Improving Communication of Asthma Related Care Between Pediatric Primary Care Providers and Schools

Introduction: Asthma is a life-altering chronic disease that affects many children throughout the state of Michigan. Evidence-based guidelines recommend a written asthma action plan (AAP) be given to all caregivers of children with asthma. This would include schools, but the plans are not making it there. This project focused on collecting school asthma data and designing a process change at a local clinic to send the plans directly to the schools. Objectives: The goal of this project was to improve communication between healthcare providers and schools for children with asthma. The objectives were to increase the percentage of children with asthma who had asthma action plans and to send the AAP directly to the school from the clinic. Additionally, information was collected from the schools to evaluate asthma care in the community. Methods: A process change was implemented among staff members in a small, pediatric clinic in southern lower Michigan. Also, a school survey was electronically sent to all schools in the county. The process change tracked the number of AAPs going to schools and counted how many asthma patients received AAPs during appointments. The intervention was guided by the Donabedian model and implementation guided by the Promoting Action on Research Implementation in Health Services (PARiHS) framework. Results: Responses from the school survey revealed that most county schools (87.5%) did not have a nurse on staff. Additionally, in over 70% of the schools that responded, office personnel were primarily in charge of routine asthma care for students. Most schools had a low rate (\u3c 25%) of AAPs on file for asthmatic students and staff stated that they found having an AAP on file was very useful. The process change was executed over 12 weeks and staff adjusted well to the change, resulting in 73% of eligible children seen in the office receiving written AAPs and having them sent directly to schools via fax at the time of the visit. Conclusions: Data from the school survey gave insight on current asthma care in schools and the schools’ desires for communication with healthcare providers. Implementing a process change focused on AAPs was successful and the office was able to provide written AAPs to schools for over 70% of asthmatic students seen in the office during the process change. Implications: This intervention of sending AAPs directly to schools improved communication between healthcare providers and schools where asthma care is given. Asthma management can be improved as communication is improved, and may decrease the number of asthma-related complications for children with this respiratory disease

Topographic Findings of the Porcine Cornea

The porcine eye is often used as an ex vivo animal model in ophthalmological research. It is well suited for investigations concerning refractive surgery; however, corneal topography data are scarce. This study investigated the corneal topography and pachymetry of the porcine eye to provide further reproducible data. We evaluated freshly enucleated porcine eyes (n = 16) by performing computerized corneal topographies (Orbscan® IIz, Bausch and Lomb, Rochester, NY, USA). We assessed the steepest and flattest keratometric powers (K1 and K2, units in diopters (D)), astigmatism (D), white-to-white (WTW) diameter (mm), thinnest point pachymetry (µm), anterior and posterior best-fit sphere (BFS) (D), refractive power of the anterior and posterior curvatures, and total refractive power of the cornea (D). The mean keratometric powers were 39.6 ± 0.89 D (K1) and 38.5 ± 0.92 D (K2), and the mean astigmatism was 1.1 ± 0.78 D. The mean WTW diameter was 13.81 ± 0.83 mm, and the mean corneal thickness was 832.6 ± 40.18 µm. The BFSs were 38.14 ± 0.73 D (anterior) and 42.56 ± 1.15 D (posterior), and the mean refractive powers were 43.27 ± 1.08 D (anterior) and -5.15 ± 0.20 D (posterior); therefore, the mean of the total refractive power was 38.16 ± 1.00 D. The topography and pachymetry of the porcine cornea showed a specific configuration differing from the human cornea. When using animal ex vivo models such as porcine corneas for experimental corneal surgery, findings such as these should be considered

