Power-Assist Wheelchair Attachment

This senior design project sought to combine the best characteristics of manual and power wheelchairs by creating a battery-powered attachment to propel a manual wheelchair. The primary customer needs were determined to be affordability, portability, and travel on uneven surfaces. After the initial prototype, using a hub motor proved unsuccessful, so a second design was developed that consisted of a gear reduction motor and drive wheel connected to the back of the wheelchair by a trailing arm that could be easily attached/detached from the frame. The prototype of the second design succeeded in meeting most of the project goals related to cost, off-road capability, inclines, and range. Improvements can be made by reducing the attachment weight and improving user control of the device

A comparison of PBDE serum concentrations in Mexican and Mexican-American children living in California.

BackgroundPolybrominated diphenyl ethers (PBDE), which are used as flame retardants, have been found to be higher in residents of California than of other parts of the United States.ObjectivesWe aimed to investigate the role of immigration to California on PBDE levels in Latino children.MethodsWe compared serum PBDE concentrations in a population of first-generation Mexican-American 7-year-old children (n = 264), who were born and raised in California [Center for Health Analysis of Mothers and Children of Salinas (CHAMACOS) study], with 5-year-old Mexican children (n = 283), who were raised in the states in Mexico where most CHAMACOS mothers had originated (Proyecto Mariposa).ResultsOn average, PBDE serum concentrations in the California Mexican-American children were three times higher than their mothers' levels during pregnancy and seven times higher than concentrations in the children living in Mexico. The PBDE serum concentrations were higher in the Mexican-American children regardless of length of time their mother had resided in California or the duration of the child's breast-feeding. These data suggest that PBDE serum concentrations in these children resulted primarily from postnatal exposure.ConclusionsLatino children living in California have much higher PBDE serum levels than their Mexican counterparts. Given the growing evidence documenting potential health effects of PBDE exposure, the levels in young children noted in this study potentially present a major public health challenge, especially in California. In addition, as PBDEs are being phased out and replaced by other flame retardants, the health consequences of these chemical replacements should be investigated and weighed against their purported fire safety benefits

Barriers and outcomes of an evidence-based approach to diagnosis and management of chronic obstructive pulmonary disease (COPD) in Australia: a qualitative study

Background. Chronic obstructive pulmonary disease (COPD) is commonly managed in primary care but there is poor awareness of evidence-based guidelines and the quality and interpretation of spirometry is suboptimal. Objectives. The aims of this qualitative study were to explore how an intervention involving case finding and management of COPD was implemented, and the extent to which the GPs and practice nurses (PNs) worked in partnership to diagnose and manage COPD. Methods. Semi-structured interviews with PNs (n = 7), GPs (n = 4) and patients (n = 26) who had participated in the Primary care EarLy Intervention for Copd mANagement (PELICAN) study. The Theoretical Domains Framework was used to guide the coding and analysis of the interviews with PN and GPs. The patient interviews were analysed thematically. Results. PNs developed technical skills and understood the requirements for good-quality spirometry. However, many lacked confidence in its interpretation and felt this was not part of their professional role. This was reflected in responses from the GPs. Once COPD was diagnosed, the GPs tended to manage the patients with the PNs less involved. This was in contrast with PNs’ active role in managing patients with other chronic diseases such as diabetes. The extent to which the GPs and PNs worked in partnership to manage COPD varied. Conclusions. PNs improved their skills and confidence in performing spirometry. Beliefs about their professional role, identity and confidence influenced the extent to which PNs were involved in interpretation of the spirometry results and managing the patient in partnership with the GP

Hip fracture incidence and mortality in chronic kidney disease

Background: Individuals on renal replacement therapy (RRT) have increased fracture risk, but risk in less advanced chronic kidney disease (CKD) is unclear. Objective: To investigate CKD associations with hip fracture incidence and mortality. Design: Record linkage cohort study (GLOMMS-II).Setting Single health region in Scotland. Participants: All individuals (>5 years) with sustained CKD stage 3-5 and those on RRT, and a 20% random sample of those with normal renal function, in the resident population in 2003. Outcome measures: Outcomes were (i) incident hip fracture measured with (a) admissions or (b) deaths, with at least 5.5 years follow-up; and (ii) post-hip fracture mortality. Unadjusted and adjusted, incident (IRR) and mortality (MRR) rate ratios, were calculated using Poisson regression. Results: Of 39 630 individuals identified in 2003 (41% males, mean age 63.3 years), 19 537 had CKD stage 3-5, 345 were on RRT, and 19 748 had normal eGFR. Hip fracture incidence, measured by admissions, was increased in CKD stage 3-5 (compared to normal eGFR), both overall (adjusted IRR 1.49 [95% CI, 1.24-1.79]) and for individual CKD stages 3a, 3b and 4. Hip fracture incidence, measured using deaths, was increased in those with CKD stage 3b and 4. Post-hip fracture mortality, was only increased in CKD stage 4. There was only a small number of individuals and events for CKD stage 5, resulting in insufficient statistical power. Conclusion: Hip fracture incidence was higher in CKD stage 3-5 compared to normal eGFR. Post-hip fracture mortality was only increased in CKD Stage 4. Reducing hip fracture incidence in CKD through regular fall and fracture risk review, should reduce overall deaths after hip fracture in the population

Patients’ Perceptions and Experiences of Familial Hypercholesterolemia, Cascade Genetic Screening and Treatment

