The Impact of Sickle Cell Disease on the Family: An Examination of the Illness Intrusiveness Framework

Sickle Cell Disease (SCD) is a genetic disorder that affects approximately 1 out of every 600 African-American newborns (NHLBI, 2006). SCD and its associated symptoms can have widespread impact on both the psychological functioning of the individual diagnosed with the illness and their families. The purpose of this study was to apply the illness intrusiveness framework to better understand the relations among vaso-occlusive pain crises (VOC), child age, pediatric health related quality of life (QOL), and parental psychosocial adjustment. Participants included 103 parent-child dyads. Parents completed a background form, the Brief Symptom Inventory-18, and the Illness Intrusiveness Rating Scale. Children completed the Pediatric Quality of Life Inventory. Results revealed that experiencing a greater frequency of VOC’s was related to decrements in QOL across domains. However, this relation was not mediated by parental perceived illness intrusiveness. Further, results revealed that the effect of frequency of vaso-occlusive pain crises in children with SCD on parental psychosocial maladjustment is mediated by parental illness intrusiveness, which is contingent upon child age

An Examination of the Influence of Stress and Coping on Psychosocial Functioning in Caregivers of Children with Sickle Cell Disease

Sickle Cell Disease (SCD) is a genetic disorder that affects approximately 1 out of every 600 African-American newborns (NHLBI, 2006). Research suggests that caregivers of children with SCD are at risk for maladjustment. The purpose of this current study was to build upon previous research regarding stress and coping of parents of children with SCD. Additionally, novel information regarding the effects of racial identity was explored. Participants included 103 caregivers (M = 41.1 years old, SD = 8.04 years) of children with SCD. Parents completed a demographic form, the Brief Symptom Inventory-18, Pediatric Inventory for Parents, Coping Health Inventory for Parents, and the Multidimensional Inventory of Black Identity. Results revealed that increases in caregiver stress associated with parenting a chronically ill child were accompanied by increases in caregiver psychosocial maladjustment. Caregiver coping did not significantly predict functioning nor moderate the stress-adjustment relation. Exploratory analysis revealed significant associations between parents’ racial identity and parenting stress

Independent assessment of improvements in dementia care and support since 2009

The Department of Health commissioned a team from the London School of Economics and Political Science and the London School of Hygiene and Tropical Medicine to consider progress in dementia care since 2009. We were asked to focus particularly on three areas: improvements in diagnosis and post-diagnostic support, changes in public attitudes, and developments in research. Two major policy documents provide the context: the National Dementia Strategy 2009, which is now finished, and the Prime Minister’s Challenge on Dementia 2012, which superseded it

An extended model to support detailed GPGPU reliability analysis

General Purpose Graphics Processing Units (GPGPUs) have been used in the last decades as accelerators in high demanding data processing applications, such as multimedia processing and high-performance computing. Nowadays, these devices are becoming popular even in safety-critical applications, such as autonomous and semi-autonomous vehicles. However, these devices can suffer from the effects of transient faults, such as those produced by radiation effects. These effects can be represented in the system as Single Event Upsets (SEUs) and are able to generate intolerable application misbehaviors in safety critical environments. In this work, we extended the capabilities of an open-source VHDL GPGPU model (FlexGrip) in order to study and analyze in a much more detailed manner the effects of SEUs in some critical modules within a GPGPU. Simulation results showed that scheduler controller has different levels of SEU sensibility depending on the affected location. Moreover, a reduced number of execution units, in the GPGPU can decrease the system reliability

The use of hydrazine-based derivatization reagents for improved sensitivity and detection of carbonyl containing compounds using MALDI-MSI

Hydrazine-based derivatization reagents have been used to detect the presence of the carbonyl containing glucocorticoid fluticasone proprionate in rat lung tissue by MALDI-MSI. Such reagents also act as a matrix for analysis by MALDI-MS and have been termed “reactive matrices”. Cryosections of rat lung tissue (12 μm), spotted with a range of concentrations of fluticasone proprionate, were derivatized in situ with 2,4-dinitrophenylhydrazine (DNPH) and 4-dimethylamino-6-(4-methoxy-1-naphthyl)-1,3,5-triazine-2-hydrazine (DMNTH) by the use of an acoustic reagent spotter. It has been demonstrated that DMNTH gave superior results compared to DNPH and that analysis of samples immediately after application of DMNTH resulted in the detection of the protonated hydrazone derivative ([MD + H]+) of fluticasone propionate at a concentration of 500 ng/μL. It has been further shown that a prolonged reaction time (~48 h) improves the detection limit of the protonated hydrazone derivative to 50 ng/μL and that improvements in sensitivity and limits of detection are obtained when a conventional MALDI matrix CHCA is employed in conjunction with the DNPH/DMNTH reactive matrix

