 59 were TBS(-). The levels of RMP for TBS(+) and TBS(-) were 4,062 ±3,285 and 2,987 ±1,454, counts/mL, respectively (p <0.02). Among these 116 TBS(+) patients, 22 did not receive antithrombotic treatment at the time of assay (HCS-1), 84 received treatment at time of assay (HCS-2), and 10 developed recurrent TBS despite therapy (HCS-3). Levels of RMP for HCS-1, HCS-2, and HCS-3 were 5,091 ±3,804, 3,973 ±3,044, and 6,191 ±3,763, respectively. Of these, HCS-2 differed significantly from HCS-3, p < 0.05. (IV) TBS with vs. without risk factors: Of 251 TBS with elevated RMP, 226 had known hematological or coagulation disorders, or risk factors for TBS (such as HA, TP, MPD, thrombocytosis, cancers, atrial fibrillation, APS, lupus, or markers for HCS). The remaining 25 without risk factors nevertheless had TBS and elevated RMP, suggesting RMP may be a useful biomarker for thrombotic risk. Discussion. (i) The cause of RMP elevation in HA is reasonably attributed to red cell destruction. The cause in TP/ITP is likely due to products of platelet destruction or leukocyte activation. The cause in MPD could result from clearance of the high burden of red cells and platelets. (ii) Patients who were TBS(+) had higher RMP than TBS(-), seen in HCS, HA, TP, raising the question of whether high RMP is a cause or consequence of TBS. To answer this will require further study. (iii) The finding of exceptionally high RMP levels in recurrent TBS vs. non-recurrent TBS (HCS-3 vs. HC-2) indicates that RMP levels reflect severity of TBS. (iv) Finally, these data indicate that RMP may be a useful biomarker of thrombotic risk, particularly because some TBS patients had elevated RMP, yet tested negative by all conventional markers of HCS workups. Disclosures No relevant conflicts of interest to declare

Correlations of Red Cell-Derived Micropareticles (RMP) with Other MP Species in Hematological and Thrombotic Disorders

Abstract Background: We have recently observed that increased levels of circulating RMP are associated with several hematological disorders and thrombophilic states, and that levels were significantly higher when thrombosis was present. However, other species of MP, such as from platelets (PMP), endothelia (EMP), leukocytes (LMP) and annixin V-binding (AnV) have also been shown to be associated with thrombophilic states. The purpose of this study was to determine if correlations exist between RMP and other MP. Methods: This is a retrospective analysis of 702 laboratory samples over an 8 year period, limited to elevated values: >2SD above normal controls (>2,000/uL).. About 87% were individuals, the remaining 13% were tested 2-3 times and all tests >3 per patient were excluded. The disorders were hemolytic anemia (HA, n=38), hypercoagulable state (HCS, n=64), immune thrombocytopenia (ITP, n=86), thrombocytopenia of all causes (TP, n=69), myeloprolifereative disorder (MPD, n=29), thrombotic thrombocytopenic purpura (TTP, n=29), antiphospholipid syndrome (APS, n=34), pulmonary embolism (PE, n=21), and all-cause thrombosis (TBS, n=251). Some were classified in more than one way. MP species assayed were RMP by glycophorinA, PMP by CD41 (PMP41), PMP by CD42 (PMP42), EMP by CD31+/42- (EMP31), EMP by CD62E (EMP62E), LMP by CD45, annexin V binding (AnV), and counts by lectin, FITC-Ulex, which efficiently detects total MP including very small. Results: In HCS, the RMP >2,000/uL correlated well with PMP41 (R=0.407, p 2,000/uL and any of the MP markers in APS, TP, or TTP. The MP species markers, EMP31, EMP62E, and AnV, failed to show correlation with RMP in any of the disorders analyzed. In addition, we tested for correlations between elevated RMP and other MP for the entire data set (all disorders combined) and found that only LMP was significant (p 0.05). Discussion: These correlation analyses shows that RMP correlated most frequently with PMP, as seen in HA, ITP, HCS, and TBS, followed by LMP, as seen in HA and TBS. These observations suggest that platelet or/and leukocyte activation may be involved in RMP generation. Of added interest is the finding that the overall data correlated well with LMP only at the higher LMP levels, not at all in the lower quintile of LMP. This suggests that RMP elevations are associated with immunolgic, inflammatory processes. In summary, correlation analysis reveals likely interaction between red cells and platelets or leukocytes during immunologic, inflammatory or in thrombophilic states, resulting in elevated RMP. Disclosures No relevant conflicts of interest to declare