General practitioner referrals to paediatric specialist outpatient clinics: Referral goals and parental influence

© 2018 Royal New Zealand College of General Practitioners. Introduction: Previous research on general practitioner (GP) referrals in adult populations demonstrated that patient pressure influenced referral practice. No research has been conducted to investigate how involvement of a parent influences paediatric referrals. Aim: To investigate whether GPs who report parental influence on their decision to refer paediatric patients differ in their referral patterns from GPs who do not report parental influence. Method: A mail survey of 400 GPs who had referred at least two children to paediatric specialist outpatient clinics during 2014 was distributed. Results: The response rate was 67% (n = 254). For initial referrals, 27% of GPs stated that parental request frequently or almost always influenced their referral decision. For returning referrals, 63% of GPs experienced parental influence to renew a referral because a paediatrician wanted a child to return; 49% of GPs experienced influence to renew a referral because a parent wanted to continue care with a paediatrician. Experiencing parental influence was associated with increased likelihood for frequent referrals in order for a paediatrician to take over management of a child's condition. Discussion: GPs who frequently refer with a goal for a paediatrician to take over management of a child's condition also report that parental request almost always influences their decision to refer

Reverse Δ-wave as a possible sign in electrocardiography to diagnose mitral valve prolapse

<p>Abstract</p> <p>Background</p> <p>Mitral valve prolapse (MVP) is defined as superior displacement of the mitral valve leaflets more than 2 mm into the left atrium during systole. Easier and cheaper assessment of this common disease is a priority in cardiac health care facilities.</p> <p>Presentation of the hypothesis</p> <p>In this study I addressed electrocardiographic presentation in 300 patients with MVP compared with 100 healthy individuals. I faced a novel finding in electrocardiogram (ECG) examination of these patients. It was a notch (reverse Δ-wave) in descending arm of QRS observed in 79% (237/300) of patients, consisting of 58% (174/300) in inferior leads and 21% (63/300) in I and aVL leads. The notch was identified only in 6 men in control group.</p> <p>Testing the hypothesis</p> <p>Considering the relatively higher prevalence of disease, a population-based diagnostic clinical trial study is appropriate to test the hypothesis.</p> <p>Implications of the hypothesis</p> <p>The hypothesis on diagnostic value of reverse Δ-wave in MVP may help in decreasing the rate of unnessessary echocardiography in some patients.</p

Response of the Ross Ice Shelf, Antarctica, to ocean gravity-wave forcing

Author Posting. © International Glaciological Society, 2012. This article is posted here by permission of International Glaciological Society for personal use, not for redistribution. The definitive version was published in Annals of Glaciology 53 (2012): 163-172, doi:10.3189/2012AoG60A058.Comparison of the Ross Ice Shelf (RIS, Antarctica) response at near-front seismic station RIS2 with seismometer data collected on tabular iceberg B15A and with land-based seismic stations at Scott Base on Ross Island (SBA) and near Lake Vanda in the Dry Valleys (VNDA) allows identification of RIS-specific signals resulting from gravity-wave forcing that includes meteorologically driven wind waves and swell, infragravity (IG) waves and tsunami waves. The vibration response of the RIS varies with season and with the frequency and amplitude of the gravity-wave forcing. The response of the RIS to IG wave and swell impacts is much greater than that observed at SBA and VNDA. A spectral peak at near-ice-front seismic station RIS2 centered near 0.5 Hz, which persists during April when swell is damped by sea ice, may be a dominant resonance or eigenfrequency of the RIS. High-amplitude swell events excite relatively broadband signals that are likely fracture events (icequakes). Changes in coherence between the vertical and horizontal sensors in the 8-12 Hz band from February to April, combined with the appearance of a spectral peak near 10 Hz in April when sea ice damps swell, suggest that lower (higher) temperatures during austral winter (summer) months affect signal propagation characteristics and hence mechanical properties of the RIS.Support for this study for P.B. from the California Department of Boating andWaterways, US National Oceanic and Atmospheric Administration (NOAA) grant NA10OAR4310121 and US National Science Foundation grant OCE1030022 is gratefully acknowledged. Support for R.S. was provided by the Edward W. and Betty J. Scripps Chair for Excellence in Oceanography at Woods Hole Oceanographic Institution.2013-05-0

