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Aflibercept plus FOLFIRI prolongs overall survival (OS) in patients with metastatic colorectal cancer after the failure of oxaliplatin-containing therapy. QoLiTrap prospectively evaluated the quality of life (QoL) and effectiveness of this regimen in daily clinical practice, according to RAS status, sex, and prior targeted therapy, especially epidermal growth factor receptor inhibitors (EGFR-I). The primary endpoint was the percentage of patients whose EORTC QLQ-C30 global health status (GHS) improved or reduced by

Objective To determine whether a history of cerebrovascular disease (CVD) increases risk of severe coronavirus disease 2019 (COVID-19). Methods In a retrospective multicenter study, we retrieved individual data from in-patients treated March 1 to April 15, 2020 from COVID-19 registries of three hospitals in Saxony, Germany. We also performed a systematic review and meta-analysis following PRISMA recommendations using PubMed, EMBASE, Cochrane Library databases and bibliographies of identified papers (last search on April 11, 2020) and pooled data with those deriving from our multicenter study. Of 3762 records identified, 11 eligible observational studies of laboratory-confirmed COVID-19 patients were included in quantitative data synthesis. Risk ratios (RR) of severe COVID-19 according to history of CVD were pooled using DerSimonian and Laird random effects model. Between-study heterogeneity was assessed using Cochran’s Q and I2-statistics. Severity of COVID-19 according to definitions applied in included studies was the main outcome. Sensitivity analyses were conducted for clusters of studies with equal definitions of severity. Results Pooled analysis included data from 1906 laboratory-confirmed COVID-19 patients (43.9% females, median age ranging from 39 to 76 years). Patients with previous CVD had higher risk of severe COVID-19 than those without [RR 2.07, 95% confidence interval (CI) 1.52–2.81; p p p p Conclusion A history of CVD might constitute an important risk factor of unfavorable clinical course of COVID-19 suggesting a need of tailored infection prevention and clinical management strategies for this population at risk.

Purpose Cone Beam Computed Tomography (CBCT) offers a valid alternative to conventional Computed Tomography (CT). A possible radiation dose reduction with the use of CBCT in postoperative imaging of CIs is of great importance. Whether the visualization of Cochlear Implant (CI) electrodes in CBCT correlates with the radiation dose applied was investigated in this study. Methods We compared the visualization quality of Contour Advance CIs to Straight CIs from Cochlear using CBCT with varying tube parameters on whole-head specimen. Results The internal diameter of the cochlea decreases from base to apex, resulting in a significantly different intracochlear positioning of the two tested CI models. While electrodes of the Contour Advance series are located close to the modiolus, thus closer to the spiral ganglion neurons, those of the Straight series are located further away. The artifact portion of the electrode amounts to 50–70% of the radiological diameter of the electrode. An increase in artifact portion from the base (electrode #1 approx. 50%) to the apex (electrode #20 approx. 70%) of the cochlea was observed. The visualization of electrodes in the medial and apical part of the cochlea is limited due to artifact overlapping. There was no correlation between the artifact size and the applied radiation dose. Conclusion The results indicate that a reduction of the radiation dose by up to 45% of the currently applied radiation dose of standard protocols would be possible. Investigations of the effects on subjective image quality still need to be performed.

Aelurostrongylus abstrusus (Nematoda, Metastrongyloidea) is a worldwide occurring lungworm causing verminous pneumonia in cats. To date the Baermann method is the most used procedure to diagnose A. abstrusus infection by isolating first stage larvae from faeces, though its sensitivity and specificity can be impaired by several factors. An enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies against A. abstrusus has been recently developed as a diagnostic alternative. The present study evaluated the seroprevalence for A. abstrusus infection in cats from two endemic areas of Italy. Overall, 250 sera were sampled and tested for the presence of antibodies against A. abstrusus. Based on the results obtained from 20 cats proven to be infected by A. abstrusus using Baermann technique and molecular methods, and from 20 negative cats (Subset A), a cut off value of 0.347 optical density (OD) was determined, leading to a sensitivity of 95% and a specificity of 100%. Two-hundred and ten cats (142 and 68 from Abruzzo and Umbria regions, respectively) were included in Subset B (i.e. 202 negative by Baermann examination and 8 positive for Troglostrongylus brevior). Antibodies against A. abstrusus were detected in forty-five (21.4%, 95% CI: 16.1-27.6%) samples. This study confirms the occurrence of A. abstrusus in endemic areas of Italy and indicates that one-fifth of randomly selected cats have or had a lungworm infection with production of antibodies.

