Text Messaging in the Patient-Centered Medical Home to Improve Glucose Control and Retinopathy Screening.

Purpose: To evaluate the effectiveness of a text messaging program (TMP) to improve glucose control, retinopathy screening (RS) rates, and self-care behaviors in patients with uncontrolled type 2 diabetes. Methods: A single-group design with a quasi-systematic random sample (n=20) received educational/exhortational text messages on their cellular phones for 3 months. Subjects, 12 of whom identified as a minority ethnicity, were mostly male, aged 27-73 years. Results: Glucose control and RS rates improved significantly. Subjects (\u3e70%) reported changes in self-care behaviors. Conclusion: Leveraging ubiquitous technology, a TMP for patients with limited access to healthcare education, holds promis

The Non-Unconscionability of Condominium Recreation Leases

The authors evaluate the theory of unconscionability as a basis for challenging long-term condominium recreation leases in Florida. They discuss the situation underlying such challenges and examine recent attempts to apply common law and U.C.C. unconscionability principles to recreation leases. An analysis of the realities of condominium development serves to dispel several commonly held misconceptions about recreation leases. The authors also analyze the presumption of unconscionability under the Florida Condominium Act, contrasting it with the proposed Federal Condominium Act. Recognizing the inefficacy of the unconscionability approach, the authors briefly discuss the recreation lease buy-out as a more feasible alternative solution

Exploring students\u27 museum experiences in the context of web-based learning environments

The paper examines the nature of school excursions to museums, and how the Internet, and in particular the web pages accompanying museum exhibitions, can be utilised to create authentic and complex learning environments for school students. The paper describes proposed research between a university and two leading museums that will investigate whether and how learners link web-based content and data in developing a broader perspective on the museum experience. It will explore in depth the use of the web to situate the onsite museum visit, not as a single one-off event, but within a complex task or problem-based learning approach that extends beyond the museum visit itself

The Non-Unconscionability of Condominium Recreation Leases

The authors evaluate the theory of unconscionability as a basis for challenging long-term condominium recreation leases in Florida. They discuss the situation underlying such challenges and examine recent attempts to apply common law and U.C.C. unconscionability principles to recreation leases. An analysis of the realities of condominium development serves to dispel several commonly held misconceptions about recreation leases. The authors also analyze the presumption of unconscionability under the Florida Condominium Act, contrasting it with the proposed Federal Condominium Act. Recognizing the inefficacy of the unconscionability approach, the authors briefly discuss the recreation lease buy-out as a more feasible alternative solution

REMCARE : pragmatic multi-centre randomised trial of reminiscence groups for people with dementia and their family carers : effectiveness and economic analysis

Background Joint reminiscence groups, involving people with dementia and family carers together, are popular, but the evidence-base is limited. This study aimed to assess the effectiveness and cost-effectiveness of joint reminiscence groups as compared to usual care. Methods This multi-centre, pragmatic randomised controlled trial had two parallel arms: intervention group and usual-care control group. A restricted dynamic method of randomisation was used, with an overall allocation ratio of 1:1, restricted to ensure viable sized intervention groups. Assessments, blind to treatment allocation, were carried out at baseline, three months and ten months (primary end-point), usually in the person's home. Participants were recruited in eight centres, mainly through NHS Memory Clinics and NHS community mental health teams. Included participants were community resident people with mild to moderate dementia (DSM-IV), who had a relative or other care-giver in regular contact, to act as informant and willing and able to participate in intervention. 71% carers were spouses. 488 people with dementia (mean age 77.5) were randomised: 268 intervention, 220 control; 350 dyads completed the study (206 intervention, 144 control). The intervention evaluated was joint reminiscence groups (with up to 12 dyads) weekly for twelve weeks; monthly maintenance sessions for further seven months. Sessions followed a published treatment manual and were held in a variety of community settings. Two trained facilitators in each centre were supported by volunteers. Primary outcome measures were self-reported quality of life for the person with dementia (QoL-AD), psychological distress for the carer (General Health Questionnaire, GHQ-28). Secondary outcome measures included: autobiographical memory and activities of daily living for the person with dementia; carer stress for the carer; mood, relationship quality and service use and costs for both. Results The intention to treat analysis (ANCOVA) identified no differences in outcome between the intervention and control conditions on primary or secondary outcomes (self-reported QoL-AD mean difference 0.07 (-1.21 to 1.35), F = 0.48, p = 0.53). Carers of people with dementia allocated to the reminiscence intervention reported a significant increase in anxiety on a General Health Questionnaire-28 sub-scale at the ten month end-point (mean difference 1.25 (0.25 to 2.26), F = 8.28, p = 0.04). Compliance analyses suggested improved autobiographical memory, quality of life and relationship quality for people with dementia attending more reminiscence sessions, however carers attending more groups showed increased care-giving stress. Economic analyses from a public sector perspective indicated that joint reminiscence groups are unlikely to be cost-effective. There were no significant adverse effects attributed to the intervention. Potential limitations of the study include less than optimal attendance at the group sessions—only 57% of participants attended at least half of the intervention sessions over the 10 month period, and a higher rate of study withdrawal in the control group. Conclusions This trial does not support the clinical effectiveness or cost-effectiveness of joint reminiscence groups. Possible beneficial effects for people with dementia who attend sessions as planned are offset by raised anxiety and stress in their carers. The reasons for these discrepant outcomes need to be explored further, and may necessitate reappraisal of the movement towards joint interventions