The relationship between personal breastfeeding experience and the breastfeeding attitudes, knowledge, confidence and effectiveness of Australian GP registrars

In conjunction with other health professionals, doctors believe they play an important role in promoting breastfeeding to women. Although many have positive breastfeeding attitudes, significant knowledge deficits often limit their capacity to effectively encourage, support and assist breastfeeding women and their infants. Personal breastfeeding experience (of self or partner) may be the main source of breastfeeding knowledge and skill development and is related to improved knowledge, more positive attitudes and greater confidence. This paper describes the relationship between the cumulative length of personal breastfeeding experience and the breastfeeding knowledge and attitudes of a cohort of Australian general practice (GP) registrars, as well as their confidence and perceived effectiveness assisting breastfeeding women. The Australian Breastfeeding Knowledge and Attitude Questionnaire containing demographic items, a 20-item attitude scale and a 40-item knowledge scale was distributed between February and May 2007 to Australian GP registrars in their final year of training. Participants with more than 52-week cumulative personal (self or partner) breastfeeding experience had the highest mean knowledge score, had more positive attitudes, and were more confident and effective than all other participants. Parents with limited personal experience (≤ 26 weeks) had the poorest breast-feeding attitudes and their knowledge base was similar to participants with no personal experience. Confidence and perceived effectiveness when assisting breastfeeding women rose with increasing cumulative breastfeeding experience. Personal breastfeeding experience per se does not guarantee better breastfeeding knowledge or attitudes although increasing length of experience is related to higher knowledge, attitude, confidence and perceived effectiveness scores

CD148 is a membrane protein tyrosine phosphatase present in all hematopoietic lineages and is involved in signal transduction on lymphocytes

Producción CientíficaEvidence is presented showing that a protein tyrosine phosphatase different from CD45 is present on the membrane of human hematopoietic cells. The molecule recognized by the monoclonal antibody 143-41, which has been classified as CD148 in the VI International Workshop on Leukocyte Differentiation Antigens, was immunopurified and sequenced. The sequence obtained from N-terminus as well as from two different CNBr-digested peptides showed a close identity with a previously described tyrosine phosphatase named HPTP-eta/DEP-1. CD148 is present on all hematopoietic lineages, being expressed with higher intensity on granulocytes than on monocytes and lymphocytes. Interestingly, whereas it is clearly present on peripheral blood lymphocytes, it is poorly expressed on different lymphoid cell lines of T and B origin. When this protein tyrosine phosphatase was cocrosslinked with CD3, an inhibition of the normally observed calcium mobilization was observed. This inhibition correlates with a decrease in phospholipase C-gamma (PLC-gamma) phosphorylation and is similar to the one observed with CD45. In addition, it is shown that the crosslinking of the CD148 alone is also able to induce an increase in [Ca2+]i. This increase is abolished in the presence of genistein and by cocrosslinking with CD45. These data, together with the induction of tyrosine phosphorylation on several substrates, including PLC-gamma, after CD148 crosslinking, suggest the involvement of a tyrosine kinase-based signaling pathway in this process. In conclusion, the data presented show that CD148 corresponds to a previously described protein tyrosine phosphatase HPTP-eta/DEP-1 and that this molecule is involved in signal transduction in lymphocytes

A survey of current and past Pediatric Infectious Diseases fellows regarding training

<p>Abstract</p> <p>Background</p> <p>The objectives of this study were to characterize the satisfaction of Pediatric Infectious Diseases fellows with their training and to understand how opinions about training have changed over time.</p> <p>Methods</p> <p>Anonymous survey studies were conducted with questions designed to include areas related to the 6 ACGME core competencies. Surveys for current fellows were distributed by fellowship directors, while surveys for graduates were mailed to all individuals with Pediatric Infectious Diseases certification.</p> <p>Results</p> <p>Response rates for current fellows and graduates were 50% and 52%, respectively. Most fellows (98%) and graduates (92%) perceived their overall training favorably. Training in most clinical care areas was rated favorably, however both groups perceived relative deficiencies in several areas. Current fellows rated their training in other competency areas (e.g., systems-based practice, research, and ethics) more favorably when compared to past graduates. Recent graduates perceived their training more favorably in many of these areas compared to past graduates.</p> <p>Conclusions</p> <p>Pediatric Infectious Diseases fellowship training is well regarded by the majority of current and past trainees. Views of current fellows reflect improved satisfaction with training in a variety of competency areas. Persistent deficiencies in clinical training likely reflect active barriers to education. Additional study is warranted to validate perceived deficiencies and to establish consensus on the importance of these areas to infectious diseases training.</p

