Missed Treatments of Hemodialysis Patients after Hurricane Maria in Puerto Rico

The consequences of a natural event such as a hurricane can especially have a negative impact on vulnerable patients such as hemodialysis patients. In former incidences such as Hurricane Katrina, factors such as living relocations disrupted hemodialysis patients’ ability to adhere to their thrice-weekly treatments (Anderson et al, 2009). In this study, 44% of the 386 hemodialysis patients who experienced Hurricane Katrina reported missing one or more dialysis sessions. Thus, the hurricane had significant negative influence on patients’ attendance at the dialysis clinic. In the aftermath of Hurricane Maria, Puerto Rico suffered extensive road blockages, electricity shortages, and lacking natural resources. Recovery procedures such as clearing of roads were not completed until several months afterward. By October, there was still a significant portion of people without sufficient resources. The primary objectives of this study are to assess the percentage of hemodialysis patients who missed dialysis sessions in the aftermath of Hurricane Maria and the social factors influencing their missed sessions. From a total of 16 facilities, three dialysis clinics in cities most highly impacted by the hurricane will be selected to participate. Data will be collected through patient interviews, surveys, and charts, to examine potential demographic characteristics and social factors that may have affected the patients’ attendance to these dialysis facilities. If there is a significant correlation between the social factors and missed treatments, then management strategies can be suggested to help hemodialysis patients adjust to post-disaster conditions and help develop planning strategies in case of future natural disasters

Quantification of optical pulsed-plane-wave-shaping by chiral sculptured thin films

The durations and average speeds of ultrashort optical pulses transmitted through chiral sculptured thin films (STFs) were calculated using a finite-difference time-domain algorithm. Chiral STFs are a class of nanoengineered materials whose microstructure comprises parallel helicoidal nanowires grown normal to a substrate. The nanowires are $\sim$10-300 nm in diameter and $\sim1-10 \mu$m in length. Durations of transmitted pulses tend to increase with decreasing (free-space) wavelength of the carrier plane wave, while average speeds tend to increase with increasing wavelength. An increase in nonlinearity, as manifested by an intensity-dependent refractive index in the frequency domain, tends to increase durations of transmitted pulses and decrease average speeds. The circular Bragg phenomenon exhibited by a chiral STFs manifests itself in the frequency domain as high reflectivity for normally incident carrier plane waves whose circular polarization state is matched to the structural handedness of the film and whose wavelength falls in a range known as the Bragg regime; films of the opposite structural handedness reflect such plane waves little. This effect tends to distort the shapes of transmitted pulses with respect to the incident pulses, and such shaping can cause sharp changes in some measures of average speed with respect to carrier wavelength. A local maximum in the variation of one measure of the pulse duration with respect to wavelength is noted and attributed to the circular Bragg phenomenon. Several of these effects are explained via frequency-domain arguments. The presented results serve as a foundation for future theoretical and experimental studies of optical pulse propagation through causal, nonlinear, nonhomogeneous, and anisotropic materials.Comment: To appear in Journal of Modern Optic

Attributed Meanings and Strategies to Prevent Challenging Behaviors of Hospitalized Children with Autism: Two Perspectives

Introduction Understanding is limited of the meaning attributed to behaviors of children with autism spectrum disorder and strategies used to prevent challenging behaviors in the context of hospitalization. Methods This qualitative study consisted of two focus groups (n = 10; five mothers and five health care providers [HCPs]). Transcripts were analyzed using the qualitative method of narrative inquiry. Results The meaning attributed to behaviors by the mothers and the HCPs differed. The mothers attributed behaviors to the child\u27s communication of frustration, hyperactivity, and self-calming. The HCPs attributed challenging behaviors to self-stimulation and child aggression. Strategies to prevent behaviors also differed. Mothers focused on preparation prior to hospitalization and attempts to partner with HCPs. HCPs identified fewer strategies and consulted mothers for strategies to manage challenging behaviors. Discussion HCP and parent collaboration could lead to strategies to increase supports for children with autism spectrum disorder in the hospital to decrease their frustration and challenging behaviors

Lavender Aromatherapy Compared to Midazolam For Quality Improvement Of Preoperative Anxiety In Elderly Surgical Patients: An Educational Module

