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Not having enough zinc in your diet can have unpleasant consequences for your skin as well as for your overall health. Wounds may heal more slowly, and you may be more likely to develop skin lesions and acne. Other possible results of zinc deficiency include hair loss, weight loss, lethargy, eye problems and skin rashes [sources: MedlinePlus, Poirot]. If the potential results of zinc deficiency don't persuade you to make sure you're getting enough zinc in your diet, then you might want to consider potential benefits -- faster wound healing as well as alleviation of acne, fungal infections and other skin irritations. The best way to get adequate zinc is to eat a balanced and varied diet. But don't overdo it -- taking too much zinc can lead to unpleasant side effects, including stomachache, vomiting and diarrhea [source: MedlinePlus]. Also, it is important to note that fruits and vegetables are not a good source of zinc because the human body cannot use the zinc found in plant proteins in the same way as zinc found in animal proteins. However, fruits and vegetables supply other valuable nutrients that benefit your skin and general health, so keep them on the menu [source: MedlinePlus]. Overall, zinc constitutes an important nutrient that provides specific value to your body and your skin. Eating a balanced diet that includes zinc-rich foods will help you lead a healthier life -- with radiant, healthy skin. In recent years, zinc remedies have become popular for treating the common cold. However, as of June 2009, the U.S. Food and Drug Administration (FDA) has issued a strong warning against Zicam zinc remedies taken via the nose. Studies have found that these zinc-based nose gels and swabs can lead to a permanent loss of your olfactory sense (your ability to smell). The recall only affects the Zicam zinc products used intranasally; it does not affect lozenges and tablets taken orally [source: U.S. Food and Drug Administration].
Smoking Tied to Higher Risk of Type 2 Diabetes Written by the Healthline Editorial Team — Updated on September 17, 2015 A meta-analysis of nearly 6 million people links smoking with a higher risk for developing type 2 diabetes and also concludes the more you smoke, the higher your risk. A new report confirms that smokers and those exposed to secondhand smoke have an increased risk for developing type 2 diabetes. Researchers from the Harvard T.H. Chan School of Public Health, Huazhong University of Science and Technology in China, and the National University of Singapore published the report in The Lancet Diabetes & Endocrinology. They conducted a meta-analysis of 88 previous studies on the link between smoking and type 2 diabetes risk, examining data from almost 6 million study participants. "It is well established that secondhand smoke is implicated in many tobacco-caused diseases, but the link between exposure to someone else's smoke and increased diabetes risk is new," said Dr. Michael Steinberg, director of the Rutgers Tobacco Dependence Program at Robert Wood Johnson Medical School. The researchers say that 11 percent of type 2 diabetes cases in men and 2.4 percent in women (more than 27 million cases worldwide) may be attributed to active smoking. Compared with people who never lit up, current smoking boosted the risk of type 2 diabetes by 37 percent. In former smokers, it increased the risk by 14 percent. In those exposed to secondhand smoke, it raised the risk for type 2 diabetes by 22 percent. Read More: Half of U.S. Cancer Deaths Linked to Smoking » The More You Smoke, the More You're at Risk The analysis also revealed that the more you smoke, the higher your risk will be. Light smokers had a 21 percent higher risk while moderate smokers had a 34 percent higher risk, and heavy smokers had a 57 percent risk for developing type 2 diabetes. "Despite the global efforts to combat the tobacco epidemic, cigarette use remains the leading cause of mortality and morbidity worldwide," said An Pan, the first author of the study and professor of epidemiology at the School of Public Health at the Tongji Medical College at China's Huazhong University of Science and Technology, in a press release. Pan said it also stresses the need to make public places free from smoke. There is good news for quitters, though. The researchers say the risk for type 2 diabetes went down over time after smokers kicked the habit. There was a 54 percent increased risk of type 2 diabetes in people who quit smoking within the past five years. That went down to 18 percent after five years and decreased to 11 percent after a decade. Earlier this year, the same journal published a report that found diabetes patients who quit smoking may see a temporary impairment in glycemic control that may last for up to three years. Read More: Are E-Cigarettes a Healthy Way to Quit Smoking? » Building a Case to Tie Smoking, Diabetes Smoking is already associated as a risk factor for cancer, respiratory disease, and heart disease, but it hasn't been as easy to build the case to link it with type 2 diabetes. In 2014, the U.S. Surgeon General's report contained a section on smoking and diabetes risk and mentioned the causal relation between them. That report did not touch on the link between passive smoking and smoking cessation with diabetes risk. "The current study goes a step further and suggests that secondhand smoke may also increase the risk of diabetes," Steinberg told Healthline. Steinberg said the findings reinforce the importance of tobacco control policies. Though it's not clear how smoking causes diabetes, Steinberg said that further research will be vital to improving public health. Tobacco and diabetes are two of the leading risk factors for cardiovascular disease, he added. Dr. Frank Hu, professor of nutrition and epidemiology and coauthor of the report, told Healthline how smoking can be a pathway for diabetes development. Smokers tend to be leaner than nonsmokers, but they also have increased abdominal obesity and visceral fat. That is a critical risk factor for insulin resistance and diabetes. Smoking is tied to increased chronic inflammation, another underlying risk factor for insulin resistance and diabetes. In addition, toxic chemicals can damage human beta cells, leading to their dysfunction and impaired insulin secretion. "Cigarette smoking should be considered as a key modifiable risk factor for diabetes. Public health efforts to reduce smoking will have a substantial impact on the global burden of type 2 diabetes," Hu said in a statement. Related Reading: How Kick Butts Day Counters Big Tobacco's Social Media Message » Metformin and Pregnancy: Is This Drug Safe? Medically reviewed by Lindsay Slowiczek, Pharm.D. Metformin is a prescription drug used to treat type 2 diabetes. It can also be used to treat polycystic ovarian syndrome (PCOS). If you're pregnant… What's the Connection Between Hypoglycemia and Pregnancy? Pregnancy affects your blood sugar and may increase your risk for hypoglycemia. We explain this connection and how to manage and prevent your symptoms. The 16 Best Foods to Control Diabetes Written by Franziska Spritzler, RD, CDE and Erin Kelly The foods you eat can have a major impact on diabetes and blood sugar levels. Here are 16 foods to get you on your way to managing diabetes. What's Behind the Alarming Increase in Cases of Diabetes Among U.S. Kids? Though the exact causes are unknown, the obesity epidemic is one likely culprit. Important Diabetes Tips From Experts (Who Are Also Diabetic) During American Diabetes Month, Healthline helps facilitate some important conversations for those living with diabetes. Rate of Suicide 3 Times Higher for Autistic People A new study found that autistic people have different risk factors for suicide and are at 3 times greater risk than the general population.
This study was published on May 1 and comes from Columbia University in New York and Pittsburgh University. They reviewed 156 pediatric patients where posterior fossa decompression surgery was performed from 2003-2013 without opening the dura (the tough membrane that covers the brain in the affected area). The researchers feel that a non-dural opening approach avoids major complications. To read MORE, please CLICK HERE. This study was published on Wednesday and comes from the United Kingdom. It looks at if using ultrasound to tailor decompression surgery in children with Chiari I is effective in reducing the risk of complications without the need for re-operation. To read MORE, please CLICK HERE. This study was published in March and comes from Italy. It looks at a technique that appears to have promise in reducing the risk of cerebral spinal fluid (CSF)-related complications in surgeries for Chiari. To read MORE, please CLICK HERE. This study was published on March 6 and comes from Yale University. Researchers studied 18 Chiari I patients who underwent extradural decompression surgery, which is a minimally invasive technique for treating Chiari I that avoids the complications of dural opening. To read MORE about this technique, which may have the potential to be the first line of treatment for Chiari I, please CLICK HERE.
As hockey gains more and more popularity with kids, the frequency of head injuries is growing. Know the signs and symptoms of concussions. Youth hockey and concussions, what you need to know. (Newswire.net -- January 22, 2019) Bend, Oregon --Youth ice hockey is growing in popularity and is gaining the interest of players as young as 5 years old. The rate of fractures and head injuries from this high-impact sport are increasing as well. Injuries suffered by young hockey players are most commonly located in the player's upper extremity, with injuries to the spine, face, trunk, and head. Because of the severity of these injuries, a thorough evaluation is necessary after a child has been hurt, especially if they have suffered an injury to the head. A concussion is a traumatic brain injury, so it shouldn't be taken lightly. Unfortunately, preventing head injuries like a concussion in a fast-paced, high contact sport such as hockey is not always possible, but there are ways to be proactive should your child experience head trauma in the future. Baseline testing measures reaction time, memory, and processing speed. The intention is to measure how the brain functions when it's not injured so that concussion assessments accurately determine the severity of a head injury, should one occur. At The Center, we encourage baseline testing for young athletes, so that in the event of a traumatic brain injury, we can compare pre and post-injury data to determine the extent of the child's injury. The Center gathers baseline and post-injury data for children between the ages of 5-11 by administering ImPACT Pediatric; a game-like, a child-friendly neurocognitive test that is taken on an iPad. ImPACT Pediatric is part of a concussion rehabilitation and return-to-activity program designed to aid in concussion evaluation, along with other tests that assess balance, oculomotor, and vestibular processes. It is the first and only computerized cognitive assessment aid for pediatric concussions to receive FDA clearance. The test generally takes 20-30 minutes to perform and is effective for one year, as children's brains develop rapidly. If your child has experienced trauma to their head in any sport or activity, it's important to remove the child from play immediately. Children who are removed from play immediately following a concussion are much more likely to recover from a concussion in less than three weeks. "It's important to seek medical attention for concussions because you can have some symptoms that might last much longer than a few days and you can get care that will help you manage those symptoms and return to everyday life," says Viviane Ugalde, MD, physical medicine and rehabilitation doctor. If you suspect your child has a concussion, and he or she has received baseline testing through the ImPACT Pediatric test at The Center, he or she will be established as a patient and their care will be streamlined. The child can be evaluated at one of our walk-in NOWcare clinics (Monday – Friday, 9:00 – 4:00) by a provider with specialized training in concussion management. The provider will use ImPACT Pediatric to gather post-injury data to measure the extent of the injury, and an individualized treatment plan will be created to return your child to play when he or she is ready. In more severe concussion cases where children need additional accommodations, The Center's providers work directly with a multi-disciplinary team, along with your child's school, until they are able to return to normal activities. The Center Orthopedic & Neurosurgical Care & Research is a multispecialty practice with 19 physicians fellowship trained in orthopedic surgery, neurosurgery, and physical medicine and rehabilitation, and 21 mid-level providers. Serving the region for over 50 years, The Center physicians have shared a commitment to the community with a focus on personal care for patients all over Central Oregon. A strong dedication to research has allowed the physicians at The Center to help develop new technologies and techniques, offering Central Oregon residents medical options unavailable in other areas of the country. To learn more visit www.thecenteroregon.com.
Home / The Review of Diabetic Studies, Vol. 8, Issue 1, 2011 / The IKEM Pancreas and Islet Transplant Program as Part of Healthcare for Type 1 Diabetes Patients: Retrospective Analysis of Outcome from 1983 to 2010 The IKEM Pancreas and Islet Transplant Program as Part of Healthcare for Type 1 Diabetes Patients: Retrospective Analysis of Outcome from 1983 to 2010 The Review of Diabetic Studies,2011,8,1,35-43. DOI:10.1900/RDS.2011.8.35 Published:May 2011 Peter Girman, and František Saudek Peter Girman and Frantisek Saudek Diabetes Center, Institute for Clinical and Experimental Medicine, Prague 14300, Czech Republic. Currently, 25-30 pancreas transplantations per year are carried out in type 1 diabetes (T1D) recipients residing in Czech Republic. Most of the recipients are transplanted together with kidney allografts, but pancreas is also transplanted alone in selected patients with brittle diabetes. Since 2005, the Institute for Clinical and Experimental Medicine (IKEM) islet transplant program was initiated as complementary therapeutic modality. The aim of this paper was to analyze the transplant program at our clinical center, and to examine the survival of recipients, and their pancreas, kidney, and islet grafts. Patient and graft survival rates were evaluated in the following three categories using Kaplan- Meier test: simultaneous pancreas and kidney transplantation (SPKTx), pancreas transplantation alone (PTA), and islet transplantation (ITx). Three hundred and ninety SPKTx, 34 PTA and 44 ITx were carried out between 1983 and 2010. One- and 5-year patient survival rates were 92 % and 81% in SPKTx, respectively. In SPKTx, the 1-year survival rate of pancreas grafts was 78%, and the 5-year rate was 66%. Kidney graft survival rates were 89% and 79%, respectively, after the same follow-up periods. In the PTA category, recipient survivals were 100% after 1 year, and 92% after 3 years. 70% and 65% of pancreatic grafts were working properly at 1 and 3-year follow-ups, respectively. To date, we have carried out 44 islet transplantations in 31 recipients. Islet function (C-peptide ≥ 0.2 ng/ml) was documented in 60% of recipients after 12 months. So far, only 3 patients remained free of exogenous insulin. While SPKTx is a well established treatment for uremic T1D patients, ITx represents an emerging complementary treatment modality. The latter is especially suitable for high-risk recipients, but routine clinical application is still hampered by the limited availability of usable organ transplants and viability of transplanted islets. Keywords:Islet transplantation, Pancreas transplantation, Rabbit anti-thymocyte globulin, Type 1 diabetes Transplant activity at IKEM. The pancreas transplant program at IKEM started in 1983 after extensive experimental work. At present, 25 to 30 pancreas transplantations per year are carried out in the Czech Republic. Pancreas transplantation alone (PTA) represents less than 10% of all transplantations. Since 2005, when we started the program, 44 procedures have been carried out. SPTx: simultaneous pancreas kidney transplantation. PTA: pancreas transplantation alone. ITx: islet transplantation. ‹ Current Perspectives on Laparoscopic Robot-Assisted Pancreas and Pancreas-Kidney Transplantation up Risks and Benefits of Transplantation in the Cure of Type 1 Diabetes: Whole Pancreas Versus Islet Transplantation. A Single Center Study ›
Smoothes fine lines and diminishes wrinkles. Improves the balance of moisture in the skin. ACTIVE INGREDIENTS: Glycolic acid (10%); L-Ascorbic acid (10%); Vitamin E; Liposomes; Lemon extract. APPLICATION: On thoroughly cleansed and completely dry skin, apply over face and neck. Massage gently until cream is absorbed. Follow with application of Glyco-C High Potent-C Serum. Use twice, daily. Shira Esthetics Glyco-C treatment system, delivers both immediate and long-term anti-aging benefits. Glycolic Acid, AHA's, BHA's and Vitamin C work synergistically to diminish the appearance of fine lines, wrinkles, dark spots and hyperpigmentation, delivering an extra boost of brightening radiance. This multi-action complex intensively corrects and refines the appearance of unevenness from visible pores, blemish marks and skin roughness by helping to build up the skin's strength to resist problems. Strong, but very beneficial ingredients allow for the acceleration of normal tissue regeneration. It renews the appearance of skin, revealing a richly hydrated look and feel for ready for anything skin all day long.
