Transcutaneous electrical nerve stimulation for cancer pain in adults.

Background Cancer-related pain is complex and multi-dimensional but the mainstay of cancer pain management has predominately used a biomedical approach. There is a need for non-pharmacological and innovative approaches. Transcutaneous Electric Nerve Stimulation (TENS) may have a role for a significant number of patients but the effectiveness of TENS is currently unknown. Objectives The aim of this systematic review was to determine the effectiveness of TENS for cancer-related pain in adults. Search strategy We searched The Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, AMED and PEDRO databases (11/04/08). Selection criteria Only randomised controlled trials (RCTS) investigating the use of TENS for the management of cancer-related pain in adults were included. Data collection and analysis The search strategy identified 37 possible published studies which were divided between two pairs of review authors that decided on study selection. A study eligibility form was used to screen each abstract and where study eligibility could not be determined from the abstract, the full paper was obtained and assessed by one pair of review authors. A standardised data extraction sheet was used to collect information on the studies and the quality of the studies was assessed independently by two review authors using the validated five-point Oxford Quality Scale. Final scores were discussed and agreed between all four review authors. The small sample sizes and differences in patient study populations of the two included studies prevented meta-analysis. Main results Only two RCTs met the eligibility criteria (64 participants). These studies were heterogenous with respect to study population, sample size, study design, methodological quality, mode of TENS, treatment duration, method of administration and outcome measures used. In one RCT, there were no significant differences between TENS and placebo in women with chronic pain secondary to breast cancer treatment. In the other RCT, there were no significant differences between acupuncture-type TENS and sham in palliative care patients; this study was underpowered. Authors' conclusions The results of this systematic review are inconclusive due to a lack of suitable RCTs. Large multi-centre RCTs are required to assess the value of TENS in the management of cancer-related pain in adults

Mechanisms associated with activation of intracellular metabotropic glutamate receptor, mGluR5

The group 1 metabotropic glutamate receptor, mGluR5, is found on the cell surface as well as on intracellular membranes where it can mediate both overlapping and unique signaling effects. Previously we have shown that glutamate activates intracellular mGluR5 by entry through sodium-dependent transporters and/or cystine glutamate exchangers. Calibrated antibody labelling suggests that the glutamate concentration within neurons is quite high (~10 mM) raising the question as to whether intracellular mGluR5 is maximally activated at all times or whether a different ligand might be responsible for receptor activation. To address this issue, we used cellular, optical and molecular techniques to show that intracellular glutamate is largely sequestered in mitochondria; that the glutamate concentration necessary to activate intracellular mGluR5 is about ten-fold higher than what is necessary to activate cell surface mGluR5; and uncaging caged glutamate within neurons can directly activate the receptor. Thus these studies further the concept that glutamate itself serves as the ligand for intracellular mGluR5

Simulation of the Elastic Properties of Reinforced Kevlar-Graphene Composites

The compressive strength of unidirectional fiber composites in the form of Kevlar yarn with a thin outer layer of graphene was investigated and modeled. Such fiber structure may be fabricated by using a strong chemical bond between Kevlar yarn and graphene sheets. Chemical functionalization of graphene and Kevlar may achieved by modification of appropriate surface-bound functional (e.g., carboxylic acid) groups on their surfaces. In this report we studied elastic response to unidirectional in-plane applied load with load peaks along the diameter. The 2D linear elasticity model predicts that significant strengthening occurs when graphene outer layer radius is about 4 % of kevlar yarn radius. The polymer chains of Kevlar are linked into locally planar structure by hydrogen bonds across the chains, with transversal strength considerably weaker than longitudinal one. This suggests that introducing outer enveloping layer of graphene, linked to polymer chains by strong chemical bonds may significantly strengthen Kevlar fiber with respect to transversal deformations

Sustainable diets in the UK—developing a systematic framework to assess the environmental Impact, cost and nutritional quality of household food purchases

Sustainable diets should not only respect the environment but also be healthy and affordable. However, there has been little work to assess whether real diets can encompass all three aspects. The aim of this study was to develop a framework to quantify actual diet records for health, affordability and environmental sustainability and apply this to UK food purchase survey data. We applied a Life Cycle Assessment (LCA) approach to detailed food composition data where purchased food items were disaggregated into their components with traceable environmental impact data. This novel approach is an improvement to earlier studies in which sustainability assessments were based on a limited number of “food groups”, with a potentially high variation of actual food items within each group. Living Costs and Food Survey data for 2012, 2013 and 2014 were mapped into published figures for greenhouse gas emissions (GHGE, taking into account processing, transport and cooking) and land use, a diet quality index (DQI) based on dietary guidelines and food cost, all standardised per household member. Households were classified as having a ‘more sustainable’ diet based on GHGE, cost and land use being less than the median and DQI being higher than the median. Only 16.6% of households could be described as more sustainable; this rose to 22% for those in the lowest income quintile. Increasing the DQI criteria to >80% resulted in only 100 households being selected, representing 0.8% of the sample. The framework enabled identification of more sustainable households, providing evidence of how we can move toward better diets in terms of the environment, health, and costs

Evaluation of social interaction features in topolor - a social personalized adaptive e-learning system

