Telehealth Services to Improve Nonadherence: A Placebo-Controlled Study

This is the publisher's version, also available electronically from http://online.liebertpub.com/doi/abs/10.1089/tmj.2006.12.289.The objective of this study was to test whether a telehealth intervention could improve the compliance with continuous positive airway pressure (CPAP) by patients with sleep apnea. These patients had been nonadherent for the initial 3 months of therapy even after receiving the initial standard and then supplemental audiotaped/videotaped patient education for adhering to CPAP nightly. The materials and methods included a randomized testing of experimental and placebo interventions. Interventions were delivered by nurses to two groups in their homes by telehealth over a 12-week period. The placebo intervention was used to control for Hawthorne effect, time and attention influences and the novelty of having telehealth in the home. Results following the telehealth interventions were that significantly more patients in the experimental group 1 (n = 10) than the placebo group 2 (n = 9) were adhering nightly to CPAP (χ2 = 4.55, p = 0.033). Group 1 patients reported greater satisfaction with their intervention. However, both groups rated telehealth delivery positively. The mean cost of each 20-minute telehealth visit was $30 while the total cost of the telehealth intervention for each patient was$420. These costs included telehealth equipment, initial installation, longdistance telephone charges, nurse salary, and intervention materials. Conclusions are that telehealth interventions are a potentially cost-effective service for increasing adherence to prescribed medical treatments. Replication studies with large samples and in other clinical groups are recommended

Consensus for the management of pancreatic exocrine insufficiency: UK practical guidelines.

INTRODUCTION: Pancreatic exocrine insufficiency is a finding in many conditions, predominantly affecting those with chronic pancreatitis, pancreatic cancer and acute necrotising pancreatitis. Patients with pancreatic exocrine insufficiency can experience gastrointestinal symptoms, maldigestion, malnutrition and adverse effects on quality of life and even survival.There is a need for readily accessible, pragmatic advice for healthcare professionals on the management of pancreatic exocrine insufficiency. METHODS AND ANALYSIS: A review of the literature was conducted by a multidisciplinary panel of experts in pancreatology, and recommendations for clinical practice were produced and the strength of the evidence graded. Consensus voting by 48 pancreatic specialists from across the UK took place at the 2019 Annual Meeting of the Pancreatic Society of Great Britain and Ireland annual scientific meeting. RESULTS: Recommendations for clinical practice in the diagnosis, initial management, patient education and long term follow up were developed. All recommendations achieved over 85% consensus and are included within these comprehensive guidelines

Seasonal Consumptive Demand and Prey Use by Stocked Saugeyes in Ohio Reservoirs

Community structure and species composition may be strongly influenced by predator-prey interactions resulting from and leading to episodes of population abundance or scarcity. We quantified diets of stocked saugeyes (female walleye Sander vitreus × male sauger S. canadensis) and estimated biomass of their primary prey, gizzard shad Dorosoma cepedianum, in three Ohio reservoirs at quarterly intervals during July 2002-July 2003 to determine whether saugeye consumptive demand could exceed the supply of available gizzard shad prey, resulting in a shift to alternative prey. We incorporated water temperature and saugeye diet composition, growth, and mortality into walleye bioenergetics models, which allowed us to compare estimated prey-specific consumption rates by saugeyes with gizzard shad standing stocks estimated with acoustics. Spring and summer were critical seasons. During spring, gizzard shad biomass was low, saugeye consumptive demand was low, and saugeyes consumed primarily alternative prey. During summer, when age-0 gizzard shad became available as prey, saugeyes consumed similar proportions of gizzard shad and alternative prey. Saugeye cumulative consumptive demand in summer was high and approached the gizzard shad standing stock. However, during fall and winter, gizzard shad supply was adequate to support high (fall) or declining (winter) saugeye consumptive demand. Across reservoirs and seasons, saugeyes consumed alternative prey to varying degrees, primarily sunfishes Lepomis spp., yellow perch Perca flavescens, logperch Percina caprodes, and minnows Pimephales spp. Seasonal asynchrony between saugeye consumptive demand and gizzard shad biomass during spring and summer indicated that a saugeye population with high survival, growth, and consumptive demand will opportunistically increase use of prey other than gizzard shad. The manner in which saugeye predation quantitatively influences these prey species could not be assessed. However, overexploitation of gizzard shad prey appears to be unlikely at current saugeye population sizes, particularly considering the opportunistic use of alternative prey and the high reproductive potential of gizzard shad.Funding for this research was provided by the Ohio Department of Natural Resources, Division of Wildlife; Federal Aid in Sport Fish Restoration Project F-69-P, Fish Management in Ohio; and the Department of Evolution, Ecology, and Organismal Biology at The Ohio State University

Dynamic Contrast-Enhanced Perfusion Processing for Neuroradiologists: Model-Dependent Analysis May Not Be Necessary for Determining Recurrent High-Grade Glioma versus Treatment Effect