Experimental Drug Remdesivir Found Effective Against Covid-19 In US Study: Reports A biotech company has claimed that an experimental drug that it had manufactured in the wake of the Ebola virus out break has proved to be effective in treating patients with the novel coronavirus infection according to a major study by the United States government that subjected the treatment using the drug to a stiff and strict test. The drug, Remdesivir, developed by the bio tech company Gilead Sciences, is the first drug and treatment mechanism that has reportedly passed such a test as a treatment against the novel coronavirus that caused the disease called Covid-19. More than 218,000 people have so far been killed by the disease all across the world since it first emerged from Human city in China at the end of last year. There can be profound effect on the global pandemic if it was possible to find a curable treatment against the disease, particularly because of a potential vaccine being predicted by health experts to be at least a year or a year and a half away at the earliest. The study for the effectiveness of the drug remdesivir against the novel coronavirus was conducted by the National Institutes of Health of the United States. The study pit the drug against the usual care for a Covid-19 patient among about 800 patients who were hospitalized with the disease all around the world. The main positive outcome from the use of the drug is the time taken by patients to recover in a hospital setting. No details of the results from the study were however provided by Gilead apart from saying that a formal announcement of the study results is expected soon. There were also no formal comments available about the study and its outcome from NIH officials. Patients are administered remdesivir through intra venous mechanism and it is designed to interfere with an enzyme that reproduces viral genetic material. The drug was found to have helped prevent infection and reduced the severity of symptoms when given early enough in the course of illness in experiments and studies that were conducted for the drug against SARS and MERS, diseases caused by similar coronaviruses, in animals. (Source:www.indiatoday.in)
Clone CBR-IC2/2 Alternative Name: ICAM2; ICAM-2; Intercellular adhesion molecule 2 Immunogen: Human ICAM-2 Transfected Cell Line Workshop Number: V S086 Entrez Gene ID: 3384 CBR-IC2/2 The CBR-IC2/2 monoclonal antibody specifically binds to CD102 which is also known as, intercellular adhesion molecule-2 (ICAM-2/ICAM2). CD102 is a type I transmembrane glycoprotein, member of the immunoglobulin supergene family, with an approximate molecular weight of 55-65 kDa. Its extracellular domain consists of two C2-type immunoglobulin-like subunits. The transmembrane region is 26 residues in size and the intracellular region also has 26 residues. CD102 is expressed on vascular endothelial cells, lymphocytes, monocytes, eosinophils, and platelets, but not on resting neutrophils. It is a ligand for the leukocyte integrin CD11a/CD18, or leukocyte function-associated antigen-1 (LFA-1), and there are reports of CD102 binding to leukocyte integrin CD11b/CD18 (Mac-1). Antibody CBR-IC2/2 blocks the binding of CD102 to leukocyte integrin CD11a/CD18. CD102 plays an important role in lymphocyte recirculation and in providing costimulatory signals in the immune response. The antibody was conjugated to BD Horizon™ BUV496 which is part of the BD Horizon Brilliant™ Ultraviolet family of dyes. This dye is a tandem fluorochrome of BD Horizon BUV395 with an Ex Max of 348-nm and an acceptor dye with an Em Max at 496-nm. BD Horizon BUV496 can be excited by the ultraviolet laser (355 nm) and detected with a 515/30 nm filter with a 450LP. Due to the excitation of the acceptor dye by other laser lines, there may be significant spillover into the channel detecting BD Horizon V500 or BV510 (eg, 525/40-nm filter). However, the spillover can be corrected through compensation as with any other dye combination. The BD Horizon Brilliant™ Ultraviolet 496 (BUV496) Dye is part of the BD Horizon Brilliant™ Ultraviolet family of dyes. This tandem fluorochrome is comprised of a BUV395 donor with an excitation maximum (Ex Max) of 350-nm and an acceptor dye with an emission maximum (Em Max) at 496-nm. BUV496, driven by BD innovation, is designed to be excited by the ultraviolet laser (355-nm) and detected using an optical filter centered near 500-nm (e.g., 515/30-nm bandpass filter). The acceptor dye can be excited by the Violet (405-nm) laser resulting in cross-laser excitation and fluorescence spillover. Please ensure that your instrument's configurations (lasers and optical filters) are appropriate for this dye. Klickstein LB, Springer TA. CD102 (ICAM-2) cluster report. In: Schlossman SF. Stuart F. Schlossman .. et al., ed. Leucocyte typing V : white cell differentiation antigens : proceedings of the fifth international workshop and conference held in Boston, USA, 3-7 November, 1993. Oxford: Oxford University Press; 1995:1550-1551. Xie J, Li R, Kotovuori P, et al. Intercellular adhesion molecule-2 (CD102) binds to the leukocyte integrin CD11b/CD18 through the A domain. J Immunol. 1995; 155(7):3619-3628. (Biology). View Reference Zola H. Leukocyte and stromal cell molecules : the CD markers. Hoboken, N.J.: Wiley-Liss; 2007. de Fougerolles AR, Stacker SA, Schwarting R, Springer TA. Characterization of ICAM-2 and evidence for a third counter-receptor for LFA-1. J Exp Med. 1991; 174(1):253-267. (Immunogen: ELISA, Flow cytometry, Functional assay, Immunohistochemistry, Immunoprecipitation, Inhibition). View Reference
Tell me about Tongue Ties, Tortiocollis, Plagiocephaly, and Postural Asymmetries affecting Feeding. Webinars are free and available to IATP members only. Not yet a member? We would love to have you join us! Webinar is for IATP Members Only. 1. List possible causes of structural and postural alignment issues. 2. Describe what feeding and functional issues are affected by structure. communication strategies and how to refer. lactation consultant in L/D, postpartum, newborn nursery, NICU, and perinatal education. babies, children, and adults in an orthodontic office. busy and remind her daily of life's joys. The following, recorded, Webinars are free and available to IATP members only. Please login for viewing information. Not yet a member? We would love to have you join us! After watching this webinar, attendees will have a clear understanding of topics related to Tongue Ties including how to define, identify, and the associated symptoms associated with Tongue Ties. In this webinar, clinical issues associated with Tongue Ties and their significance/effect on feeding, speech, and other oral-motor related difficulties. This webinar was broadcast on August 18, 2018. KATHERINE FISHER, B.Sc, M.Sc, IBCLC. Katherine is fully insured, for both Lactation Consultancy and Frenulotomy and holds a current enhanced DBS certificate. This webinar was broadcast on July 21, 2018. 1995-Present date; International Board Certified Lactation Consultant. The registration requirements for this membership include that members re-register by examination or CERPS (continuing education points every 5 years). I have successfully reregistered and maintained my registration for the past 23 years and am currently registered to practise until 2020. I am fully insured, for both Lactation Consultancy and Frenulotomy and hold a current enhanced DBS certificate. I have worked as a volunteer Breastfeeding Counsellor for the NCT, have operated a Baby Café and worked for 3 years as an Infant Feeding Specialist for Sure Start. 2007; Attained certificate of competency to undertake frenulotomy at St Mary's Hospital Southampton under the supervision Of Mervyn Griffiths Consultant Paediatric Surgeon. 2008-2016 Lactation Consultant and Team Leader of the paediatric tongue tie service at Kings College Hospital, London. Until August 2017 I was the Band 7 Team Leader for this service and was responsible for the smooth running of the clinics including the following tasks; supervision and training of junior staff, formulation of written clinical policies relating to the treatment and post procedure aftercare following frenulotomy , service development, initiating and participating in research, reviewing referrals to the clinic, assessing and treating Ankyloglossia in infants up to the age of 6 months. I retired from the Team Leader role in July 2016 and returned to work the following month as a Band 6 Lactation Consultant and Frenulotomy Practitioner. In addition I have a Private Lactation Consultancy Practise, offering Frenulotomy. I am competent in being able to assess and treat all types of tongue tie i.e. anterior and posterior, by direct surgical division, using a technique that safely attains an adequate the sub-lingual rhomboid. I am fully competent in reviewing post frenulotomy patients and the use of salvage wound adhesion techniques by blunt digital dissection to assist in the prevention of reoccurrence. I also work in Private Practice at The London Tongue tie Clinic with Shailesh Patel Consultant Paediatric Surgeon, one of the specialisations in this clinic is treatment of recurrent Tongue tie. International collaborator The Norwegian Tongue tie Project; Trained Doctors in Norway to treat Ankyloglossia and enabled formation of services in Norway. Ongoing prevalence studies and formation of national guidance for the assessment and treatment of Tongue tie and aftercare/support. Published writer and speaker on Lactation, Breastfeeding and Tongue- tie issues. Co-author of poster presentations on Posterior Tongue Tie, AWM active wound management following Frenulotomy, and Ankyloglossia and GER/GORD. An in-depth explanation of what Myofunctional therapy is, what a Myofunctional therapist does, how it differs from bodywork, and how it a large piece of the puzzle pre and post frenectomy to help patients achieve long-term optimal oral function. This webinar was broadcast on June 16, 2018. Brooke works full time as an orofacial myofunctional therapist, and is the owner-operator of Myofunction Junction in Richmond, VA. She completed her initial training through the Academy of Orofacial Myofunctional Therapy (AOMT) and MyoMentor, then took part in an online mentorship program. She was among the first class to complete the orofacial myology specialist program through the Graduate School of Behavioral Health Sciences. She attended symposium training through the International Association of Orofacial Myology (IAOM), and plans to start their training program and certification track this year. A lover of lifelong learning, Brooke has taken extensive continuing education courses relating to myofunctional studies. She lights up discovering different approaches and perspectives pertaining to orofacial myofunctional issues. Passionate about the multidisciplinary span of myofunctional science, Brooke has spent hundreds of hours studying with, shadowing, learning from, and partnering alongside pediatric and airway-focused dentists and orthodontists, speech language pathologists, physical therapists, otolaryngologists, occupational therapists, and international board certified lactation consultants. She strongly believes a team approach is necessary for optimal oromyofunctional outcomes. Brooke has a background in dental hygiene, and graduated from Virginia Commonwealth University in 2009. She has spoken nationally and internationally on a variety of oral health topics. Understand the integrative care model for the treatment of clients with oral tie issues. Identify the benefits of multiple hands CranioSacral Therapy for babies and family members. Explain the advantage of a team approach for both treatment and educational opportunities/support for families.recognize the concept of whole family treatment. This webinar was broadcast on May 19, 2018. Founder/Director of Postpartum Place- Holistic Lactation & Parenting Center (formerly known as The Lactation Resource Center) since 1996. Maria has been profiled in the American Journal of Nursing, New York Times, Daily Record, Courier News and featured on ABC News, EBRUTV and Channel 13 & News 12 NJ. Maria is a frequent speaker and contributing writer for maternal/child health issues on both the community and professional levels. Published in the book "Liquid Gold". Previous: Northwest NJ WIC Breastfeeding Promotion & Support Regional Coordinator, clinical instructor for the AHS Pediatric Residency Program, columnist for The Motherhood publication. Maria is the co-creature and co-practitioner of the Balanced Baby Clinic. Trained in bodywork as a Cransiosacral Fascial Therapist since 2013. She is an active member of the New Jersey Breastfeeding Coalition (NJBFC) & International Affiliation of Tongue-tie Professionals (IATP) and has three grown children. Dr. Richard Baxter is a board-certified pediatric dentist and board-certified laser surgeon. He is passionate about educating parents and healthcare practinioners about the effects a tongue-tie can have on patients throughout the lifespan. This webinar was broadcast on April 14, 2018. LAWRENCE A. KOTLOW D.D.S., P.C. Since 1974, Dr. Kotlow has been in private practice, serving the specialized needs of children. Dr. Kotlow is known throughout the country for his innovative techniques and caring manner, and has lectured for some of the top dental societies and dental companies. Dr. Kotlow has lectured in Australia, Taiwan, Canada, England, France, and throughout the United States concerning Pediatric Dentistry and lasers. He has written over 35 articles and authored chapters on pediatric dentistry and lasers for three laser textbooks. This webinar was broadcast on March 10, 2018. International Affiliation of Tongue Tie Professionals.
© Daniel Ndaki Nkonya et al. The Pan African Medical Journal - ISSN 1937-8688. 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. Introduction: malaria diagnosis is known to be non-specific because of the overlap of symptoms of malaria with other infectious diseases that is made worse with declining malaria burden. Though the use of malaria rapid diagnostic test (mRDT) for malaria confirmation has universally been adopted, malaria decline may alter performance of mRDT. This study examined accuracy of clinical diagnosis and mRDT and its influence on prescription for febrile underfives. Methods: a cross-sectional study of 600 underfives was carried out in 6 randomly selected health facilities in Misungwi district, Mwanza; from November - December 2014. Consecutive underfives with a fever consultation were recruited: for each fever and the clinical diagnosis entertained were recorded. Parasitological confirmation of malaria was done by mRDT and microscopic examination of finger prick blood samples. Treatment was based on mRDT results, drugs prescribed recorded. Accuracy of clinical diagnosis and mRDT in predicting malaria was assessed by performance indices against microscopy. Antimalarial and antibiotics prescriptions were assessed against parasitological findings. Results: clinically, 37.2% had malaria; 32.8% were mRDTpositive and 17.0% microscopically positive. Sensitivity of clinical diagnosis was very high (97.0% [95%CI: 91.0-99.2]); specificity 66.7% [95%CI: 62.3-70.8], and positive predictive value 37.4% (95%CI: 31.6-43.5). Sensitivity of mRDTwas very high (99.0% [95%CI: 93.9-99.9]), specificity (80.7% [95%CI: 76.9-84.0]), positive predictive value 51.3% [95% CI: 44.1-58.4]) and negative predictive 99.75% [95%CI: 99.4-100.0]. Those receiving antimalarial prescription, 75.0% were mRDT positive; 39.4% microscopically positive. Those receiving antibiotic, 78.8% were mRDT negative; 90.1% microscopically negative. Conclusion: decline in malaria lowered specificity of mRDT to < 95% against WHO recommendation. Though adherence to mRDT results was high, there was over prescription of antibiotics. Fever (raised body temperature) has been the entry point for the clinical diagnosis of malaria for decades; thus the first suspicion of malarial illness in an individual is based on the history of fever and / or measured fever . Despite the decline in malaria burden in sub-Saharan Africa , fever has remained a major cause of outpatient attendance in health facilities , thus overemphasizing the need for a parasitological confirmation of malaria among patients of all age groups with fever in line with the World Health Organization (WHO) recommendation . In most health facilities in peripheral settings, the operationally feasible parasitological confirmation of malaria is by use of malaria rapid diagnostic test (mRDT) . In Tanzania, available data show that malaria incidence and prevalence have declined in most parts of the country as shown in the national survey of 2007/8 whereby the overall prevalence of