BRAD: A Model of Caring for Persons with Frontotemporal Dementia

Frontotemporal dementia (FTD) is caused by u progressive degeneration of the frontal and temporal lobes of the brain (Boxer & Miller, 2005), This degeneration causes profound alterations in personality, social behavior, and language skills. FTD is particularly devastating due to the fact that it commonly affects people during mid-life or earlier. Evidence has shown that caregivers face higher rates of burden, distress and isolation when providing care for someone with FTD than other forms of dementia (de Vugt, Riedijk, Aalten, Tibben, van Swieten, & Verhey,2006; Kumamoto, Arai, Hashimoto, Ikeda, Mizuno, & Washio, 2004). The Behavioral Recognition, Assessment and Delivery (BRAD) model of care was developed for caregivers to better manage the unique challenging behaviors of persons with frontotemporal dementia. The BRAD model of care is grounded in the work of Margaret Newman and her theory of Health as Expanding Consciousness (HEC)

Hemoglobin A1C and the Diagnosis of Diabetes and Prediabetes in Children and Adolescents

Although the American Diabetes Association (ADA) adopted the use of the glycated hemoglobin (A1C) test as a method of diabetes and prediabetes diagnosis, the ADA has not developed firm guidelines concerning the use of the A1C test in children and adolescents, as research has not validated thresholds in this group. Diabetes and prediabetes are diseases influenced by multiple factors, including race and ethnicity, age, vitamin D deficiency, and body mass index (BMI). The purpose of this study was to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the A1C test compared to the gold standard use of the fasting plasma glucose (FPG) and 2-hour oral glucose tolerance test (OGTT) to detect diabetes and prediabetes in a children and adolescents considered to be at higher risk for impaired glucose metabolism. In addition, ROC curve analysis was performed to determine optimal thresholds for the diagnosis of prediabetes in available groups of the research sample. The study also to examined the correlation between A1C and race and ethnicity, age, vitamin D levels, and body mass index, in addition to comparing the relationship of A1C to beta cell dysfunction and insulin sensitivity. A retrospective review of 902 patient electronic medical records in an urban endocrinology clinic was conducted. Based on FPG and 2-hr glucose during the OGTT, patients were classified based on the ADA 2014 criteria as having diabetes or prediabetes Subjects ranged in age from 2-18 (11.6 ± 3.32), were predominantly minority (70.7% African American, 17.3% Hispanic, 12.0% Caucasian) and female (60.7%). The results yielded a high specificity (99.7%) and high negative predictive value (99.9%) for the whole sample, although the results were lower for the African American group. The results also yielded a low specificity (35.3%) but a high negative predictive value (99.8%) for the entire sample. Although results were once again lower for the African American subset. ROC curve analysis for prediabetes yielded a threshold of 5.8% for sample. Multiple regression found some correlation between fasting glucose and A1C, although statistical analysis was not possible for the aggregate sample. No statistically significant association was found between the A1C and age, vitamin D, and BMI in the sample. Correlation analysis found stronger associations between the A1C and beta cell dysfunction versus insulin sensitivity. In this predominantly minority population A1C had a high specificity and sensitivity for the diagnosis of diabetes. While the A1C resulted in a high number of false positives for prediabetes, A1C \u3c5.7% accurately identified individuals with normal glucose tolerance. Children and adolescents considered to be at higher risk for impaired glucose metabolism (family history of diabetes, obesity, minorities, or history of gestational diabetes) with A1C ≥5.7% or with symptoms of diabetes should undergo OGTT testing. In addition, different threshold levels for racial and ethnic groups should be considered in the diagnosis of prediabetes

Revising Mary Queen of Scots: from Protestant Persecution to Patriarchal Struggle

