Transition Program for Adolescents with Congenital Heart Disease Focusing on Self-Management Knowledge

Introduction: The primary goal of this project was to implement a pilot transition education program to prepare adolescents with congenital heart defects (CHD) by increasing knowledge about self-management of their health condition. Method: An educational program was developed and included use of an interactive binder. A total of 20 adolescents with CHD between the ages of 16 – 18 years participated in transition education during a single outpatient cardiology visit with pre and post education knowledge assessment performed using the Leuven Knowledge Questionnaire for Congenital Heart Disease (LKQCHD). Results: Following participation in the transition education, the overall mean knowledge scores increased from 43.6% (+/-) to 89.4%. (+/-). All participants scored \u3e 50% post intervention. Discussion: A formal transition education program demonstrated increased patient knowledge regarding their CHD. Advanced practice nurses are able to implement a transition education program and provide the necessary education to make a significant impact on patient knowledge

Ophelia as archetype: Jake Heggie's Songs and sonnets to Ophelia

The character Ophelia has captured humanity's imagination for centuries. In Shakespeare's Hamlet, her role, although small, was instrumental as the title character's erstwhile girlfriend who goes mad. Ophelia remains relevant in modern culture, whether it be in Natalie Merchant's pop CD title Ophelia or in Jake Heggie's Songs and Sonnets to Ophelia. This paper demonstrates why a 21st century audience can still relate to and identify with Ophelia. The reader will learn why and how Ophelia's image has transformed over the last 400 years through a brief discussion of Carl Jung's archetypal theories, and examples of images of Ophelia in artwork since the 1700's. Further discussion will reveal how Jake Heggie, with his careful choice of poet and of poetry, and use of compositional techniques was able to personify the archetypes that Ophelia has represented through the centuries in his 1999 composition, Songs and Sonnets to Ophelia

Role of prescribed medication in the development of iron deficiency anaemia in adults-a case-control study.

OBJECTIVE: To estimate the strength of association between exposure to selected classes of prescribed medications and the risk of developing iron deficiency anaemia (IDA), specifically considering oral anticoagulants (OACs), antidepressants, antiplatelet agents, proton pump inhibitors (PPIs) and non-steroidal anti-inflammatories. DESIGN: A case-control study involving the analysis of community repeat prescriptions among subjects referred with IDA, and unmatched controls referred as gastroenterology fast-tracks for other indications. Multivariable logistic regression modelling was used to calculate ORs for the association between IDA presentation and each medication class, adjusted for age, sex and coprescribing. For those classes showing significance, it was also used to calculate risk differences between those in the IDA group with or without haemorrhagic lesions on investigation. RESULTS: A total of 1210 cases were analysed-409 in the IDA group, and 801 in the control group. Significant associations were identified between presentation with IDA and long-term exposure to PPIs (OR 3.29, 95% CI: 2.47 to 4.41, p<0.001) and to OACs (OR 2.04, 95% CI: 1.29 to 3.24, p=0.002). IDA was not associated with long-term exposure to any of the other three drug classes. In contrast to the relationship with PPIs, the association with OACs was primarily in the IDA sub-group with haemorrhagic lesions. CONCLUSION: Long-term exposure to PPIs and OACs are independently associated with the risk of developing IDA. There are grounds for considering that these associations may be causal, though the underlying mechanisms probably differ

Vitamin D with Calcium reduces mortality: patient level pooled analysis of 70,528 patients from eight major vitamin D trials

Introduction: Vitamin D may affect multiple health outcomes. If so, an effect on mortality is to be expected. Using pooled data from randomized controlled trials, we performed individual patient data (IPD) and trial level meta-analyses to assess mortality among participants randomized to either vitamin D alone or vitamin D with calcium. Subjects and Methods: Through a systematic literature search, we identified 24 randomized controlled trials reporting data on mortality in which vitamin D was given either alone or with calcium. From a total of 13 trials with more than 1000 participants each, eight trials were included in our IPD analysis. Using a stratified Cox regression model, we calculated risk of death during 3 yr of treatment in an intention-to-treat analysis. Also, we performed a trial level meta-analysis including data from all studies. Results: The IPD analysis yielded data on 70,528 randomized participants (86.8% females) with a median age of 70 (interquartile range, 62–77) yr. Vitamin D with or without calcium reduced mortality by 7% [hazard ratio, 0.93; 95% confidence interval (CI), 0.88–0.99]. However, vitamin D alone did not affect mortality, but risk of death was reduced if vitamin D was given with calcium (hazard ratio, 0.91; 95% CI, 0.84–0.98). The number needed to treat with vitamin D plus calcium for 3 yr to prevent one death was 151. Trial level meta-analysis (24 trials with 88,097 participants) showed similar results, i.e. mortality was reduced with vitamin D plus calcium (odds ratio, 0.94; 95% CI, 0.88–0.99), but not with vitamin D alone (odds ratio, 0.98; 95% CI, 0.91–1.06). Conclusion: Vitamin D with calcium reduces mortality in the elderly, whereas available data do not support an effect of vitamin D alone