malaria among underfives was 18.1%, while in the 2011/12 survey the overall prevalence was 9.7% by mRDT and 4.2% by microscopy [6, 7]. Based on the surveys, the decline was recorded in all geographical zones; and in both surveys the Lake, Southern and Western zones had the highest prevalence while the Northern and Southern high land zones had the lowest prevalence. The decline in malaria parasites prevalence and the number of cases of malaria related fevers may conceivably lower the specificity and predictive value of the clinical diagnosis of malaria as well as the specificity and predictive value of mRDT for the prediction of malaria parasitaemia . The decrease in malaria prevalence, and declining proportion of fevers due to malaria [2, 6], which is known to affect the accuracy (sensitivity, specificity and predictive values) of clinical diagnosis and rapid malaria diagnostic tests , primarily prompted us to conduct this study. The secondary objective was to examine the influence of laboratory findings in the guidance of case management of underfives with fever in terms of prescribing antimalarial drug for the mRDT positives and an antibiotic for the mRDT negatives suspected to have a bacterial infection [9,10]. Findings from this study are envisaged to appraise on the influence of laboratory confirmation of malaria on the management of underfives with fever and provide an informed policy decision for improving management of fever in primary health facilities . Here we report the accuracy of a clinical malaria diagnosis and mRDT for malaria diagnosis under reduced malaria burden and its influence in the management of children attending to health facilities on account of fever. Study area: the study was conducted in Misungwi district, Mwanza region, north-west Tanzania located at an altitude of 1,178m above sea level; with a region malaria prevalence of 18.6% by mRDT and 5.4% by microscopy . The district has two annual rainy seasons, the long rains between February and May and the short rains between November and December; the dry and relatively hot season is from June to September. Malaria transmission is seasonal, with peaks in one to two months after the rains . Study design and population: a facility based quantitative cross sectional study was conducted in 6 randomly selected health facilities of Misungwi district between November and December 2014 among children under-five years of age attending to the respective health facilities on account of fever. Sample size estimation: the sample size was estimated based on the reported prevalence of malaria of 12.0% among underfives in one of the districts in Mwanza . The margin of error (ε) was taken to be 2% at 95% confidence interval. The Sample size was computed using the formula: n = z2 p(1-p)/ε2 or n = z2p(100-p)/ε2 Where: Z = level of confidence (1.96 for 95% confidence level) p = expected prevalence (=12%) ε = margin of error = 2% →N = 1.962 x 12(100 - 12) = 518 Adjustment for non-response: for a facility study it was expected that the response rate (R) would be than 90%. To adjust for non-response, a factor F = 1/R was multiplied by N to get an adjusted sample size. In this case, 1/R x N = 1/0.9 x 518 = 575 was the minimum sample size; in this study 600 participants were recruited. Sampling procedure: to identify health facilities to be included in the study, a cluster sampling technique was used. This was carried out by classifying health facilities in three different clusters according to levels: hospital, health center or dispensary from which 6 facilities; a hospital, two health centers and three dispensaries were randomly selected. Thereafter the sample size allocated for each facility was based on the catchment population. Consecutive underfives attending to the selected facilities on account of fever were recruited. A questionnaire was used to record the socio-demographic and clinical characteristics of the underfives; for each a history of fever and axillary temperature (digital thermometry) were recorded. Parasitological malaria confirmation was done by mRDT and a prescription was given based on the mRDT findings. Blood smears for microscopic malaria confirmation were sent to the Parasitology laboratory at Muhimbili University of Health & Allied Sciences for expert microscopy. Two experienced microscopist unaware of the mRDT results performed microscopy each time comparing their results (Figure 1). Data Analysis: data were cleaned, entered and processed using SPSS computer software version 13. Analysis was carried out using SPSS version 13 whereby descriptive analyses were done by using frequencies and proportions to estimate magnitude of the outcomes of interest. Accuracy of clinical malaria diagnosis and mRDT for the identification of underfives with malaria parasitaemia was assessed from the performance indices with their 95% CI. Influence of parasitological malaria confirmation on prescription of antimalarial and antibiotics was assessed against mRDT and microscopic findings. Ethical Consideration: the study ethically cleared the Institutional Review Board of the Muhimbili University of Health and Allied Sciences. Informed consent for participation in the study was sought from parents/caregivers on behalf of the underfives. Administrative permission to carry out the study was sought from the appropriate Regional and District authorities as well as the Medical Officers in charge of all selected health facilities. A total of 600 underfives with a history of fever in the last 48 hours were referred to laboratory for parasitological confirmation of malaria by mRDT and microscopy. The characteristics of the study participants are shown in Table 1. Less than a quarter (22.3%) had received an antimalarial two weeks prior to the survey. On visit, less than a half (42.8%) had fever with a body temperature of 37.5οC-40.3οC; about a third (37.2%) had a clinical diagnosis of malaria. Parasitological malaria diagnosis by mRDT and microscopy : of the 600 underfives referred for parasitological malaria confirmation, 32.8% were positive by mRDT while only 17.0% were microscopically positive. Among those positive for malaria by microscopy, close to two thirds (62.7%) had parasite counts 10,000-350,000 / µL of blood (Table 2). Performance of a clinical malaria diagnosis and mRDT for the prediction of malaria parasitaemia among under-fives: as expected, a clinical diagnosis of malaria had a very high sensitivity (97.0% (95%CI: 91.0-99.2)) for correctly identifying underfives with malaria parasitaemia (Table 3). However, a clinical malaria diagnosis could correctly identify underfives without malaria parasitaemia in only about two thirds (66.7% [95%CI: 62.3-70.8]) of underfives. A clinical malaria diagnosis could predict presence of malaria parasites in only about a third (37.4% (95%CI: 31.6-43.5)) of underfives, but could predict absence of malaria parasites in a very high percentage (99.1% [95%CI: 97.2-99.8]). The prevalence of malaria parasitaemia was 17.0% by microscopy and 32.8 by mRDT. The mRDT had a very high sensitivity (99.0% [95%CI: 93.9-99.9]) and specificity (80.7% [95%CI: 76.9-84.0]) for correctly identifying underfives with and without malaria parasitaemia (Table 3). The mRDT could predict presence of malaria parasite in just about a half (51.3% [95%CI: 44.1-58.4]) of underfives and could predict absence of malaria parasites in a very high percentage (99.75% (95%CI: 99.4-100.0)). The present study show that malaria is still a problem as 22.3% of the underfives were reported to have been treated for malaria in the last two weeks; and during the study a clinical diagnosis of malaria was entertained in 32.7% of the consultations. The observed prevalence of parasitaemia by both microscopy (17.5%) and mRDT (32.8%) at facility level is higher than the microscopic prevalence of 5.4% and 18.6% mRDT observed at the community level for Mwanza region through a recent national survey . The Tanzania national guidelines for malaria diagnosis and treatment provides that fever (history of fever or measured fever) is the entry point for suspecting malaria in an underfive but other features such as gastroenteritis (diarrhea / vomiting), pallor (palms / conjunctiva), inactivity and inability to feed together constitute a clinical malaria diagnosis . The present study show that a clinical diagnosis of malaria, although not specific, has the advantage of being highly sensitive (sensitivity 97.0% [95%CI: 91.0-99.2]) for correctly identifying underfives with malaria parasitaemia. In this situation, sensitivity is more important than specificity particularly because, although treatable, malaria is potentially fatal . This emphasizes on the need for ensuring availability of guidelines and adherence to the clinical algorithm for malaria diagnosis coupled with parasitological confirmation because diagnosis based on clinical features alone has a low specificity and increases the risk of over-diagnosis especially under reduced malaria prevalence as is the current situation [16, 17]. The Mwanza region had recorded a decline in malaria prevalence (by mRDT) among underfives; from 31.4% in the year 2007/2008 to 18.6 % in the year 2011/2012 representing a relative reduction of 40.8% [6,7]. The primary goal of this study was to examine whether the decline of malaria prevalence would have reduced the diagnostic performance of mRDT routinely used in health facilities for parasitological malaria confirmation. The present findings show that despite the decline in malaria prevalence in the study area, the mRDT still retained high sensitivity (99.0% [95%CI: 93.9-99.9]) for correctly identifying underfives with malaria parasitaemia, and was at the level of sensitivity ≥95% recommended by WHO . The mRDT also retained a high specificity (80.7% [95%CI: 76.9-84.0]) for correctly identifying underfives without malaria parasitaemia, but this was lower than the WHO recommendation of a specificity ≥95% for an ideal mRDT. Malaria rapid diagnostic tests (mRDT) have been rolled out in Tanzania following the recommendations by the WHO to adopt universal testing to confirm presence of malaria parasites before antimalarial treatment . Universal testing to confirm presence of malaria parasites is envisaged to guide the prescription of an antimalarial drug to those with positive mRDT results, while those with negative mRDT results with a suspected bacterial infection would receive an antibiotic. The present findings show that of the 254 underfives who received an antimalarial prescription, three quarters (75.0%) had positive mRDT results; only a quarter (25.0%) had negative mRDT results, implying a major adherence to test results by prescribers. Similar observations have been made in Rufiji, southeastern Tanzania whereby adherence to mRDT findings resulted in reduction of overtreatment with antimalarial drugs by more than two thirds (71.5%) conceivably resulting from the early health promotion campaigns as Rufiji was one of the districts where mRDT was first introduced as part of the national mRDT rollout . Since the rollout of malaria rapid diagnostic tests for routine use in all levels of health care was envisaged as a strategy for targeting antimalarial use, in this case ACT, to only those with positive mRDT results , the present findings show that adherence to test results has lead to a reduction of antimalarial drug over use by three quarters as demonstrated by other studies [19, 20]. Of those receiving antibiotic prescription on suspicion of invasive bacterial disease, the large majority (90.1%) had negative mRDT results. This represents an over-treatment with antibiotics as it has been shown that even in low to moderate malaria transmission settings, invasive bacterial disease is uncommon in underfives with non-severe illness . Giving an antibiotic prescription to all febrile underfive with a negative mRDT result is not justifiable because recently it has been shown that most underfives with fever probably have pathogens that do not require treatment with an antibiotic . The fact that only about a third (32.8%) of the underfives were parasitologically confirmed by mRDT to have malaria implies that two thirds of the of those evaluated for malaria on account of fever were suffering from a condition other than malaria. Various non-malarial infections have been found to be major causes of febrile syndromes in tropical settings but often clinically indistinguishable without confirmatory tests . There is therefore a need to develop RDTs for other tropical infections for the individual case-management of non-malarial tropical infections presenting with fever . Findings reaffirm that a clinical malaria diagnosis is a poor marker of malarial disease that is likely to be worse under reduced malaria burden. The decline in malaria prevalence has altered the performance of mRDT to a specificity < 95% below the WHO recommendation. There was a reduction in over prescription of antimalarial by three quarters due to a high adherence to mRDT results. There was an over prescription of antibiotics as not all mRDT negatives would necessarily have an invasive bacterial disease. The performance of clinical diagnosis and mRDT is known to change with the prevalence of malaria. To what extent parasitological confirmation of malaria by mRDT guides the management of febrile underfives in terms of antimalarial and antibiotic prescriptions in settings of reduced malaria burden. Authors declared they have no conflict of interests. Daniel Ndaki Nkonya: made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; and have given final approval of the version to be published. Donath Samuel Tarimo: made substantial contributions to conception and design, acquisition of data, analysis and interpretation; drafted the manuscript and revising it critically for important intellectual content; and have given final approval of the version to be published. Rogath Saika Kishimba: made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; and have given final approval of the version to be published. We are grateful to the parents and guardians who permitted their children to participate in the study. We are thankful to the Mwanza Region and Misungwi District administrative authorities for granting us permission to carry out this study in the respective health facilities. Special thanks go to the staff of the respective health facilities for kindly offering the space and other logistical support during the study. This study received financial support from the Directorate of Postgraduate Studies, MUHAS through the Tanzania Field Epidemiology & Laboratory Training Program.
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Izvornik: Psychologische Medizin / Egger, Josef W. (ur.). - Beč : facultas.wuv Universitatsverlag , 2014. 41-41. Mjesto i datum: Sibiu, Rumunjska, 25-28.06.2014. Purpose: To investigate the relationship between perceived burden of illness and measures of anxiety and health related quality of life in IBS patients. Methods: Forty four outpatients with irritable bowel syndrome (age M=45, 33, SD=13, 66 ; 74% females) completed a set of psychosocial measures including State-Trait Anxiety Inventory (STAI-T), Visceral Sensitivity Index (VSI), Short Form-36 Health Survey (SF-36), Irritable Bowel Syndrome Questionnaire (IBS-36) and the Pictorial Representation of Illness and Self Measure Revised II (PRISM-RII). The PRISM-RII consists of two measures: illness perception measure (IPM) and self-illness separation (SIS). IPM is a pictorial representation of the size of the illness with regard to the patient's self (smaller, equal to and larger than the self). SIS represents the distance between the self and the illness. Also, the patients filled out a symptom severity diary for a period of 14 days. The symptom severity score was calculated as the average intensity of present symptoms over the period of measurement. Results: Self-illness separation and illness perception measure have a significant negative correlation (r=-0, 35 ; p<0, 05). In order to examine possible differences in anxiety and health related quality of life, with regard to IPM and SIS, we performed t-test analyses. The results show that patients with a higher score on IPM express higher visceral anxiety (t(2, 42)=2, 36, p<0, 05), lower general quality of life (mental component, t(2, 42)=2, 24, p<0, 05) and report more severe symptoms (t(2, 42)=2, 26, p<0, 05). Also, patients with higher scores on SIS express higher visceral anxiety (t(2, 42)=2, 42, p<0, 05). Discussion: The results indicate that IPM and SIS can be useful in discriminating patients with more prominent psychological difficulties. It seems that PRISM-RII is a valid instrument which adds additional relevant information to commonly used measures of psychological functioning of IBS patients.