Since Mary Queen of Scots’ execution in 1587, she has become a symbol of Scottish identity, failed female leadership, and Catholic martyrdom. Throughout the twentieth century, Mary was regularly depicted on screen (Ford, 1936; Froelich, 1940; Jarrott, 1971) as a thrice-wed Catholic queen, unable to rule her country due to her feminine nature and Catholic roots. However, with the rise of third wave feminism and postfeminism in media, coupled with the increased influence of female directors and writers, Mary’s characterization has shifted from portraying female/emotional weakness and religious sacrifice to female/collaborative strength in hardship and a struggle against patriarchal prejudice. Josie Rourke’s film Mary Queen of Scots (2018) and CW’s Reign (2013-2017) present a queen who is no longer limited to her religious identity as a Catholic martyr, and consequently a weak ruler. Instead religious division is mostly sidelined, and gendered politics is the central struggle, highlighting similarities between Mary and Queen Elizabeth I of England, where previous films presented opposites. Together, these two productions transform Mary’s narrative from fragility and religion, into a struggle against misogynistic control of powerful women

Differential Regulation of Neuropeptide Y in the Amygdala and Prefrontal Cortex during Recovery from Chronic Variable Stress

Accumulating evidence from clinical studies and pre-clinical animal models supports a role for neuropeptide Y (NPY) in adaptive emotional response following stress. The long-term impact of stress, particularly chronic stress, on availability, and function of resilience factors such as NPY may be critical to understanding the etiology of stress-related psychopathology. In these studies, we examined expression of NPY during recovery from a chronic variable stress (CVS) model of repetitive trauma in rats. Due to the importance of amygdala and prefrontal cortex in regulating emotional responses, we predicted chronic changes in NPY expression could contribute to persistent behavioral deficits seen in this model. Consistent with the hypothesis, ELISA for NPY peptide identified a significant reduction in NPY at the delayed (7 days) recovery time-point. Interestingly, a significant increase in prefrontal NPY was observed at the same recovery time-point. The mRNA expression for NPY was not changed in the amygdala or PFC, although there was a modest but not statistically significant increase in NPY mRNA at the delayed recovery time-point in the prefrontal cortex. The observed changes in NPY expression are consistent with maladaptive coping and enhanced emotionality, due to the nature of NPY signaling within these respective regions, and the nature of reciprocal connections between amygdala and prefrontal cortex

IMPACT Concept of Operations

NASAs future exploration missions mandate a significant paradigm change for mission planning, spacecraft design, human systems integration, and in-flight medical care due to constraints on mass, volume, power, resupply missions, and medical evacuation capabilities. These constraints require further development of the human health and performance system, which includes the medical, task performance, wellness, data, human and other systems necessary to keep the crew healthy and functioning optimally. The human health and performance system will be tightly integrated with mission and habitat design to provide a sufficient human health and performance infrastructure to enable mission success. A suite of systems engineering tools will aid in the decision making process for the development of such a human health and performance system. This Concept of Operations provides a vision for a tool suite to conduct evaluations of human health and performance system options, inform research prioritization, and provide trade study support, based on evidence, risks, and systems engineering principles. The integrated tool suite under development is IMPACT

Glutamine supplementation to prevent morbidity and mortality in preterm infants

BACKGROUND: Glutamine is a conditionally essential amino acid. Endogenous biosynthesis may be insufficient for tissue needs in states of metabolic stress. Evidence exists that glutamine supplementation improves clinical outcomes in critically ill adults. It has been suggested that glutamine supplementation may also benefit preterm infants. OBJECTIVES: To determine the effects of glutamine supplementation on mortality and morbidity in preterm infants. SEARCH METHODS: We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, 2015, Issue 12), MEDLINE, EMBASE and Maternity and Infant Care (to December 2015), conference proceedings and previous reviews. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials that compared glutamine supplementation versus no glutamine supplementation in preterm infants at any time from birth to discharge from hospital. DATA COLLECTION AND ANALYSIS: We extracted data using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by two review authors. We synthesised data using a fixed-effect model and reported typical relative risk, typical risk difference and weighted mean difference. MAIN RESULTS: We identified 12 randomised controlled trials in which a total of 2877 preterm infants participated. Six trials assessed enteral glutamine supplementation and six trials assessed parenteral glutamine supplementation. The trials were generally of good methodological quality. Meta-analysis did not find an effect of glutamine supplementation on mortality (typical relative risk 0.97, 95% confidence interval 0.80 to 1.17; risk difference 0.00, 95% confidence interval -0.03 to 0.02) or major neonatal morbidities including the incidence of invasive infection or necrotising enterocolitis. Three trials that assessed neurodevelopmental outcomes in children aged 18 to 24 months and beyond did not find any effects. AUTHORS' CONCLUSIONS: The available trial data do not provide evidence that glutamine supplementation confers important benefits for preterm infants

