Population-specific modelling of between/within-subject flow variability in the carotid arteries of the elderly

Computational fluid dynamics models are increasingly proposed for assisting the diagnosis and management of vascular diseases. Ideally, patient-specific flow measurements are used to impose flow boundary conditions. When patient-specific flow measurements are unavailable, mean values of flow measurements across small cohorts are used as normative values. In reality, both the between-subjects and within-subject flow variabilities are large. Consequently, neither one-shot flow measurements nor mean values across a cohort are truly indicative of the flow regime in a given person. We develop models for both the between-subjects and within-subject variability of internal carotid flow. A log-linear mixed effects model is combined with a Gaussian process to model the between-subjects flow variability, while a lumped parameter model of cerebral autoregulation is used to model the within-subject flow variability in response to heart rate and blood pressure changes. The model parameters are identified from carotid ultrasound measurements in a cohort of 103 elderly volunteers. We use the models to study intracranial aneurysm flow in 54 subjects under rest and exercise and conclude that OSI, a common wall shear-stress derived quantity in vascular CFD studies, may be too sensitive to flow fluctuations to be a reliable biomarker.

Utility of a chemotherapy toxicity prediction tool for older patients in a community setting

Background

Expert groups have recommended incorporation of a geriatric assessment into clinical practice for older patients starting oncologic therapy. However, that practice is not standard primarily because of resource limitations. In the present study, we evaluated the effect on treatment decisions by oncologists in the community oncology setting of a brief geriatric assessment tool that estimates risk of toxicity.

Methods

This prospective longitudinal study in 5 community oncology practices in British Columbia involved patients 70 years of age and older starting a new cytotoxic chemotherapy regimen. Clinical personnel completed a brief validated geriatric assessment tool-the Cancer and Aging Research Group chemotherapy toxicity tool (carg-tt)-that estimates the risk of grade 3 or greater toxicity in older patients. Physicians were asked if the carg-tt changed their treatment plan or prompted extra supports. Patients were followed to assess the incidence of toxicity during treatment.

Results

The study enrolled 199 patients between July 2016 and February 2018. Mean age was 77 years. Treatment was palliative in 61.4% of the group. Compared with physician judgment, the carg-tt predicted higher rates of toxicity. In 5 patients, treatment was changed based on the carg-tt. In 38.5% of the patients, data from the tool prompted extra supports. Within the first 3 cycles of treatment, 21.3% of patients had experienced grade 3 or greater toxicity.

Conclusions

This study demonstrates that use of a brief geriatric assessment tool is possible in a broad community oncology practice. The tool modified the oncologist's supportive care plan for a significant number of older patients undertaking cytotoxic chemotherapy.

Severe Anemia and Helicobacter Pylori Infection in school age Children; A case reports

BACKGROUND

Iron-deficiency anemia is a widespread public health problem with major consequences for human health especially, children. However, in a fraction of patients an underlying cause is never found during routine investigation. Recent studies have suggested an association between Helicobacter pylori (H. Pylori) infection and iron-deficiency anemia.

CASE PRESENTATION

Here is reported four school aged children (two male, two female) with refractory severe iron-deficiency anemia associated H. Pylori gastritis. Mean age of the patients was 13.62 years old and they were admitted with chief complaints of abdominal, chest pain weakness, headache and respiratory distress. Mean hemoglobin level in patients was 6.2 g/dl with persistence to iron therapy. After the diagnosis and therapy of H. pylori infection, clinical complaints, hemoglobin level and iron profiles were being normal and they gained weight.

CONCLUSION

This study suggests screening of H. pylori infection and appropriate treatment in any case of refractory moderate to severe iron-deficiency anemia, especially with clinical manifestations of gastrointestinal tract in children.

Seroprevalence of Hepatitis B, Hepatitis C and Human Immunodeficiency Viruses among Thalassemia Patients in West North of Iran

BACKGROUND

Thalassemia patients that are conventionally treated by a regular transfusion regimen are exposed to blood born viral infections.The aim of this study was to investigate the seroprevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and human Immunodeficiency virus (HIV) among all multitransfused thalassemia patients in west north of Iran.

