Klipsun Magazine, 2011, Volume 41, Issue 03 - Winter

I know what you re thinking: Who cares about dirt anyway? It\u27s all around us, finding its way onto our shoes, into our homes and under our fingernails. But we didn’t make this issue to highlight dirt’s prevalence. It’s dirt’s ability to play a unique part in so many people’s lives that makes it special. For some nature seekers, it takes a little more than a hike to get the blood flowing. Off-roading gives these daring drivers an opportunity to become one with nature, and kick up some dirt along the way. It’s also common for people to associate dreadlocks with dirt — a connotation that one Klipsun reporter found is not always true. Humans are always looking for ways to stay clean. But in spas around the world, people are realizing all that may take is a healthy portion of mud. And even sometimes people can be inherently dirty. Take Dirty Dan, Fairhaven’s putrid patriarch, a man famous for his filthy lifestyle. True, these stories are all about dirt. But they are also about the way people walk on it, drive over it, wear it, bathe in it, get rid of it and live their lives with it. So roll up your sleeves, put away the soap and remember a little dirt never hurt anyone.https://cedar.wwu.edu/klipsun_magazine/1254/thumbnail.jp

Klipsun Magazine, 2010, Volume 40, Issue 05 - Fall

The difference between inside and outside can be surprisingly small. Outside my window right now is dirt, wind and pouring rain. Meanwhile inside it is a cozy 65 degrees, and my computer, iPod and guitars are at no threat from the elements. This difference is due to less than two feet of wall and fiberglass. In an unassuming shopping center in Edmonds, this same thickness of wall separates families enjoying pizza dinners and gym-goers from shelves lined with varieties of medical marijuana, its pungent smell shielded by a thick door. Sometimes these barriers are made of other material. Plastic surgery allows people to bypass the wall of skin and change their appear­ance on the outside to what they feel on the inside. And in one Klipsun reporter\u27s experience, this can prove to be life changing. Often the simple barrier separating what s inside from out has the power to change the people who cross it. The patrons of the Bellingham Academy of Self Defense, for example, routinely leave behind their daily lives and step inside to study the ancient art of Karate, allowing them the focus to reflect on their lives outside. This issue of Klipsun examines the many differ­ent meanings and interpretations of“inside/outside,” and keeping with the spirit of the theme, I hope you will enjoy reading what s inside these pages as much as we enjoyed making it.https://cedar.wwu.edu/klipsun_magazine/1252/thumbnail.jp

Molecular Engineering Strategies for the Design and Synthesis of New Organic Photovoltaic Materials

Dramatic improvements in organic photovoltaic device efficiency can be obtained by optimizing spectral absorbance and frontier molecular orbital (FMO) energies, increasing solid state exciton/charge mobility, and utilizing p-/n-type nanoarchitecture. Combining all of these properties into a new material presents a considerable synthetic challenge because potential commercial applications require materials that are high-performance and inexpensive. Thus, it is advantageous to design new materials using a versatile, modular synthetic approach that allows each design criterion to be engineered individually, in a synthetically efficient manner. Several strategies were successfully pursued using simple interchangeable electron donor and acceptor components as functional modules, which provided various donor-acceptor chromophores in a synthetically straightforward manner. This approach provided broad functional tunability to the range of materials produced and, as a result, various molecular engineering requirements were systematically addressed. In some cases, these materials were utilized in photovoltaic devices as p-type active layers or redox enhancement additives. In these cases, competitive power conversion efficiencies were obtained or test device performance was considerably enhanced by comparison to control devices. Fluorenone, fluorenylidene-malononitrile, and squaric acid were utilized as electron acceptor modules, and electron donor module strength was varied using a styrene-based and several di- and triarylamine-based components. One strategy, published in Phys. Chem. Chem. Phys., (Chapter 2, DOI-10.1039/C2CP41813D) is to fix the donor-acceptor lowest unoccupied molecular orbital energy using the synthetically versatile fluorenone module. Fluorenone was chosen because of its ready availability and synthetic versatility, and its multiple functionalization sites allow for selective FMO engineering. Extrapolation of this approach was published in J. Phys. Chem. A. (Chapter 3, DOI-10.1021/jp407854r), describing various fluorenylidene-malononitrile derivatives. Chemical oxidation of fluorenone-based triarylamines to produce stable radicals was published in Tetrahedron Letters (Chapter 4, DOI-10.1016/j.tetlet.2012.10.060). Fluorenone derivatives applied as dye sensitized solar cell redox system enhancement additives was described in RSC Advances (Chapter 5, DOI-10.1039/C3RA40986D). Development of new, functionalized, squaraine-based materials was described in J. Phys. Chem. C. (Chapter 6, DOI-10.1021/jp410362d) and was extrapolated for use in single-heterojunction photovoltaic cells having 4.8% maximum power conversion efficiency. The fundamental insights provided by these findings will be valuable for developing new high-performance photovoltaic materials in the future