ABSTRACT BACKGROUND AND PURPOSE: Dynamic contrast-enhanced perfusion MR imaging has proved useful in determining whether a contrastenhancing lesion is secondary to recurrent glial tumor or is treatment-related. In this article, we explore the best method for dynamic contrast-enhanced data analysis

Gothic visions of classical architecture in Hablot Knight Browne’s “dark” illustrations for the novels of Charles Dickens

In the early gothic literature of the eighteenth century danger lurked in the darkness beneath the pointed arches of gothic buildings. During the nineteenth century there was a progressive, although never complete, dislocation of gothic literary readings from gothic architecture. This article explores a phase in that development through discussion of a series of ‘dark’ illustrations produced by Hablot Knight Browne to illustrate novels by Charles Dickens. These show the way in which the rounded arches of neo-classical architecture were depicted in the mid-nineteenth century as locales of oppression and obscurity. Such depictions acted, in an age of political and moral reform, to critique the values of the system of power and authority that such architecture represented

Occurrence and temporal variations of TMDD in the river Rhine, Germany

Background, aim, and scope: The chemical substance 2,4,7,9-tetramethyl-5-decyne-4,7-diol (TMDD) is a non-ionic surfactant used as an industrial defoaming agent and in various other applications. Its commercial name is Surynol 104® and the related ethoxylates are also available as Surfynol® 420, 440, 465 and 485 which are characterized by different grades of ethoxylation of TMDD at both hydroxyl functional groups. TMDD and its ethoxylates offer several advantages in waterborne industrial applications in coatings, inks, adhesives as well as in paper industries. TMDD and its ethoxylates can be expected to reach the aquatic environment due its widespread use and its physico-chemical properties. TMDD has previously been detected in several rivers of Germany with concentrations up to 2.5 µg/L. In the United States, TMDD was also detected in drinking water. However, detailed studies about its presence and distribution in the aquatic environment have not been carried out so far. The aim of the present study was the analysis of the spatial and temporal concentration variations of TMDD in the river Rhine at the Rheingütestation Worms (443.3 km). Moreover, the transported load in the Rhine was investigated during two entire days and 7 weeks between November 2007 and January 2008. Materials and methods: The sampling was carried out at three different sampling points across the river. Sampling point MWL1 is located in the left part of the river, MWL2 in the middle part, and MWL4 in the right part. One more sampling site (MWL3) was run by the monitoring station until the end of 2006, but was put out of service due to financial constrains. The water at the left side of the river Rhine (MWL1) is influenced by sewage from a big chemical plant in Ludwigshafen and by the sewage water from this city. The water at the right side of the river Rhine (MWL4) is largely composed of the water inflow from river Neckar, discharging into Rhine 14.9 km upstream from the sampling point and of communal and industrial wastewater from the city Mannheim. The water from the middle of the river (MWL2) is largely composed of water from the upper Rhine. Water samples were collected in 1-L bottles by an automatic sampler. The water samples were concentrated by use of solid-phase extraction (SPE) using Bond Elut PPL cartridges and quantified by use of gas chromatography-mass spectrometry (GC-MS). The quantification was carried out with the internal standard method. Based on these results, concentration variations were determined for the day profiles and week profiles. The total number of analyzed samples was 219. Results: The results of this study provide information on the temporal concentration variability of TMDD in river Rhine in a cross section at one particular sampling point (443.3 km). TMDD was detected in all analyzed water samples at high concentrations. The mean concentrations during the 2 days were 314 ng/L in MWL1, 246 ng/L in MWL2, and 286 ng/L in MWL4. The variation of concentrations was low in the day profiles. In the week profiles, a trend of increasing TMDD concentrations was detected particularly in January 2008, when TMDD concentrations reached values up to 1,330 ng/L in MWL1. The mean TMDD concentrations during the week profiles were 540 ng/L in MWL1, 484 ng/L in MWL2, and 576 ng/L in MWL4. The loads of TMDD were also determined and revealed to be comparable in all three sections of the river. The chemical plant located at the left side of the Rhine is not contributing additional TMDD to the river. The load of TMDD has been determined to be 62.8 kg/d on average during the entire period. By extrapolation of data obtained from seven week profiles the annual load was calculated to 23 t/a. Discussion: The permanent high TMDD concentrations during the investigation period indicate an almost constant discharge of TMDD into the river. This observation argues for effluents of municipal wastewater treatment plants as the most likely source of TMDD in the river. Another possible source might be the degradation of ethoxylates of TMDD (Surfynol® series 400), in the WWTPs under formation of TMDD followed by discharge into the river. TMDD has to be considered as a high-production-volume (HPV) chemical based on the high concentrations found in this study. In the United States, TMDD is already in the list of HPV chemicals from the Environmental Protection Agency (EPA). However, the amount of TMDD production in Europe is unknown so far and also the biodegradation rates of TMDD in WWTPs have not been investigated. Conclusions: TMDD was found in high concentrations during the entire sampling period in the Rhine river at the three sampling points. During the sampling period, TMDD concentrations remained constant in each part of the river. These results show that TMDD is uniformly distributed in the water collected at three sampling points located across the river. ‘Waves’ of exceptionally high concentrations of TMDD could not be detected during the sampling period. These results indicate that the effluents of WWTPs have to be considered as the most important sources of TMDD in river Rhine. Recommendations and perspectives: Based also on the occurrence of TMDD in different surface waters of Germany with concentrations up to 2,500 ng/L and its presence in drinking water in the USA, more detailed investigations regarding its sources and distribution in the aquatic environment are required. Moreover, the knowledge with respect to its ecotoxicity and its biodegradation pathway is scarce and has to be gained in more detail. Further research is necessary to investigate the rate of elimination of TMDD in municipal and industrial wastewater treatment plants in order to clarify the degradation rate of TMDD and to determine to which extent effluents of WWTPs contribute to the input of TMDD into surface waters. Supplementary studies are needed to clarify whether the ethoxylates of TMDD (known as Surfynol 400® series) are hydrolyzed in the aquatic environment resulting in formation of TMDD similar to the well known cleavage of nonylphenol ethoxylates into nonylphenols. The stability of TMDD under anaerobic conditions in groundwater is also unknown and should be studied