MATERIAL AND METHODS

A retrospective study was conducted in February 2014, on 32 patients in Urmia, suffering from transfusion dependent thalassemia were admitted to Motahari and Emam Khomeini hospitals. Patients' medical records were studied for HBs antigen and seropositivity for HCV, and HIV antibodies.

RESULTS

Out of 32transfusion dependent thalassemia patients aged between 5-17years, 18 (56.25%) and14 (43.75%) were male and female, respectively. All of them were found seronegative for HBs antigen, HCV, and HIV antibodies.

CONCLUSION

It seems that screening of blood products is efficient in Urmia, capital of West Azarbaijan, Iran for prevention of blood born viral infections.

Cardiac and Hepatic T2*-Weighted Magnetic Resonance Imaging in Transfusion Dependent Hemoglobinopathy in North West of Iran

BACKGROUND

Iron overload is the main transfusion related side effects in patients with transfusion dependent hemoglobinopathies. Severe iron deposition in tissues leads to organ dysfunction. Many organs can be affected such as heart, liver, and endocrine organs. Cardiac failure and liver fibrosis are the consequent of Iron overload in transfusion dependent hemoglobinopathy. Magnetic Resonance Imaging (MRI) is a safe, noninvasive, and accurate method for the assessment of iron deposition in different tissues. This study assessed iron levels in liver and heart of the patients with transfusion dependent hemoglobinopathies.

MATERIALS AND METHODS

The studied population consisted of 12 patients (7 male and 5 female) with transfusion dependent hemoglobinopathies, aged between 10-18 years old. Then, Cardiac and liver T2*- weighted magnetic resonance imaging (MRI) were obtained.

RESULTS

In current study, 1patient (8.33%) had severe, 2 patients (16.66%) had moderate and 2(16.66%) had mild cardiac iron deposition. Out of 12 patients, 1 had severe iron deposition in liver (8.33%), 5(41.66%) and 4(33.33%) had moderate and mild hepatic iron deposition, respectively. Differences between Hepatic and cardiac iron levels were not significant between males and females (p>0.05).

CONCLUSION

Since cardiac and liver iron levels were higher than normal in most of the study group, checking ferritin level and liver function test and also echocardiography in shorter intervals (each 3 months) in involved group is suggested instead of checking routinely in 6 month intervals in patients with transfusion dependent hemoglobinopathies.

Bone density in transfusion dependent thalassemia patients in Urmia, Iran

BACKGROUND

Patients with thalassemia major and intermedia are susceptible to osteopenia and osteoporosis. The mechanism of osteoporosis in these patients is multifactorial. Transfusion related iron overload in endocrine organs leads to impaired growth hormone secretion, diabetes mellitus, hypothyroidism, hypoparathyroidism, lack of sex steroids and vitamin D deficiency that contribute to impairment in achieving an adequate bone mass .The aim of this study was assessment of frequency of bone loss in patients with thalassemia major and intermedia in Urmia City of West Azerbaijan, Iran.

MATERIALS AND METHODS

In this cross sectional descriptive study,10 patients (lower than 18 y/o)with transfusion dependent thalassemia attending to Motahari and Emam Khomeini hospitals in Urmia city of Iran were enrolled and scanned for Bone Mineral Density (BMD) starting at around 10 years old.

RESULTS

Tenatients (6 male and 4 female) with transfusion dependent thalassemia (β-thalassemia major and intermedia) aged 13to 17 years in Urmia city of Iran were enrolled. Mean age of patients was 15.1±.37year old. Among them, 8 patients (80%)had low BMD and2 of them (20%) had normal BMD in lumbar spine. Only 30% of patients had low BMD in the neck of femur.

CONCLUSION

We should perform annual BMD in patients with thalassemia major and intermedia and hemoglobin H disease in age of higher than 8 year old and treat low BMD with administration of bisphosphonate, calcium and vitamin D supplements. Medical consultation with a rheumatologist and /or an endocrinologist should be performed in these patients. Changing lifestyle with mild daily exercise, adequate calcium containing foods, avoiding heavy activities, stop smoking, iron chelation therapy in adequate dosage, early diagnosis and treatment of endocrine insufficiency and regular blood transfusions can help to achieve an optimal bone density in these patients.