Differences in the effects of phorbol esters and diacylglycerols on protein kinase C M. D. Bazzi, G. L. Nelsestuen The binding of protein kinase C (PKC) to membranes and appearance of kinase activity are separable events. Binding is a two-step process consisting of a reversible calcium-dependent interaction followed by an irreversible interaction that can only be dissociated by detergents. The irreversibly bound PKC is constitutively active, and the second step of binding may be a major mechanism of PKC activation [Bazzi and Nelsestuen (1988) Biochemistry 27, 7589]. This study examined the activity of other forms of membrane-bound PKC and compared the effects of phorbol esters and diacylglycerols. Like the membrane-binding event, activation of PKC was a two-stage process. Diacylglycerols (DAG) participated in forming an active PKC which was reversibly bound to the membrane. In this case, both activity and membrane binding were terminated by addition of calcium chelators. DAG functioned poorly in generating the constitutively active, irreversible PKC-membrane complex. These properties differed markedly from phorbol esters which activated PKC in a reversible complex but also promoted constitutive PKC activation by forming the irreversible PKC-membrane complex. The concentration of phorbol esters needed to generate the irreversible PKC-membrane complex was slightly higher than the concentration needed to activate PKC. In addition, high concentrations of phorbol esters (≥50 nM) activated PKC and induced irreversible PKC-membrane binding in the absence of calcium. Despite these striking differences, DAG prevented binding of phorbol esters to high-affinity sites on the PKC-membrane complex. Taken together, the results may suggest that a low-affinity interaction between PKC, phorbol esters, and/or the membrane component was responsible for the irreversible membrane-binding event that produced the constitutively active kinase. These different behaviors of DAG and phorbol ester may be consistent with their different and complex effects in whole cells and tissues. https://doi.org/10.1021/bi00450a011 10.1021/bi00450a011 Fingerprint Dive into the research topics of 'Differences in the effects of phorbol esters and diacylglycerols on protein kinase C'. Together they form a unique fingerprint. Diglycerides Chemical Compounds Phorbol Esters Chemical Compounds Protein Kinase C Chemical Compounds Phosphotransferases Chemical Compounds Biochemistry Chemical Compounds Calcium Chelating Agents Chemical Compounds Calcium Chemical Compounds Bazzi, M. D., & Nelsestuen, G. L. (1989). Differences in the effects of phorbol esters and diacylglycerols on protein kinase C. Biochemistry, 28(24), 9317-9323. https://doi.org/10.1021/bi00450a011 Differences in the effects of phorbol esters and diacylglycerols on protein kinase C. / Bazzi, M. D.; Nelsestuen, G. L. In: Biochemistry, Vol. 28, No. 24, 1989, p. 9317-9323. Bazzi, MD & Nelsestuen, GL 1989, 'Differences in the effects of phorbol esters and diacylglycerols on protein kinase C', Biochemistry, vol. 28, no. 24, pp. 9317-9323. https://doi.org/10.1021/bi00450a011 Bazzi MD, Nelsestuen GL. Differences in the effects of phorbol esters and diacylglycerols on protein kinase C. Biochemistry. 1989;28(24):9317-9323. https://doi.org/10.1021/bi00450a011 Bazzi, M. D. ; Nelsestuen, G. L. / Differences in the effects of phorbol esters and diacylglycerols on protein kinase C. In: Biochemistry. 1989 ; Vol. 28, No. 24. pp. 9317-9323. @article{ceef1b728d4e4bd796748ddee30147f6, title = "Differences in the effects of phorbol esters and diacylglycerols on protein kinase C", abstract = "The binding of protein kinase C (PKC) to membranes and appearance of kinase activity are separable events. Binding is a two-step process consisting of a reversible calcium-dependent interaction followed by an irreversible interaction that can only be dissociated by detergents. The irreversibly bound PKC is constitutively active, and the second step of binding may be a major mechanism of PKC activation [Bazzi and Nelsestuen (1988) Biochemistry 27, 7589]. This study examined the activity of other forms of membrane-bound PKC and compared the effects of phorbol esters and diacylglycerols. Like the membrane-binding event, activation of PKC was a two-stage process. Diacylglycerols (DAG) participated in forming an active PKC which was reversibly bound to the membrane. In this case, both activity and membrane binding were terminated by addition of calcium chelators. DAG functioned poorly in generating the constitutively active, irreversible PKC-membrane complex. These properties differed markedly from phorbol esters which activated PKC in a reversible complex but also promoted constitutive PKC activation by forming the irreversible PKC-membrane complex. The concentration of phorbol esters needed to generate the irreversible PKC-membrane complex was slightly higher than the concentration needed to activate PKC. In addition, high concentrations of phorbol esters (≥50 nM) activated PKC and induced irreversible PKC-membrane binding in the absence of calcium. Despite these striking differences, DAG prevented binding of phorbol esters to high-affinity sites on the PKC-membrane complex. Taken together, the results may suggest that a low-affinity interaction between PKC, phorbol esters, and/or the membrane component was responsible for the irreversible membrane-binding event that produced the constitutively active kinase. These different behaviors of DAG and phorbol ester may be consistent with their different and complex effects in whole cells and tissues.", author = "Bazzi, {M. D.} and Nelsestuen, {G. L.}", doi = "10.1021/bi00450a011", journal = "Biochemistry", T1 - Differences in the effects of phorbol esters and diacylglycerols on protein kinase C AU - Bazzi, M. D. AU - Nelsestuen, G. L. N2 - The binding of protein kinase C (PKC) to membranes and appearance of kinase activity are separable events. Binding is a two-step process consisting of a reversible calcium-dependent interaction followed by an irreversible interaction that can only be dissociated by detergents. The irreversibly bound PKC is constitutively active, and the second step of binding may be a major mechanism of PKC activation [Bazzi and Nelsestuen (1988) Biochemistry 27, 7589]. This study examined the activity of other forms of membrane-bound PKC and compared the effects of phorbol esters and diacylglycerols. Like the membrane-binding event, activation of PKC was a two-stage process. Diacylglycerols (DAG) participated in forming an active PKC which was reversibly bound to the membrane. In this case, both activity and membrane binding were terminated by addition of calcium chelators. DAG functioned poorly in generating the constitutively active, irreversible PKC-membrane complex. These properties differed markedly from phorbol esters which activated PKC in a reversible complex but also promoted constitutive PKC activation by forming the irreversible PKC-membrane complex. The concentration of phorbol esters needed to generate the irreversible PKC-membrane complex was slightly higher than the concentration needed to activate PKC. In addition, high concentrations of phorbol esters (≥50 nM) activated PKC and induced irreversible PKC-membrane binding in the absence of calcium. Despite these striking differences, DAG prevented binding of phorbol esters to high-affinity sites on the PKC-membrane complex. Taken together, the results may suggest that a low-affinity interaction between PKC, phorbol esters, and/or the membrane component was responsible for the irreversible membrane-binding event that produced the constitutively active kinase. These different behaviors of DAG and phorbol ester may be consistent with their different and complex effects in whole cells and tissues. AB - The binding of protein kinase C (PKC) to membranes and appearance of kinase activity are separable events. Binding is a two-step process consisting of a reversible calcium-dependent interaction followed by an irreversible interaction that can only be dissociated by detergents. The irreversibly bound PKC is constitutively active, and the second step of binding may be a major mechanism of PKC activation [Bazzi and Nelsestuen (1988) Biochemistry 27, 7589]. This study examined the activity of other forms of membrane-bound PKC and compared the effects of phorbol esters and diacylglycerols. Like the membrane-binding event, activation of PKC was a two-stage process. Diacylglycerols (DAG) participated in forming an active PKC which was reversibly bound to the membrane. In this case, both activity and membrane binding were terminated by addition of calcium chelators. DAG functioned poorly in generating the constitutively active, irreversible PKC-membrane complex. These properties differed markedly from phorbol esters which activated PKC in a reversible complex but also promoted constitutive PKC activation by forming the irreversible PKC-membrane complex. The concentration of phorbol esters needed to generate the irreversible PKC-membrane complex was slightly higher than the concentration needed to activate PKC. In addition, high concentrations of phorbol esters (≥50 nM) activated PKC and induced irreversible PKC-membrane binding in the absence of calcium. Despite these striking differences, DAG prevented binding of phorbol esters to high-affinity sites on the PKC-membrane complex. Taken together, the results may suggest that a low-affinity interaction between PKC, phorbol esters, and/or the membrane component was responsible for the irreversible membrane-binding event that produced the constitutively active kinase. These different behaviors of DAG and phorbol ester may be consistent with their different and complex effects in whole cells and tissues. U2 - 10.1021/bi00450a011 DO - 10.1021/bi00450a011 JO - Biochemistry JF - Biochemistry
Orthognathics Attention new phone numbers for our clinic are 02 9247 2817 or 02 9169 3871 Orthognathic Surgery and Surgical Orthodontics Orthognathic surgery is from the Greek terms orthos meaning straight and gnathos meaning jaws. It is also commonly known as surgical orthodontics. Whilst the vast majority of people with incorrect bite can be treated with orthodontics alone, a small percentage have a discrepancy in jaw size or position which is too large. In those cases orthodontics alone can lead to a very poor aesthetic and functional result, with relapse common once the braces are removed. Jaw surgery can seem a daunting prospect at first, but most patients recover surprisingly quickly and return to normal activities within a short period of time. There are several stages to orthognathic surgery. Firstly the teeth need to be aligned to accommodate the planned change in jaw position. This is done with braces by an orthodontist and usually takes around 12 – 18 months. Once things are prepared a date is made for surgery. The surgery itself takes a few hours, and the stay in hospital is usually only 3-4 days. After an initial few weeks for healing, the orthodontist takes over again for final detailing, with the braces coming off about 6 months after surgery. Other types of surgical orthodontics include the exposure of impacted teeth to allow the orthodontist to move these teeth into the bite. This most commonly involves the upper canine teeth, which often become stuck within the palate. A small surgical procedure is required to locate the tooth and cement a gold chain which is then connected to the braces. Dr Mouser and Dr Deane will discuss with you the best way of treating your individual case, and will outline the type of procedures required, including the risks, costs and expected post-operative recovery. Back to Services List Macquarie OMS Suite 501 BMA House 135 Macquarie Street Phone 02 9247 2817 OR Email [email protected] © 2017 Macquarie Oral and Maxillofacial Specialists \| Site Map \| Website by Burst Creative \| Privacy Policy
International comparison of spending and utilization at the end of life for hip fracture patients Blankart, Carl Rudolf, Gool, Kees, Papanicolas, Irene ORCID: 0000-0002-8000-3185, Bernal‐delgado, Enrique, Bowden, Nicholas, Estupiñán‐romero, Francisco, Gauld, Robin, Knight, Hannah, Abiona, Olukorede, Riley, Kristen, Schoenfeld, Andrew J., Shatrov, Kosta, Wodchis, Walter P. and Figueroa, Jose F. (2021) International comparison of spending and utilization at the end of life for hip fracture patients. Health Services Research, 56 (S3). 1370 - 1382. ISSN 0017-9124 Text (1475-6773.13734) - Published Version Scopus publication Identification Number: 10.1111/1475-6773.13734 Objective To identify and explore differences in spending and utilization of key health services at the end of life among hip fracture patients across seven developed countries. Data Sources Individual-level claims data from the inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC). Study Design We retrospectively analyzed utilization and spending from acute hospital care, emergency department, outpatient primary care and specialty physician visits, and outpatient drugs. Patterns of spending and utilization were compared in the last 30, 90, and 180 days across Australia, Canada, England, Germany, New Zealand, Spain, and the United States. We employed linear regression models to measure age- and sex-specific effects within and across countries. In addition, we analyzed hospital-centricity, that is, the days spent in hospital and site of death. Data Collection/Extraction Methods We identified patients who sustained a hip fracture in 2016 and died within 12 months from date of admission. Principal Findings Resource use, costs, and the proportion of deaths in hospital showed large variability being high in England and Spain, while low in New Zealand. Days in hospital significantly decreased with increasing age in Canada, Germany, Spain, and the United States. Hospital spending near date of death was significantly lower for women in Canada, Germany, and the United States. The age gradient and the sex effect were less pronounced in utilization and spending of emergency care, outpatient care, and drugs. Conclusions Across seven countries, we find important variations in end-of-life care for patients who sustained a hip fracture, with some differences explained by sex and age. Our work sheds important insights that may help ongoing health policy discussions on equity, efficiency, and reimbursement in health care systems. https://onlinelibrary.wiley.com/journal/14756773 Personal Social Services Research Unit R Medicine > RA Public aspects of medicine http://eprints.lse.ac.uk/id/eprint/111934
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Highly-selective µ-opioid receptor antagonism does not block L-DOPA-induced dyskinesia in a rodent model Mitchell J. Bartlett1,2, Lisa Y. So3, Lajos Szabò4, David P. Skinner2, Kate L. Parent4, Michael L. Heien4, Todd W. Vanderah2, Robin Polt4, Scott J. Sherman1 & Torsten Falk1,2,3 Dopamine-replacement utilizing L-DOPA is still the mainstay treatment for Parkinson's disease (PD), but often leads to development of L-DOPA-induced dyskinesia (LID), which can be as debilitating as the motor deficits. There is currently no satisfactory pharmacological adjunct therapy. The endogenous opioid peptides enkephalin and dynorphin are important co-transmitters in the direct and indirect striatofugal pathways and have been implicated in genesis and expression of LID. Opioid receptor antagonists and agonists with different selectivity profiles have been investigated for anti-dyskinetic potential in preclinical models. In this study we investigated effects of the highly-selective μ-opioid receptor antagonist CTAP (> 1200-fold selectivity for μ- over δ-opioid receptors) and a novel glycopeptide congener (gCTAP5) that was glycosylated to increase stability, in the standard rat LID model. Intraperitoneal administration (i.p.) of either 0.5 mg/kg or 1 mg/kg CTAP and gCTAP5 completely blocked morphine's antinociceptive effect (10 mg/kg; i.p.) in the warm water tail-flick test, showing in vivo activity in rats after systemic injection. Neither treatment with CTAP (10 mg/kg; i.p.), nor gCTAP5 (5 mg/kg; i.p.) had any effect on L-DOPA-induced limb, axial, orolingual, or locomotor abnormal involuntary movements. The data indicate that highly-selective μ-opioid receptor antagonism alone might not be sufficient to be anti-dyskinetic. The mainstay of treatment for Parkinson's disease (PD) consists of dopamine replacement therapy with levodopa (L-DOPA; l-3,4-dihydroxyphenylalanine), which was introduced in the 1960′s, remains the most efficacious symptomatic therapy and is considered the gold standard. Although tolerated well in the short term, the chronic use of levodopa, in combination with progression of the disease, results in the development of involuntary movements termed L-DOPA-induced dyskinesia (LID), a common and disabling side effect [1, 2]. Individuals with LID exhibit abnormal levels of many neurotransmitters in addition to dopamine. For example, endogenous opioids are dysregulated in dyskinetic patients, and the striatum is rich in receptors for µ- and δ-opioid receptors. Striatal neurons utilize the opioid peptides dynorphin and met-enkephalin as co-transmitters, and levels of these peptides are altered significantly in PD. Long-term L-DOPA therapy leading to the development of LID elevates levels of opioid peptides and mRNA encoding their precursors in animal models of PD. In postmortem studies, individuals with PD who expressed motor fluctuations due to long-term L-DOPA use express increased striatal preproenkephalin A and preproenkephalin B levels [3, 4]. There is disparity of data from both preclinical and clinical studies that has led to conflicting concepts that opioids represent either a cause of LID or a compensatory mechanism, and both opioid receptor antagonism and agonism, possibly specific to the μ-opioid receptors, are actively being studied for their anti-dyskinetic properties [5,6,7]. In order to investigate the anti-dyskinetic potential of specifically only blocking μ-opioid receptors we conducted experiments in the standard rodent model of established LID, 6-hydroxydopamine (6-OHDA)-lesioned hemi-parkinsonian rats primed with L-DOPA, using the highly-selective μ-opioid receptor antagonists CTAP (IC50 = 3.5 nM and > 1200-fold selective for μ- over δ-opioid receptors) [8] and a congener gCTAP5, that had been glycosylated to increase stability [9]. Main text CTAP glycopeptides were prepared using published methods [10]. CTAP: dPhe-Cys-Tyr-dTrp-Arg-Thr-Pen-Thr (parent peptide); glycosylated congener gCTAP5: dPhe-Cys-Tyr-dTrp-Arg-Thr-Pen-Thr-Gly–Gly-Ser-β Glucopyranoside. Peptide assembly The peptides were assembled on Rink resin using Fmoc (fluorenylmethoxycarbonyl protecting group) methodology. Couplings were accomplished with 1-hydroxy-benzotriazole, N,N′-diisopropyl-carbodiimide and the desired amino acid. Coupling times ranged from 40 min up to 4 h for the more sterically encumbered sequences. For the serine glucoside, 1.3 equiv of the amino acid, and the couplings were monitored with the Kaiser ninhydrin test. For all other amino