Plant responses to simulated carbon capture and transport leakage: the effect of impurities in the CO2 gas stream

To deliver an effective transition from a carbon-based 24 to a carbon-free energy market, bridging technologies are required. One such possibility is the use of carbon capture and storage, (CCS). However, before such innovations can be rolled out a key requirement is to understand the environmental impact of these technologies. Recent experimental work has demonstrated that small scale CO2 leakage from CCS pipeline infrastructure has a localised and possibly transient impact. However, what remains unknown is the possibility of synergistic impact of impurities in the CO2 gas stream. Here we report the impact of two impurities SO2 (100 ppm SO2 in pure CO2) and H2S (80ppm H2S in pure CO2) on the growth and performance of two crop species (spring wheat, Triticum aestivum and beetroot, Beta vulgaris) in fully replicated experiments. Our data show that when compared to CO2-only gassed controls, the impact of these impurities are minimal as there are no statistically significant differences between performance parameters (photosynthesis, stomatal conductance and transpiration) or biomass. These results signify that from a plant health perspective it may not be necessary to completely remove these specific impurities prior to CO2 transportation

Mesenchymal chondroprogenitor cell origin and therapeutic potential

Mesenchymal progenitor cells, a multipotent adult stem cell population, have the ability to differentiate into cells of connective tissue lineages, including fat, cartilage, bone and muscle, and therefore generate a great deal of interest for their potential use in regenerative medicine. During development, endochondral bone is formed from a template of cartilage that transforms into bone; however, mature articular cartilage remains in the articulating joints, where its principal role is reducing friction and dispersing mechanical load. Articular cartilage is prone to damage from sports injuries or ageing, which regularly progresses to more serious joint disorders, such as osteoarthritis. Osteoarthritis is a degenerative joint disease characterized by the thinning and eventual wearing of articular cartilage, and affects millions of people worldwide. Due to low chondrocyte motility and proliferative rates, and complicated by the absence of blood vessels, cartilage has a limited ability to self-repair. Current pharmaceutical and surgical interventions fail to generate repair tissue with the mechanical and cellular properties of native host cartilage. The long-term success of cartilage repair will therefore depend on regenerative methodologies resulting in the restoration of articular cartilage that closely duplicates the native tissue. For cell-based therapies, the optimal cell source must be readily accessible with easily isolated, abundant cells capable of collagen type II and sulfated proteoglycan production in appropriate proportions. Although a cell source with these therapeutic properties remains elusive, mesenchymal chondroprogenitors retain their expansion capacity with the promise of reproducing the structural or biomechanical properties of healthy articular cartilage. As current knowledge regarding chondroprogenitors is relatively limited, this review will focus on their origin and therapeutic application

SIV antigen immunization induces transient antigen-specific T cell responses and selectively activates viral replication in draining lymph nodes in retroviral suppressed rhesus macaques

<p>Abstract</p> <p>Background</p> <p>HIV infection causes a qualitative and quantitative loss of CD4⁺T cell immunity. The institution of anti-retroviral therapy (ART) restores CD4⁺T cell responses to many pathogens, but HIV-specific responses remain deficient. Similarly, therapeutic immunization with HIV antigens of chronically infected, ART treated subjects results in poor induction of HIV-specific CD4 responses. In this study, we used a macaque model of ART treatment during chronic infection to study the virologic consequences of SIV antigen stimulation in lymph nodes early after immunization. Rhesus CMV (RhCMV) seropositive, Mamu A*01 positive rhesus macaques were chronically infected with SIVmac251 and treated with ART. The immune and viral responses to SIV gag and RhCMV pp65 antigen immunization in draining lymph nodes and peripheral blood were analyzed. Animals were immunized on contralateral sides with SIV gag and RhCMV pp65 encoding plasmids, which allowed lymph nodes draining each antigen to be obtained at the same time from the same animal for direct comparison.</p> <p>Results</p> <p>We observed that both SIV and RhCMV immunizations stimulated transient antigen-specific T cell responses in draining lymph nodes. The RhCMV-specific responses were potent and sustained (50 days post-immunization) in the periphery, while the SIV-specific responses were transient and extinguished quickly. The SIV antigen stimulation selectively induced transient SIV replication in draining lymph nodes.</p> <p>Conclusions</p> <p>The data are consistent with a model whereby viral replication in response to SIV antigen stimulation limits the generation of SIV antigen-specific responses and suggests a potential mechanism for the early loss and poor HIV-specific CD4⁺T cell response observed in HIV-infected individuals.</p

Indicators of pulmonary exacerbation in cystic fibrosis: A Delphi survey of patients and health professionals

Background: There is uncertainty about the most important indicators of pulmonary exacerbations in CF. Methods: Two parallel Delphi surveys in 13 CF centres (UK and Ireland). Delphi 1: 31 adults with CF, ≥ one exacerbation over 12 months. Delphi 2: 38 CF health professionals. Rounds 1 and 2 participants rated their level of agreement with statements relating to indicators of exacerbation; Round 3 participants rated the importance of statements which were subsequently placed in rank order. Results: Objective measurements were of higher importance to health professionals. Feelings of increased debility were rated most important by adults with CF. Conclusions: There were clear differences in perspectives between the two groups as to the most important indicators of an exacerbation. This highlights that CF health professionals should take more cognisance of specific signs and symptoms reported by adults with CF, especially since these may be a precursor to an exacerbation