The Role of Niacin in the Management of Dyslipidemia

Niacin or nicotinic acid has been used for the management of dyslipidemia for over 50 years, and it is the first medication that has been shown to reduce both coronary disease events and mortality. It is unique among the various lipid therapies in that it can not only reduce all of atherogenic lipid fractions (total cholesterol, low-density lipoprotein, very low-density lipoprotein, non-HDL lipoproteins, and triglycerides), but is also the most effective agent for raising high-density lipoprotein (specifically Apolipoprotein A-1). It is also the only lipid therapy that can lower lipoprotein (a). Niacin also has non-lipid benefits that improve vascular health and reduce atherogenesis. Niacin therapy was initially hampered by a high incidence of side effects, especially flushing, but this has largely been overcome by extended-release formulations and dosing and administering properly. Despite the failure of two recent clinical trials to show benefit of combining niacin with statins, there are many trials that support using niacin as monotherapy or in combination with other lipid agents including statins. Niacin is also the cheapest lipid agent available, and with the epidemic of cardiovascular disease in the world, it offers great value in the population-wide management of this health problem

Assessing the Lack of Transgender Participation in Sports

Transgender athletes face many challenges when attempting to participate in sport competitions. Facing these challenges causes many transgender athletes to abandon their sport. Whether it be a lack of adequate locker rooms, or fearing to show themselves in public, transgender athletes face many roadblocks on their path to sport achievement. Many of these roadblocks cause a transgender athlete to lose interest in the sport they love and create the potential to affect participation in sports and physical activity all together. It is clear sports and physical activity participation is lower in transgender athletes than participation by cisgender athletes due to sociological and psychological factors, as well as restrictive sport policies. This paper reviews the relevant literature examining trans-athlete experiences through a sociological and psychological lens, that leads to a lack of sport participation

Exploring rural palliative care patients’ experiences of accessing psychosocial support through telehealth:A longitudinal approach

In this research we explore the experiences of rural palliative care patients receiving psychosocial support through telehealth. A longitudinal approach considered how experiences vary over time. Three patients with a terminal cancer diagnosis were given a laptop to access psychosocial support via telehealth over three months. Semi-structured interviews were conducted at monthly intervals. Interpretative phenomenological analysis identified four themes; Deepening understanding through unburdened and continuous connections; the ever-present paradox of visible and invisible telehealth; insight into the holistic self: from barrier to facilitator; and, the immediate change from unnecessary distraction to mindful engagement. Findings challenge previous conclusions regarding the inability of telehealth to support meaningful relationships, and instead provide novel insights to explain why enabling rural palliative care patients to access support from home is supportive for their wellbeing and the quality of healthcare relationships. Our conclusions question whether the indirect benefits of telehealth could also offer a valuable way of accessing health services beyond a palliative care setting

Exploring the acceptance of telehealth within palliative care:A Self-Determination Theory perspective

The aim of this paper was to explore potential divergence and convergence in relation to health care professionals’ and patients’ acceptability of the use of telehealth within palliative care provision through the lens of Self-Determination Theory. The research utilized a deductive qualitative approach utilizing semi-structured interviews to explore divergence and convergence between health care professionals’ preconceptions of the use of telehealth in palliative care and the lived experiences of patients accessing support in this manner. Semi-structured interviews were conducted with both professionals and patients to explore whether the barriers and benefits of telehealth perceived by professionals corresponded to the patient’s lived experience of utilizing the technology in their palliative care. Interviews were analyzed using a deductive thematic analysis. Professionals and patients identified that the use of telehealth could satisfy the need for autonomy, however this manifested in different ways. Greater divergence was apparent between patient and professional perceptions about how telehealth could satisfy the need for relatedness and competence needs. The findings of this paper highlight how professionals preconceived concerns about the use of telehealth in relation to providing supportive palliative care may not be realized when exploring the experiences of patients accessing services through this medium. This paper highlights the important role of psychological need satisfaction when considering acceptability of telehealth, and motivation to engage in the implementation of technologically driven health services

