Follow-up study of chronically ill patients discharged from hospital

A study was made of 82 patients with selected illnesses of specified severity before and after discharge from the ward services of three general hospitals in a metropolitan community. An initial appraisal was made by a resident physician who evaluated the health status of each patient and made recommendations for care and supervision following discharge from hospital. After an average period of 3 months, each patient was visited by a student of social work who reconstructed the course of events following discharge and determined the extent to which the physicians' recommendations were complied with and the reasons for non-compliance. The usual consequences of chronic illness--persistent disability, unemployment and recurrent and lengthy institutionalization--were amply evident in this group. So was the fact that the burden of continued care falls heavily upon the members of the family. Other sources of help were trivial by comparison. The recommendations made by the discharging physician constitute an interesting, and sobering, inventory of continued need for care. More than a half of all patients did not comply with one or more recommendations made by the physician. In addition, about 40 per cent of patients reported unmet need for one or more services touching upon many aspects of medical care. A variety of lessons relevant to the organized provision of care may be drawn from a consideration of the services needed and desired by patients and of the reasons for, and factors related to, non-compliance with medical recommendations.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/32173/1/0000228.pd

U.S. Department of Energy Hydrogen Storage Cost Analysis

The overall objective of this project is to conduct cost analyses and estimate costs for on- and off-board hydrogen storage technologies under development by the U.S. Department of Energy (DOE) on a consistent, independent basis. This can help guide DOE and stakeholders toward the most-promising research, development and commercialization pathways for hydrogen-fueled vehicles. A specific focus of the project is to estimate hydrogen storage system cost in high-volume production scenarios relative to the DOE target that was in place when this cost analysis was initiated. This report and its results reflect work conducted by TIAX between 2004 and 2012, including recent refinements and updates. The report provides a system-level evaluation of costs and performance for four broad categories of on-board hydrogen storage: (1) reversible on-board metal hydrides (e.g., magnesium hydride, sodium alanate); (2) regenerable off-board chemical hydrogen storage materials(e.g., hydrolysis of sodium borohydride, ammonia borane); (3) high surface area sorbents (e.g., carbon-based materials); and 4) advanced physical storage (e.g., 700-bar compressed, cryo-compressed and liquid hydrogen). Additionally, the off-board efficiency and processing costs of several hydrogen storage systems were evaluated and reported, including: (1) liquid carrier, (2) sodium borohydride, (3) ammonia borane, and (4) magnesium hydride. TIAX applied a âÂÂbottom-upâ costing methodology customized to analyze and quantify the processes used in the manufacture of hydrogen storage systems. This methodology, used in conjunction with DFMAî software and other tools, developed costs for all major tank components, balance-of-tank, tank assembly, and system assembly. Based on this methodology, the figure below shows the projected on-board high-volume factory costs of the various analyzed hydrogen storage systems, as designed. Reductions in the key cost drivers may bring hydrogen storage system costs closer to this DOE target. In general, tank costs are the largest component of system cost, responsible for at least 30 percent of total system cost, in all but two of the 12 systems. Purchased BOP cost also drives system cost, accounting for 10 to 50 percent of total system cost across the various storage systems. Potential improvements in these cost drivers for all storage systems may come from new manufacturing processes and higher production volumes for BOP components. In addition, advances in the production of storage media may help drive down overall costs for the sodium alanate, SBH, LCH2, MOF, and AX-21 systems

Single-Pass Albumin Dialysis in the Treatment of Children with Liver Failure

Background and Aims: Acute and acute on chronic liver failure are life-threatening conditions, and bridging to transplantation is complicated by a paucity of suitable organs for children. While different modalities of extracorporeal liver support exist, their use in children is complicated by a large extracorporeal volume, and data on their use in children is limited. The aim of this analysis was to investigate the efficacy and safety of single-pass albumin dialysis (SPAD) in children with liver failure. Methods: Retrospective medical chart review of pediatric patients with liver failure treated with SPAD. The decrease in hepatic encephalopathy (HE) and the serum levels of bilirubin and ammonia were measured to determine efficacy. Adverse events were documented to assess safety. Results: Nineteen pediatric patients with a median age of 25.5 months and a median body weight of 11.9 kg were treated with SPAD between January 2011 and March 2018. Total bilirubin (p < 0.001) and ammonia (p = 0.02) significantly decreased after treatment with SPAD. As clinical outcome parameter, HE significantly improved (p = 0.001). Twelve patients were bridged successfully to liver transplantation. In all patients, 71 SPAD sessions were run. Clotting in the dialysis circuit was observed in 49% of all sessions. Heparin and citrate were used for anticoagulation and were significantly superior to dialysis without any anticoagulation (p= 0.03). Transfusion of packed blood cells (57%) and catecholamine therapy (49%) were frequently necessary. Conclusions: Treatment with SPAD was effective in detoxification, as measured by significant improvement of HE and clearance from surrogate laboratory parameters