Diagrammatic analysis of correlations in polymer fluids: Cluster diagrams via Edwards' field theory

A straightforward expansion of Edwards' functional integral representation of the grand partition function for a polymer liquid as an infinite set of Feynman diagrams is shown to yield a cluster expansion that is closely related to the corresponding Mayer cluster expansion developed for flexible molecules by Chandler and coworkers. The procedure initially yields a perturbative cluster expansion in which all free energies and correlation functions are expressed diagrammatically as functionals of single-molecule correlation functions of non-interacting molecules. Topological reduction yields several renormalized expansions for collective correlation functions of all orders as functionals of single-molecule correlation functions in the interacting fluid. Renormalized expansions are also obtained for a generalized Ornstein-Zernicke (OZ) direct correlation function and for intramolecular correlation functions. The application of the formalism to coarse-grained models of polymer fluids is discussed, and a loop expansion about self-consistent field theory is shown to converge for sufficiently coarse-grained models, in which monomers are strongly overlapping. The formalism is used to derive a new expression for the OZ direct correlation function and to recover known results for the 2-point intramolecular correlation function to first order in a loop expansion, for binary blends and diblock copolymer melts.Comment: 98 pages, 13 figures, accepted by Annals of Physic

Analytical and numerical analyses of the micromechanics of soft fibrous connective tissues

State of the art research and treatment of biological tissues require accurate and efficient methods for describing their mechanical properties. Indeed, micromechanics motivated approaches provide a systematic method for elevating relevant data from the microscopic level to the macroscopic one. In this work the mechanical responses of hyperelastic tissues with one and two families of collagen fibers are analyzed by application of a new variational estimate accounting for their histology and the behaviors of their constituents. The resulting, close form expressions, are used to determine the overall response of the wall of a healthy human coronary artery. To demonstrate the accuracy of the proposed method these predictions are compared with corresponding 3-D finite element simulations of a periodic unit cell of the tissue with two families of fibers. Throughout, the analytical predictions for the highly nonlinear and anisotropic tissue are in agreement with the numerical simulations

Dyskinesias after neural transplantation in Parkinson's disease: what do we know and what is next?

Since the 1980 s, when cell transplantation into the brain as a cure for Parkinson's disease hit the headlines, several patients with Parkinson's disease have received transplantation of cells from aborted fetuses with the aim of replacing the dopamine cells destroyed by the disease. The results in human studies were unpredictable and raised controversy. Some patients showed remarkable improvement, but many of the patients who underwent transplantation experienced serious disabling adverse reactions, putting an end to human trials since the late 1990 s. These side effects consisted of patients' developing troublesome involuntary, uncontrolled movements in the absence of dopaminergic medication, so-called off-phase, graft-induced dyskinesias. Notwithstanding the several mechanisms having been proposed, the pathogenesis of this type of dyskinesias remained unclear and there was no effective treatment. It has been suggested that graft-induced dyskinesias could be related to fiber outgrowth from the graft causing increased dopamine release, that could be related to the failure of grafts to restore a precise distribution of dopaminergic synaptic contacts on host neurons or may also be induced by inflammatory and immune responses around the graft. A recent study, however, hypothesized that an important factor for the development of graft-induced dyskinesias could include the composition of the cell suspension and specifically that a high proportion of serotonergic neurons cografted in these transplants engage in nonphysiological properties such as false transmitter release. The findings from this study showed serotonergic hyperinnervation in the grafted striatum of two patients with Parkinson's disease who exhibited major motor recovery after transplantation with fetal mesencephalic tissue but later developed graft-induced dyskinesias. Moreover, the dyskinesias were significantly attenuated by administration of a serotonin agonist, which activates the inhibitory serotonin autoreceptors and attenuates transmitter release from serotonergic neurons, indicating that graft-induced dyskinesias were caused by the dense serotonergic innervation engaging in false transmitter release. Here the implications of the recent findings for the development of new human trials testing the safety and efficacy of cell transplantation in patients with Parkinson's disease are discussed