Employment Practices and Trends and the Deaf Client: A Response

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Kinetics of metabolism in the perfused heart

The kinetics of the permeation of cardiac muscle cells by glucose and the effect of insulin on this process were examined in the isolated perfused rat heart. Previous attempts to determine the parameters of permeation by glucose are considered to be imprecise because endogenous insulin influenced experi¬ mental results, intracellular glucose was inaccurately measured and estimates of glucose utilisation were not associated with defined concentrations of extracellular or intracellular glucose. In principle the parameters of permeation can be deter¬ mined from a steady state relationship between glucose uptake and the intracellular and extracellular concentration of glucose. Alternatively they can be determined from the relationship between the uptake and the extracellular concentration of glucose. if the kinetics of glucose metabolism are taken into account. A novel apparatus for cardiac perfusion was therefore developed in which hearts were brought to a steady state of glucose permeation and utilisation. In the apparatus hearts were perfused with a small volume of perfusate under well controlled conditions. Glucose concentration in perfusates was estimated by rapid and accurate automated methods which met the requirements of the procedure. The utilisation of glucose was determined not only in the steady state but also throughout the approach to that state. The first method for the determination of the parameters of permeation was impracticable because accurate estimates of intracellular glucose could not be made with methods currentlyavailable. Consequently the kinetics of glucose utilisation were compared with the predictions of a mathematical model in which permeation was assumed to be a simple carrier mechanism and the phosphorylation of glucose to be an irreversible enzymecatalysed reaction. Agreement was found. Estimates made of the parameters of permeation in the presence and absence of insulin were in qualitative accord with previous work. The hormone increased the half saturation constant at least 3-fold and the maximum rate of permeation 5-fold. The estimates of the parameters of permeation in the presence of insulin may be inaccurate because in their determination the possibility of a concentration gradient in the extracellular glucose was ignored. However, the estimates provide a reason¬ able explanation of a phenomenon which was observed when the time-course of glucose utilisation was studied in the absence of exogenous insulin. A stimulation of utilisation, presumably by endogenous insulin, occurred consistently only at concentra¬ tions of glucose greater than ImM. It was concluded that the estimates are an improvement on previous values and that the apparatus is a useful addition to the methods available for the study of the metabolism of isolated hearts

A Systematic Review and Aggregated Analysis on the Impact of Amyloid PET Brain Imaging on the Diagnosis, Diagnostic Confidence, and Management of Patients being Evaluated for Alzheimer's Disease.

BACKGROUND: Amyloid PET (aPET) imaging could improve patient outcomes in clinical practice, but the extent of impact needs quantification. OBJECTIVE: To provide an aggregated quantitative analysis of the value added by aPET in cognitively impaired subjects. METHODS: Systematic literature searches were performed in Embase and Medline until January 2017. 1,531 cases over 12 studies were included (1,142 cases over seven studies in the primary analysis where aPET was the key biomarker; the remaining cases included as defined groups in the secondary analysis). Data was abstracted by consensus among two observers and assessed for bias. Clinical utility was measured by diagnostic change, diagnostic confidence, and patient management before and after aPET. Three groups were further analyzed: control patients for whom feedback of aPET scan results was delayed; aPET Appropriate Use Criteria (AUC+) cases; and patients undergoing additional FDG/CSF testing. RESULTS: For 1,142 cases with only aPET, 31.3% of diagnoses were revised, whereas 3.2% of diagnoses changed in the delayed aPET control group (p < 0.0001). Increased diagnostic confidence following aPET was found for 62.1% of 870 patients. Management changes with aPET were found in 72.2% of 740 cases and in 55.5% of 299 cases in the control group (p < 0.0001). The diagnostic value of aPET in AUC+ patients or when FDG/CSF were additionally available did not substantially differ from the value of aPET alone in the wider population. CONCLUSIONS: Amyloid PET contributed to diagnostic revision in almost a third of cases and demonstrated value in increasing diagnostic confidence and refining management plans

Laparoscopic versus open liver resection: a meta‐analysis of long‐term outcome

AbstractBackgroundLaparoscopic liver resection is growing in popularity, but the long‐term outcome of patients undergoing laparoscopic liver resection for malignancy has not been established. This paper is a meta‐analysis and compares the long‐term survival of patients undergoing laparoscopic (LHep) versus open (OHep) liver resection for the treatment of malignant liver tumours.MethodsA PubMed database search identified comparative human studies analysing LHep versus OHep for malignant tumours. Clinical and survival parameters were extracted. The search was last conducted on 18 March 2012.ResultsIn total, 1002 patients in 15 studies were included (446 LHep and 556 OHep). A meta‐analysis of overall survival showed no difference [1‐year: odds ratio (OR) 0.71, 95% confidence interval (CI) 0.42 to 1.20, P = 0.202; 3‐years: OR 0.76, 95% CI 0.56 to 1.03, P = 0.076; 5‐years: OR 0.8, 95% CI 0.59 to 1.10, P = 0.173]. Subset analyses of hepatocellular carcinoma (HCC) and colorectal metastases (CRM) were performed. There was no difference in the 1‐, 3‐, and 5‐year survival for HCC or in the 1‐year survival for CRM, however, a survival advantage was found for CRM at 3 years (LHep 80% versus OHep 67.4%, P = 0.036).ConclusionsLaparoscopic surgery should be considered an acceptable alternative for the treatment of malignant liver tumours

Electrical performance and reliability characterization of a SiC MOSFET power module with embedded decoupling capacitors

Integration of decoupling capacitors in SiC MOSFET modules is an advanced solution to mitigate the effect of parasitic inductance induced by module assembly interconnects. In this paper, the switching transient behavior is reported for a 1.2kV SiC MOSFET module with embedded DC-link capacitors. It shows faster switching transition and less overshoot voltage compared to a module using an identical package but without capacitors. Active power cycling and passive temperature cycling are carried out for package reliability characterization and comparisons are made with commercial Si and SiC power modules. Scanning acoustic microscopy images and thermal structure functions are presented to quantify the effects of package degradation. The results demonstrate that the SiC modules with embedded capacitors have similar reliability performance to commercial modules and that the reliability is not adversely affected by the presence of the decoupling capacitors

On Becoming a DNP user: Some Reflections on the Developing Use of a Computer

This paper considers the development of a tool to support the presentation of the material forming an ethnographic report. The paper focuses on the way in which use of the system has evolved to offer appropriate facilities. The use of viewpoints to present material from a number of studies is described. The paper concludes by reflecting on the need to consider the way in ethnographers have become users of the tool

Does reading a book in bed make a difference to sleep in comparison to not reading a book in bed? : The People's Trial- an online, pragmatic, randomised trial

Acknowledgements The People’s Trial team members acknowledge with gratitude the study participants. We would also like to acknowledge and thank Claire O’Connell, Simone Lepage, Aoife O’Shaughnessy and Louise Foley for their support with the research project. Trial funder This research was funded by the Health Research Board in Ireland, through the Health Research Board – Trials Methodology Research Network as part of a Knowledge Exchange and Dissemination Scheme Award 2018 (grant reference KEDS-2018-012). The funder of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit.Peer reviewedPublisher PD