The efficacy of a shared-care surveillance protocol for asymptomatic renal calculi

Objective:

Patients at our institution with asymptomatic calyceal stones (<11 mm) are discharged to their GPs with a request for 12- and 24-month X-ray KUBs with specific re-referral criteria. We aimed to assess the effectiveness of this shared care protocol as well as to investigate long-term outcomes.

Patients and methods:

All patients satisfying the above criteria discharged during October 2009–June 2011 were reviewed for protocol compliance, symptomatic events and/or surgical intervention up to July 2015.

Results:

A total of 134 patients were identified. Out of 115 patients eligible for their first X-ray, and 100 patients eligible for their second X-ray, 43% and 26% respectively were performed. Of these, 75% demonstrated no progression. No patients were treated surgically solely on the basis of radiographic progression. Over a mean five-year follow-up, patients had a 39% chance of experiencing a symptomatic event and a 24% chance of requiring surgical intervention (ESWL, ureteroscopy and/or PCNL). Risk factors included a previous stone history and having a total stone size >10 mm.

Conclusion:

There was poor adherence to this protocol. Despite this, only symptomatic patients were treated surgically, challenging the value of indefinite surveillance of asymptomatic patients. Longitudinal studies are needed to determine a cost-effective manner in which these patients can be safely followed up.

Glycemic Control in US Immigrant and Nonimmigrant Black Youth with Type 1 Diabetes

Differences in glycemic control based on race have been reported in pediatric populations with type 1 diabetes (T1D). It is unknown if differences exist between pediatric populations within the same race classification. This retrospective study identified all immigrant and nonimmigrant Black youth diagnosed with T1D and treated at Seattle Children's Hospital from 2001 to 2011. Demographic characteristics and hemoglobin A1c (HbA1c) levels at 12, 24, and 36 months post diagnosis were obtained from existing medical records. Immigrant youth had lower mean HbA1c levels at all three time points. The ethnicity effect on mean HbA1c levels approached significance at 36 months. When comparing 12 and 36 months, the time effect was significant; the ethnicity effect approached significance. Clinically important differences may exist in glycemic control between pediatric populations with T1D from the same race classification. Additional work is needed to confirm these findings and determine potential causes.

SEM Studies of Cholesteric Liquid Crystals

A special method of preparation of cholesteric liquid crystals is reported, which is useful for the investigation of cholesteric structures with very small pitches. This freeze-etching method makes it possible to observe pitches with scanning electron microscopy without influencing the structure by solvent molecules.

Notizen: Electroreduction of Organic Compounds, XVIII / Electrochemical Dehalogenation of Chlorinated Dibenzofurans and Dibenzo-p-dioxins in Methanol

Mono and polyhalogenated dibenzofurans and dibenzo-p-dioxins are electrochemically reduced in a divided cell in technical methanol at a lead cathode.

Electroreduction of Organic Compounds, 27 Electrochemical Dehalogenation of Endosulfane

Partial dechlorination takes place if Endosulfane® is electrolysed in methanol solution at lead cathodes. The products are detected and identified by GC/MS, IR and NMR spectroscopy. The structure of the product 2 is confirmed by an X-ray structural analysis.

Electroreduction of Organic Compounds, 25 Electrochemical Dehalogenation of Chlorinated Insecticides

Partial but regio- and stereoselective dechlorination takes place if polychlorinated oligocyclic insecticides (Diels-Alder adducts and dimers of hexachlorocyclopentadiene) are electrolysed in methanol solution at lead cathodes. The products are detected and identified by GC/MS, IR and NMR spectroscopy. The structure of the product 2 formed from Mirex® is confirmed by an X-ray structural analysis.

Solute and Temperature Induced Pitch Changes and Pretransitional Effects in Cholesteric Liquid Crystals

The effect of non-chiralic solute molecules on the pitch of cholesteric mixtures of cholesteryl chloride and cholesteryl nonanoate has been studied as a function of the composition and the temperature. The occurrence of a pretransition to the smectic state at low CC content is established. In the pretransitional state the pitch decreases exponentially with increasing temperature and is extremely sensitive against the addition of most organic molecules. In the normal cholesteric state the pitch increases with increasing temperature. In this state only a very limited number of nonchiralic molecules exert an appreciable influence on the pitch.

