Care for the Carers: A Self-management program for carers of people with vision impairment

Care for the Carers is a self-management program for carers of people with a vision impairment. The Care for the Carers manual includes all the materials necessary for a health professional to initiate and facilitate a six-session course for carers of people with a vision impairment. Step-by-step instructions for establishing the course and recruiting participants are also provided. The program is underpinned by the principles of self-management. The Care for the Carers program grew out of a series of workshops for carers developed for ABWA by Susan Douglas and Lisa Viska. The Care for the Carers self-management program builds upon these workshops and embeds the principles of self-management in a structured program tailored for carers of people with vision loss. This protocol aims to provide people in a care giving role with the opportunity to gain more knowledge about their partner’s or family member’s vision loss, with practical strategies to assist their partner or family member to manage their vision loss and also with skills and strategies to enhance their self-care. The Care for the Carers program comprised one component of the Vision Self-management in Practice Project, a collaborative project between the Centre for Research into Disability and Society of Curtin University and the Association for the Blind of Western Australia. The project aimed to develop and evaluate new self-management interventions, to provide health professionals with the knowledge and skills to facilitate self-management programs, and to develop organisational capacity to electronically record and monitor participant outcomes over time. The Care for the Carers component specifically aimed to empower people in a caring role, by providing them with information, strategies and skills, so as to increase their confidence in managing their caring role

771-3 Direct Characterization of F1ecalnide Binding Rates from Use-Dependent Conduction Delay In Canine Purkinje Fibers

To quantitatively characterize flecainide-induced channel blockade from usedependent conduction delay (CD), 12 canine purkinje fibers were studied using a dual microelectrode technique. During 60 sec of pacing at interstimulus intervals (ISI) of 1.25–0.4 sec with 2μM flecainide (FLEC), incremental CD followed a monoexponential time course, the rates of which were linearly related to the interpulse recovery interval (tr=ISI — action potential duration). Steady state block was an exponential function of the recovery rates. Use-dependent block derived from incremental CD and decremental squared conduction velocity (θ2) was characterized by the forward (k) and reverse (I) rate constants for the activated (a) and resting (r) states:ka (× 106) (mol-1 s-1)la (s-1)kr (× 102) (mol-1 s-1)Ir (s-1)CD7.0±2.612.0±4.40.6±1.74.01±1.63θ210.0±3.414.7±2.52.8±5.73.66±1.40Vmax(prox)6.8±2.315.9±5.05.1±10.34.22±1.11These rates reflect marked open state Na+ channel block and closed channel trapping at resting membrane potentials with FLEC. The addition of 1μM isoproterenol (ISO) to FLEC-superfused fibers reversed the FLEC-induced reduction of θ2 from 1.79±0.7 to 1.89±0.89 (m/s)2 (p=0.017) without changing V˙max. The rate constants for FLEC binding and unbinding were not altered by ISO. Thus FLEC's apparent binding rates can be quantified from its use-{jependent effects on conduction. Both ISO's selective reversal of FLEC effect on θ2 but not V˙max and the absence of changes in the rate constants suggest that the modulation of FLEC effect is due to an alteration in passive membrane properties. These characterizations will facilitate subsequent comparisons of FLEC interactions in pathologic and hyperadrenergic states in vivo

Ablation vs drug use for atrial fibrillation

The relative merits of rate and rhythm control in the treatment of patients with atrial fibrillation (AF) have been compared in several major clinical trials, none of which demonstrated a significant difference in all-cause mortality. Yet, there is clear evidence that restoration and maintenance of sinus rhythm is associated with beneficial reverse atrial and ventricular remodelling. In addition, patients may feel better if AF is resolved, and data from some post hoc analyses suggest a possible mortality benefit. These apparently contradictory findings may reflect the high risk of serious adverse events associated with currently available antiarrhythmic drugs (AAD), counterbalancing their beneficial effect in restoring sinus rhythm. Catheter ablation offers an alternative means of restoring sinus rhythm in patients with AF and several clinical trials have indicated superior outcomes in certain subgroups after ablation with or without AAD vs. antiarrhythmic therapy alone. This study reviews the relative advantages and actual use of catheter ablation and other therapeutic options in the treatment of AF, with or without concomitant heart failure or structural heart disease. Catheter ablation is recognized in the latest ACC/AHA/ESC guidelines as a valid second-line option in patients who have failed or were intolerant of first-line antiarrhythmic therapy. In the absence of new antiarrhythmics with an improved benefit/risk profile, it could become a first-line strategy for certain patient populations. The ongoing CABANA trial should confirm its impact on overall survival relative to that of pharmacological rate or rhythm control