Evaluation of genetic counseling among cystic fibrosis carriers, Michigan Newborn Screening

Objective A quality improvement (QI) strategy to improve the rate of genetic counseling (GC) services was initiated in cystic fibrosis (CF) care Center E in 2010. This statewide study was conducted to determine: (1) GC rates before and after implementation of the QI strategy at Center E; (2) characteristics associated with not receiving GC; and (3) topic areas addressed during GC. Methods The retrospective study included 1,097 CF carriers born from 2008 to 2011 identified through Michigan's Newborn Screening Program. Rate of GC services was determined for Center E and the other four CF centers before and after the QI change. Bivariate and multivariable logistic regression was used to determine associations between select characteristics and not receiving GC. Topic areas discussed during GC sessions were assessed using frequency tables. Results Rate of GC services in Center E increased from 23% in 2008–2010 to 91% in 2011, while at the other centers approximately 92% received GC services across those years. In 2008–2010, being seen at Center E and black race were significantly associated with increased likelihood of not receiving GC services in adjusted analyses. In 2011, neither characteristic was associated with receipt of GC. Of 16 target topic areas, all were discussed in 85% of GC sessions. Conclusions Implementing a QI strategy of providing sweat test results at the GC appointment within Center E resulted in more CF carriers receiving comprehensive GC services. Center‐specific procedure differences should be assessed to increase rate of GC services following a positive CF newborn screen. Pediatr Pulmonol. 2013; 48:123–129. © 2012 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/96254/1/22703_ftp.pd

The effectiveness and safety of antifibrinolytics in patients with acute intracranial haemorrhage: statistical analysis plan for an individual patient data meta-analysis

Introduction: The Antifibrinolytic Trialists Collaboration aims to increase knowledge about the effectiveness and safety of antifibrinolytic treatment by conducting individual patient data (IPD) meta-analyses of randomised trials. This article presents the statistical analysis plan for an IPD meta-analysis of the effects of antifibrinolytics for acute intracranial haemorrhage. Methods: The protocol for the IPD meta-analysis has been registered with PROSPERO (CRD42016052155). We will conduct an individual patient data meta-analysis of randomised controlled trials with 1000 patients or more assessing the effects of antifibrinolytics in acute intracranial haemorrhage. We will assess the effect on two co-primary outcomes: 1) death in hospital at end of trial follow-up, and 2) death in hospital or dependency at end of trial follow-up. The co-primary outcomes will be limited to patients treated within three hours of injury or stroke onset. We will report treatment effects using odds ratios and 95% confidence intervals. We use logistic regression models to examine how the effect of antifibrinolytics vary by time to treatment, severity of intracranial bleeding, and age. We will also examine the effect of antifibrinolytics on secondary outcomes including death, dependency, vascular occlusive events, seizures, and neurological outcomes. Secondary outcomes will be assessed in all patients irrespective of time of treatment. All analyses will be conducted on an intention-to-treat basis. Conclusions: This IPD meta-analysis will examine important clinical questions about the effects of antifibrinolytic treatment in patients with intracranial haemorrhage that cannot be answered using aggregate data. With IPD we can examine how effects vary by time to treatment, bleeding severity, and age, to gain better understanding of the balance of benefit and harms on which to base recommendations for practice