acids, 3.0 equiv were used. For tyrosine and cysteine, penicillamine O-tert-butyl and S-trityl protecting groups were employed. Then, the N-terminal FMOC-groups were removed, and the acetate groups of the glycoside were removed with hydrazine hydrate in MeOH while on the solid support. After ester cleavage, the resin was washed several times to remove excess hydrazine and vacuum-dried to obtain mass determination. The dried peptide resins were cleaved with a cocktail mixture (9.0 mL trifluoroacetic acid (TFA), 1.0 mL CH2Cl2, 0.25 mL Et3SiH, 0.25 mL H2O, and 0.05 mL anisole per 1.0 g peptide resin) for 2 h at RT. After cleavage was complete, the solutions were filtered to remove the cleaved resin, and the resulting solution was concentrated to an oil in vacuo. After concentration, cold Et2O was poured over the peptide solutions for precipitation. The crude peptides were centrifuged, dried, and purified via preparative reverse-phase high performance liquid chromatography (HPLC) with a linear gradient of 5–80% CH3CN:0.1% aqueous TFA to yield the pure reduced compounds. These samples were cyclized with a solution of 3.0 equiv of K3Fe(CN)6 at pH 8.5 for roughly 16 h using a high-dilution, reverse-addition protocol. Then, these solutions were acidified to pH 4.0, anion-exchanged with Amberlite IRL-80 exchange resin, filtered, and lyophilized. The crude cyclic material was repurified with a preparative as before. CTAP: 63 mg (yield 8.7%), purity > 99% at 280 nm, retention time (Rt): 10.55 min (gradient 5–80%/15 min). Calc. C51H69N13O11S2 Mw: 1103.5, Found electrospray ionization (ESI) [M + H]+ 1104.6. gCTAP5: 47 mg (yield 6.4%), purity > 99% at 280 nm, Rt: 10.07-min (gradient 5–80%/15 min). Calc. C64H90N16O20S2 Mw:1466.6, Found ESI [M + H]+ 1467.3. Animals for LID model and Tail flick experiments Male Sprague–Dawley rats (n = 8 for LID study: 250 g and n = 8 for Tail Flick: 200 g; Harlan, Indianapolis, IN) were used and housed in a temperature and humidity-controlled room with 12-h light/dark cycles with food and water available ad libitum. All animals were treated as approved by the Institutional Animal Care and Use Committee at the University of Arizona and in accordance with the NIH Guidelines for the Care and Use of Laboratory Animals. Number of animals used and their suffering were minimized. Tail-flick paradigm The animals (n = 8) were gently restrained and nociception was administered by dipping the distal third of the tail in a 52 °C water bath. Latency to tail-flick was recorded as the time required for the tail to withdraw from the bath, with a cutoff of 10-seconds to prevent tissue damage. Prior to administering compounds, three measurements of tail-flick latency were recorded with 2-min intervals between tests to establish control latency. The antinociceptive effect of intraperitoneal (i.p.) morphine (10 mg/kg) was determined for each animal every 15 min with measurements of tail-flick latency between 15 and 90 min post-injection. The individual abilities of CTAP and gCTAP5 (0.1, 0.5 and 1 mg/kg, i.p.) to antagonize the antinociceptive effect of morphine were then tested at 48 h intervals. The μ-opioid receptor antagonists were administered 10-min after morphine in order to coincide with its peak effect. Latency time and maximum possible effect (%MPE) were calculated at 45 min post μ-opioid receptor antagonists injection. %MPE = (post injection latency-baseline latency)/[cutoff (10 s)-baseline latency] × 100. The unilateral 6-hydroxydopamine (6-OHDA)-lesion rat PD model Injection of 20 μg 6-OHDA (5.0 μg/μl in 0.9% sterilized saline with 0.02% ascorbic acid; Sigma, St Louis, MO) in 2 locations in the medial forebrain bundle (MFB), as published [11, 12]. The rate of the injection was 0.5 μl per min using a Stoelting microinjector (Stoelting Co., Wood Dale, IL). Rats were pretreated 30 min prior with 12.5 mg/kg desipramine hydrochloride (Sigma, St Louis, MO) given i.p. to prevent damage to noradrenergic neurons. Induction of LID in unilateral lesioned rats Two weeks after surgery the unilateral 6-OHDA-lesioned rats were injected with D-amphetamine (5.0 mg/kg, i.p. injection; Sigma) to induce asymmetrical dopamine release. The number of ipsiversive rotations during 1-minute intervals, every 5 min were counted for a total of 60 min after the injection. 2) Rats with ≥ 4 rotations/minute were selected and were daily treated with 7 mg/kg L-DOPA (with 15 mg/kg benserazide, both i.p.; Sigma) for 3 weeks to establish LID, and the 6 rats that developed stable LID were included in the LID study. Behavioral analysis in the LID rat model L-DOPA-induced abnormal involuntary movements (AIMs) were scored by an experimentally blinded investigator according to an established protocol [11, 12], with a 'within subjects cross over design' to have a vehicle control for every drug tested. For each drug animals were randomized to either receive vehicle or drug on one testing day, and switched 3–4 days later, so that each drug has a separate vehicle control. For quantification of the severity of the AIMs, rats were observed individually in their standard cages every 20th min at 20–80 min after an injection of L-DOPA, and were classified as described [11, 12]. The sum of limb, axial, and orolingual (LAO) AIMs and the sum of locomotor AIMs scores per testing session were used for statistical analyses. Euthanasia and brain tissue harvest Rats were sacrificed after the last dose of drug with carbon dioxide. For a quantitative measure of the extent of the PD-lesion for n = 6 animals the whole brains were extracted, striatal tissue was prepped and frozen at − 80 °C. To validate the lesions post hoc quantitative dopamine (DA) measurements in striatal tissue was then conducted with HPLC-EC, as published [11, 12]. Statistical analysis was performed using GraphPad Prism 8.1 software (GraphPad Software, Inc., La Jolla, CA). Repeated measures one-way ANOVA with Tukey post hoc tests was used for the tail-flick time point raw MPE data. For the DA analysis a two-tailed t test of the raw data was conducted. Non-parametric Kruskal–Wallis test with Dunn's multiple comparisons post hoc tests was used to compare the effect of treatment on LAO- and locomotor AIMs. The null hypothesis was rejected when p < 0.05. CTAP had been shown in prior work to be a blood–brain barrier penetrant drug [8], and used in many rodent studies. Tail-flick testing verified that not only CTAP but also gCTAP5 crossed the blood–brain barrier sufficiently to exhibit a strong reduction of morphine's antinociceptive activity, as tested with the warm water tail-flick paradigm (Fig. 1). This block of morphine's maximal effect at 45 min was seen at doses as small as 0.5 mg/kg, i.p. for both CTAP and gCTAP5 (F3.122, 21.85 = 17.24; p < 0.0001). CTAP and gCTAP5 block morphine effects in a rat model of nociception. At the doses of 0.5 mg/kg and 1.0 mg/kg both gCTAP5 (open triangles) and CTAP (open squares) completely blocked the antinociceptive effect of morphine (10 mg/kg; black circles) effect at the maximum at 45 min. For gCTAP5 even at 0.1 mg/kg a trend of a reduction was evident that did not reach significance. The mean %MPE ± SEM is plotted (n = 8; repeated measures ANOVA with Tukey post hoc tests; p < 0.01, **p < 0.0001) As has been shown in prior work [11, 12] the MFB 6-OHDA-lesion protocol in our hands leads to > 95% depletion of striatal DA content on the lesioned side. We confirmed the lesion post hoc by measuring striatal DA content, and did see a significant reduction (n = 6; two-tailed t-test on raw data before normalization, p < 0.0005) in the lesioned hemisphere by > 95%. In line with this, amphetamine-induced ipsiversive rotations for PD animals (n = 6) included in this study was 5.1 ± 1.3 (mean ± SEM). These animals exhibited severe and stable LID after the 3-week priming with daily L-DOPA treatment. The stability was confirmed with testing the severity of the AIMs three times 3–4 days apart before testing of compounds ensued. The severity of LID is evidenced by mean LAO-AIMs scores of 60, and mean locomotor AIMs scores of 20. When testing for anti-dyskinetic activity in the LID rats, neither CTAP nor gCTAP5 did reduce either LAO-AIMs (Fig. 2a and c) or locomotor AIMs (Fig. 2b and d), not at 5 mg/kg gCTAP, or at the high dose of 10 mg/kg CTAP. The time course data for the LAO-AIMs for CTAP vs. vehicle and gCTAP5 vs. vehicle are presented in Fig. 2 e and f, respectively. Highly-selective μ-opioid receptor antagonism had no effect on L-DOPA-induced AIMs. CTAP (10 mg/kg, i.p.) had no effect on either LAO or locomotor AIMs. a The mean total LAO AIMs scores over 180 min were plotted and there was no difference between vehicle (gray bar) and CTAP (black bar) condition (mean AIMs count ± SEM; n = 6; paired two-tailed t-test). b The mean total locomotor AIMs scores over 180 min were plotted and there was no difference between vehicle (gray bar) and CTAP (black bar) condition. Similarly, gCTAP5 (5 mg/kg, i.p.) had no effect on either LAO or locomotor AIMs. c The mean total LAO AIMs scores over 180 min were plotted and there was no difference between vehicle (gray bar) and gCTAP5 (black bar) condition. d The mean total locomotor AIMs scores over 180 min were plotted and there was no difference between vehicle (gray bar) and gCTAP5 (black bar) condition. In all graphs the mean AIMs counts ± SEM were plotted; n = 6; paired two-tailed t-test. e Time course of the LAO-AIMs (mean ± SEM) data after CTAP administration presented in (a). f Time course of the LAO-AIMs (mean ± SEM) data after gCTAP5 administration presented in (c) The data presented indicate that highly-specific μ-opioid receptor antagonism does not reduce LID in the standard rodent model. This was a surprising finding given prior published findings showing anti-dyskinetic activity of drugs with μ-opioid antagonist activity [7]. There could be 'hidden' beneficial δ-opioid receptor properties in the μ-opioid receptor antagonist ADL5510 that had not been examined as extensively as the much used highly-selective μ-antagonist CTAP. Specifically, it is important that ADL5510 is only 15-fold selective for μ- vs. δ-opioid receptors, while CTAP is > 1200 fold selective for μ- over δ-opioid receptors. In that respect, it is of interest that ADL5510 had a U-shaped dose–response curve in the non-human primate experiments, indicative of more than one property being involved in its therapeutic activity [7]. Further, a recent study did show that the novel molecule DPI-289, a mixed δ-opioid agonist/μ-opioid receptor antagonist, was anti-dyskinetic in both rodent and non-human primate LID models [13]. Similarly, the mixed κ-opioid receptor agonist/μ-opioid receptor antagonist nalbuphine did also reduce LID in dyskinetic non-human LID primates [14]. And the combination of the mixed μ/δ-opioid receptor agonist MMP-2200, with the N-Methyl-d-aspartate receptor (NMDAR) antagonist MK-801 was also shown to be anti-dyskinetic [12]. This points to a possible need of a contribution of μ- and δ-or κ-opioid receptor activity, or a combination of drugs to target opioid and NMDA receptors to achieve anti-dyskinetic action. In Conclusion, combined with the presented data, those findings discussed above indicate that a combination of more than one opioid receptor activity might be needed for full anti-dyskinetic activity of therapeutic drug candidates targeting the opioid system to treat LID, and that highly-selective μ-opioid receptor antagonism alone is not sufficient. Species differences could also account for the discrepancy to the published anti-dyskinetic effects of the modestly-selective μ-opioid receptor antagonist ADL5510 in a non-human primate model of LID [7]. A full dose–response was not conducted in the LID studies, therefore anti-dyskinetic effects of a lower dose cannot be ruled out, yet are not likely given that U-shaped response curves point to a second mode of action that is unlikely in the case of a compound as highly-selective as CTAP (> 1200-fold μ- vs. δ-opioid receptors) [8]. ADL5510: Modestly-selective µ-opioid receptor antagonist Abnormal involuntary movements CTAP: Highly-selective µ-opioid receptor antagonist DPI-289: Mixed δ-opioid agonist/µ-opioid receptor antagonist ESI: Electrospray ionization Fmoc: Fluorenylmethoxycarbonyl protecting group gCTAP5: Glycosylated CTAP HPLC: High performance liquid chromatography HPLC-EC: HPLC with electric coupling IC50: Half maximal inhibitory concentration i.p : Intraperitoneal administration LAO: Limb, axial and orolingual L-DOPA: l-3,4-Dihydroxyphenylalanine LID: L-DOPA-induced dyskinesia MFB: Medial forebrain bundle MPE: Maximum possible effect NMDAR: N-Methyl-d-aspartate receptor Rt: Standard error of the mean 6-OHDA: 6-Hydroxydopamine Trifluoroacetic acid Olanow CW, Stern MB, Sethi K. The scientific and clinical basis for the treatment of Parkinson disease. Neurology. 2009;72:S1–136. Huot P, Johnston TH, Koprich JB, Fox SH, Brotchie JM. The pharmacology of L-DOPA-induced dyskinesia in Parkinson's disease. Pharmacol Rev. 2013;65:171–222. Gertler TS, Chan CS, Surmeier DJ. Dichotomous anatomical properties of adult striatal medium spiny neurons. J Neurosci. 2008;28:10814–24. Seizinger BR, Grimm C, Höllt V, Herz A. Evidence for a selective processing of proenkephalin B into different opioid peptide forms in particular regions of rat brain and pituitary. J Neurochem. 1984;42:447–57. Breslin MB, Lindberg I, Benjannet S, Mathis JP, Lazure C, Seidah NG. Differential processing of proenkephalin by prohormone convertases 1(3) and 2 and furin. J Biol Chem. 1993;268:27084–93. Atwood BK, Kupferschmidt DA, Lovinger DM. Opioids induce dissociable forms of long-term depression of excitatory inputs to the dorsal striatum. Nat Neurosci. 2014;17:540–8. Koprich JB, Fox SH, Johnston TH, Goodman A, Bourdonnec B, Dolle RE, DeHaven RN, DeHaven-Hudkins DL, Little PJ, Brotchie JM. The selective mu-opioid receptor antagonist ADL5510 reduces levodopa-induced dyskinesia without affecting antiparkinsonian action in MPTP-lesioned macaque model of Parkinson's disease. Mov Disord. 2011;26:1225–33. Abbruscato TJ, Thomas S, Hruby VJ, Davis TP. Blood-brain barrier permeability and bioavailability of a highly potent and mu-selective opioid receptor antagonist, CTAP: comparison with morphine. J Pharmacol Exp Ther. 1997;280:402–9. Jones EM, Polt R. CNS active O-linked glycopeptides. Front Chem. 2015;3:40. Mitchell SA, Pratt MR, Hruby VJ, Polt R. Solid-phase synthesis of O-linked glycopeptide analogues of encephalin. J Org Chem. 2001;66:2327–42. Bartlett MJ, Joseph RM, LePoidevin LM, Parent KL, Laude ND, Lazarus LB, Heien ML, Estevez M, Sherman SJ, Falk T. Long-term effect of sub-anesthetic ketamine in reducing L-DOPA-induced dyskinesias in a preclinical model. Neurosci Lett. 2016;612:121–5. Flores AJ, Bartlett MJ, Root BK, Parent KL, Heien ML, Porreca F, Polt R, Sherman SJ, Falk T. The combination of the opioid glycopeptide MMP-2200 and a NMDA receptor antagonist reduced l-DOPA-induced dyskinesia and MMP-2200 by itself reduced dopamine receptor 2-like agonist-induced dyskinesia. Neuropharmacology. 2018;141:260–71. Johnston TH, Versi E, Howson PA, Ravenscroft P, Fox SH, Hill MP, Reidenberg BE, Corey R, Brotchie JM. DPI-289, a novel mixed delta opioid agonist/mu opioid antagonist (DAMA), has L-DOPA-sparing potential in Parkinson's disease. Neuropharmacology. 2018;131:116–27. Potts LF, Park ES, Woo JM, Dyavar Shetty BL, Singh A, Braithwaite SP, Voronkov M, Papa SM, Mouradian MM. Dual κ-agonist/μ-antagonist opioid receptor modulation reduces levodopa-induced dyskinesia and corrects dysregulated striatal changes in the nonhuman primate model of Parkinson's disease. Neurology. 2015;77:930–41. Support: The Michael J. Fox Foundation for Parkinson's Research provided the funds for the study to SJS and RP, but was not involved in design, analysis, or writing of the manuscript. Department of Neurology, The University of Arizona, Tucson, AZ, 85724, USA Mitchell J. Bartlett, Scott J. Sherman & Torsten Falk Department of Pharmacology, The University of Arizona, Tucson, AZ, 85724, USA Mitchell J. Bartlett, David P. Skinner, Todd W. Vanderah & Torsten Falk Graduate Interdisciplinary Program in Neuroscience, The University of Arizona, Tucson, AZ, 85724, USA Lisa Y. So & Torsten Falk Department of Chemistry & Biochemistry, The University of Arizona, Tucson, AZ, 85721, USA Lajos Szabò, Kate L. Parent, Michael L. Heien & Robin Polt Mitchell J. Bartlett Lisa Y. So Lajos Szabò David P. Skinner Kate L. Parent Michael L. Heien Todd W. Vanderah Robin Polt Scott J. Sherman Torsten Falk TF and SJS conceived of the study. MJB and LYS conducted the behavioral studies. TF, RP, SJS and MJB analyzed the data and wrote the manuscript. LS and RP synthesized the glycopeptides. KLP and MLH did the HPLC analysis. DPS and TWV contributed to the tail-flick analysis. All authors read and approved the final manuscript. Correspondence to Torsten Falk. All animals were treated as approved by the Institutional Animal Care and Use Committee at the University of Arizona and in accordance with the NIH Guidelines for the Care and Use of Laboratory Animals. Bartlett, M.J., So, L.Y., Szabò, L. et al. Highly-selective µ-opioid receptor antagonism does not block L-DOPA-induced dyskinesia in a rodent model. BMC Res Notes 13, 149 (2020). https://doi.org/10.1186/s13104-020-04994-7 Mu-opioid receptors Delta-opioid receptors Promoting Negative Results
MW below 22.4 kDa. Chitosan and LMW chitosans were coated to 2.62 mg/in_ on corona treated Cryovac¨ HangPakTM film and examined for inhibition zones on direct contact with 105 CFU/ml inoculated L. innocua TSA agar plates. The results clearly showed neither inhibition zones nor diffusion for non irradiated as well as irradiated chitosan samples. The same results were obtained with paper disks dipped in chitosan and dried for 24 hours. The average amount of chitosan absorbed was found to be 26mg/disk. Native and LMW chitosan bound in the paper disk matrix and was not released into the surrounding media. However, wet paper disks showed clear inhibition zones around the disks for native as well as LMW chitosan. Sirmats, Ebuel, "EFFECT OF MOLECULAR WEIGHT REDUCTION BY GAMMA IRRADIATION ON THE ANTIMICROBIAL ACTIVITY OF CHITOSAN" (2009). All Theses. 537.
The Deep tissue / Therapeutic massage we perform at our Plymouth massage center is similar to Swedish massage but is used to target knots and release chronic muscle tension. If you have pain or tension in a specific area of your body, massaging those muscles along with other muscles with that particular referral pain, will help alleviate the pain that is occurring. Our deep tissue massage therapist will assist you to become more aware of your posture and educate you about the muscular system. Our Deep tissue massage therapist will incorporate stretches in the massage and show you how to stretch at home to aid in the healing process. This massage is good for chronic pain, general soreness or stiffness, loss of range of motion, neck pain, TMJ (grinding, clenching), low back pain, sciatica, knee problems, carpal tunnel syndrome, rotator cuff problems and much more.