Depressive symptoms, self-esteem, HIV symptom management self-efficacy and self-compassion in people living with HIV

The aims of this study were to examine differences in self-schemas between persons living with HIV/AIDS with and without depressive symptoms, and the degree to which these self-schemas predict depressive symptoms in this population. Self-schemas are beliefs about oneself and include self-esteem, HIV symptom management self-efficacy, and self-compassion. Beck's cognitive theory of depression guided the analysis of data from a sample of 1766 PLHIV from the USA and Puerto Rico. Sixty-five percent of the sample reported depressive symptoms. These symptoms were significantly (p ≤ 0.05), negatively correlated with age (r = -0.154), education (r = -0.106), work status (r = -0.132), income adequacy (r = -0.204, self-esteem (r = -0.617), HIV symptom self-efficacy (r = - 0.408), and self-kindness (r = - 0.284); they were significantly, positively correlated with gender (female/transgender) (r = 0.061), white or Hispanic race/ethnicity (r = 0.047) and self-judgment (r = 0.600). Fifty-one percent of the variance (F = 177.530 (df = 1524); p < 0.001) in depressive symptoms was predicted by the combination of age, education, work status, income adequacy, self-esteem, HIV symptom self-efficacy, and self-judgment. The strongest predictor of depressive symptoms was self-judgment. Results lend support to Beck's theory that those with negative self-schemas are more vulnerable to depression and suggest that clinicians should evaluate PLHIV for negative self-schemas. Tailored interventions for the treatment of depressive symptoms in PLHIV should be tested and future studies should evaluate whether alterations in negative self-schemas are the mechanism of action of these interventions and establish causality in the treatment of depressive symptoms in PLHIV.

A multinational study of self-compassion and human immunodeficiency virus-related anxiety

AIM

This study represents an initial effort at examining the association between the construct of self-compassion and human immunodeficiency virus (HIV)-related anxiety in a multinational population with HIV disease.

BACKGROUND

Previous studies have found that self-compassion is a powerful predictor of mental health, demonstrating positive and consistent linkages with various measures of affect, psychopathology and well-being, including anxiety.

METHODS

Cross-sectional data from a multinational study conducted by the members of the International Nursing Network for HIV Research (n = 1986) were used. The diverse sample included participants from Canada, China, Namibia, the United States of America and the territory of Puerto Rico. Study measures included the anxiety subscale of the Symptom Checklist-90 instrument, the Brief Version Self-Compassion Inventory and a single item on anxiety from the Revised Sign and Symptom Checklist.

FINDINGS

Study findings show that anxiety was significantly and inversely related to self-compassion across participants in all countries. We examined gender differences in self-compassion and anxiety, controlling for country. Levels of anxiety remained significantly and inversely related to self-compassion for both males (P = 0.000) and females (P = 0.000). Levels of self-compassion and anxiety varied across countries.

CONCLUSIONS

Self-compassion is a robust construct with cross-cultural relevance. A culturally based brief treatment approach aimed at increasing self-compassion may lend itself to the development of a cost effective adjunct treatment in HIV disease, including the management of anxiety symptoms.

Mediators of antiretroviral adherence: a multisite international study

The purpose of this study was to investigate the effects of stressful life events (SLE) on medication adherence (3 days, 30 days) as mediated by sense of coherence (SOC), self-compassion (SCS), and engagement with the healthcare provider (eHCP) and whether this differed by international site. Data were obtained from a cross-sectional sample of 2082 HIV positive adults between September 2009 and January 2011 from sites in Canada, China, Namibia, Puerto Rico, Thailand, and US. Statistical tests to explore the effects of stressful life events on antiretroviral medication adherence included descriptive statistics, multivariate analysis of variance, analysis of variance with Bonferroni post-hoc analysis, and path analysis. An examination by international site of the relationships between SLE, SCS, SOC, and eHCP with adherence (3 days and 30 days) indicated these combined variables were related to adherence whether 3 days or 30 days to different degrees at the various sites. SLE, SCS, SOC, and eHCP were significant predictors of adherence past 3 days for the United States (p = < 0.001), Canada (p = 0.006), and Namibia (p = 0.019). The combined independent variables were significant predictors of adherence past 30 days only in the United States and Canada. Engagement with the provider was a significant correlate for antiretroviral adherence in most, but not all, of these countries. Thus, the importance of eHCP cannot be overstated. Nonetheless, our findings need to be accompanied by the caveat that research on variables of interest, while enriched by a sample obtained from international sites, may not have the same relationships in each country.

Impact of brain tumor location on morbidity and mortality: a retrospective functional MR imaging study

BACKGROUND AND PURPOSE

fMRI is increasingly used in neurosurgery to preoperatively identify areas of eloquent cortex. Our study evaluated the efficacy of clinical fMRI by analyzing the relationship between the distance from the tumor border to the area of functional activation (LAD) and patient pre- and postoperative morbidity and mortality.

MATERIALS AND METHODS

The study included patients with diagnosis of primary or metastatic brain tumor who underwent preoperative fMRI-based motor mapping (n=74) and/or language mapping (n=77). The impact of LAD and other variables collected from patient records was analyzed with respect to functional deficits in terms of morbidity (paresis and aphasia) and mortality.