Ariel - Volume 9 Number 3

Executive Editor Emily Wofford Business Manager Fredric Jay Matlin University News John Patrick Welch World News George Robert Coar Editorials Editor Steve Levine Features Mark Rubin Brad Feldstein Photo Rick Spaide Circulation Victor Onufreiczuk Lee Wugofski Graphics and Art Steve Hulkower Commons Editor Brenda Peterso

Efficacy, safety and quality of life in a multicenter, randomized, placebo-controlled trial of low-dose peanut oral immunotherapy in children with peanut allergy

BACKGROUND: Only 2 small placebo-controlled trials on peanut oral immunotherapy (OIT) have been published. OBJECTIVE: We examined the efficacy, safety, immunologic parameters, quality of life (QOL), and burden of treatment (BOT) of low-dose peanut OIT in a multicenter, double-blind, randomized placebo-controlled trial. METHODS: A total of 62 children aged 3 to 17 years with IgE-mediated, challenge-proven peanut allergy were randomized (1:1) to receive peanut OIT with a maintenance dose of 125 to 250 mg peanut protein or placebo. The primary outcome was the proportion of children tolerating 300 mg or more peanut protein at oral food challenge (OFC) after 16 months of OIT. We measured the occurrence of adverse events (AEs), immunologic changes, and QOL before and after OIT and BOT during OIT. RESULTS: Twenty-three of 31 (74.2%) children of the active group tolerated at least 300 mg peanut protein at final OFC compared with 5 of 31 (16.1%) in the placebo group (P < .001). Thirteen of 31 (41.9%) children of the active versus 1 of 31 (3.2%) of the placebo group tolerated the highest dose of 4.5 g peanut protein at final OFC (P < .001). There was no significant difference between the groups in the occurrence of AE-related dropouts or in the number, severity, and treatment of objective AEs. In the peanut-OIT group, we noted a significant reduction in peanut-specific IL-4, IL-5, IL-10, and IL-2 production by PBMCs compared with the placebo group, as well as a significant increase in peanut-specific IgG4 levels and a significant improvement in QOL; 86% of children evaluated the BOT positively. DISCUSSION: Low-dose OIT is a promising, effective, and safe treatment option for peanut-allergic children, leading to improvement in QOL, a low BOT, and immunologic changes showing tolerance development

Modular proteins from the Drosophila sallimus (sls) gene and their expression in muscles with different extensibility

The passive elasticity of the sarcomere in striated muscle is determined by large modular proteins, such as titin in vertebrates. In insects, the function of titin is divided between two shorter proteins, projectin and sallimus (Sls), which are the products of different genes. The Drosophila sallimus (sls) gene codes for a protein of 2 MDa. The N-terminal half of the protein is largely made up of immunoglobulin domains and unique sequence; the C-terminal half has two stretches of sequence similar to the elastic PEVK region of titin, and at the end of the molecule there is a region of tandem Ig and fibronectin domains. We have investigated splicing pathways of the sls gene and identified isoforms expressed in different muscle types, and at different stages of Drosophila development. The 5’ half of sls codes for zormin and kettin; both proteins contain Ig domains and can be expressed as separate isoforms, or as larger proteins linked to sequence downstream. There are multiple splicing pathways between the kettin region of sls and sequence coding for the two PEVK regions. All the resulting protein isoforms have sequence derived from the 3’ end of the sls gene. Splicing of exons varies at different stages of development. Kettin RNA is predominant in the embryo, and longer transcripts are expressed in larva, pupa and adult. Sls isoforms in the indirect flight muscle (IFM) are zormin, kettin and Sls(700), in which sequence derived from the end of the gene is spliced to kettin RNA. Zormin is in both M-line and Z-disc. Kettin and Sls(700) extend from the Z-disc to the ends of the thick filaments, though, Sls(700) is only in the myofibril core. These shorter isoforms would contribute to the high stiffness of IFM. Other muscles in the thorax and legs have longer Sls isoforms with varying amounts of PEVK sequence; all span the I-band to the ends of the thick filaments. In muscles with longer Ibands, the proportion of PEVK sequence would determine the extensibility of the sarcomere. Alternative Sls isoforms could regulate the stiffness of the many fibre types in Droso phila muscles