Keeping your gums healthy not only prevents gingivitis and periodontal disease, but it can also help improve your memory, according to the Journal of Neurology, Neurosurgery, and Psychiatry. In a study done by the journal, adults who had gingivitis performed worse than those who didn't on tests of memory and cognitive skills. They were more likely to perform poorly on tests of delayed verbal recall and subtraction – two skills we use everyday! Diabetes can make you less able to fight off infection, which includes infections of the gums like periodontal disease. And, some experts have linked uncontrolled diabetes with gum disease, suggesting that untreated periodontal disease may make it more difficult to control blood sugar levels. Having a healthy mouth will help you protect your overall health by making it easier to control and maintain your diabetes. Some research suggests a link between gingivitis and preterm, low-birth-weight infants. With 1 in 8 babies born premature, prevention is the key! Maintaining good oral health may help prevent premature delivery. See your dentist as part of your prenatal care. They will give you good tips and insight into oral health and a healthy pregnancy. It's never too early to start teaching your children to take care of their teeth and gums — healthy habits learned in childhood can pay off in adulthood. And, if you're tempted to shrug off your good oral hygiene habits — brushing, flossing, and seeing your dentist regularly — remember that you're a role model for your kids! The American Academy of Pediatric Dentistry (AAPD) recommends taking children to their first dental appointment after their first tooth grows in. Just like adults, children should see the dentist every six months for cleanings. These visits set a model of oral hygiene children can live by for the rest of their lives. With more than half the 4 million children born each year developing at least one cavity before second grade, teaching our children the importance of good oral hygiene can not be stressed enough! Children should begin brushing their own teeth around the age of 6 years old. Until then, parents are encouraged to brush their children's teeth after their first tooth grows in. Just like adults, teeth should be brushed twice daily and flossed each night. Flossing is necessary to maintaining good home care and should be done when any two of your child's teeth touch each other. Maintaining a healthy diet with lots of fruits and vegetables will not only help their growing bodies, but will also help maintain strong healthy teeth!
Envita has the potential to replace nitrogen fertilizer inputs while maintaining high yields and can even provide a yield bump at a full rate of nitrogen fertilizer. In order to get the best results with Envita, follow these instructions for in-furrow application on corn. For best results we recommend Envita be applied in-furrow. To be clear our research and field scale trials show equal results between seed treatment and in-furrow application – what is most important is that Envita be applied directly to the seed. Past formulations of Envita were less concentrated and required higher water volumes for seed treatments. Our current formulation allows for lower volume seed treatment volumes that are much more practical for commercial application. We will guarantee results with Envita on Corn when applied in-furrow or as a seed treatment when label and use guidelines are followed (read more about our Envita Partner Program), we just want farmers to know that we have more experience and data related to in-furrow applications than seed treatment applications with our new formulation. If you have any questions contact us.
Lumbar Artificial Disc History of spinal fusions: The treatment of spinal disorders has evolved considerably over the last decade. While spinal deformity has always existed, Polio was the major impetus for the use of spine stabilization devices such as Harrington rods and bone grafts. Ultimately superior fixation devices were developed which produced more consistent deformity correction and stability of the spine. With modern fixation devices such as screws and rods, the three-dimensional deformity of scoliosis curvature can be greatly corrected in children and adolescents, and moderately corrected and stabilized in adults. The use of rigid metallic fixation devices for scoliosis, spondylolisthesis, trauma, and spinal reconstruction after cancer will continue to be used until the etiology of these disorders is discovered. Today most of these stabilization devices are utilized to treat age-related degenerative disc disease, and low back pain with nerve compression disorders. Motion Preservation: I am frequently asked to lecture on the pros and cons of the artificial disc because of my familiarity with motion preservation literature written nationally and internationally. Throughout my career, I have studied Adjacent Segment Degeneration and technique for maintaining the natural balance of the spine, which is a major consideration in preserving motion of the spine. The lumbar artificial disc: Advocates of the lumbar artificial disc argue that spinal fusion has two significant drawbacks. The first argument is that stabilization of the spine inherently reduces the functional capacity of the individual because of decreased spinal motion. Secondly, a transfer of forces to the adjacent segments of a spinal fusion accelerates therefore creating the potential for degeneration and the possibility of future reconstructive surgery. According to their theory, motion preservation technologies for spinal disorders would obviate these two negative consequences of spinal fusion. Current lumber artificial disc replacement at L5-S1 is rarely indicated for the following reasons. Failure of lumbar disc replacement and need for revision can be life threatening. There is no significant functional motion at L5-S1. Adjacent segment degeneration has been shown to be equal between disc replacement and fusion at L5-S1. Lumber artificial disc replacement will be subjected to a much steeper learning curve, the short and long-term outcomes may be marginal, and the revision for failed implants will be difficult and at times life-threatening. Current literature suggests that lumber artificial disc replacement when compared to spinal fusion does little to improve overall functional spine motion. Moreover, the current studies indicate when lumber artificial disc replacement is observed for a long period of time, the failure rate is high, and there appears to be little benefit to protecting the adjacent segment as with standard fusion. This leads to a situation where the short-term benefit of the theoretical advantages of lumber artificial disc replacement for motion preservation may lead to significant long-term problems. These findings suggest that the lumbar spine is subjected to significant forces which put high mechanical stress on these implants leading to their failure. From an anatomical standpoint, failure of lumber artificial disc replacement may have serious consequences. The anterior part of the spine lies behind large vessels and intra abdominal structures which make it difficult to reach after the first operation is performed. The Future: Hopefully in the not-too-distant future gene therapy technologies will be applied so that the patient's own disc can be reconstituted and restored to its natural function. In the meantime, fusion or artificial disc devices will be used in clinical trials to treat these conditions. In the News: Dr. Pashman agrees with the conclusions rendered by Medicare in these articles: New York Times Examines Johnson & Johnson's Efforts To Obtain Medicare Coverage for Implantable Spinal Disk, Mar 20, 2006 CMS Proposes To Deny Medicare Coverage for Johnson & Johnson Artificial Spinal Disk, Feb. 17, 2006 Anterior Lumbar Fusion Spine Anatomy
Massive weight loss through exercise and diet or bariatric surgery can be a life-changing achievement. However, often times this accomplishment is overshadowed by loose, excess skin that no longer contracts over the body. In turn, individuals are hesitant (or even embarrassed) to show off their slimmer, thinner bodies. If you have recently lost a large amount of weight but have been left with hanging skin, Dr. Bernabe Vazquez, a Miami board certified surgeon with over 30 years of experience, would like to help. He offers upper and lower body lift surgeries to sculpt the abdomen, buttocks and back areas, for more beautiful contours that accurately represent your slimmer physique. What Does Body Lift Accomplish? Upper and lower body lifts are body contouring procedures that remove excess skin left over after massive weight loss or pregnancy. The upper body lift procedure focuses on toning and firming the arms, outer chest and upper back areas. A lower body lift sculpts the lower abdomen, outer thighs, hips and buttocks. Both procedures tighten the remaining skin to create an overall slimmer appearance. Following surgery, body lift patients often report seeing improvements in their daily lives, both physically and mentally. Most patients find that their clothes fit better, their discomfort from sagging skin is alleviated and their confidence is higher. During an upper body lift procedure, Dr. Vazquez makes an incision at the armpit that extends around the patient's upper body and ends at the back bone. He then removes excess skin, re-sculpts the tissue and tightens the remaining skin. In many cases, the doctor will perform liposuction to eliminate small fat deposits for smoother contours. During a lower body lift procedure, Dr. Vazquez will make an incision that extends around the patient's waist. He will remove any excess fat from the lower abdomen, outer thighs and buttocks with liposuction and then excise loose skin and tighten the remaining skin. Depending on the extent of the procedure, body lift patients may be required to stay overnight in one of our recovery suites. The lower body lift procedure, in particular, can be extensive and may be divided into two smaller procedures. The front of the lower body may be operated on as an extended tummy tuck surgery, while the second half may be operated on as part of a lateral thigh and buttock lift. These two smaller procedures can be done on an outpatient basis. Immediately following surgery, patients must wear a compression garment, and drains may be placed to remove excess fluids from the treated areas. There will be mild to moderate swelling, which should subside within five to seven days. Strenuous exercise, as well as heavy lifting and bending, should be avoided for the first two weeks of recovery. Most patients are able to return to work about two to three weeks after surgery. If you desire a more svelte physique and firmer, tighter skin, Dr. Vazquez can help. He will gladly discuss your body lift options in detail to determine the option that best meets your goals. Schedule a personal consultation today by calling (305) 858-8222. © 2019 Dr. Bernabe Vazquez Surgery - All rights reserved.
Cell Proliferation in Developing Hippocampal Region Nowakowski, Richard S. University of Medicine & Dentistry of NJ, Piscataway, NJ, United States Search 26 grants from Richard Nowakowski Search grants from University of Medicine & Dentistry of NJ Voltage-gated sodium channel regulation of neocortical development Ambystoma Genetic Stock Center Descriptive Database Development for EGRP-Supported Cancer Epidemiology Consortia Enhanced Cell-mediated Immunogenicity of KSHV LANA1 Protein Antiepileptogenic &Disease Modifying Effects of AEDs Telehealth to Improve Prevention of Suicide (TIPS) in EDs Mechanism underlying cognitive and synaptic flexibility Assessment of EEG Responses to Spinal Cord Stimulation Waveforms in Chronic Pain Patients The regulation of cell number and, more specifically, neuron number in the developing CNS is a largely unexplored question. Any answer to this question must consider two important developmental issues: 1) the regulation of neuronal production and 2) the phenomenon of naturally occurring cell death. This project is concerned with the first of these issues. We will determine: 1) how the relative number of proliferative cells changes during the development of a structure, 2) how frequently the proliferative cells divide, and 3) what proportion of the proliferative population becomes permanently post-mitotic at each pass through the cell cycle. We will examine this issue in four different proliferative zones in the developing hippocampal region of the mouse: 1) the ventricular zone of the hippocampus and subiculum, 2) the ventricular zone of the periallocortex (presubiculum, parasubiculum and entorhinal area, 3) the subventricular zone of the periallocortex, and 4) the intrahilar proliferative zone of the dentate gyrus. We will measure the length of the cell cycle (Tc) and the DNA-synthetic phase (Ts) for all of the proliferative population and also for that subpopulation which will produce neurons. For several ages, the proportion of the daughter cells that leave the proliferative zones to become permanently post-mitotic will be determined to test the hypothesis that during developing that proportion increases gradually such that the proliferative population becomes self-exhausting several generations before cell proliferation for that structure ceases. The output of the proliferative zones will be measured by determining the distribution of cells that leave each of the four proliferative populations within a one-hour period (i.e., a """"""""one-hour cohort""""""""). The pattern of distribution of labeled cells from retroviral infections for progeny from three of the four different proliferative populations will be determined. We will develop three probabilistically- driven cytogenetic and histogenic models, a cytokinetic model, and output (or cell proliferation) model, and a cell dispersion model. The model will be used to determine if the results of the various experiments are consistent internally and with each other and to make specific testable predictions. The major methods to be used are: 1) bromodeoxyuridine immunohistochemistry and tritiated thymidine autoradiography both alone and in a series of double labeling experiments, and 2) retroviral transfection of clonally related populations. 1R01NS028061-01A1 Neurology B Subcommittee 2 (NEUB) University of Medicine & Dentistry of NJ Schools of Medicine R01 NS Cell Proliferation in Developing Hippocampal Region Nowakowski, Richard S. / University of Medicine & Dentistry of NJ Takahashi, T; Nowakowski, R S; Caviness Jr, V S (1997) The mathematics of neocortical neuronogenesis. Dev Neurosci 19:17-22 Cai, L; Hayes, N L; Nowakowski, R S (1997) Synchrony of clonal cell proliferation and contiguity of clonally related cells: production of mosaicism in the ventricular zone of developing mouse neocortex. J Neurosci 17:2088-100 Cai, L; Hayes, N L; Nowakowski, R S (1997) Local homogeneity of cell cycle length in developing mouse cortex. J Neurosci 17:2079-87 Takahashi, T; Nowakowski, R S; Caviness Jr, V S (1996) Interkinetic and migratory behavior of a cohort of neocortical neurons arising in the early embryonic murine cerebral wall. J Neurosci 16:5762-76 Caviness Jr, V S; Takahashi, T; Miyama, S et al. (1996) Regulation of normal proliferation in the developing cerebrum potential actions of trophic factors. Exp Neurol 137:357-66 Takahashi, T; Nowakowski, R S; Caviness Jr, V S (1996) The leaving or Q fraction of the murine cerebral proliferative epithelium: a general model of neocortical neuronogenesis. J Neurosci 16:6183-96 Sekiguchi, M; Abe, H; Nagato, Y et al. (1996) The abnormal distribution of mossy fiber bundles and morphological abnormalities in hippocampal formation of dreher(J) (dr(J)/dr(J))mouse. Brain Res Dev Brain Res 92:31-8 Caviness Jr, V S; Takahashi, T; Nowakowski, R S (1995) Numbers, time and neocortical neuronogenesis: a general developmental and evolutionary model. Trends Neurosci 18:379-83 Takahashi, T; Nowakowski, R S; Caviness Jr, V S (1995) The cell cycle of the pseudostratified ventricular epithelium of the embryonic murine cerebral wall. J Neurosci 15:6046-57 Sekiguchi, M; Nowakowski, R S; Nagato, Y et al. (1995) Morphological abnormalities in the hippocampus of the weaver mutant mouse. Brain Res 696:262-7 Showing the most recent 10 out of 19 publications Be the first to comment on Richard Nowakowski's grant
KetoViante: is the most recent decision of weight reduction item and it is additionally demonstrating for its amazing outcome. As of now, most accessible weight reduction item endorsed by the wellbeing division. It has the property of keeping up over the top day by day admission calories that may decrease undesirable fat from the body. This dietary enhancement is an uncommonly detailed formula comprised of chosen home grown concentrates blended with regular fixings which cuts additional craving want and look after digestion. It is very in consuming fat and lipids inside the body. It is made remembering all inconveniences, for example, expands cholesterol, sugar and increment heart issue too. In this way for diminishing these maladies alongside weight it is come to you decreasing stoutness and keeps up your hankering of undesirable nourishment. It is a Personalized Protein item improved with better quality proteins than fulfill hunger and contains exceptionally nutritious fixings and whey protein. KetoViante produced using characteristic strands can help decrease muscle versus fat by stifling your craving. Moreover, you maintain a strategic distance from those disagreeable symptoms frequently connected with pharmaceuticals diet pills. KetoViante is an ideal weight reduction item that can keep up your wellbeing by control your hankering and decimates your undesirable nourishment want. It likewise diminishes the danger of cholesterol and hypertension. • Increase muscle tone: this weight reducer leaving ladies conditioned and men chiseled. • Decreased extends: it doesn't just get thinner however get more tightly, progressively wonderful skin without treatment. • Thin and smooth waistline: it can begin wearing garments you truly need to wear. • Reduce unsafe poisons: It will lessen every single destructive poison from your body. • Support to Avoid lousy nourishment: this powerful weight reduction item stays away from cheap food and can be controlled to take low quality nourishment. • Improve digestion: An extremely quick digestion that touches off your fat throughout the day, so you continue consuming fat even while you rest. • Eliminate hurtful dangerous: it is very invigorating your disposition since it wipes out unsafe poisonous components from the nourishment and aides in detoxification which thusly gives you quality. • Step1-most importantly, you have to take a total dinner before applying these pills. • Step4-You should proceed with your every day exercise and exercise additionally to keep up the parity of your body. • Step5-Drinks bunches of water together of these pills. • Step6-You needs to take this application before bedstead with your life accomplice. • Step7-you can take this supplication before the execution of play area. HCA: It is a characteristic fixing that can be taken with a sound eating routine and customary exercise program. It likewise builds your serotonin levels and it enhances synapse that supports your state of mind, a greater amount of it is created. HCA can stop your additional craving and unquestionably decline the speed with which the body shapes its stores of muscle to fat ratio. This makes it not simply the best weight reduction supplement there is, yet in addition something that helps bring down your danger of circulatory strain issues and malignant growth. Vegetable cellulose: it is an insoluble fiber that your body doesn't have the chemicals to process. It is a wellspring of fiber that assimilates water which adds mass dampness to stool and help avert blockage that is the reason for fat. This implies the best wellsprings of cellulose are vegetables with an absolute fiber. That is likewise to enhance surface and keep from sugar. 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KetoViante is gainful to weight reduction and it is making a point to comprehend your hunger level and reestablish serotonin in human wellbeing. • Improve digestion: This common item enhances digestion and control overabundance craving which is a reason for weight gain. • Burn fat: this is best and best fat shaper that truly helps a great deal in consuming your fat quick. • Improve insusceptible framework: builds your insusceptibility control and sets you up in battling numerous ordinary maladies like cold, hack, fever, cerebral pains and that's only the tip of the iceberg. • Controls blood cholesterol level: more often than not individuals endure heart infections and because of this cholesterol builds step by step yet this offered item wellbeing keeps from hearts issues. • Cure stomach related brokenness: it controls stomach related procedures and snappy consuming of fat atoms and furthermore upgrade vitality to perform every day exercises. KetoViante power to allow great eating regimen for your ideal wellbeing and the assistance of this enhancement may diminish destructive sustenance want which isn't useful for wellbeing, for example, low quality nourishment and sleek sustenance. You should take proteins, magnesium, and potassium by maintaining a strategic distance from unfortunate sustenance. Cereal: As indicated by research, it should take in breakfast since it might enable you to consume fatter, recommended an ongoing report in the diary of sustenance. Plate of mixed greens/soup: Research demonstrates that eating a first-course plate of mixed greens can decrease in general calorie admission at a feast by up to 12 percent. Appreciate these solid soup or plate of mixed greens formulas. Broccoli: It is an incredible wellspring of calcium and critical malignant growth battling mixes and it additionally has strands and will set you back just required calories. It serves to simpler to process. Dark colored rice: Dark colored rice is contained with filaments and 1.7 grams of fat-consuming safe starch and is a low vitality thickness sustenance. KetoViante is a characteristic and home grown item for weight reduction. It is set up under the reconnaissance of analyst and tried on different parameters. Aside from that, it is demonstrated that this weight reducer adjusts the hormones that assistance in controlling body development. It is awesome weight reducer and it is perfect for controlling weight and other wellbeing issue. It conveys protein and nourishment in human wellbeing that can secure for quite a while and does not discharge alongside compound response.