Background: Familial hypercholesterolemia (FH) is a serious genetic disorder affecting approximately 1 in every 300 to 500 individuals and is characterised by excessively high low-density lipoprotein (LDL) cholesterol levels, substantially increased risk of early-onset coronary heart disease (CHD) and premature mortality. If FH is untreated, it leads to a greater than 50 % risk of CHD in men by the age of 50 and at least 30 % in women by the age of 60. FH can be diagnosed through genetic screening and effectively managed through pharmacological treatment and lifestyle changes. Purpose: Familial hypercholesterolemia (FH) is a genetic health condition that increases the risk of cardiovascular disease. Although FH can be effectively managed with appropriate pharmacological and dietary interventions, FH detection rate through genetic screening remains low. The present study explored perceptions and experiences of FH patients (N = 18) involved in a genetic cascade screening programme. Methods: Face-to-face interviews were conducted to assess patients’ knowledge and understanding of FH, explore factors linked to adherence to health-protective behaviours and examine perceptions of genetic screening. Results: Thematic analysis of interviews revealed four themes: disease knowledge, severity of FH, lifestyle behavioural change and barriers to cascade screening and treatment. Participants recognised FH as a permanent, genetic condition that increased their risk of CHD and premature mortality. Many participants dismissed the seriousness of FH and the importance of lifestyle changes because they perceived it to be effectively managed through medication. Despite positive attitudes toward screening, many participants reported that relatives were reluctant to attend screening due to their relatives’ ‘fatalistic’ outlook or low motivation. Participants believed that they had insufficient authority or control to persuade family members to attend screening and welcomed greater hospital assistance for contact with relatives. Conclusions: Findings support the adoption of direct methods of recruitment to cascade screening led by medical professionals, who were perceived as having greater authority. Other implications included the need for clinicians to provide clear information, particularly to those who are asymptomatic, related to the seriousness of FH and the necessity for adherence to medication and lifestyle changes

A pragmatic, open-label, randomized controlled trial of Plasma-Lyte-148 versus standard intravenous fluids in children receiving kidney transplants (PLUTO)

Acute electrolyte and acid-base imbalance is experienced by many children following kidney transplant. This is partly because doctors give very large volumes of artificial fluids to keep the new kidney working. When severe, fluid imbalance can lead to seizures, cerebral edema and death. In this pragmatic, open-label, randomized controlled trial, we randomly assigned (1:1) pediatric kidney transplant recipients to Plasma-Lyte-148 or standard of care perioperative intravenous fluids (predominantly 0.45% sodium chloride and 0.9% sodium chloride solutions). We then compared clinically significant electrolyte and acid-base abnormalities in the first 72 hours post-transplant. The primary outcome, acute hyponatremia, was experienced by 53% of 68 participants in the Plasma-Lyte-148 group and 58% of 69 participants in the standard fluids group (odds ratio 0·77 (0·34 - 1·75)). Five of 16 secondary outcomes differed with Plasma-Lyte-148: hypernatremia was significantly more frequent (odds ratio 3·5 (1·1 - 10·8)), significantly fewer changes to fluid prescriptions were made (rate ratio 0·52 (0·40-0·67)), and significantly fewer participants experienced hyperchloremia (odds ratio 0·17 (0·07 - 0·40)), acidosis (odds ratio 0·09 (0·04 - 0·22)) and hypomagnesemia (odds ratio 0·21 (0·08 - 0·50)). No other secondary outcomes differed between groups. Serious adverse events were reported in 9% of participants randomized to Plasma-Lyte-148 and 7% of participants randomized to standard fluids. Thus, perioperative Plasma-Lyte-148 did not change the proportion of children who experienced acute hyponatremia compared to standard fluids. However fewer fluid prescription changes were made with Plasma-Lyte-148, while hyperchloremia and acidosis were less common

The UfM and the Middle East 'Peace Process': An Unhappy Symbiosis

This contribution explores differing theories on how the failure of the ‘peace process’ featured in the design and goals of the UfM, drawing on lessons from the period when the EMP was pursued in parallel with the peace process. In each case, institutional overlaps are identified, as well as commonalities in the approaches of the actors to both pursuits. Crucially, however, the persistence and intensification of the Arab–Israeli conflict, in combination with the shift from multilateralism to bilateralism embodied in the UfM, has politicized the latter at the expense of the functionalist aspirations of its architects

Determinants of Organophosphorus Pesticide Urinary Metabolite Levels in Young Children Living in an Agricultural Community

Organophosphorus (OP) pesticides are used in agriculture and several are registered for home use. As young children age they may experience different pesticide exposures due to varying diet, behavior, and other factors. We measured six OP dialkylphosphate (DAP) metabolites (three dimethyl alkylphosphates (DMAP) and three diethyl alkylphosphates (DEAP)) in urine samples collected from ∼400 children living in an agricultural community when they were 6, 12, and 24 months old. We examined bivariate associations between DAP metabolite levels and determinants such as age, diet, season, and parent occupation. To evaluate independent impacts, we then used generalized linear mixed multivariable models including interaction terms with age. The final models indicated that DMAP metabolite levels increased with age. DMAP levels were also positively associated with daily servings of produce at 6- and 24-months. Among the 6-month olds, DMAP metabolite levels were higher when samples were collected during the summer/spring versus the winter/fall months. Among the 12-month olds, DMAP and DEAP metabolites were higher when children lived ≤60 meters from an agricultural field. Among the 24-month-olds, DEAP metabolite levels were higher during the summer/spring months. Our findings suggest that there are multiple determinants of OP pesticide exposures, notably dietary intake and temporal and spatial proximity to agricultural use. The impact of these determinants varied by age and class of DAP metabolite