Testing the effects of an empowerment-based leadership development programme: part 1 - leader outcomes

AIM

To determine if a leadership development programme based on an empowerment framework significantly increased leaders' use of empowering behaviours.

BACKGROUND

Leadership programmes are effective ways to prepare nurse leaders for their complex roles. Relational competencies, such as leader empowering behaviours, are associated with improved leader, staff and practice environment outcomes.

METHODS

A quasi-experimental, pre-test-post-test design was used to compare perceptions and self-reported behaviours of leaders who participated in a year-long leadership programme with those of similar leaders who did not attend the programme. Multiple regression analyses were used to evaluate a conceptual framework of leader empowerment.

RESULTS

The leadership programme was directly associated with leaders' perceptions of using more empowering behaviours. Leader empowering behaviours were also associated with feelings of being structurally empowered, mediated through feelings of being psychologically empowered, although the source of empowerment needs further investigation.

CONCLUSIONS

Leaders' use of empowering behaviours can be increased through focused training and through a workplace empowerment process.

IMPLICATIONS FOR NURSE MANAGEMENT

Leader empowering behaviours have been shown to be associated with more engaged staff and healthier work environments. Based on study results, we suggest that these behaviours are teachable, and they should be emphasized in leadership development programmes.

Birth weight and risk of childhood acute leukaemia

Studies of risk factors for acute leukaemia are inconclusive. This case-control study was done in West Azerbaijan province, Islamic Republic of Iran, to determine the relationship between birth weight and acute leukaemia in children aged under 15 years. For every patient 2 age- and sex-matched controls were selected from hospital and community populations. Of 130 cases diagnosed over the period 2003-2009,108 (83.1%) had lymphoblastic and 22 (16.9%) myloblastic type. Significantly more of them were male than female (55.4% versus 44.6%). In a multivariate logistic regression model variables significantly associated with acute leukaemia were: birth weight (OR = 2.25), birth order (OR = 2.25), birth place (OR = 7.93), history of chickenpox (OR = 0.46) and mothers' education (OR = 3.23). The risk of acute leukaemia increased significantly with increasing birth weight in the total group and among girls, but not among boys.

Comparison of therapeutic effect of topical Nigella with Betamethasone and Eucerin in hand eczema

BACKGROUND

Nigella sativa has been used in traditional medicine. Although it was investigated in different studies, its effect on hand eczema has not been studied yet.

OBJECTIVE

To compare the effects of Nigella, Betamethasone and Eucerin on severity of hand eczema and patients' life quality.

METHODS

In this randomized, controlled, double-blinded clinical trial, we allocated new cases of hand eczema with 18-60 years of age in three therapeutic groups (Nigella, Betamethasone and Eucerin) by using permuted blocks for randomization. Patients applied medications twice a day and followed in a 4-week period. The primary outcome of the study was changes in severity and life quality, which were assessed at the beginning, 14th and 28th days of the study by Hand Eczema Severity index (HECSI) and Dermatology Life Quality Index (DLQI) respectively.

RESULTS

Sixty patients recruited in the study with 20 patients allocated in each study arm. Eighteen, 19 and 15 patients in Eucerin, Nigella and Betamethasone groups, respectively, attended at least one of the therapy sessions. Nigella and Betamethasone showed significantly more rapid improvement in hand eczema compared with Eucerin (P = 0.003 and P = 0.012 respectively); Nigella and Betamethasone ointments caused significant decreases in DLQI scores compared with Eucerin (P < 0.0001 and P = 0.007 respectively). No significant difference was detected in mean DLQI and HECSI of the Nigella and Betamethasone groups over time (P = 0.38 and P = 0.99 respectively).

CONCLUSION

It seems that Nigella might have the same efficacy as Betamethasone in improvement of life quality and decreasing severity of hand eczema.

