Biochemical diagnosis of ventricular dysfunction in elderly patients in general practice: observational study

Objective: To investigate the usefulness of measuring plasma concentrations of B type natriuretic peptide in the diagnosis of left ventricular systolic dysfunction in an unselected group of elderly people. Design: Observational study. Setting: General practice with four centres in Poole, Dorset. Participants: 155 elderly patients aged 70 to 84 years. Main outcome measures: Diagnostic characteristics of plasma B type natriuretic peptide measured by radioimmunoassay as a test for left ventricular systolic dysfunction assessed by echocardiography. Results: The median plasma concentration of B type natriuretic peptide was 39.3 pmol/l in patients with left ventricular systolic dysfunction and 15.8 pmol/l in those with normal function. The proportional area under the receiver operator curve was 0.85. At a cut-off point of 18.7 pmol/l the test sensitivity was 92% and the predictive value 18%. Conclusions: Plasma concentration of B type natriuretic peptide could be used effectively as an initial test in a community screening programme and, possibly, using a low cut-off point, as a means of ruling out left ventricular systolic dysfunction. It is, however, not a good test to “rule in” the diagnosis, and access to echocardiography remains essential for general practitioners to diagnose heart failure early

Theoretical investigation of process controls upon flood frequency: role of thresholds

International audienceTraditional statistical approaches to flood frequency inherently assume homogeneity and stationarity in the flood generation process. This study illustrates the impact of heterogeneity associated with threshold non-linearities in the storage-discharge relationship associated with the rainfall-runoff process upon flood frequency behaviour. For a simplified, non-threshold (i.e. homogeneous) scenario, flood frequency can be characterised in terms of rainfall frequency, the characteristic response time of the catchment, and storm intermittency, modified by the relative strength of evaporation. The flood frequency curve is then a consistent transformation of the rainfall frequency curve, and could be readily described by traditional statistical methods. The introduction of storage thresholds, namely a field capacity storage and a catchment storage capacity, however, results in different flood frequency "regions" associated with distinctly different rainfall-runoff response behaviour and different process controls. The return period associated with the transition between these regions is directly related to the frequency of threshold exceedence. Where threshold exceedence is relatively rare, statistical extrapolation of flood frequency on the basis of short historical flood records risks ignoring this heterogeneity, and therefore significantly underestimating the magnitude of extreme flood peaks

Physical Environmental Barriers to School Attendance among Children with Disabilities in two Community Based Rehabilitation Centres in Rwanda

Background: It is estimated that more than 90% of children with disabilities in developing countries do not attend schools. Children with disabilities either do not receive any education or, if they do, it is often inappropriate. The aim of this study was to identify the physical Environmental barriers to school attendance by children with disabilities in two community based rehabilitation (CBR) centres in Rwanda. Method: A quantitative, cross-sectional, descriptive study was conducted to identify barriers to school attendance in two CBR centres. Parents/caregivers of children with disabilities participated in the study. The data was analysed using Statistical Package for the Social Sciences (SPSS).The level of significance (alpha) was set at α=0.05. Results: The long distance from home to the nearest school, and the status of the school physical environment were the major barriers to school attendance. Conclusion: To meet the Special Needs Education, strengthening existing measures to make a conducive physical environment would enhance school attendance among children with disabilities and subsequently the overall inclusive education.Key words: Parents/caregivers, children with disabilities, barrier

From building blocks to programming: Investigating how best to integrate computational thinking into early years settings

This study aims to examine the different ways in which early years teachers lay solid foundations for computational thinking in the early years. Moreover, it aims to uncover the materials and activities that tend to run in the classroom background to promote computational thinking skills of children without being noticed as part of a daily routine. Therefore, it is designed to understand more about the attitudes of early childhood teachers towards computational thinking, the linkage between their attitudes and teaching practices, and the potential computational thinking benefits of children reaped from classroom games and activities

Pretreatment with beta-blockers and the frequency of hypokalemia in patients with acute chest pain

Plasma potassium concentration was measured at admission in 1234 patients who presented with acute chest pain. One hundred and ninety five patients were on P blockers before admission. The potassium concentrations of patients admitted early (within four hours of onsetof symptoms) were compared with those admitted later (4-18 hours after onset of symptoms). There was a transient fall in plasma potassium concentrations in patients not pre-treated with , B blockers. This was not seen in patients who had been on P blockers before admission. Nonselective, B blockers were more effective than cardioselective agents in maintaining concentrationsof plasma potassium. These findings suggest a mechanism for the beneficial effects of ,B blockers on morbidity and mortality in acute myocardial infarction

