A psychometric evaluation of the PedsQL™ Family Impact Module in parents of children with sickle cell disease

<p>Abstract</p> <p>Background</p> <p>Caring for a child with a chronic condition, such as sickle cell disease, can have a significant impact on parents and families. In order to provide comprehensive care and support to these families, psychometrically sound instruments are needed as an initial step in measuring the impact of chronic diseases on parents and families. We sought to evaluate the psychometric properties of the PedsQL™ Family Impact Module in populations of children with and without sickle cell disease. In addition, we sought to determine the correlation between parent's well being and their proxy report of their child's health-related quality of life (HRQL).</p> <p>Methods</p> <p>We conducted a cross-sectional study of parents of children with and without sickle cell disease who presented to an urban hospital-based sickle cell disease clinic and an urban primary care clinic. We assessed the HRQL and family functioning of both groups of parents utilizing the PedsQL™ Family Impact Module. The reliability, validity and factor structure of the instrument were determined and scores from the instrument were correlated with scores from parent-proxy report of their child's HRQL using the PedsQL™ 4.0 Generic Core Scales.</p> <p>Results</p> <p>Parents of 170 children completed the module (97 parents of children with sickle cell disease and 73 parents of children without sickle cell disease). The Family Impact Module had high ceiling effects but was reliable (Cronbach's alpha > 0.80 in all scales). The empirical factor structure was generally consistent with the theoretical factor structure and supported construct validity. The Family Impact Module discriminated between parents of children with severe sickle cell disease from parents of children with mild disease or no disease in the areas of communication and worry. There were no significant differences across any of the subscales between parents of children with mild sickle cell disease and those with no disease. Parents with higher scores, representing better HRQL and family functioning, generally reported higher HRQL scores for their children.</p> <p>Conclusion</p> <p>The PedsQL™ Family Impact module was reliable, however it displayed large ceiling effects and did not discriminate well between parents of children with and without sickle cell disease. Future research to evaluate the psychometric properties of the Family Impact Module for parents of healthy children may be helpful.</p

Depleted Energy Charge and Increased Pulmonary Endothelial Permeability Induced by Mitochondrial Complex I inhibition are Mitigated by Coenzyme Q\u3csub\u3e1\u3c/sub\u3e in the Isolated Perfused Rat Lung

Mitochondrial dysfunction is associated with various forms of lung injury and disease that also involve alterations in pulmonary endothelial permeability, but the relationship, if any, between the two is not well understood. This question was addressed by perfusing isolated intact rat lung with a buffered physiological saline solution in the absence or presence of the mitochondrial complex I inhibitor rotenone (20 μM). Compared to control, rotenone depressed whole lung tissue ATP from 5.66±0.46 (SEM) to 2.34±0.15 µmol·g−1 dry lung, with concomitant increases in the ADP:ATP and AMP:ATP ratios. Rotenone also increased lung perfusate lactate (from 12.36±1.64 to 38.62±3.14 µmol·15 min−1 perfusion·g−1 dry lung) and the lactate:pyruvate ratio, but had no detectable impact on lung tissue GSH:GSSG redox status. The amphipathic quinone coenzyme Q1 (CoQ1; 50 μM) mitigated the impact of rotenone on the adenine nucleotide balance, wherein mitigation was blocked by NAD(P)H-quinone oxidoreductase 1 or mitochondrial complex III inhibitors. In separate studies, rotenone increased the pulmonary vascular endothelial filtration coefficient (Kf) from 0.043±0.010 to 0.156±0.037 ml·min−1·cm H2O−1·g−1 dry lung, and CoQ1 protected against the effect of rotenone on Kf. A second complex I inhibitor, piericidin A, qualitatively reproduced the impact of rotenone on Kf and the lactate:pyruvate ratio. Taken together, the observations imply that pulmonary endothelial barrier integrity depends on mitochondrial bioenergetics as reflected in lung tissue ATP levels and that compensatory activation of whole lung glycolysis cannot protect against pulmonary endothelial hyperpermeability in response to mitochondrial blockade. The study further suggests that low-molecular-weight amphipathic quinones may have therapeutic utility in protecting lung barrier function in mitochondrial insufficiency

Potassium administration increases and potassium deprivation reduces urinary calcium excretion in healthy adults

Potassium administration increases and potassium deprivation reduces urinary calcium excretion in healthy adults. This study was undertaken to evaluate the effects of dietary K intake, independent of whether the accompanying anion is Cl- or HCO3-, on urinary Ca excretion in healthy adults. The effects of KCl, KHCO3, NaCl and NaHCO3 supplements, 90 mmol/day for four days, were compared in ten subjects fed normal constant diets. Using synthetic diets, the effects of dietary KCl-deprivation for five days followed by recovery were assessed in four subjects and of KHCO3-deprivation for five days followed by recovery were assessed in four subjects. On the fourth day of salt administration, daily urinary Ca excretion and fasting UCaV/GFR were lower during the administration of KCl than during NaCl supplements (Δ = -1.11 ± 0.28 SEM mmol/day; P < 0.005 and -0.0077 ± 0.0022 mmol/liter GFR; P < 0.01), and lower during KHCO3 than during control (-1.26 ± 0.29 mmol/day; P < 0.005 and -0.0069 ± 0.0019 mmol/liter GFR; P = 0.005). Both dietary KCl and KHCO3 deprivation (mean reduction in dietary K intake -67 ± 8 mmol/day) were accompanied by an increase in daily urinary Ca excretion and fasting UCaV/GFR that averaged on the fifth day +1.31 ± 0.25 mmol/day (P < 0.005) and +0.0069 ± 0.0012 mmol/liter GFR (P < 0.005) above control. Both daily urinary Ca excretion and fasting UCaV/GFR returned toward or to control at the end of recovery. These observations indicate that: 1) KHCO3 decreases fasting and 24-hour urinary Ca excretion; 2) KCl nor NaHCO3, unlike NaCl, do not increase fasting or 24-hour Ca excretion and 3) K deprivation increases both fasting and 24-hour urinary Ca excretion whether the accompanying anion is Cl- or HCO3-. The mechanisms for this effect of K may be mediated by: 1) alterations in ECF volume, since transient increases in urinary Na and CI excretion and weight loss accompanied KCl or KHCO3 administration, while persistent reductions in urinary Na and Cl excretion and a trend for weight gain accompanied K deprivation; 2) K mediated alterations in renal tubular phosphate transport and renal synthesis of 1, 25-(OH)2-vitamin D, since KCl or KHCO3 administration tended to be accompanied by a rise in fasting serum PO4 and TmPO4 and a fall in fasting UPO4 V/GFR, a fall in serum 1,25-(OH)2-D and a decrease in fasting UCaV/GFR, while dietary KCl or KHCO3 deprivation were accompanied by a reverse sequence

