Service-Learning and Community Service in K-12 Public Schools

The National Center for Education Statistics (NCES) of the U.S. Department of Education used the Fast Response Survey System (FRSS) to conduct the National Student Service-Learning and Community Service Survey in spring 1999. This is the first survey to provide reliable national estimates of the percentage of public elementary, middle, and high1 schools incorporating service-learning into their course curriculum, as well as providing the most recent data on school engagement in community service

Case report: Low dose dexmedetomidine infusion for the management of hypoglycemia in a dog with an insulinoma

ObjectiveTo describe the use of a low dose dexmedetomidine infusion as preoperative treatment for hypoglycemia secondary to a functional pancreatic tumor in a dog.Case summaryAn 8.7-year-old castrated male Hungarian Vizsla presented for further evaluation of persistent hypoglycemia after the referring veterinarian established a tentative diagnosis of insulinoma based on paired insulin and glucose measurements. Abdominal ultrasound and computed tomography demonstrated evidence of a pancreatic mass with possible hepatic metastases. Attempts to aspirate the lesions under ultrasound guidance were unsuccessful, and the dog was hospitalized overnight for planned surgical resection of the presumed pancreatic tumor and biopsy of the hepatic lesions the following day. In response to a progressive increase in patient anxiety and agitation trazodone was prescribed ~5 mg/kg orally every 8 h and gabapentin at ~7 mg/kg every 8 h. As the dog continued to remain anxious dexmedetomidine at a dose of 1 mcg/kg was administered intravenously immediately followed with an infusion of dexmedetomidine at 1 mcg/kg/h. The anxious behaviors were successfully controlled with minimal cardiovascular side effects. Serial blood glucose measurements obtained during this time demonstrated euglycemia. The dog remained euglycemic while receiving dexmedetomidine for the remainder of the pre-operative period and for duration of hospitalization following surgical resection and biopsy.New or unique information providedThis case report demonstrates a possible role for dexmedetomidine to counteract hypoglycemia in dogs with insulinomas

Ising-Model Critical Indices in Three Dimensions from the Callan-Symanzik Equation

The coefficients in the Callan-Symanzik equations for a three-dimensional, continuous spin Ising model with an exp(-As^4+Bs^2) spin-weight factor are expanded in the dimensionless, renormalized coupling constant. These series are summed by the Padé-Borel method to yield the critical indices γ=1.241±0.002, η=0.02±0.02, ν=0.63±0.01, and Δ1=0.49±0.01

Inspiratory muscle training for intensive care patients: A multidisciplinary practical guide for clinicians

Objectives To describe a multidisciplinary approach to inspiratory muscle training (IMT) for patients in the intensive care unit (ICU). Background Inspiratory muscle weakness is a known consequence of prolonged mechanical ventilation, and there is emerging evidence that specific IMT can ameliorate this weakness. However, IMT is not yet standard practice in many ICUs, possibly because of the wide variety of methods reported and a lack of published practical guidelines. While the optimal parameters for IMT are yet to be established, we share our detailed methodology which has been shown to be safe in selected ventilator-dependent patients and is the only approach which has been shown to increase quality of life in ICU patients. Methods Patients who have experienced invasive mechanical ventilation for at least 7 days can commence IMT in either the ventilator-dependent phase or when weaned from mechanical ventilation. Intensity should be prescribed based on maximum inspiratory pressure, which is measurable through the tracheostomy or endotracheal tube via the ventilator or a respiratory pressure meter. Using a removable threshold device, we recommend high-intensity training (5 sets of 6 breaths at a minimum of 50% of maximum inspiratory pressure) performed once per day, supervised by the physiotherapist, with intensity increased daily such that patients can only just complete the 6th breath in each set. Results Using this high-intensity approach, IMT is likely to improve not only inspiratory muscle strength but also quality of life in patients recently weaned from mechanical ventilation of 7 days' duration or longer. Effective IMT requires a multidisciplinary approach to maximise feasibility, with doctors, nurses, and therapists working closely to optimise conditions for successful IMT. Conclusions This multidisciplinary approach to implement IMT in ICU patients should assist clinicians in translating best-available evidence into practice, with the potential to enhance patient recovery.acknowledge the financial support of the Australian Capital Territory Chief Allied Health Office in the publication of this articl

The impact of the metabotropic glutamate receptor and other gene family interaction networks on autism.