Behavioral Approaches for Infant Pain Relief

Infants experience a host of painful medical procedures including heel sticks, venipuncture, and immunizations. Historically, little attention was given to infant pain management due to misconceived myths and beliefs about the experience and long-term effects of pain in infants. Recent data suggest that there are both short- and long-term negative repercussions associated with unmanaged infant pain. In response, a number of non-pharmacological approaches have been developed to provide infants with pain relief associated with medical events. This paper will review these behavioral approaches including positioning, parent training, distraction, sucrose, and skin-to-skin contact. Recommendations for best practices will be provided and future direction for infant pain management will be outlined

Role and prevalence of impaired awareness of hypoglycaemia in ambulance service attendances to people who have had a severe hypoglycaemic emergency: a mixed-methods study

Objectives (1) To compare the experiences of people who are affected by diabetes-related hypoglycaemia and either do or do not require an emergency attendance and (2) to measure the prevalence of impaired awareness of hypoglycaemia in patients who are attended by an ambulance service due to a severe hypoglycaemic event.  Design A sequential mixed-methods study.  Setting A qualitative interview study was undertaken with 31 people with diabetes (types 1 and 2) resident in the central belt of Scotland. A national prevalence survey of 590 Scottish Ambulance Service patients who had recently experienced a severe hypoglycaemic emergency requiring ambulance clinicians attendance. Impaired awareness of hypoglycaemia was measured using two standardised measures.  Results Considerable differences in impaired awareness of hypoglycaemia were found in the experiences of participants who did or did not require the ambulance service to treat their severe hypoglycaemic events. Those who required an ambulance reported fewer warning signs and symptoms. The prevalence of impaired awareness of hypoglycaemia in ambulance service call-outs as assessed by two standardised measures was 53% and 60%, respectively.  Conclusions The prevalence of impaired awareness of hypoglycaemia among those who require an ambulance following a hypoglycaemic event is more than twice that found in the general population of people with diabetes. This may be because the experiences of impaired awareness in people who require an ambulance following a severe hypoglycaemic event differ to those who do not. This study provides important information to guide future prehospital clinical practice, and to develop and evaluate theoretically informed interventions. Improvements in prehospital care for this patient population could lead to global improvements in health outcomes and decreased service costs

Psychological Approaches to Acute Pediatric Pain Management

Children endure numerous acute painful events, most of which occur within the medical arena. For instance, by the time a child reaches the age of 6, the child will have experienced approximately 30 immunization injections (Centers for Disease Control and Prevention, 2008). Grounded in the Gate Control Theory (Melzack & Wall, 1965), psychological methods of pain management have focused on anxiety and pain management via behavioral means. In addition, ample research has been devoted to how best to prepare children and their parents for upcoming painful or distress-provoking procedures (e.g., surgery, hospitalization, injection). This paper will review the preparation literature, which details how to inform and arm children and their parents for impending procedures and will highlight the psychological pain management literature which includes distraction, cognitive behavioral therapy, and additional promising interventions

Biogeographical variation in diurnal behaviour of Acanthaster planci versus Acanthaster cf. solaris

Crown-of-thorns starfish (CoTS; Acanthaster spp.) are among the most extensively studied coral reef taxa, largely owing to their devastating impacts on live coral cover during population outbreaks. Much of this research has however, been conducted in the western Pacific, although it is now apparent that there are several distinct species of Acanthaster spp. across the Indo-Pacific. The purpose of this study was to test for biogeographical variation in behaviour, comparing between Acanthaster planci at Lankanfushi Island in the Maldives and Acanthaster cf. solaris at Rib Reef on Australia’s Great Barrier Reef. The extent to which CoTS were exposed (cf. concealed within or beneath coral substrates) was substantially higher (63.14%) for A. planci at Lankanfushi Island, compared to 28.55% for A. cf. solaris at Rib Reef, regardless of time of day. More importantly, only 52% of individuals were exposed at night at Rib Reef compared to >97% at reefs around Lankanfushi Island. Biogeographic variation in the behaviour of Acanthaster spp. was independent of differences in the size structure of starfish and coral cover at specific study sites, but may be attributable to other environmental factors such as habitat complexity or prey availability. This is the first study to explicitly test for biogeographical differences in the biology and behaviour of Acanthaster spp., potentially linked to species-specific differences in the causes and explanations of population outbreaks. However, we did not find evidence at this stage of differences in behavior among regions, rather behavioural differences observed were most likely products of different environments

Nanoscale-length control of the flagellar driveshaft requires hitting the tethered outer membrane

The bacterial flagellum exemplifies a system where even small deviations from the highly regulated flagellar assembly process can abolish motility and cause negative physiological outcomes. Consequently, bacteria have evolved elegant and robust regulatory mechanisms to ensure that flagellar morphogenesis follows a defined path, with each component self-assembling to predetermined dimensions. The flagellar rod acts as a driveshaft to transmit torque from the cytoplasmic rotor to the external filament. The rod self-assembles to a defined length of ~25 nanometers. Here, we provide evidence that rod length is limited by the width of the periplasmic space between the inner and outer membranes. The length of Braun's lipoprotein determines periplasmic width by tethering the outer membrane to the peptidoglycan layer