Immediate Versus Delayed Insertion of the Levonorgestrel Intrauterine Device in Postpartum Adolescents: A Randomized Pilot Study.

This pilot study assessed the feasibility of conducting a larger randomized controlled trial comparing the proportion of adolescents using a levonorgestrel intrauterine device (LNG IUD) at six months postpartum when it is inserted immediately after vaginal delivery (within 10 minutes after placental expulsion) compared to insertion four to six weeks postpartum. Pregnant adolescents (14 to 19 years) who desired a LNG IUD for postpartum contraception were randomized to insertion of the LNG IUD either within 10 minutes of delivery of the placenta or at 4-6 weeks postpartum. Study follow-up visits were conducted at 4-6 weeks postpartum, 10 weeks postpartum, and 6 months postpartum. From November 2013 to June 2015, eleven adolescents were randomized - six participants to the immediate postpartum LNG IUD insertion group, and five to the delayed insertion group. All six women in the immediate insertion group had successful immediate postpartum insertion; two of five women in the delayed insertion group had an IUD inserted. At six months postpartum, four of six women in the immediate insertion group had a LNG IUD in place; of the five women in the delayed group, three did not have a LNG IUD in place and two were pregnant. The study was discontinued after 19 months because of suboptimal enrollment. Though insertion of a LNG IUD immediately after delivery is an appropriate option for some adolescents, a larger prospective study comparing immediate to delayed LNG IUD insertion is unlikely to be feasible at our institution

Formula versus maternal breast milk for feeding preterm or low birth weight infants

BACKGROUND: Artificial formula can be manipulated to contain higher amounts of macro-nutrients than maternal breast milk but breast milk confers important immuno-nutritional advantages for preterm or low birth weight (LBW) infants. OBJECTIVES: To determine the effect of feeding preterm or LBW infants with formula compared with maternal breast milk on growth and developmental outcomes. SEARCH METHODS: We used the standard strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 9), and Ovid MEDLINE, Ovid Embase, Ovid Maternity & Infant Care Database, and CINAHL to October 2018. We searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials that compared feeding preterm or low birth weight infants with formula versus maternal breast milk. DATA COLLECTION AND ANALYSIS: Two review authors planned independently to assess trial eligibility and risk of bias, and extract data. We planned to analyse treatment effects as described in the individual trials and report risk ratios and risk differences for dichotomous data, and mean differences for continuous data, with 95% confidence intervals. We planned to use a fixed-effect model in meta-analyses and to explore potential causes of heterogeneity in subgroup analyses. We planned to use the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We did not identify any eligible trials. AUTHORS' CONCLUSIONS: There are no trials of formula versus maternal breast milk for feeding preterm or low birth weight infants. Such trials are unlikely to be conducted because of the difficulty of allocating an alternative form of nutrition to an infant whose mother wishes to feed with her own breast milk. Maternal breast milk remains the default choice of enteral nutrition because observational studies, and meta-analyses of trials comparing feeding with formula versus donor breast milk, suggest that feeding with breast milk has major immuno-nutritional advantages for preterm or low birth weight infants