Thermal insulation of wet shielded metal arc welds

Thesis (Nav. E.)--Massachusetts Institute of Technology, Dept. of Ocean Engineering, 1994, and Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Materials Sciences & Engineering, 1994.Includes bibliographical references (leaf 55).by Patrick Joseph Keenan.M.S.Nav.E

Improvement in time to treatment, but not time to diagnosis, in patients with mucopolysaccharidosis type I

Objective Early diagnosis and treatment initiation are important factors for successful treatment of mucopolysaccharidosis type I (MPS I). The purpose of this observational study was to assess whether age at diagnosis and time to first treatment for individuals with MPS I have improved over the last 15 years. Study design Data from the MPS I Registry (NCT00144794) for individuals with attenuated or severe disease who initiated therapy with laronidase enzyme replacement therapy (ERT) and/or hematopoietic stem cell transplantation (HSCT) between 1 January 2003 and 31 December 2017 were included. Results Data were available for 740 individuals with attenuated (n=291) or severe (n=424) MPS I (unknown n=25). Median age at diagnosis for attenuated disease did not change over time and ranged between 4.5 and 6 years of age while the median duration from diagnosis to first ERT decreased from 5.6 years before/during 2004 to 2.4 months in 2014–2017. For severe MPS I treated with HSCT, median age at diagnosis was less than 1 year and median time to first treatment was less than 3 months throughout the 15-year observation period. Conclusions Times to diagnosis and HSCT initiation for individuals with severe MPS I were consistent over time. For individuals with attenuated MPS I, the time to ERT initiation after diagnosis has improved substantially in the last 15 years, but median age at diagnosis has not improved. Efforts to improve early diagnosis in attenuated MPS I are needed to ensure that patients receive appropriate treatment at the optimal time

Exploring Clinician Wellbeing within a Mentalization-Based Treatment Service for Adult Offending Males with Antisocial Personality Disorder in the Community

Mentalization Based Treatment (MBT) is offered as a potential treatment for clients with Antisocial Personality Disorder (ASPD), however, research suggests that delivering MBT can often present challenges for clinicians. Furthermore, there is agreement that working with clients with ASPD can significantly impact upon staff wellbeing. This project highlights the challenges experienced by clinicians when delivering an MBT service with adult offending males with ASPD within the community. Interpretative Phenomenological Analysis was conducted following semi-structured interviews with six MBT clinicians. Findings highlight how the challenges of working with clients with ASPD presented a significant threat to clinicians’ professional identity. These challenges were compounded by confusion surrounding the MBT model, lack of support from multidisciplinary staff and insufficient service infrastructure. MBT clinicians’ attempts to overcome these barriers led to them striving and breaching time boundaries, leaving them at risk of burnout. These findings contribute to existing literature surrounding clients with ASPD and provide new insight into implementation barriers when delivering a community based MBT service with this client group

Disseny d’un sistema per a la monitorització d’una micro-xarxa elèctrica híbrida

La societat està vivint una transició del model energètic actual degut als greus problemes mediambientals, l’augment de la demanda energètica i l’elevat cost de la seva producció. Aquesta transició tendeix cap a un sistema descentralitzat i totalment renovable per així millorar la eficiència i la fiabilitat del subministrament elèctric, tal com les micro-xarxes. Les micro-xarxes són sistemes que tenen com a font principal d’energia un o més recursos renovables, normalment acompanyades per una font convencional de suport, com la xarxa elèctrica o un generador dièsel, donant lloc a l’anomenada micro-xarxa híbrida. En aquest projecte es monitoritza una micro-xarxa híbrida a partir del programa informàtic LabVIEW, focalitzant el centre de control en l’inversor Axpert del sistema. Aquesta micro-xarxa està composta per un mòdul fotovoltaic, un banc de bateries, l’inversor i les càrregues electròniques programables des d’on s’exporten els consums de la instal·lació. L’objectiu principal és comunicar l’inversor amb el programa de tal forma que l’usuari pugui enviar ordres i rebre els resultats a temps real sobre l’estat dels components. La realització d’aquest projecte s’ha dut a terme amb l’equipament del laboratori E3PACS de l’Escola d’Enginyeria de Barcelona Est (EEBE)