More and more patients are the recipients of solid organ transplants or SOT. Examples include kidney, liver or heart transplants. These patients have their immune systems shut down so their body does not reject their transplanted organ. A recent study included 340 surgeons who performed 552 cosmetic procedures in SOT PATIENTS. The overall complication rate was 4.3% which is not at all excessive. A short time ago I performed a breast augmentation procedure on a kidney transplant patient and she did well. Overall 68% of SOT patients had a kidney transplant.
Right thoracotomy for mitral reoperatron: Analysis of technique and outcome William L. Holman, Steven P. Goldberg, Lesley J. Early, David C. McGiffin, James K. Kirklin, Derrick H. Cho, Albert D. Pacifico Background. This report describes technical details of the right thoracotomy approach for mitral surgery, and analyzes our experience with this procedure for patients with a prior sternotomy. Three methods for myocardial management (hypothermic cardioplegic arrest, beating heart, and fibrillating heart) are compared. Methods. Records were abstracted of patients who had a right thoracotomy between January 1, 1992 and July 1, 1999 for mitral surgery after at least one prior sternotomy. Demographic, operative, and outcome data were collected for analysis. Telephone follow-up was used to measure postoperative New York Heart Association functional status. Results. Eighty-four patients (mean age 60 ± 15 years) had reoperative mitral surgery via a right thoracotomy. Myocardial management included ventricular fibrillation in 10 patients, operation on the beating heart in 58 patients, and hypothermic blood cardioplegia arrest in 16 patients. The mean time in the operating room was 185 ± 73 minutes, and the mean duration of cardiopulmonary bypass was 63 ± 56 minutes. There were no perioperative strokes and the prevalence of death for patients who received cardioplegic arrest was significantly higher than the prevalence of death for patients who had mitral surgery with perfused fibrillating or beating heart techniques (p = 0.007; Fisher's exact test comparing risk-unadjusted mortality). Conclusions. Right thoracotomy provides efficient exposure for reoperative mitral surgery. Mitral valve procedures on the fibrillating or beating heart are feasible in most patients and are at least as safe as surgery using cardioplegic arrest. The Annals of Thoracic Surgery Holman, W. L., Goldberg, S. P., Early, L. J., McGiffin, D. C., Kirklin, J. K., Cho, D. H., & Pacifico, A. D. (2000). Right thoracotomy for mitral reoperatron: Analysis of technique and outcome. The Annals of Thoracic Surgery, 70(6), 1970-1973. https://doi.org/10.1016/S0003-4975(00)02066-X Holman, William L. ; Goldberg, Steven P. ; Early, Lesley J. ; McGiffin, David C. ; Kirklin, James K. ; Cho, Derrick H. ; Pacifico, Albert D. / Right thoracotomy for mitral reoperatron : Analysis of technique and outcome. In: The Annals of Thoracic Surgery. 2000 ; Vol. 70, No. 6. pp. 1970-1973. @article{1aa3954cb63444acb4ae058e210f3da3, title = "Right thoracotomy for mitral reoperatron: Analysis of technique and outcome", abstract = "Background. This report describes technical details of the right thoracotomy approach for mitral surgery, and analyzes our experience with this procedure for patients with a prior sternotomy. Three methods for myocardial management (hypothermic cardioplegic arrest, beating heart, and fibrillating heart) are compared. Methods. Records were abstracted of patients who had a right thoracotomy between January 1, 1992 and July 1, 1999 for mitral surgery after at least one prior sternotomy. Demographic, operative, and outcome data were collected for analysis. Telephone follow-up was used to measure postoperative New York Heart Association functional status. Results. Eighty-four patients (mean age 60 ± 15 years) had reoperative mitral surgery via a right thoracotomy. Myocardial management included ventricular fibrillation in 10 patients, operation on the beating heart in 58 patients, and hypothermic blood cardioplegia arrest in 16 patients. The mean time in the operating room was 185 ± 73 minutes, and the mean duration of cardiopulmonary bypass was 63 ± 56 minutes. There were no perioperative strokes and the prevalence of death for patients who received cardioplegic arrest was significantly higher than the prevalence of death for patients who had mitral surgery with perfused fibrillating or beating heart techniques (p = 0.007; Fisher's exact test comparing risk-unadjusted mortality). Conclusions. Right thoracotomy provides efficient exposure for reoperative mitral surgery. Mitral valve procedures on the fibrillating or beating heart are feasible in most patients and are at least as safe as surgery using cardioplegic arrest.", author = "Holman, {William L.} and Goldberg, {Steven P.} and Early, {Lesley J.} and McGiffin, {David C.} and Kirklin, {James K.} and Cho, {Derrick H.} and Pacifico, {Albert D.}", journal = "The Annals of Thoracic Surgery", Holman, WL, Goldberg, SP, Early, LJ, McGiffin, DC, Kirklin, JK, Cho, DH & Pacifico, AD 2000, 'Right thoracotomy for mitral reoperatron: Analysis of technique and outcome', The Annals of Thoracic Surgery, vol. 70, no. 6, pp. 1970-1973. https://doi.org/10.1016/S0003-4975(00)02066-X Right thoracotomy for mitral reoperatron : Analysis of technique and outcome. / Holman, William L.; Goldberg, Steven P.; Early, Lesley J.; McGiffin, David C.; Kirklin, James K.; Cho, Derrick H.; Pacifico, Albert D. In: The Annals of Thoracic Surgery, Vol. 70, No. 6, 01.12.2000, p. 1970-1973. T1 - Right thoracotomy for mitral reoperatron T2 - Analysis of technique and outcome AU - Holman, William L. AU - Goldberg, Steven P. AU - Early, Lesley J. AU - McGiffin, David C. AU - Kirklin, James K. AU - Cho, Derrick H. AU - Pacifico, Albert D. N2 - Background. This report describes technical details of the right thoracotomy approach for mitral surgery, and analyzes our experience with this procedure for patients with a prior sternotomy. Three methods for myocardial management (hypothermic cardioplegic arrest, beating heart, and fibrillating heart) are compared. Methods. Records were abstracted of patients who had a right thoracotomy between January 1, 1992 and July 1, 1999 for mitral surgery after at least one prior sternotomy. Demographic, operative, and outcome data were collected for analysis. Telephone follow-up was used to measure postoperative New York Heart Association functional status. Results. Eighty-four patients (mean age 60 ± 15 years) had reoperative mitral surgery via a right thoracotomy. Myocardial management included ventricular fibrillation in 10 patients, operation on the beating heart in 58 patients, and hypothermic blood cardioplegia arrest in 16 patients. The mean time in the operating room was 185 ± 73 minutes, and the mean duration of cardiopulmonary bypass was 63 ± 56 minutes. There were no perioperative strokes and the prevalence of death for patients who received cardioplegic arrest was significantly higher than the prevalence of death for patients who had mitral surgery with perfused fibrillating or beating heart techniques (p = 0.007; Fisher's exact test comparing risk-unadjusted mortality). Conclusions. Right thoracotomy provides efficient exposure for reoperative mitral surgery. Mitral valve procedures on the fibrillating or beating heart are feasible in most patients and are at least as safe as surgery using cardioplegic arrest. AB - Background. This report describes technical details of the right thoracotomy approach for mitral surgery, and analyzes our experience with this procedure for patients with a prior sternotomy. Three methods for myocardial management (hypothermic cardioplegic arrest, beating heart, and fibrillating heart) are compared. Methods. Records were abstracted of patients who had a right thoracotomy between January 1, 1992 and July 1, 1999 for mitral surgery after at least one prior sternotomy. Demographic, operative, and outcome data were collected for analysis. Telephone follow-up was used to measure postoperative New York Heart Association functional status. Results. Eighty-four patients (mean age 60 ± 15 years) had reoperative mitral surgery via a right thoracotomy. Myocardial management included ventricular fibrillation in 10 patients, operation on the beating heart in 58 patients, and hypothermic blood cardioplegia arrest in 16 patients. The mean time in the operating room was 185 ± 73 minutes, and the mean duration of cardiopulmonary bypass was 63 ± 56 minutes. There were no perioperative strokes and the prevalence of death for patients who received cardioplegic arrest was significantly higher than the prevalence of death for patients who had mitral surgery with perfused fibrillating or beating heart techniques (p = 0.007; Fisher's exact test comparing risk-unadjusted mortality). Conclusions. Right thoracotomy provides efficient exposure for reoperative mitral surgery. Mitral valve procedures on the fibrillating or beating heart are feasible in most patients and are at least as safe as surgery using cardioplegic arrest. JO - The Annals of Thoracic Surgery JF - The Annals of Thoracic Surgery Holman WL, Goldberg SP, Early LJ, McGiffin DC, Kirklin JK, Cho DH et al. Right thoracotomy for mitral reoperatron: Analysis of technique and outcome. The Annals of Thoracic Surgery. 2000 Dec 1;70(6):1970-1973. https://doi.org/10.1016/S0003-4975(00)02066-X
Background: In 2008-09, evidence of Reston ebolavirus (RESTV) infection was found in domestic pigs and pig workers in the Philippines. With species of bats having been shown to be the cryptic reservoir of filoviruses elsewhere, the Philippine government, in conjunction with the Food and Agriculture Organization of the United Nations, assembled a multi-disciplinary and multi-institutional team to investigate Philippine bats as the possible reservoir of RESTV. Methods: The team undertook surveillance of bat populations at multiple locations during 2010 using both serology and molecular assays. Results: A total of 464 bats from 21 species were sampled. We found both molecular and serologic evidence of RESTV infection in multiple bat species. RNA was detected with quantitative PCR (qPCR) in oropharyngeal swabs taken from Miniopterus schreibersii, with three samples yielding a product on conventional hemi-nested PCR whose sequences differed from a Philippine pig isolate by a single nucleotide. Uncorroborated qPCR detections may indicate RESTV nucleic acid in several additional bat species (M. australis, C. brachyotis and Ch. plicata). We also detected anti-RESTV antibodies in three bats (Acerodon jubatus) using both Western blot and ELISA. Conclusions: The findings suggest that ebolavirus infection is taxonomically widespread in Philippine bats, but the evident low prevalence and low viral load warrants expanded surveillance to elaborate the findings, and more broadly, to determine the taxonomic and geographic occurrence of ebolaviruses in bats in the region. © 2015 Jayme et al.