International audienceAlthough multiple reports show that defective genetic networks underlie the aetiology of autism, few have translated into pharmacotherapeutic opportunities. Since drugs compete with endogenous small molecules for protein binding, many successful drugs target large gene families with multiple drug binding sites. Here we search for defective gene family interaction networks (GFINs) in 6,742 patients with the ASDs relative to 12,544 neurologically normal controls, to find potentially druggable genetic targets. We find significant enrichment of structural defects (P≤2.40E-09, 1.8-fold enrichment) in the metabotropic glutamate receptor (GRM) GFIN, previously observed to impact attention deficit hyperactivity disorder (ADHD) and schizophrenia. Also, the MXD-MYC-MAX network of genes, previously implicated in cancer, is significantly enriched (P≤3.83E-23, 2.5-fold enrichment), as is the calmodulin 1 (CALM1) gene interaction network (P≤4.16E-04, 14.4-fold enrichment), which regulates voltage-independent calcium-activated action potentials at the neuronal synapse. We find that multiple defective gene family interactions underlie autism, presenting new translational opportunities to explore for therapeutic interventions

Convergence of Genes and Cellular Pathways Dysregulated in Autism Spectrum Disorders.

International audienceRare copy-number variation (CNV) is an important source of risk for autism spectrum disorders (ASDs). We analyzed 2,446 ASD-affected families and confirmed an excess of genic deletions and duplications in affected versus control groups (1.41-fold, p = 1.0 × 10(-5)) and an increase in affected subjects carrying exonic pathogenic CNVs overlapping known loci associated with dominant or X-linked ASD and intellectual disability (odds ratio = 12.62, p = 2.7 × 10(-15), ∼3% of ASD subjects). Pathogenic CNVs, often showing variable expressivity, included rare de novo and inherited events at 36 loci, implicating ASD-associated genes (CHD2, HDAC4, and GDI1) previously linked to other neurodevelopmental disorders, as well as other genes such as SETD5, MIR137, and HDAC9. Consistent with hypothesized gender-specific modulators, females with ASD were more likely to have highly penetrant CNVs (p = 0.017) and were also overrepresented among subjects with fragile X syndrome protein targets (p = 0.02). Genes affected by de novo CNVs and/or loss-of-function single-nucleotide variants converged on networks related to neuronal signaling and development, synapse function, and chromatin regulation

Common genetic variants in the CLDN2 and PRSS1-PRSS2 loci alter risk for alcohol-related and sporadic pancreatitis

Pancreatitis is a complex, progressively destructive inflammatory disorder. Alcohol was long thought to be the primary causative agent, but genetic contributions have been of interest since the discovery that rare PRSS1, CFTR, and SPINK1 variants were associated with pancreatitis risk. We now report two significant genome-wide associations identified and replicated at PRSS1-PRSS2 (1×10-12) and x-linked CLDN2 (p < 1×10-21) through a two-stage genome-wide study (Stage 1, 676 cases and 4507 controls; Stage 2, 910 cases and 4170 controls). The PRSS1 variant affects susceptibility by altering expression of the primary trypsinogen gene. The CLDN2 risk allele is associated with atypical localization of claudin-2 in pancreatic acinar cells. The homozygous (or hemizygous male) CLDN2 genotype confers the greatest risk, and its alleles interact with alcohol consumption to amplify risk. These results could partially explain the high frequency of alcohol-related pancreatitis in men – male hemizygous frequency is 0.26, female homozygote is 0.07

Specific inspiratory muscle training is safe in selected patients who are ventilator-dependent: a case series

Background: Mechanical ventilation of intensive care patients results in inspiratory muscle weakness. Inspiratory muscle training may be useful, but no studies have specifically described the physiological response to training. Research questions: Is inspiratory muscle training with a threshold device safe in selected ventilator-dependent patients? Does inspiratory muscle strength increase with high-intensity inspiratory muscle training in ventilator-dependent patients? Design: Prospective cohort study of 10 medically stable ventilator-dependent adult patients. Setting: Tertiary adult intensive care unit. Methods: Inspiratory muscle training 5-6 days per week with a threshold device attached to the tracheostomy without supplemental oxygen. Outcome measures: Physiological response to training (heart rate, mean arterial pressure, oxygen saturation and respiratory rate), adverse events, training pressures. Results: No adverse events were recorded in 195 sessions studied. For each patient's second training session, no significant changes in heart rate (Mean Difference 1.3bpm, 95% CI -2.7 to 5.3), mean arterial pressure (Mean Difference -0.9mmHg, 95% CI -6.4 to 4.6), respiratory rate (Mean Difference 1.2bpm, 95% CI -1.1 to 3.5bpm) or oxygen saturation (Mean Difference 1.2%, 95% CI -0.6 to 3.0) were detected Training pressures increased significantly (Mean Difference 18.6cmH O, 95% CI 11.8-25.3). Conclusion: Threshold-based inspiratory muscle training can be delivered safely in selected ventilator-dependent patients without supplemental oxygen. Inspiratory muscle training is associated with increased muscle strength, which may assist ventilatory weaning