Fundamental differences between SPH and grid methods

We have carried out a hydrodynamical code comparison study of interacting multiphase fluids. The two commonly used techniques of grid and smoothed particle hydrodynamics (SPH) show striking differences in their ability to model processes that are fundamentally important across many areas of astrophysics. Whilst Eulerian grid based methods are able to resolve and treat important dynamical instabilities, such as Kelvin-Helmholtz or Rayleigh-Taylor, these processes are poorly or not at all resolved by existing SPH techniques. We show that the reason for this is that SPH, at least in its standard implementation, introduces spurious pressure forces on particles in regions where there are steep density gradients. This results in a boundary gap of the size of the SPH smoothing kernel over which information is not transferred.Comment: 15 pages, 13 figures, to be submitted to MNRAS. For high-resolution figures, please see http://www-theorie.physik.unizh.ch/~agertz

Fundamental differences between SPH and grid methods

We have carried out a comparison study of hydrodynamical codes by investigating their performance in modelling interacting multiphase fluids. The two commonly used techniques of grid and smoothed particle hydrodynamics (SPH) show striking differences in their ability to model processes that are fundamentally important across many areas of astrophysics. Whilst Eulerian grid based methods are able to resolve and treat important dynamical instabilities, such as Kelvin-Helmholtz or Rayleigh-Taylor, these processes are poorly or not at all resolved by existing SPH techniques. We show that the reason for this is that SPH, at least in its standard implementation, introduces spurious pressure forces on particles in regions where there are steep density gradients. This results in a boundary gap of the size of an SPH smoothing kernel radius over which interactions are severely dampe

Identity-by-descent estimation with population- and pedigree-based imputation in admixed family data

BACKGROUND: In the past few years, imputation approaches have been mainly used in population-based designs of genome-wide association studies, although both family- and population-based imputation methods have been proposed. With the recent surge of family-based designs, family-based imputation has become more important. Imputation methods for both designs are based on identity-by-descent (IBD) information. Apart from imputation, the use of IBD information is also common for several types of genetic analysis, including pedigree-based linkage analysis. METHODS: We compared the performance of several family- and population-based imputation methods in large pedigrees provided by Genetic Analysis Workshop 19 (GAW19). We also evaluated the performance of a new IBD mapping approach that we propose, which combines IBD information from known pedigrees with information from unrelated individuals. RESULTS: Different combinations of the imputation methods have varied imputation accuracies. Moreover, we showed gains from the use of both known pedigrees and unrelated individuals with our IBD mapping approach over the use of known pedigrees only. CONCLUSIONS: Our results represent accuracies of different combinations of imputation methods that may be useful for data sets similar to the GAW19 pedigree data. Our IBD mapping approach, which uses both known pedigree and unrelated individuals, performed better than classical linkage analysis

John Rawls between two enlightenments

John Rawls shares the Enlightenment's commitment to finding moral and political principles which can be reflectively endorsed by all individuals autonomously. He usually presents reflective autonomy in Kantian, rationalist terms: autonomy is identified with the exercise of reason, and principles of justice must be constructed which are acceptable to all on the basis of reason alone. Yet David Hume, Adam Smith and many other Enlightenment thinkers rejected such rationalism, searching instead for principles which can be endorsed by all on the basis of all the faculties of the human psyche, emotion and imagination included. The influence of these sentimentalists on Rawls is clearest in his descriptive moral psychology, but I argue that it is also present in Rawls's understanding of the sources of normativity. Although this debt is obscured by Rawls's explicit "Kantianism," his theory would be strengthened by a greater understanding of its debts to the sentimentalist Enlightenment