Why Chinese steelmakers are using less scrap in their blast furnaces Back Insight Author Jordan Permain Analyst View profile Steel Steelmaking Raw Materials Ironmakers are continuously seeking ways to increase production efficiency and reduce costs but, particularly when profitability is good, productivity is a focus area. To achieve this, ironmakers can increase their usage of metallics in the blast furnace (BF) and benefits include, not only increased productivity but also a lower coke requirement, as the iron in metallics is already 'reduced'. This Insight explores the fundamental impacts and limitations of charging metallics into the BF and why Chinese ironmakers have decreased the rate of scrap charging in the past year. Higher scrap use increases productivity and lowers costs The usage of scrap in integrated carbon steelmaking has traditionally been limited to that charged into the basic oxygen furnace (BOF) before the hot metal is added. Other than serving as a necessary coolant during steelmaking, the respective prices of hot metal and scrap, the latter related to availability, largely determined how much scrap would be added. However, scrap, and other metallics, can also be charged directly into the BF along with other burden materials by loading scrap into the top of the BF via the same conveyors that are used to charge iron ore (n.b. as sinter, lump or pellet) and coke and this can provide benefits for ironmakers as outlined below. Higher BF productivity BF productivity increases when more scrap is used. Since scrap contains ~95% Fe that is already fully reduced, energy is only required for heating and melting purposes. This lowers coke consumption as the energy previously required from the coke for reduction of the iron ore is no longer required and energy is only required for melting. A productivity increase is achieved because less coke is required in the BF, which frees up space for more ore to be charged, and because lower slag rates can be achieved. Productivity gains from charging more scrap will be sought by steelmakers with latent BOF capacity, during periods of high margins or when capacity is restricted for environmental reasons, as seen in China in recent years. Impact on ironmaking costs It may be that, from an operating cost perspective, costs are not lowered significantly as a lower ore and coke requirement is likely to be offset by the higher scrap costs. However, a higher productivity should allow fixed costs to be diluted across higher volumes. Where scrap charging into the BF is more routine (e.g. in the USA where scrap is plentiful, cost effective and correct qualities available), this will allow upstream facilities to be downsized relative to total steel make and this will provide a cost saving as the on-going costs of maintaining the asset base should be lower. Scrap usage in the BF has limitations and disadvantages Charging scrap into the BF is not without technical limitations and logistical and operational disadvantages. The most critical risk for ironmakers to consider is that the chemical and physical properties of scrap could disrupt the stability of the BF. Logistically, the storage of scrap would require additional space at the steel site and the scrap may damage the charge conveyor belts. Scrap can be charged at a maximum rate of ~10% of the Fe burden A BF requires ~960 kg of Fe burden to produce 1 tonne of hot metal (i.e. 960 kg/thm) and, due to the respective Fe contents of sinter, lump and pellet, this typically requires a total of ~1.6 t of iron ore burden to be charged. It is also of critical importance to operate BFs in a stable manner. For smooth operation, it is essential that temperature and gas flow in the BF remain constant, but charging scrap can have a cooling effect in the BF due to the lower usage of coke and the physical manner in which scrap is charged into the BF is also important to ensure operational stability. That is, charging scrap in the centre of the BF can reduce the gas permeability. Therefore, scrap is normally charged towards the wall of the BF to mitigate this effect. Our research shows that scrap can be charged up to a maximum of ~10% of the Fe burden without disrupting operational stability, equivalent to ~100 kg/thm. At this level of scrap charging, the coke rate will decrease up to a maximum of ~10%, productivity will increase up to a maximum of ~13% and slag generation will fall up to a maximum of ~8%. Chinese ironmakers have decreased usage of scrap in BFs CRU has conducted significant primary research and understands that steel mills in China have decreased their usage of scrap in the BF in the past year. Our data from 2018 indicates an average scrap rate in the BF of ~68 kg/thm but in 2019 this decreased to ~28 kg/thm. Some ironmakers have reported that they were charging the maximum ~10% of the Fe burden as scrap, whereas others said that they did not use any scrap due to the adverse cooling effect in the BF. A scrap size of ~10 mm, which is a relatively small size, was said to be favoured to prevent damage to conveyors, but scrap up to ~100 mm was manageable. We also found that ironmakers with smaller BFs (i.e. <1,000 m3 in size) were, on average, charging higher amounts of scrap than larger BFs, which likely related to more conservative operating practices in larger BFs. Our analysis of the Chinese steel industry suggests that ironmakers may have decreased the amount of scrap charged into the BF due to lower margins. When we surveyed ironmakers in May 2018, average industry margins (n.b, the average of HRC and rebar) were ~28% but this had decreased to ~8% in May 2019 when our most recent data was collected. In the months preceding May 2018, strict capacity restrictions were in place as part of WHS 2017/2018, which pushed up margins. To capitalise on this, Chinese ironmakers were incentivised to increase productivity at operating BFs by charging more scrap. Conversely, when restrictions were loosened in WHS 2018/2019, falling steel margins led mills to reduce overall scrap usage as the push for additional productivity was not required. One ironmaker remarked that they stopped charging scrap into the BF in early-2019 due to lower margins that arose as a result of oversupply and weak demand. Scrap charging in BFs is beneficial but depends on technical and economic factors From our research we conclude that ironmakers can benefit from productivity gains from charging scrap into BFs but technical limitations, logistical difficulties and economic conditions must be considered. In the past year, Chinese ironmakers have decreased the rate at which they are charging scrap in BFs due to falling margins. Want to read more? Register to continue reading and gain access to all CRU Insights CRU STEELMAKING RAW MATERIALS The CRU Steelmaking Raw Materials team sets the standard for providing in-depth market analysis and forecasts, price assessments and cost analysis for the global steelmaking raw materials industry. Read our Steelmaking Raw Materials story CRU STEELMAKING RAW MATERIALS COVERAGE Metallurgical Coal Metallurgical Coke The Latest from CRU By Jordan Permain 10 July 2019 Topics: Steel, Steelmaking Raw Materials How ASI certifications impact the aluminium market Topic: Aluminium Nornickel to help fill Class 1 supply gap, but more investment needed Topic: Nickel Topics: Aluminium, Aluminium Raw Materials, Coal, Ferroalloys, Nitrogen, Steel, Steelmaking Raw Materials, Uranium
We have 61 guests and 1 member online Black heel=العقب الاسود Black Heel (Calcaneal Petechiae) Black heel (calcaneal petechiae) is a self-limited, asymptomatic, trauma-induced darkening of the posterior or posterolateral aspect of the heel that occurs primarily in young adult athletes. Black heel was first described in a group of basketball players in 1961.1 Although clinically insignificant, black heel is important because of its close clinical resemblance to melanoma. A similar lesion termed black palm (tache noir) has been described on the thenar eminence in weightlifters, gymnasts, golfers, tennis players, and mountain climbers. Black heel (calcaneal petechiae) is caused by a repeated lateral shearing force of the epidermis sliding over the rete pegs of the papillary dermis. This damages the delicate papillary dermal capillaries, resulting in intraepidermal hemorrhage. The exact incidence of black heel (calcaneal petechiae) is unknown. One study involving 596 19-year-old sports participants revealed an incidence of 2.9%.2 This sports-related dermatosis probably is much more common than has been reported. The lesion of black heel (calcaneal petechiae) usually is asymptomatic, although both pain and tenderness can occur. The black areas always resolve spontaneously if the traumatic inciting events are discontinued. Black heel (calcaneal petechiae) primarily occurs in young adult athletes, but it may appear in persons of any age if the appropriate conditions occur. Black heel (calcaneal petechiae) occurs in adolescents and young adults who participate in sports that involve frequent starts and stops, such as basketball, football, soccer, lacrosse, and racquet sports. Additionally, constant pounding on hard surfaces causes injury of the heel against the back of the shoe in runners.3 Patients present with an irregular dark macule over the heel . The lesion usually is asymptomatic and does not inhibit the patient from performing routine daily activities. The patient may or may not relate the onset of the lesions to participation in sports. Examination reveals a blue-to-black macule or patch ranging in size from a few millimeters to several centimeters in diameter. The posterior and posterolateral heel are affected most commonly. On close inspection, multiple petechiae are centrally aggregated with a few scattered satellite macules. The dyschromia often is in a horizontal distribution; however, both circular and oval lesions may occur. Treatment is not necessary for black heel (calcaneal petechiae) because the lesion resolves spontaneously with discontinuation of the causative activity. The placement of a felt pad in the heel of the shoe may be curative. Skin lubrication, heel cups, a change of footwear, wearing 2 pairs of thick socks, and a break from training may reduce the incidence of black heel (calcaneal petechiae). Paring down the black heel (calcaneal petechiae) lesion with a scalpel blade may result in a complete clearing of the dyschromia. Sports participation can be continued without harm to the patient, although the black heel (calcaneal petechiae) will persist unless padding is added to the heel of the athletic shoe
Click to toggle navigation menu. About UsClick to expand menu. Government Contract Vehicles Kristin Anderson Moore Lecture ResearchClick to expand menu. Child Maltreatment/Child Welfare Families and Parenting Race Equity Teen Pregnancy/Reproductive Health ECDCClick to expand menu. About ECDC SHINE Initiative Integrated Early Childhood Data State-Level Data Systems Staff/Contact Hispanic InstituteClick to expand menu. Childhood adversity screenings are just one part of an effective policy response to childhood trauma David Murphey, Jessica Dym Bartlett Exposure to adversity in childhood is widespread and can pose a serious threat to individual health and well-being over the life course. By age 18, nearly half (45 percent) of children in the United States have had at least one adverse experience; among young children and other vulnerable subgroups, the prevalence is much higher.[1],[2],[3],[4] Childhood adversity is defined as one or more stressful events or conditions that can threaten a child's sense of safety and negatively affect the child's developing brain, physical and mental health, and behavior.[5] Examples of common childhood adversities include abuse and neglect, living with a parent with mental illness or a substance abuse disorder, or witnessing violence. Policymakers should promote adversity screening only as one component of a comprehensive, trauma-informed, strengths-based approach to addressing childhood adversity. Amid increasing public awareness and concern about the harmful consequences of early adversity, policymakers in a number of states are calling for routine screening of individual children—in pediatric care, home visiting programs, early care and education, schools, and other child and family service settings—using the short list of adversities included in the original Adverse Childhood Experiences (ACEs) study.[6] As this movement gains traction, it is essential for policymakers to understand the limitations of this approach, as well as its potential for unintended consequences. These include: The potential for re-traumatizing children and families Contributing to stigma and a deficits focus The lack of age- and culture-sensitive screening tools A misleadingly narrow conception of adversity Given the limitations of a screening-only approach, we recommend that policymakers instead adopt the following strategies for addressing childhood adversity: Train service providers across child and family service systems in trauma-informed care (TIC).[7] TIC includes a wide range of approaches to identifying and addressing childhood adversity and lays a critical foundation for comprehensive screening and follow-up. Training in TIC has been shown to increase trauma knowledge and skills among service providers, family members, and foster parents, and to promote positive behaviors and mental health outcomes among children with symptoms of posttraumatic stress (e.g., problem behaviors, problems forming healthy attachments).[8],[9],[10],[11] Promote adversity screening only as one component of a comprehensive, trauma-informed, strengths-based approach to addressing childhood adversity. Essential elements of this approach include the following: Service providers who are trained to sensitively conduct screening for adversity, without traumatizing or re-traumatizing the child and family, and without drawing faulty assumptions about a child's future prospects High-quality screening tools shown to be valid for the child's age and culture, and which account for social inequities (e.g., poverty, homelessness, discrimination, community violence, adversity related to immigration) Screening that assesses not only a child's exposure to adversity (i.e., the types of adversity a child has experienced), but also a child's reactions (i.e., trauma symptoms and related behaviors), which vary widely and require different types of intervention—or no intervention at all Service systems that can facilitate a family's access to evidence-based treatment and supports, when needed Screening that is accompanied by comprehensive assessment across multiple domains of development (e.g., social-emotional, cognitive, language, physical development); such assessments can identify delays and other potential barriers to children's healthy development, as well as promotive and protective factors in the household and community that can prevent or mitigate the harmful effects of early adversity Support research to develop more sensitive tools for assessing adversity exposure in young children. Children's reactions to adversity vary widely. Personal characteristics such as age and developmental stage, along with family and environmental stressors and supports, shape each child's adjustment following exposure. Few screening tools are appropriate for infants and toddlers, despite the fact that their risk of exposure to many types of adversity (e.g., child abuse and neglect, domestic violence, unintentional injuries) is greater than for older children, and that they are especially vulnerable to the negative effects of trauma.[12],[13],[14] Adverse childhood experiences are different than child trauma, and it's critical to understand why American Indians and Alaska Natives must be included in research on adverse childhood experiences The prevalence of adverse childhood experiences, nationally, by state, and by race or ethnicity Increase the availability and accessibility of evidence-based therapies. There are a number of effective treatments for childhood trauma following adversity (e.g., Child-Parent Psychotherapy,[15] Parent-Child Interaction Therapy,[16] Trauma-Focused Cognitive Behavioral Therapy[17]). Yet current demand far exceeds capacity, and children—particularly infants and toddlers—often face lengthy waits before they can access treatment because few trained providers are available in their community. Increasing the number of professionals trained to deliver evidence-based treatment—in addition to increasing families' access to such professionals—is essential for children whose well-being may be compromised in the absence of such support. Implement preventive strategies that reduce the likelihood of early adversity and its harmful effects on children and promote resilience in development. Prevention and early intervention are the most effective strategies for avoiding the negative effects of childhood adversity on children, families, and society. Making economic opportunity more inclusive, particularly for population groups who experience multiple disadvantages, should be part of this agenda; it is especially important to reduce poverty among children. Reducing children's exposure to violence; and supporting safe, stable, nurturing relationships in families, schools, and other settings also represent essential overarching strategies. We view growing public recognition of the importance of childhood adversity as a monumental development in the promotion of child well-being. However, it is also critical to guide policymakers toward the most effective, evidence-based strategies. Policymakers should not presume that screening as a standalone strategy is an adequate response to addressing the needs of children and their families. Thus, we join a number of experts[18],[19] cautioning against oversimplified adversity screening strategies, particularly those that employ tools such as the ACEs study index.[20] Rather, we need more comprehensive, trauma-informed[21] approaches that account for social-structural adversity and are aligned with current science on recognizing, understanding, responding effectively to—and preventing—childhood adversity. Adverse childhood experience (ACE) – A term introduced by the Adverse Childhood Experiences (ACE) study (Centers for Disease Control and Prevention, and Kaiser Permanente, 1995-1997) to refer to the specific types of household challenges assessed in that study, occurring prior to an individual's reaching age 18. ACE study index – The measure used in the ACE study to assess childhood exposure to the following adversities: physical, emotional, and sexual abuse; parental mental illness; substance abuse in the household; incarceration of a household member; and witnessing violence against a mother. Two additional adversities—child neglect (emotional or physical) and parental separation or divorce—were added to the study in follow-up investigations. Childhood adversity – One or more events or circumstances (including, but not limited to, those used in the ACE study) that can be harmful to a child's short- and long-term physical and psychological health. Trauma – An individual's experience of one or more events or circumstances as psychologically and/or physically harmful or life-threatening. Toxic stress – A over-activation of the body's stress response system, accompanying trauma, which can lead to lasting impairments in physical and mental health, brain development, and genetic structure. Trauma-informed care – A service system, program, or intervention in which all participations, practices, and policies reflect an understanding of the far-reaching impact of trauma, identify its signs and symptoms in individuals, provide pathways for recovery, and avoid re-traumatizing the individuals affected. [1] Benjet, C., Bromet, E., Karam, E. G., & Kessler, R. C., McLaughlin, K. A., Ruscio, A. M., …Koenen, K. C. (2016). The epidemiology of traumatic event exposure worldwide: Results from the World Mental Health Survey Consortium. Psychological Medicine, 46(2), 327-343. [2] Fantuzzo, J., & Fusco, R. (2007). Children's direct exposure to types of domestic violence crime: A population-based investigation. Journal of Family Violence, 22(7), 543-552. [3] Grossman, G. (2000). The history of injury control and the epidemiology of child and adolescent injuries. The Future of Children, 10(1), 23-52. [4] U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. (2019). Child maltreatment 2017. Retrieved March 8, 2019 from https://www.acf.hhs.gov/cb/resource/child-maltreatment-2017 [5] SAMHSA-HRSA Center for Integrated Health Solutions. (2018). Trauma. Rockville, MD: Author. Retrieved February 22, 2019 from https://www.samhsa.gov/capt/practicing-effective-prevention/prevention-behavioral-health/adverse-childhood-experiences [6] Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258. [7] Substance Abuse and Mental Health Services Administration. (2014). Substance Abuse and Mental Health Services Administration. (2014). SAMHSA's concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Author. [8]Bartlett, J. D., & Steber, K., (2019, May). How to implement trauma-informed care to build resilience to childhood trauma. Bethesda, MD: Child Trends. Retrieved May 17, 2019 from https://www.childtrends.org/publications/how-to-implement-trauma-informed-care-to-build-resilience-to-childhood-trauma [9] Barto, B., Bartlett, J. D., Bodian, R., Noroña, C.R., Spinazzola, J., Griffin, J. L., Goldman-Fraser, J., Montagna, C., & Todd, M. (2018). The impact of a statewide trauma-informed child welfare initiative on children's permanency and maltreatment outcomes. Children & Youth Services Review, 81, 149-160. [10] Redd, Z., Malm, K., Moore, K., Murphey, K., & Beltz, M. (2017). KVC's Bridging the Way Home: An innovative approach to the application of Trauma Systems Therapy in child welfare. Children & Youth Services Review, 76, 170-180. [11] Murphy, K., Moore, K. A., Redd, Z., & Malm, K. (2017). Trauma-informed child welfare systems and children's well-being: A longitudinal evaluation of KVC's bridging the way home initiative. Children & Youth Services Review, 75, 22-34. [12] Fantuzzo, J., & Fusco, R. (2007). Children's direct exposure to types of domestic violence crime: A population-based investigation. Journal of Family Violence, 22(7), 543-552. [13] Grossman, D. C. (2000). The history of injury control and the epidemiology of child and adolescent injuries. The Future of Children, 10(1), 23-52. [14] U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. (2019). Child maltreatment 2017. Retrieved February 3, 2019 from https://www.acf.hhs.gov/sites/default/files/cb/cm2017.pdf [15] Lieberman, A., & Van Horn, P. (2004/2016). Don't hit my mommy: A manual for Child-Parent Psychotherapy with young witnesses of family violence. Washington, DC: Zero to Three Press. [16] Eyberg, S. M., Boggs, S., & Algina, J. (1995). Parent–Child Interaction Therapy: A psychosocial model for the treatment of young children with conduct problem behavior and their families. Psychopharmacology Bulletin, 31, 83–91. [17] Cohen, J. C., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: Guilford. [18] Finkelhor, D. (2018). Screening for adverse childhood experiences (ACEs): Cautions and suggestions. Child Abuse & Neglect, 85, 174-179. [19] McEwen, C., & Gregerson, S. F. 2019). A critical assessment of the Adverse Childhood Experiences Study at 20 Years. American Journal of Preventive Medicine, 56(6), 790-794. [20] Felitti et al. (1998). [21] Substance Abuse and Mental Health Services Administration. (2014). Close newsletter popup. 7315 Wisconsin Avenue, Suite 1200W © Copyright 2020 ChildTrends

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