Appetite stimulants use in cystic fibrosis

Cystic fibrosis (CF) is an autosomal recessive disease. It affects multiple body organs. The lungs and pancreas are the most affected which results in progressive lung damage and pancreatic insufficiency. Due to the disease process, CF patients require significantly higher caloric intake than recommended for other individuals. The nutritional goal for CF patients is to achieve normal growth and development and, once genetic potential is reached, to maintain good nutritional status throughout life. Evidence has shown that lung function is closely associated with nutritional status in CF and that nutritional status is an independent predictor of survival. Most CF patients are on a high calorie diet to help achieve normal growth and development and maintain good lung function. Inadequate caloric intake in CF can lead to malnutrition. Malnutrition in CF requires careful, multidisciplinary history taking, physical exam, and overall patient/family assessment. Only by determining the actual cause of the malnutrition can appropriate and safe therapies be used to treat it. Appetite stimulants, although efficacious in treating malnutrition in CF, should only be prescribed if decreased food intake secondary to inadequate appetite is the principal cause of the malnutrition and all other contributing factors have been assessed, ruled-out or treated. In this review, we attempted to summarize the use of several appetite stimulants used in CF and other diseases to improve appetite and maximize caloric intake. Pediatr Pulmonol. 2008; 43:209–219. © 2008 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/57930/1/20766_ftp.pd

European Cystic Fibrosis Society standards of care: best practice guidelines

Specialised CF care has led to a dramatic improvement in survival in CF: in the last four decades, well above what was seen in the general population over the same period. With the implementation of newborn screening in many European countries, centres are increasingly caring for a cohort of patients who have minimal lung disease at diagnosis and therefore have the potential to enjoy an excellent quality of life and an even greater life expectancy than was seen previously. To allow high quality care to be delivered throughout Europe, a landmark document was published in 2005 that sets standards of care. Our current document builds on this work, setting standards for best practice in key aspects of CF care. The objective of our document is to give a broad overview of the standards expected for screening, diagnosis, pre-emptive treatment of lung disease, nutrition, complications, transplant/end of life care and psychological support. For comprehensive details of clinical care of CF, references to the most up to date European Consensus Statements, Guidelines or Position Papers are provided in Table 1. We hope that this best practice document will be useful to clinical teams both in countries where CF care is developing and those with established CF centres

ECFS best practice guidelines: the 2018 revision

Developments in managing CF continue to drive dramatic improvements in survival. As newborn screening rolls-out across Europe, CF centres are increasingly caring for cohorts of patients who have minimal lung disease on diagnosis. With the introduction of mutation-specific therapies and the prospect of truly personalised medicine, patients have the potential to enjoy good quality of life in adulthood with ever-increasing life expectancy. The landmark Standards of Care published in 2005 set out what high quality CF care is and how it can be delivered throughout Europe. This underwent a fundamental re-write in 2014, resulting in three documents; center framework, quality management and best practice guidelines. This document is a revision of the latter, updating standards for best practice in key aspects of CF care, in the context of a fast-moving and dynamic field. In continuing to give a broad overview of the standards expected for newborn screening, diagnosis, preventative treatment of lung disease, nutrition, complications, transplant/end of life care and psychological support, this consensus on best practice is expected to prove useful to clinical teams both in countries where CF care is developing and those with established CF centres. The document is an ECFS product and endorsed by the CF Network in ERN LUNG and CF Europe

Group Treatment in Hippotherapy

Most therapists incorporate hippotherapy using the German model of individual sessions one client, one horse, one therapist. This type of treatment has been the standard for hippotherapy across physical therapy, occupational therapy, and speech-language pathology both within the US as well as internationally. The one therapist-one client-one horse model provides for dynamic accommodation and adjustment for both the movement qualities of the horse and the treatment activities of the client. However, within speech-language pathology, many treatment goals involve improvement of communication between two people. We propose that hippotherapy can be the facilitator for improved nervous system functioning leading to improved communication for each client in a group environment. The purpose of this session is to discuss and demonstrate group treatment using hippotherapy with the treatment goals of improved social communication and pragmatic language. Video examples from group hippotherapy sessions will be shown and discussed