Predatory senescence in ageing wolves

It is well established that ageing handicaps the ability of prey to escape predators, yet surprisingly little is known about how ageing affects the ability of predators to catch prey. Research into long-lived predators has assumed that adults have uniform impacts on prey regardless of age. Here we use longitudinal data from repeated observations of individually-known wolves (Canis lupus) hunting elk (Cervus elaphus) in Yellowstone National Park to demonstrate that adult predatory performance declines with age and that an increasing ratio of senescent individuals in the wolf population depresses the rate of prey offtake. Because this ratio fluctuates independently of population size, predatory senescence may cause wolf populations of equal size but different age structure to have different impacts on prey populations. These findings suggest that predatory senescence is an important, though overlooked, factor affecting predator-prey dynamics. Supplemental table S! (15 pp.) attached below

Catheter-based intervention for pulmonary vein stenosis due to fibrosing mediastinitis: The Mayo Clinic experience

AbstractIntroductionFibrosing mediastinitis (FM) is a rare but fatal disease characterized by an excessive fibrotic reaction in the mediastinum, which can lead to life-threatening stenosis of the pulmonary veins (PV). Catheter-based intervention is currently the only viable option for therapy. However, the current literature on how best to manage these difficult cases, especially in regards to sequential interventions and their potential complications is very limited.MethodsWe searched through a database of all patients who have undergone PV interventions at the Earl H. Wood Cardiac Catheterization Laboratory in Mayo Clinic, Rochester. From this collection, we selected patients that underwent PV intervention to relieve stenosis secondary to FM.ResultsEight patients were identified, with a mean age of 41years (24–59years). Five were men, and three were women. Three patients underwent balloon angioplasty alone, and five patients had stents placed. The majority of patients had acute hemodynamic and symptomatic improvement. More than one intervention was required in five patients, four patients had at least one episode of restenosis, and four patients died within four weeks of their first PV intervention.ConclusionsWe describe the largest reported case series of catheter-based intervention for PV stenosis in FM. Although catheter-based therapy improved hemodynamics, short-term vascular patency, and patient symptoms, the rate of life-threatening complications, restenosis, and mortality associated with these interventions was found to be high. Despite these associated risks, catheter-based intervention is the only palliative option available to improve quality of life in severely symptomatic patients with PV stenosis and FM. Patients with PV stenosis and FM (especially those with bilateral disease) have an overall poor prognosis in spite of undergoing these interventions due to the progressive and recalcitrant nature of the disease. This underscores the need for further innovative approaches to manage this disease

MusA: Using Indoor Positioning and Navigation to Enhance Cultural Experiences in a museum

In recent years there has been a growing interest into the use of multimedia mobile guides in museum environments. Mobile devices have the capabilities to detect the user context and to provide pieces of information suitable to help visitors discovering and following the logical and emotional connections that develop during the visit. In this scenario, location based services (LBS) currently represent an asset, and the choice of the technology to determine users' position, combined with the definition of methods that can effectively convey information, become key issues in the design process. In this work, we present MusA (Museum Assistant), a general framework for the development of multimedia interactive guides for mobile devices. Its main feature is a vision-based indoor positioning system that allows the provision of several LBS, from way-finding to the contextualized communication of cultural contents, aimed at providing a meaningful exploration of exhibits according to visitors' personal interest and curiosity. Starting from the thorough description of the system architecture, the article presents the implementation of two mobile guides, developed to respectively address adults and children, and discusses the evaluation of the user experience and the visitors' appreciation of these application

Risk of herpes zoster after exposure to varicella to explore the exogenous boosting hypothesis: self controlled case series study using UK electronic healthcare data.

OBJECTIVE: To assess the magnitude and duration of any hypothesised protective effect of household exposure to a child with varicella on the relative incidence of herpes zoster in adults. DESIGN: Self controlled case series. SETTING: UK general practices contributing to Clinical Practice Research Datalink. PARTICIPANTS: 9604 adults (≥18 years) with a diagnosis of herpes zoster (in primary care or hospital records) between 1997 and 2018, who during their observation period lived with a child (<18 years) with a diagnosis of varicella. MAIN OUTCOME MEASURES: Relative incidence of herpes zoster in the 20 years after exposure to a child with varicella in the household compared with baseline time (all other time, excluding the 60 days before exposure). RESULTS: 6584 of the 9604 adults with herpes zoster (68.6%) were women. Median age of exposure to a child with varicella was 38.3 years (interquartile range 32.3-48.8 years) and median observation period was 14.7 (11.1-17.7) years. 4116 adults developed zoster in the baseline period, 433 in the 60 days before exposure and 5055 in the risk period. After adjustment for age, calendar time, and season, strong evidence suggested that in the two years after household exposure to a child with varicella, adults were 33% less likely to develop zoster (incidence ratio 0.67, 95% confidence interval 0.62 to 0.73) compared with baseline time. In the 10-20 years after exposure, adults were 27% less likely to develop herpes zoster (0.73, 0.62 to 0.87) compared with baseline time. A stronger boosting effect was observed among men than among women after exposure to varicella. CONCLUSIONS: The relative incidence of zoster was lower in the periods after exposure to a household contact with varicella, with modest but long lasting protective effects observed. This study suggests that exogenous boosting provides some protection from the risk of herpes zoster, but not complete immunity, as assumed by previous cost effectiveness estimates of varicella immunisation