The Lantern Vol. 44, No. 2, Spring 1978

• Ode To the Death of a Patient • The Bloody Brand of Honor • Deserted Trail • The Apple Revisited • Consciousness in Awares • Middle Class • Clock • Snow • The Case • Your Eyes Speak Falsely • Finding a Place • Legacy of Ellis Island • John • Work • A Gift • When She is Gone • Qual. Lamenthttps://digitalcommons.ursinus.edu/lantern/1112/thumbnail.jp

Instabilities in crystal growth by atomic or molecular beams

The planar front of a growing a crystal is often destroyed by instabilities. In the case of growth from a condensed phase, the most frequent ones are diffusion instabilities, which will be but briefly discussed in simple terms in chapter II. The present review is mainly devoted to instabilities which arise in ballistic growth, especially Molecular Beam Epitaxy (MBE). The reasons of the instabilities can be geometric (shadowing effect), but they are mostly kinetic or thermodynamic. The kinetic instabilities which will be studied in detail in chapters IV and V result from the fact that adatoms diffusing on a surface do not easily cross steps (Ehrlich-Schwoebel or ES effect). When the growth front is a high symmetry surface, the ES effect produces mounds which often coarsen in time according to power laws. When the growth front is a stepped surface, the ES effect initially produces a meandering of the steps, which eventually may also give rise to mounds. Kinetic instabilities can usually be avoided by raising the temperature, but this favours thermodynamic instabilities. Concerning these ones, the attention will be focussed on the instabilities resulting from slightly different lattice constants of the substrate and the adsorbate. They can take the following forms. i) Formation of misfit dislocations (chapter VIII). ii) Formation of isolated epitaxial clusters which, at least in their earliest form, are `coherent' with the substrate, i.e. dislocation-free (chapter X). iii) Wavy deformation of the surface, which is presumably the incipient stage of (ii) (chapter IX). The theories and the experiments are critically reviewed and their comparison is qualitatively satisfactory although some important questions have not yet received a complete answer.Comment: 90 pages in revtex, 45 figures mainly in gif format. Review paper to be published in Physics Reports. Postscript versions for all the figures can be found at http://www.theo-phys.uni-essen.de/tp/u/politi

The effects of interleukin-8 on airway smooth muscle contraction in cystic fibrosis

<p>Abstract</p> <p>Background</p> <p>Many cystic fibrosis (CF) patients display airway hyperresponsiveness and have symptoms of asthma such as cough, wheezing and reversible airway obstruction. Chronic airway bacterial colonization, associated with neutrophilic inflammation and high levels of interleukin-8 (IL-8) is also a common occurrence in these patients. The aim of this work was to determine the responsiveness of airway smooth muscle to IL-8 in CF patients compared to non-CF individuals.</p> <p>Methods</p> <p>Experiments were conducted on cultured ASM cells harvested from subjects with and without CF (control subjects). Cells from the 2^ndto 5^thpassage were studied. Expression of the IL-8 receptors CXCR1 and CXCR2 was assessed by flow cytometry. The cell response to IL-8 was determined by measuring intracellular calcium concentration ([Ca²⁺]_i), cell contraction, migration and proliferation.</p> <p>Results</p> <p>The IL-8 receptors CXCR1 and CXCR2 were expressed in both non-CF and CF ASM cells to a comparable extent. IL-8 (100 nM) induced a peak Ca²⁺release that was higher in control than in CF cells: 228 ± 7 versus 198 ± 10 nM (p < 0.05). IL-8 induced contraction was greater in CF cells compared to control. Furthermore, IL-8 exposure resulted in greater phosphorylation of myosin light chain (MLC₂₀) in CF than in control cells. In addition, MLC₂₀expression was also increased in CF cells. Exposure to IL-8 induced migration and proliferation of both groups of ASM cells but was not different between CF and non-CF cells.</p> <p>Conclusion</p> <p>ASM cells of CF patients are more contractile to IL-8 than non-CF ASM cells. This enhanced contractility may be due to an increase in the amount of contractile protein MLC₂₀. Higher expression of MLC₂₀by CF cells could contribute to airway hyperresponsiveness to IL-8 in CF patients.</p

Virtual Reality for Obsessive-Compulsive Disorder: Past and the Future

The use of computers, especially for virtual reality (VR), to understand, assess, and treat various mental health problems has been developed for the last decade, including application for phobia, post-traumatic stress disorder, attention deficits, and schizophrenia. However, the number of VR tools addressing obsessive-compulsive disorder (OCD) is still lacking due to the heterogeneous symptoms of OCD and poor understanding of the relationship between VR and OCD. This article reviews the empirical literatures for VR tools in the future, which involve applications for both clinical work and experimental research in this area, including examining symptoms using VR according to OCD patients' individual symptoms, extending OCD research in the VR setting to also study behavioral and physiological correlations of the symptoms, and expanding the use of VR for OCD to cognitive-behavioral intervention