Topographic Findings of the Porcine Cornea

The porcine eye is often used as an ex vivo animal model in ophthalmological research. It is well suited for investigations concerning refractive surgery; however, corneal topography data are scarce. This study investigated the corneal topography and pachymetry of the porcine eye to provide further reproducible data. We evaluated freshly enucleated porcine eyes (n = 16) by performing computerized corneal topographies (Orbscan® IIz, Bausch and Lomb, Rochester, NY, USA). We assessed the steepest and flattest keratometric powers (K1 and K2, units in diopters (D)), astigmatism (D), white-to-white (WTW) diameter (mm), thinnest point pachymetry (µm), anterior and posterior best-fit sphere (BFS) (D), refractive power of the anterior and posterior curvatures, and total refractive power of the cornea (D). The mean keratometric powers were 39.6 ± 0.89 D (K1) and 38.5 ± 0.92 D (K2), and the mean astigmatism was 1.1 ± 0.78 D. The mean WTW diameter was 13.81 ± 0.83 mm, and the mean corneal thickness was 832.6 ± 40.18 µm. The BFSs were 38.14 ± 0.73 D (anterior) and 42.56 ± 1.15 D (posterior), and the mean refractive powers were 43.27 ± 1.08 D (anterior) and -5.15 ± 0.20 D (posterior); therefore, the mean of the total refractive power was 38.16 ± 1.00 D. The topography and pachymetry of the porcine cornea showed a specific configuration differing from the human cornea. When using animal ex vivo models such as porcine corneas for experimental corneal surgery, findings such as these should be considered

NADPH-diaphorase expression in the Meibomian glands of rat palpebra in postnatal development

In the current study, we aimed at investigating the presence of nitric oxide synthase (NOS) positive nerve fibers in rat meibomian glands (MGs) at various stages of development. There is good evidence to suggest that nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) is a surrogate for neuronal nitric oxide synthase (NOS). Sections of the central, upper eyelids of Wistar rats were processed histochemically for NADPH-d to investigate the presence and distribution of NOS-positive nerve fibers at the following time points: day 1 and weeks 1, 2 and 3 post partum, and in adult controls. At day 1, MG acini were lightly stained and located at a distance from the mucosal border. Vessels were accompanied by intensely stained NADPH-d positive nerve fibers. At the week 1 time point, both the vessels and the NADPH-d positive fibers were still present, but less numerous. MGs were now closer to the mucosa, so that the submucosa was thinner. The acini were mostly pale but occasionally darker. At week 3, there were fewer blood vessels in both the sub-mucosa and within the septa. Darker acini were more common than lightly stained acini. NADPH-d positive dots were observed in the vicinity of the MGs. At the week 3 time point, MGs were adjacent to the mucosal border and stained more intensely than at earlier times; almost all acini were stained. The microscopic appearances were almost identical with those of adult palpebra. Submucosal and septal blood vessels and NADPH-d positive nerve fibers were less numerous. NADPH-d histochemical staining confirmed differences in the density of stained nerve fibers at different developmental stages. The greatest density of NADPH-d -positive nerve fibers occurred in 1-day-old rats whereas they were less numerous in adult rat eyelids. Nerves innervating MGs utilize nitric oxide (NO) as a neurotransmitter mostly in early developmental stages and this need thereafter decreases and stabilizes at 3 weeks postnatally

Nitrogen fixation of hay and pasture legumes

The International Hill Land Symposium was held at Oregon State University in April 1983.Nitrogen is the major limiting nutrient for grain crops and for forages and grasslands of the United States. Nitrogen also is the most costly of the major nutrients on a land area basis because of the quantities applied and because of its dependence for manufacture upon increasingly scarce and expensive natural gas. Nitrogen fixed by symbiosis in legume root nodules can be substi­tuted for fertilizer N, and thus effect financial and energy savings, by adoption of management practices that result in a net return of symbiotically fixed N2 to the soil. Legumes can be grown in rotation with nonlegumes, and the legume residues plowed down to provide N to the succeeding nonlegume. Also, legumes in legume-grass swards may furnish N to the grass by decomposition of plant residues or through animal excreta. In either of these practices, the amount of fertilizer N that can be displaced by legume N depends upon (a) the quantity of N2 fixed by the legume, (b) the quantity of legume residues returned to the soil, (c) the proportion of Nin the residues derived from symbiotic fixa­tion, and (d) the rate at which the Nin the residues becomes available to the associated nonlegume crop. The benefits from substituting a hay or pasture legume for N fertilizer in a cropping system will depend on how the legume is managed. If the legume is managed for maximum hay production, little net N input to the soil may occur if sparce regrowth is plowed down at the end of the cropping cycle. If a lush stand of herbage is incor­porated, the prospect of a net N addition to the cropping system is enhanced. Grazing of legume-grass swards may result in substantial transfer of legume N through animal excreta to the associated grass