Here we present a case study that analyses the social interaction features in Topolor, an adaptive personalized social e-learning system. This paper focuses on the evaluation of the perceived usefulness and usability. The results show a considerably high satisfaction of the students. We discuss the evaluation results and outline the plan for improvement

Implications of Transitional Care Interventions on Hospital Readmissions in Patients With Destination Therapy Left Ventricular Assist Devices

Background: The rising number of patients with a left ventricular assist device (LVAD) require care management to successfully transition home after implantation. These patients and their families need to manage their heart failure, and the complexities of an LVAD and the associated lifestyle modifications. Translating knowledge of transitional care interventions in patients with chronic diseases to those with an LVAD may provide valuable insight. To help inform the furthering of care transitions in the LVAD patient population, an integrative review was conducted. Aim: The aim of this review was to explore the transitions of care interventions of care in patients and its potential for application in the destination therapy LVAD. Methods: This integrative review was guided by the Whittemore and Knafl's methodology. Results: A total of 12 articles from 264 retrieved articles met inclusion criteria and were included in the literature review. Discussion: This review identified that evidence-based transitional care interventions have been shown to decrease avoidable rehospitalization, the associated costs, and improve quality of life when compared to usual care. Implications for Practice: A common feature of transitional care interventions is the inclusion of nurse leadership. Nurses should be prepared to participate in transitional care interventions to optimally improve outcomes for patients with heart failure and potentially those with an LVAD. Additionally, to make transitional care interventions more effective they should be implemented with moderate intensity or greater. Conclusion: This review provided information supporting the trialing of transitional care interventions in patients with an LVAD and suggests pilot research to optimize interventions for this population

Assessment of porcine endogenous retrovirus transmission across an alginate barrier used for the encapsulation of porcine islets

BACKGROUND: Subcutaneous implantation of a macroencapsulated patch containing human allogenic islets has been successfully used to alleviate type 1 diabetes mellitus (T1DM) in a human recipient without the need for immunosuppression. The use of encapsulated porcine islets to treat T1DM has also been reported. Although no evidence of pathogen transfer using this technology has been reported to date, we deemed it appropriate to determine if the encapsulation technology would prevent the release of virus, in particular, the porcine endogenous retrovirus (PERV). METHODS: HEK293 (human epithelial kidney) and swine testis (ST) cells were co-cultured with macroencapsulated pig islets embedded in an alginate patch, macroencapsulated PK15 (swine kidney epithelial) cells embedded in an alginate patch and free PK15 cells. Cells and supernatant were harvested at weekly time points from the cultures for up to 60 days and screened for evidence of PERV release using qRT-PCR to detect PERV RNA and SG-PERT to detect reverse transcriptase (RT). RESULTS: No PERV virus, or evidence of PERV replication, was detected in the culture medium of HEK293 or pig cells cultured with encapsulated porcine islets. Increased PERV activity relative to the background was not detected in ST cells cultured with encapsulated PK15 cells. However, PERV was detected in 1 of the 3 experimental replicates of HEK293 cells cultured with encapsulated PK15 cells. Both HEK293 and ST cells cultured with free PK15 cells showed an increase in RT detection. CONCLUSIONS: With the exception of 1 replicate, there does not appear to be evidence of transmission of replication competent PERV from the encapsulated islet cells or the positive control PK15 cells across the alginate barrier. The detection of PERV would suggest the alginate barrier of this replicate may have become compromised, emphasizing the importance of quality control when producing encapsulated islet patches

Modelling the Value Adding Attributes of Real Estate to the Wealth Maximization of the Firm

Firms develop strategies to help them achieve their primary goal of maximizing the wealth of the shareholders. These strategies should define the supporting role corporate real estate management plays; however current theory and practice do not adequately identify the direct and indirect methods by which corporate real estate management (CREM) adds value to the firm. We develop a model of how real estate adds value to the firm to help fill this void. This model can be then used to develop more precise and complete metrics to measure the value real estate adds to the firm.

Very small deletions within the NESP55 gene in pseudohypoparathyroidism type 1b

Pseudohypoparathyroidism (PHP) is caused by reduced expression of genes within the GNAS cluster, resulting in parathormone resistance. The cluster contains multiple imprinted transcripts, including the stimulatory G protein α subunit (Gs-α) and NESP55 transcript preferentially expressed from the maternal allele, and the paternally expressed XLas, A/B and antisense transcripts. PHP1b can be caused by loss of imprinting affecting GNAS A/B alone (associated with STX16 deletion), or the entire GNAS cluster (associated with deletions of NESP55 in a minority of cases). We performed targeted genomic next-generation sequencing (NGS) of the GNAS cluster to seek variants and indels underlying PHP1b. Seven patients were sequenced by hybridisation-based capture and fourteen more by long-range PCR and transposon-mediated insertion and sequencing. A bioinformatic pipeline was developed for variant and indel detection. In one family with two affected siblings, and in a second family with a single affected individual, we detected maternally inherited deletions of 40 and 33 bp, respectively, within the deletion previously reported in rare families with PHP1b. All three affected individuals presented with atypically severe PHP1b; interestingly, the unaffected mother in one family had the detected deletion on her maternally inherited allele. Targeted NGS can reveal sequence changes undetectable by current diagnostic methods. Identification of genetic mutations underlying epigenetic changes can facilitate accurate diagnosis and counselling, and potentially highlight genetic elements critical for normal imprint settin