Multicenter prospective cohort study of the Strata valve for the management of hydrocephalus in pediatric patients

Journal ArticleObject. Previous reports suggest that adjustable valves may improve the survival of cerebrospinal fluid shunts or relieve shunt-related symptoms. To evaluate these claims, the authors conducted a prospective multicenter cohort study of children who underwent placement of Strata valves. Methods. Patients undergoing initial shunt placement (Group 1) or shunt revision (Group 2) were treated using Strata valve shunt systems. Valves were adjustable to five performance level settings by using an externally applied magnet. The performance levels were checked using an externally applied hand tool and radiography. Patients were followed for 1 year or until they underwent shunt revision surgery. Between March 2000 and February 2002, 315 patients were enrolled in the study. In Group 1 (201 patients) the common causes of hydrocephalus were myelomeningocele (16%), aqueductal stenosis (14%), and hemorrhage (14%). The overall 1-year shunt survival was 67%. Causes of shunt failure were obstruction (17%), overdrainage (1.5%), loculated ventricles (2%), and infection (10.6%). Patients in Group 2 (114 patients) were older and the causes of hydrocephalus were similar. Among patients in Group 2 the 1-year shunt survival was 71%. There were 256 valve adjustments. Symptoms completely resolved (26%) or improved (37%) after 63% of adjustments. When symptoms improved or resolved, they did so within 24 hours in 89% of adjustments. Hand-tool and radiographic readings of valve settings were the same in 234 (98%) of 238 assessments. Conclusions. The 1-year shunt survival for the Strata valve shunt system when used in initial shunt insertion procedures or shunt revisions was similar to those demonstrated for other valves. Symptom relief or improvement following adjustment was observed in 63% of patients. Hand-tool assessment of performance level settings reliably predicted radiographic assessments

Juvenile pilocytic astrocytoma of the brainstem in children

Journal ArticleObject. In reports involving the operative treatment of brainstem tumors, multiple histological types are often grouped together. To determine prognosis after resection, histology-specific data may be helpful. Methods. Twenty-eight patients with juvenile pilocytic astrocytoma (JPA) of the brainstem (six in the midbrain, four in the pons, and 18 in the medulla) were identified from the medical records. Initial treatment was resection in 25 and biopsy sampling in three. Postoperative imaging revealed gross-total resection (GTR) or resection with linear enhancement (RLE) in 12 of 25 patients and solid residual tumor in the other 13. In 10 of the 13 patients harboring solid residual tumor, observation was undertaken; the residual lesion disappeared in one, was stable in four, and progressed in five. Of the 12 patients with complete excision or RLE only, seven underwent no further treatment, with tumor progression occurring in one. All patients were alive at last follow-up examination (range 0.3-20.4 years, mean 6 years). New neurological deficits commonly appeared immediately after resection but often resolved. In six of the 28 patients, the new postoperative deficit was still present at last follow-up visit. The 5- and 10-year progression-free survival was 74 and 62%, respectively, after GTR or RLE and 19 and 19%, respectively, when solid residual tumor was present. Conclusions. Long-term survival after resection of JPAs of the brainstem has been observed and appears to be related to the extent of initial excision

Perspectives of Employed People Experiencing Homelessness of Self and Being Homeless: Challenging Socially Constructed Perceptions and Stereotypes

In a study that sought to identify the multiple factors resulting in homelessness from the perspective of 65 individuals in Calgary, Alberta, Canada who were both employed and homeless, we found that participants\u27 perceptions of being homeless emerged as a major theme which impacts their entry to and exit from homelessness. Four sub-themes related to these perceptions were identified: (1) perceptions of self and situation; (2) impact of being homeless on self-reflection; (3) aspects of hope to consider; and (4) perspectives on having a permanent residence. Analytically, these findings help challenge present stereotypes about homelessness and usefully inform social service delivery organizations

Gamma-Interferon-Induced Nitric-Oxide Production Reduces Chlamydia-Trachomatis Infectivity in McCoy Cells