Impact: Investigation into the anxiolytic effects of lavender aromatherapy across several patient populations, application types, and outcome measures establish that lavender oil relieves anxiety, reduces mental stress, provides sedation, and promotes good sleep. Background: Studies have investigated the link between age and the occurrence of undesired responses to premedication with agents of the benzodiazepine drug class. This link is explained by age-related pathophysiologic changes that occur as a function of aging. Despite numerous knowledge-based concerns, benzodiazepines prevail among the top psychotropic medications prescribed in elderly patients aged between 65 and 80 years. Objective: This quality improvement project aims to enhance anesthesia providers\u27 knowledge, beliefs, and attitude regarding the value of aromatherapy with lavender oil as an affordable, safe, and effective alternative to midazolam administration for preoperative anxiolysis in elderly surgical patients. Methods: An extensive literature search was conducted to synthesize studies relevant to the PICO question and create an evidence-based educational module for virtual presentation. An anonymous online platform was used to distribute the project’s intervention and survey components to a sample of anesthesia providers working at a South Florida level-1 trauma center and to record and statistically analyze data. Results: Collectively, the evidence-based literature presented by this project positively impacts the perioperative care of older adults, as it demonstrates lavender aromatherapy as a beneficial alternative to midazolam administration for improved management of preoperative anxiety in elderly surgical patients. Discussion: Analysis of the pre-and post-survey results reveals that this quality improvement project met the objective of expanding anesthesia providers’ knowledge and understanding of the use of lavender oil aromatherapy to optimize preoperative anxiety and care outcomes in elderly surgical patients. As a result, they will be more competent and effective in helping elderly patient populations achieve relief from anxiety before surgery and improved perioperative care outcomes. The small sample size, short project duration, and online delivery platform were limitations of this project

Characteristics of Ramachandran maps of L-alanine diamides as computed by various molecular mechanics, semiempirical and ab initio MO methods. A search for primary standard of peptide conformational stability

The optimized geometries and relative energies obtained by four force field and two semi-empirical methods were compared with ab initio results computed for formyl-L-alaninamide. Not all methods yielded the same number of minimum energy conformers. Furthermore, while the optimized geometries of the conformers found were comparable, the computed relative energies varied substantially. Also, the force field calculations produced Ramachandran maps that did not even have the appearance of the ab initio Ramachandran map. Correlating the ab initio relative energies (Delta E) or free energy (Delta G) with the log of relative populations, In(p(x)/p(gamma L)), led to linear relationships from which four conformers deviated; two of them (alpha(L) and epsilon(L)) were overly destabilized and two of them (gamma(L) and gamma(D)) were over-stabilized. It is suggested that, after such deviations are corrected, a primary standard may be obtained that might be useful in further investigations related to force-field parametrization as well as protein folding. (C) 1998 Elsevier Science B.V. All rights reserved

Biological and technical variables affecting immunoassay recovery of cytokines from human serum and simulated vaginal fluid: A multicenter study

The increase of proinflammatory cytokines in vaginal secretions may serve as a surrogate marker of unwanted inflammatory reaction to microbicide products topically applied for the prevention of sexually transmitted diseases, including HIV-1. Interleukin (IL)-1β and IL-6 have been proposed as indicators of inflammation and increased risk of HIV-1 transmission; however, the lack of information regarding detection platforms optimal for vaginal fluids and interlaboratory variation limit their use for microbicide evaluation and other clinical applications. This study examines fluid matrix variants relevant to vaginal sampling techniques and proposes a model for interlaboratory comparisons across current cytokine detection technologies. IL-1β and IL-6 standards were measured by 12 laboratories in four countries, using 14 immunoassays and four detection platforms based on absorbance, chemiluminescence, electrochemiluminescence, and fluorescence. International reference preparations of cytokines with defined biological activity were spiked into (1) a defined medium simulating the composition of human vaginal fluid at pH 4.5 and 7.2, (2) physiologic salt solutions (phosphate-buffered saline and saline) commonly used for vaginal lavage sampling in clinical studies of cytokines, and (3) human blood serum. Assays were assessed for reproducibility, linearity, accuracy, and significantly detectable fold difference in cytokine level. Factors with significant impact on cytokine recovery were determined by Kruskal−Wallis analysis of variance with Dunn’s multiple comparison test and multiple regression models. All assays showed acceptable intra-assay reproducibility; however, most were associated with significant interlaboratory variation. The smallest reliably detectable cytokine differences (P < 0.05) derived from pooled interlaboratory data varied from 1.5- to 26-fold depending on assay, cytokine, and matrix type. IL-6 but not IL-1β determinations were lower in both saline and phosphate-buffered saline as compared to vaginal fluid matrix, with no significant effect of pH. The (electro)chemiluminescence-based assays were most discriminative and consistently detected <2-fold differences within each matrix type. The Luminex-based assays were less discriminative with lower reproducibility between laboratories. These results suggest the need for uniform vaginal sampling techniques and a better understanding of immunoassay platform differences and cross-validation before the biological significance of cytokine variations can be validated in clinical trials. This investigation provides the first standardized analytic approach for assessing differences in mucosal cytokine levels and may improve strategies for monitoring immune responses at the vaginal mucosal interface