RESULTS

Significant relationships were found between motor and language LAD and the existence of either pre- or postoperative motor (P < .001) and language deficits (P=.009). Increasing age was associated with motor and language deficits (P=.02 and P=.04 respectively). Right-handedness was related to language deficits (P=.05). Survival analysis revealed that pre- and postoperative deficits, grade, tumor location, and LAD predicted mortality. Motor deficits increased linearly as the distance from the tumor to the primary sensorimotor cortex decreased. Language deficits increased exponentially as the distance from the tumor to the language areas decreased below 1 cm. Postoperative mortality analysis showed an interaction effect between motor or language LAD and mortality predictors (grade and tumor location, respectively).

CONCLUSIONS

These findings indicate that tumors may affect language and motor function differently depending on tumor LAD. Overall, the data support the use of fMRI as a tool to evaluate patient prognosis and are directly applicable to neurosurgical planning.

Structural stability and decomposition of Mg(BH(4))(2) isomorphs-an ab initio free energy study

We present the first comprehensive comparison between free energies, based on a phonon dispersion calculation within density functional theory, of theoretically predicted structures and the experimentally proposed α (P6(1)) and β (Fddd) phases of the promising hydrogen storage material Mg(BH(4))(2). The recently proposed low-density [Formula: see text] ground state is found to be thermodynamically unstable, with soft acoustic phonon modes at the Brillouin zone boundary. We show that such acoustic instabilities can be detected by a macroscopic distortion of the unit cell. Following the atomic displacements of the unstable modes, we have obtained a new F 222 structure, which has a lower energy than all previously experimentally and theoretically proposed phases of Mg(BH(4))(2) and is free of imaginary eigenmodes. A new meta-stable high-density I4(1)/amd structure is also derived from the [Formula: see text] phase. Temperatures for the decomposition are found to be in the range of 400-470 K and largely independent of the structural complexity, as long as the primary cation coordination polyhedra are properly represented. This opens a possibility of using simple model structures for screening and prediction of finite temperature stability and decomposition temperatures of novel borohydride systems.

Symptom management and self-care for peripheral neuropathy in HIV/AIDS

Peripheral neuropathy is the most common neurological complication in HIV and is often associated with antiretroviral therapy. As part of a larger study on self-care for symptoms in HIV disease, this study analyzed the prevalence and characteristics of peripheral neuropathy in HIV disease, sociodemographic and disease-related correlates and self-care strategies. A convenience sample of 1,217 respondents was recruited from data collection sites in several US cities, Puerto Rico, Colombia and Taiwan. Results of the study indicated that respondents with peripheral neuropathy (n=450) identified 20 self-care behaviors including complementary therapies, use of medications, exercise and rest and/or elevation of extremities. Ratings of frequency and effectiveness were also included. An activities checklist summarized into five categories of self-care behaviors including activities/thoughts, exercise, medications, complementary therapies and substance was used to determine self-care behaviors. Taking a hot bath was the most frequent strategy used by those with peripheral neuropathy (n=292) and received the highest overall rating of effectiveness of any self-management strategies included in this study at 8.1 (scale 1-10). Other self-care strategies to manage this symptom included: staying off the feet (n=258), rubbing the feet with cream (n=177), elevating the feet (n=236), walking (n=262), prescribed anti-epileptic agent (n=80), prescribed analgesics (n=84), over-the-counter medications (n=123), vitamin B (n=122), calcium supplements (n=72), magnesium (n=48), massage (n=156), acupuncture (n=43), reflexology (n=23) and meditation (n=80). Several behaviors that are often deemed unhealthy were included among the strategies reported to alleviate peripheral neuropathy including use of marijuana (n=67), cigarette smoking (n=139), drinking alcohol (n=81) and street drugs (n=30).

Hydrogen Dynamics in Na3AlH6: A Combined Density Functional Theory and Quasielastic Neutron Scattering Study

Understanding the elusive catalytic role of titanium-based additives on the reversible hydrogenation of complex hydrides is an essential step toward developing hydrogen storage materials for the transport sector. Improved bulk diffusion of hydrogen is one of the proposed effects of doping sodium alanate with TiCl3, and here we study hydrogen dynamics in doped and undoped Na3AlH6 using a combination of density functional theory calculations and quasielastic neutron scattering. The hydrogen dynamics is found to be vacancy mediated and dominated by localized jump events, whereas long-range bulk diffusion requires significant activation. The fraction of mobile hydrogen is found to be small for both undoped and doped Na3AlH6, even at 350 K, and improved hydrogen diffusion as a result of bulk-substituted titanium is found to be unlikely. We also propose that previously detected low-temperature point defect motion in sodium alanate could result from vacancy-mediated sodium diffusion.

Customizing a clinical data warehouse for housestaff education in practice-based learning and improvement

We developed Systems and Practice Analysis for Resident Competencies (SPARC), a Web-based tool to support teaching the practice-based learning and improvement (PBLI) ACGME competencies. SPARC allows Department of Medicine residents to explore de-identified, population-based data about their patient panels with peer comparisons. Data primarily comes from an existing data warehouse that has been customized for this application. Our preliminary evaluation suggests that it improves residents' abilities in PBLI, is easy to use, and perceived as important and useful by the housestaff.