McCoy cells, murine-derived cells commonly used for propagation of chlamydiae, were found to be efficient producers of nitric oxide (NO) when primed with murine gamma interferon (IFN-gamma) and then exposed to the second signals provided by Escherichia coli lipopolysaccharide, human interleukin-1 alpha, murine tumor necrosis factor alpha, or Chlamydia trachomatis type H. Murine recombinant IFN-gamma over a range of 0 to 50 U/ml inhibited infectivity of C. trachomatis type H in a dose-dependent fashion in McCoy cells while simultaneously inducing NO production. Quantitation of infectious chlamydia progeny remaining in McCoy cells 48 or 72 h postinfection revealed that IFN-gamma-primed McCoy cells reduced chlamydial inclusion-forming units (expressed as units per milliliter) by 4 log10 units at higher IFN-gamma concentrations (50 U/ml) compared with control values. The magnitude of this antichlamydial effect was directly related to increased synthesis of NO, the production of which was IFN-gamma dose dependent. The antichlamydial effects of IFN-gamma were blocked in a dose-dependent manner by the addition of N-guanidino-monomethyl L-arginine (MLA), an inhibitor of nitric oxide synthesis. These results suggest that although IFN-gamma priming of McCoy cells is required for antichlamydial activity, nitric oxide is a necessary effector molecule involved in the mechanism(s) of IFN-gamma-induced inhibition of chlamydial proliferation in this murine cell line. The ability to block the potent antichlamydial effects of IFN-gamma by inhibition of a specific enzyme, nitric oxide synthase, may give insights into mechanisms by which IFN-gamma and perhaps other cytokines are able to control proliferation of chlamydiae and other intracellular pathogens

Culicoides species composition and abundance on Irish cattle farms: implications for arboviral disease transmission

peer-reviewedBackground Following the emergence of Schmallenberg virus (SBV) in Ireland in 2012, a sentinel herd surveillance program was established in the south of Ireland with the primary aim of investigating the species composition and abundance of Culicoides on livestock farms in the region. Methods Ultraviolet-light trapping for Culicoides was carried out on 10 sentinel farms. Each site was sampled fortnightly over 16 weeks (21st July to 5th November 2014). One Onderstepoort Veterinary Institute UV light trap was run overnight at each site and catches were transferred immediately into 70% ethanol. Culicoides were morphologically identified to species level. Collection site habitats were characterised using the Phase 1 habitat survey technique (Joint Nature Conservation Committee). Results A total of 23,929 individual Culicoides from 20 species was identified, including one species identified in Ireland for the first time, Culicoides cameroni. The most abundant species identified were Culicoides obsoletus/Culicoides scoticus (38%), Culicoides dewulfi (36%), Culicoides pulicaris (9%), Culicoides chiopterus (5%) and Culicoides punctatus (5%), comprising 93% of all Culicoides specimens identified. Collection site habitats were dominated by improved grassland and a combination of broadleaf woodland and native woodland species. Conclusions The most abundant species of Culicoides identified were the putative vectors of bluetongue virus (BTV) and SBV in northern Europe. Their presence and abundance demonstrates the potential for future transmission of arboviruses among livestock in this region

UPDATING AND TESTING THE PASRR SCREEN IN KANSAS: REAL WORLD IMPLICATIONS

This work is licensed under a Creative Commons Attribution 4.0 International License.Kansas is updating the PASRR (Preadmission Screen and Resident Review) Level 1 screen per new guidance from the PASRR Technical Assistance Committee (PTAC), via a partnership between the State and university researchers. PTAC has directed states to screen for undiagnosed serious and persistent mental illness (SPMI) and also recommends screening for substance related disorders. Stakeholders were engaged through advisory workgroups and a content validity expert panel. These activities led to the creation of a revised PASRR Level-1 screen, but stakeholders also raised several concerns. PASRR law does not require Level-1 assessors to have professional training in mental health diagnoses or treatment, yet new guidelines asks them to screen for undiagnosed SPMI. Further, there are apparent discrepancies between these new guidelines and PASRR Level-2 criteria. Finally, current information management systems are not equipped to handle the higher security protocols associated substance use disorders. The draft instrument was tested with a sample of 103 nursing facility applicants by trained PASRR assessors and inter-rater reliability (IRR) was tested via a standardized vignette with 14 trained PASRR assessors. Only 3% of actual NF applicants were identified as possibly having an undiagnosed SPMI and only 43% of assessors correctly identified symptoms of a suspected SPMI in the standardized vignette, indicating poor validity and reliability in assessing for undiagnosed SPMI during the Level-1 screen. New PASRR guidelines may better ensure that nursing facility residents receive appropriate care for SPMI, however, there are many challenges to ensuring an accurate screen and supporting successful implementation