802 research outputs found

    Myelomeningocele And Hydrocephalus In Uganda: The Intersection Of Culture, Supportive Care, And Long-Term Survival

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    The treatment of neurosurgical disease in the developing world presents challenges on numerous levels, not the least of which are the litany of logistical and infrastructural barriers which stand in the way of delivering care. The scarcity of neurosurgeons combined with limited mobility in developing countries requires a reconsideration of approaches to treatment; this is particularly true of ventriculoperitoneal (VP) shunt insertion for the treatment of hydrocephalus. While VP shunt implantation is the mainstay of treatment in the United States, it is prone to failure requiring rapid access to neurosurgical care making shunt dependency a dangerous proposition in this setting. Endoscopic third ventriculostomy (ETV) offers an alternative to VP shunt dependency and has been shown to be effective in treating hydrocephalus at intervals of up to 14 months. The purpose of this study is to compare the five-year survival for children treated with endoscopic third ventriculostomy (ETV) to those treated with ventriculoperitoneal (VP) shunt implantation for myelomeningocele-associated hydrocephalus. Because of the well known dangers of shunt dependency, it is hypothesized that patients treated with ETV will have a survival advantage when compared with patients treated with VPS at a follow-up interval of five years. In order to address this hypothesis, a retrospective observational study of children treated with ETV or VP shunt implantation for myelomeningocele-related hydrocephalus at the CURE Children\u27s Hospital of Uganda was carried out, including a control group consisting of myelomeningocele patients who had not developed hydrocephalus. Survival status was determined for 128 of 131 study participants (98%). 47/128 (37%) of patients had expired at five years post-treatment, and 55/128 (42%) patients had expired at a mean follow-up interval of 84.4 months. Only two cases of death were attributable to the development of hydrocephalus, none as a result of treatment failure. Kaplan-Meier survival analysis found no statistically significant relationship between survival and method of treatment for hydrocephalus (p=0.45), sex of patient (p=0.53), HIV status (p=0.69), age at repair ( p=0.34), or myelomeningocele level (p=0.12). Survival analysis performed for districts with community based rehabilitation (CBR) programs and districts without CBR programs revealed a significant interaction (p=0.001). The uniformly high mortality across all groups suggests that the chief causes of long-term mortality are both powerful and independent of hydrocephalus. The only correlation with survival identified in this study, the presence of a CBR program providing in-home rehabilitation, fulfills both of these criteria: myelomeningocele patients require long-term rehabilitation regardless of the development of hydrocephalus and these programs exert a powerful influence on survival. This substantial difference in long-term survival highlights the fact that children in communities without CBR programs are not receiving life-saving supportive care, in part due to a lack of parental understanding of the need for longitudinal care. Established cultural beliefs about myelomeningocele, hydrocephalus, and disability in general also hampered efforts to improve survival. Understanding the practical barriers to the delivery of care in a developing country as well as the cultural mores through which diseases are understood are critical to effectively treating disease across cultures and continents

    G. Ernest Wright Papers, 1957-1972

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    This collection primarily contains correspondence from Wright’s years as president of ASOR. Material dates as far back as 1957, and proceed into the early 1970’s. Some of Wright’s more notable correspondents include William F. Albright, A. Henry Detweiler, Paul W. Lapp, William Reed, and Dean Seiler. Subject-specific correspondence includes records of expenditures, budget planning, corporate memberships, and the Jerusalem School

    G. Ernest Wright Papers, 1957-1972

    Full text link
    This collection primarily contains correspondence from Wright’s years as president of ASOR. Material dates as far back as 1957, and proceed into the early 1970’s. Some of Wright’s more notable correspondents include William F. Albright, A. Henry Detweiler, Paul W. Lapp, William Reed, and Dean Seiler. Subject-specific correspondence includes records of expenditures, budget planning, corporate memberships, and the Jerusalem School

    Brief Study of Working Conditions of Colored Citizens in New Orleans Louisiana

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    The following report is the result of a study of the Colored worker during the present cataclysm in political and industrial affairs. The present panic has helped the laborer from many angles. It has given him a realization of the value of money and the necessity of sane action in the distribution of it

    Thermal (Silicon Diode) Data Acquisition Systems

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    Marshall Space Flight Center s X-ray Cryogenic Facility (XRCF) has been performing cryogenic testing to 20 Kelvin since 1999. Two configurations for acquiring data from silicon diode temperature sensors have been implemented at the facility. The facility's environment is recorded via a data acquisition system capable of reading up to 60 silicon diodes. Test article temperature is recorded by a second data acquisition system capable of reading 150+ silicon diodes. The specifications and architecture of both systems will be presented

    Active site voltage clamp fluorometry of the sodium glucose cotransporter hSGLT1.

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    In the human sodium glucose cotransporter (hSGLT1) cycle, the protein undergoes conformational changes where the sugar-binding site alternatively faces the external and internal surfaces. Functional site-directed fluorometry was used to probe the conformational changes at the sugar-binding site. Residues (Y290, T287, H83, and N78) were mutated to cysteines. The mutants were expressed in Xenopus laevis oocytes and tagged with environmentally sensitive fluorescent rhodamines [e.g., tetramethylrhodamine (TMR)-thiols]. The fluorescence intensity was recorded as the mutants were driven into different conformations using voltage jumps. Sugar binding and transport by the fluorophore-tagged mutants were blocked, but Na+ binding and the voltage-dependent conformational transitions were unaffected. Structural models indicated that external Na+ binding opened a large aqueous vestibule (600 Ã…3) leading to the sugar-binding site. The fluorescence of TMR covalently linked to Y290C, T287C, and H83C decreased as the mutant proteins were driven from the inward to the outward open Na+-bound conformation. The time courses of fluorescence changes (milliseconds) were close to the SGLT1 capacitive charge movements. The quench in rhodamine fluorescence indicated that the environment of the chromophores became more polar with opening of the external gates as the protein transitioned from the inward to outward facing state. Structural analyses showed an increase in polar side chains and a decrease in hydrophobic side chains lining the vestibule, and this was reflected in solvation of the chromophore. The results demonstrate the opening and closing of external gates in real time, with the accompanying changes of polarity of the sugar vestibule
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