Sagopilone (ZK-EPO, ZK 219477) for recurrent glioblastoma. A phase II multicenter trial by the European Organisation for Research and Treatment of Cancer (EORTC) Brain Tumor Group

Background: Sagopilone (ZK 219477), a lipophylic and synthetic analog of epothilone B, that crosses the blood–brain barrier has demonstrated preclinical activity in glioma models

Resident Training Curriculum in Adolescent Depression and Suicide Screening

Introduction: Routine screening of adolescents for depression and suicide risk is now considered best clinical practice. However, due to a lack of training, many physicians do not engage in screening. The goal of this curriculum is to improve learner knowledge of and comfort in adolescent depression and suicide risk assessment and management. Methods: The didactic session typically takes 60-90 minutes to complete. In addition to a teaching PowerPoint that provides instruction in both the assessment and management of adolescent depression and suicide risk, the curriculum also includes a suicide assessment and management protocol. This protocol outlines an algorithm that assists in distinguishing between individuals at high and low risk of suicide. The algorithm enables clinicians to determine the most appropriate management plan based on the assessed level of suicide risk. Results: Outcome measures indicate that the majority of residents improved their self-perceived knowledge and comfort in assessing and managing depression and suicide risk, with an average of 61.7% of residents moving from the novice to the proficient group at the conclusion of the rotation. These results reflect learners obtaining 4 weeks of supervised clinical experience after the didactic session. Discussion: This curriculum was designed for use with pediatric and internal medicine–pediatric residents during their adolescent medicine rotation but could easily be adapted for use with other learners in different settings

Understanding NF-κB signaling via mathematical modeling

Mammalian inflammatory signaling, for which NF-κB is a principal transcription factor, is an exquisite example of how cellular signaling pathways can be regulated to produce different yet specific responses to different inflammatory insults. Mathematical models, tightly linked to experiment, have been instrumental in unraveling the forms of regulation in NF-κB signaling and their underlying molecular mechanisms. Our initial model of the IκB–NF-κB signaling module highlighted the role of negative feedback in the control of NF-κB temporal dynamics and gene expression. Subsequent studies sparked by this work have helped to characterize additional feedback loops, the input–output behavior of the module, crosstalk between multiple NF-κB-activating pathways, and NF-κB oscillations. We anticipate that computational techniques will enable further progress in the NF-κB field, and the signal transduction field in general, and we discuss potential upcoming developments

Northeast Folklore volume 1 numbers 1-4

The first ever issue of Northeast Folklore was published in the spring of 1958 under the editorship of Edward D. Ives (known as Sandy) and Bacil F. Kirtley through the Department of English at the University of Maine. The four editions that year were later bound into a single volume. Table of Contents Number 1 (Spring): Mishaps of a Maine Lobsterman Maine Winter Menus: A Study in Ingenuity “Young Jimmy Foulger:” A Hitherto Unrecorded Ballad in the Northeast John Ellis – Hunter, Guide, Legend Number 2 (Summer): Bibliography of New England-Maritimes Folklore Selected Bibliography of New England-Maritimes Folklore Collections and Studies Prior to 1950 Number 3 (Fall): Folklore from Aroostook County, Maine, and Neighboring Canada The Creation of Folk Songs Number 4 (Winter): Yankee Doodle: An Early Version Two Stories from the Maine Lumberwoods The First Miramichi Folksong Festival Folklore from Aroostook County, Maine, and Neighboring Canadahttps://digitalcommons.library.umaine.edu/nf/1001/thumbnail.jp

Northeast Folklore volume 1 numbers 1-4

The first ever issue of Northeast Folklore was published in the spring of 1958 under the editorship of Edward D. Ives (known as Sandy) and Bacil F. Kirtley through the Department of English at the University of Maine. The four editions that year were later bound into a single volume. Table of Contents Number 1 (Spring): Mishaps of a Maine Lobsterman Maine Winter Menus: A Study in Ingenuity “Young Jimmy Foulger:” A Hitherto Unrecorded Ballad in the Northeast John Ellis – Hunter, Guide, Legend Number 2 (Summer): Bibliography of New England-Maritimes Folklore Selected Bibliography of New England-Maritimes Folklore Collections and Studies Prior to 1950 Number 3 (Fall): Folklore from Aroostook County, Maine, and Neighboring Canada The Creation of Folk Songs Number 4 (Winter): Yankee Doodle: An Early Version Two Stories from the Maine Lumberwoods The First Miramichi Folksong Festival Folklore from Aroostook County, Maine, and Neighboring Canadahttps://digitalcommons.library.umaine.edu/nf/1001/thumbnail.jp