Improvements in sperm motility following low or high intensity dietary interventions in men with obesity

Introduction: Obesity increases risks of male infertility, but bariatric surgery does not improve semen quality. Recent uncontrolled studies suggest that a low-energy diet (LED) improves semen quality. Further evaluation within a randomized, controlled setting is warranted. Methods: Men with obesity (18-60 years) with normal sperm concentration (normal count) (n = 24) or oligozoospermia (n = 43) were randomized 1:1 to either 800 kcal/day LED for 16 weeks or control, brief dietary intervention (BDI) with 16 weeks’ observation. Semen parameters were compared at baseline and 16 weeks. Results: Mean age of men with normal count was 39.4 ± 6.4 in BDI and 40.2 ± 9.6 years in the LED group. Mean age of men with oligozoospermia was 39.5 ± 7.5 in BDI and 37.7 ± 6.6 years in the LED group. LED caused more weight loss than BDI in men with normal count (14.4 vs 6.3 kg; P < .001) and men with oligozoospermia (17.6 vs 1.8 kg; P < .001). Compared with baseline, in men with normal count total motility (TM) increased 48 ± 17% to 60 ± 10% (P < .05) after LED, and 52 ± 8% to 61 ± 6% (P < .0001) after BDI; progressive motility (PM) increased 41 ± 16% to 53 ± 10% (P < .05) after LED, and 45 ± 8% to 54 ± 65% (P < .001) after BDI. In men with oligozoospermia compared with baseline, TM increased 35% [26] to 52% [16] (P < .05) after LED, and 43% [28] to 50% [23] (P = .0587) after BDI; PM increased 29% [23] to 46% [18] (P < .05) after LED, and 33% [25] to 44% [25] (P < .05) after BDI. No differences in postintervention TM or PM were observed between LED and BDI groups in men with normal count or oligozoospermia. Conclusion: LED or BDI may be sufficient to improve sperm motility in men with obesity. The effects of paternal dietary intervention on fertility outcomes requires investigation

Rhizosphere-scale quantification of hydraulic and mechanical properties of soil impacted by root and seed exudates

Using rhizosphere-scale physical measurements we test the hypothesis that plant exudates gel together soil particles and on drying they enhance soil water repellency. Barley and maize root exudates were compared with chia seed exudate, a commonly used root exudate analogue. Sandy loam and clay loam soils were treated with root exudates at 0.46 and 4.6 mg exudate g-1 dry soil, and chia seed exudate at 0.046, 0.46, 0.92, 2.3 and 4.6 mg exudate g-1 dry soil. Soil hardness and modulus of elasticity were measured at -10 kPa matric potential using a 3 mm diameter spherical indenter. Water sorptivity and repellency index of air-dry soil were measured using a miniaturized infiltrometer device with a 1 mm tip radius. Soil hardness increased by 28% for barley root exudate, 62% for maize root exudate, and 86% for chia seed exudate at 4.6 mg g-1 concentration for sandy loam soil. For a clay loam soil, root exudates did not affect soil hardness, whereas chia seed exudate increased soil hardness by 48% at 4.6 mg g-1concentration. Soil water repellency increased by 48% for chia seed exudate and 23% for maize root exudate, but not for barley root exudate at 4.6 mg g-1 concentration for sandy loam soil. For clay loam soil, chia seed exudate increased water repellency by 45%, whereas root exudates did not affect water repellency at 4.6 mg g-1concentration. Water sorptivity and repellency were both correlated with hardness, presumably due to the combined influence of exudates on hydrological and mechanical properties of soils