Treatment of steroid and cyclosporine-resistant idiopathic nephrotic syndrome in children

Steroid-resistant nephrotic syndrome (SRNS) in children carries a significant risk of progression to end-stage renal failure (ESRF). We report a two-step protocol adapted in children with SRNS. Thirty-seven SRNS were treated with cyclosporine A (CyA) in association with prednisolone (alternate day) for 6 months (first-step treatment). Twelve patients (32.4%) went into complete remission, and 2 (5.4%) got partial remission. The other 23 cases who were steroid and CyA resistant entered a second-step treatment with withdrawing steroids, with CyA (5 mg/kg/day) in association with mycophenolate mofetil (MMF) 30 mg/kg/day for 6 months. Complete remission was observed in 11 cases (47.82%) and partial remission in 2 cases (8.7%). After two steps of treatment, 27/37 children went into total remission. In steroid and CyA-resistant INS, the association of MMF with CyA was able to induce remission in about half cases without relevant side effects.

The effect of anger management on adjustment and self-efficacy

Introduction

Today anger and its manifestation has become a great health problem among adolescents.

Aim

The aim of this study is to determine the effectiveness of teaching anger management on adjustment and self-efficacy of adolescents.

Methods

This is an experimental study which was conducted on 50 students that were chosen through random sampling method. Data were collected through adjustment and self-efficacy questionnaire. Content validity and Test-retest methods were used for validity and reliability of the questionnaire. Initially, the two adjustments and self-efficacy questionnaires were given to the students, then, anger management was taught in for 8 sessions each lasting 1.5 hours. Two weeks after the last session of teaching, the two questionnaires were filled again and the results were compared. Data analysis using descriptive and inferential statistics.

Results

The analysis of data with Wilkinson's test revealed that teaching anger management has been effective on adjustment with p < 0/001 and on self-efficacy of adolescent also with p < 0/001.

Conclusion

Adolescents’ anger is a major concern for the society. With regard to the conclusions drawn in this study and the effects that appropriate control of anger has on adolescents’ adjustment and self-efficacy, it is advisable that educational programs for suitable control of feelings including anger be given top priority in the state educational system.

Effects of corn processing and dietary fiber source on feedlot performance, visceral organ weight, diet digestibility, and nitrogen metabolism in lambs

In Exp. 1, early-weaned Targhee and Polypay crossbred lambs (60 ewes and 66 rams; initial BW 24 +/- 1.0 kg) were used in a 2 x 3 factorial experiment to determine the effects of corn processing (whole shelled corn [WSC] or ground and pelleted corn [GC]) in combination with supplemental fiber (none [control]; soybean hulls, SBH [highly digestible]; or peanut hulls, PH [highly indigestible]) on DMI, ADG, feed efficiency, and visceral organ weight. For the total trial, WSC resulted in a 4% increase (P < .01) in ADG vs GC, and supplemental fiber resulted in increased (P < .01) DMI and ADG vs the control diet. Experiment 2 was conducted using 12 Targhee and Polypay crossbred wether lambs (initial BW 25 +/- 7 kg) to determine the effects of corn processing and fiber source in high-concentrate diets on diet digestibility and N retention using the same diets as in Exp. 1. Lambs fed WSC had greater (P < .001) apparent N digestion, true N digestion, and N retention (P < .01) than those fed GC. The apparent digestibilities of DM, OM, and NDF were greater (P < .001) for WSC than for GC diets. Peanut hulls resulted in decreased (P < .01) DM, OM, and NDF apparent digestibilities compared with the control and SBH diets. Starch digestion was not affected (P > .10) by diet. Whole corn resulted in improved DM, OM, NDF, and N digestibility compared with GC. Overall, both the SBH and PH diets resulted in greater DMI and ADG than the control diet, which lacked supplemental fiber.

System considerations in CCD-based x-ray imaging for digital chest radiography and digital mammography

System modeling is used to investigate the effect of various system parameters on the image quality in CCD-based x-ray imaging systems. The systems considered consist of a typical phosphor-based scintillating screen coupled to a CCD through lens or fiberoptic taper. Two applications, chest radiography and mammography, are analyzed. For each application typical system characteristics and operating conditions are used to determine the detective quantum efficiency (DQE) as a function of spatial frequency, optical collection efficiency, optical demagnification factor, and electronic noise. The DQE is modeled by extending the analysis for storage phosphor systems. The calculations are done for typical exposure conditions (0.25 mR for chest and 10.0 mR for mammography); however, the exposure effects are also discussed. It was found that a reasonable DQE can be obtained for both applications through each coupling approach; however, the demagnification requirements and electronic noise limitations are more stringent for the digital mammography application.