Study protocol of cost-effectiveness and cost-utility of a biopsychosocial multidisciplinary intervention in the evolution of non-specific sub-acute low back pain in the working population: cluster randomised trial.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Low back pain (LBP), with high incidence and prevalence rate, is one of the most common reasons to consult the health system and is responsible for a significant amount of sick leave, leading to high health and social costs. The objective of the study is to assess the cost-effectiveness and cost-utility analysis of a multidisciplinary biopsychosocial educational group intervention (MBEGI) of non-specific sub-acute LBP in comparison with the usual care in the working population recruited in primary healthcare centres. Methods/design: The study design is a cost-effectiveness and cost-utility analysis of a MBEGI in comparison with the usual care of non-specific sub-acute LBP.Measures on effectiveness and costs of both interventions will be obtained from a cluster randomised controlled clinical trial carried out in 38 Catalan primary health care centres, enrolling 932 patients between 18 and 65 years old with a diagnosis of non-specific sub-acute LBP. Effectiveness measures are: pharmaceutical treatments, work sick leave (% and duration in days), Roland Morris disability, McGill pain intensity, Fear Avoidance Beliefs (FAB) and Golberg Questionnaires. Utility measures will be calculated from the SF-12. The analysis will be performed from a social perspective. The temporal horizon is at 3 months (change to chronic LBP) and 12 months (evaluate the outcomes at long term. Assessment of outcomes will be blinded and will follow the intention-to-treat principle. Discussion: We hope to demonstrate the cost-effectiveness and cost-utility of MBEGI, see an improvement in the patients' quality of life, achieve a reduction in the duration of episodes and the chronicity of non-specific low back pain, and be able to report a decrease in the social costs. If the intervention is cost-effectiveness and cost-utility, it could be applied to Primary Health Care Centres. Trial registration: ISRCTN: ISRCTN5871969

Congenital heart diseases: post-operative appearance on multi-detector CT—a pictorial essay

Echocardiography is considered as an initial imaging modality of choice in patients with congenital heart disease (CHD), and magnetic resonance (MR) imaging is preferred for detailed functional information. Multi-detector computed tomography (CT) plays an important role in clinical practice in assessing post-operative morphological and functional information of patients with complex CHD when echocardiography and MR imaging are not contributory. Radiologists should understand and become familiar with the complex morphology and physiology of CHD, as well as with various palliative and corrective surgical procedures performed in these patients, to obtain CT angiograms with diagnostic quality and promptly recognise imaging features of normal post-operative anatomy and complications of these complex surgeries

Detection of Intra-Tumor Self Antigen Recognition during Melanoma Tumor Progression in Mice Using Advanced Multimode Confocal/Two Photon Microscope

Determining how tumor immunity is regulated requires understanding the extent to which the anti-tumor immune response “functions” in vivo without therapeutic intervention. To better understand this question, we developed advanced multimodal reflectance confocal/two photon fluorescence intra-vital imaging techniques to use in combination with traditional ex vivo analysis of tumor specific T cells. By transferring small numbers of melanoma-specific CD8+ T cells (Pmel-1), in an attempt to mimic physiologic conditions, we found that B16 tumor growth alone was sufficient to induce naive Pmel-1 T cell proliferation and acquisition of effector phenotype. Tumor -primed Pmel-1 T cells, are capable of killing target cells in the periphery and secrete IFNγ, but are unable to mediate tumor regression. Within the tumor, Pmel-1 T cells have highly confined mobility, displaying long term interactions with tumor cells. In contrast, adoptively transferred non tumor-specific OT-I T cells show neither confined mobility, nor long term interaction with B16 tumor cells, suggesting that intra-tumor recognition of cognate self antigen by Pmel-1 T cells occurs during tumor growth. Together, these data indicate that lack of anti-tumor efficacy is not solely due to ignorance of self antigen in the tumor microenvironment but rather to active immunosuppressive influences preventing a protective immune response