Research productivity of academics in a physiotherapy department: a case study

Objective: Research productivity is an important activity among academics. This study was done to document the research productivity of the academics of a physiotherapy department in South Africa. Method: An archival research design was used to document the research productivity for the physiotherapy department between 2002 and 2009. Data were analysed by two independent reviewers and consensus was reached on the information to be included in the study. Results: Among the nine academics there were 67 publications, 20 articles in progress, 7 under review and 63 conferences attended. While the overall research productivity of the department seems to be good, the bulk of the productivity rests in the hands of the senior academics. Conclusion: There is a need to facilitate the acquisition of research skills in academic staff, particularly in upgrading staff to PhD level and improving publication output

Gastrinoma and Zollinger-Ellison Syndrome in Canids: A Literature Review and a Case in a Mexican Gray Wolf

Gastrinoma, an infrequent diagnosis in middle-aged dogs, occurs with nonspecific gastrointestinal morbidity. Laboratory tests can yield a presumptive diagnosis, but definitive diagnosis depends on histopathology and immunohistochemistry. We describe a malignant pancreatic gastrinoma with lymph node metastases and corresponding Zollinger–Ellison syndrome in a Mexican gray wolf (Canis lupus baileyi) and review this endocrine neoplasm in domestic dogs. A 12-y-old, captive, male Mexican gray wolf developed inappetence and weight loss. Abdominal ultrasonography revealed a thickened duodenum and peritoneal effusion. Two duodenal perforations were noted on exploratory celiotomy and were repaired. Persisting clinical signs led to a second celiotomy that revealed a mesenteric mass, which was diagnosed histologically as a neuroendocrine carcinoma. During the following 16 mo, the wolf received a combination of H2-receptor antagonists, proton-pump inhibitors, gastroprotectants, and anti-emetics, but had recurrent episodes of anorexia, nausea, acid reflux, and remained underweight. Worsening clinical signs and weakness prompted euthanasia. The antemortem serum gastrin concentration of 414 ng/L (reference interval: 10–40 ng/L) corroborated hypergastrinemia. Autopsy revealed a mass expanding the right pancreatic limb; 3 parapancreatic mesenteric masses; duodenal ulcers; focal duodenal perforation with septic fibrinosuppurative peritonitis; chronic-active ulcerative esophagitis; and poor body condition. The pancreatic mass was diagnosed histologically as a neuroendocrine carcinoma and the parapancreatic masses as lymph node metastases. Immunohistochemistry of the pancreatic mass was positive for gastrin and negative for glucagon, insulin, pancreatic polypeptide, serotonin, somatostatin, and vasoactive intestinal peptide

Attitudes of physiotherapists in Botswana to treating people living with HIV/AIDS

Physiotherapists are increasingly treating people living with HIV /AIDS.However, there is little information reported on either their attitudes when providingtreatment to people with HIV /AIDS, or what facilitates positive attitudes. This studyaimed to determine the attitudes of physiotherapists in Botswana towards treating people living with HIV /AIDS. A  qualitative approach was used with a purposive sample of 10 physiotherapists working in hospitals and private clinics in Gaborone and Ramotswa. In-depth interviews were conducted with individual physiotherapists, utilising an interview guide in. The results indicated that most physiotherapists had a positive attitude towards treating people living with HIV /AIDS. The positive attitude was associated with interrelated factors including their experiencewith people living with HIV /A IDS (PLW HA ); knowledge of HIV /AIDS; job satisfaction; and a belief in a duty to treatall. A  few physiotherapists had a negative attitude which was related to being judgmental and to a fear of acquiring HIVthrough occupational infection

Additive Intensity Regression Models in Corporate Default Analysis

We consider additive intensity (Aalen) models as an alternative to the multiplicative intensity (Cox) models for analyzing the default risk of a sample of rated, nonfinancial U.S. firms. The setting allows for estimating and testing the significance of time-varying effects. We use a variety of model checking techniques to identify misspecifications. In our final model, we find evidence of time-variation in the effects of distance-to-default and short-to-long term debt. Also we identify interactions between distance-to-default and other covariates, and the quick ratio covariate is significant. None of our macroeconomic covariates are significant