Feline lungworms affect the respiratory tract of domestic cats causing respiratory conditions of various degrees. In this study, we investigated the exposure of cats to feline lungworm infections by detecting antibodies in a large population of animals from several regions of Italy. Sera of 1087 domestic cats living in regions of the north (n = 700), the centre (n = 227) and the south (n = 160) of Italy were examined by a newly developed indirect ELISA conceived for detection of antibodies against the most frequently occurring feline lungworm Aelurostrongylus abstrusus. Individual cat data (i.e., age, sex, neutering status and provenience) were analysed as potential risk factors for exposure to lungworm infections. Samples were additionally screened for feline leukaemia virus (FeLV) and feline immunodeficiency virus (FIV) proviral DNAs. Overall, 9% (98/1087; 95% confidence interval (CI) 7.4-10.9%) of the animals tested seropositive to lungworm antibodies. Positive cats were identified in the north (7.1%; CI 5.5-9.3%), in the centre (5.3%; CI 3.0-9.0%) and in the South (22.5%; CI 16.7-29.6%), with more seropositive animals in the latter area (p

The purpose of this study was to explore linkages between mindfulness-based practices (MBP) applied in schools and a social and emotional (SEL) framework using the five competency areas endorsed by the Collaborative for Academic, Social, and Emotional Learning (self-awareness, self-management, social awareness, relationship skills, and responsible decision-making). A qualitative exploration of linkages was conducted to identify ways the two might be integrated in schools and to stimulate transdisciplinary dialogue. A literature review yielded 40 studies that met the criteria: (a) use of MBP, (b) study conducted in a school setting, (c) inclusion of a goal to promote mindfulness, and (d) at least one outcome variable relevant to at least one of the five SEL competency areas. After coding SEL-related constructs measured in the studies, we reached consensus for the SEL competency area under which each construct best fits and reviewed the extent to which constructs were measured across the five SEL competency areas. Results suggested a conceptual fit between MBP and a SEL framework. Each of the five competency areas varied in their representation of the effects of MBP on students. The competency area of self-management was represented in all studies reviewed. No studies mentioned the use of the five competency areas in a SEL framework to guide or classify outcome variables. Only eight studies measured mindfulness as a construct. Future evaluations of MBP in schools should consider how outcomes fit within the context of a SEL framework to further understand the linkages between MBP and SEL.

Cervical cytology screening using a Papanicolaou (Pap) smear has played a significant role in reducing the mortality and incidence of cervical cancer in developed countries since its introduction in the 1940s (Mbulaiteye, Bhatia, Adebamowo, & Sasco, 2011). Despite this evidence, the success has not yet been achieved in sub-Saharan Africa. Therefore, cervical cancer remains the leading cancer in women in sub-Saharan Africa. It is estimated that 34.8 new cases of cervical cancer are diagnosed per 100,000 women annually, and 22.5 per 100,000 women die from the disease, compared to 6.6 and 2.5 per 100,000 women, respectively, in North America (World Health Organization, 2013). The incidence of cervical cancer in sub-Saharan Africa is reported to be even higher in rural areas. It is noted that 60% to 75% of women in sub-Saharan Africa who develop cervical cancer live in rural areas, and that many of these women go untreated, mostly due to lack of access to health care (Parkin, Whelan, Ferlay, Teppo, & Thomas, 2002).The link between cervical cancer and sexually transmitted human papillomavirus (HPV) has been clearly established (Bosch, Lorincz, Munoz, Meijer, & Shah, 2002). Evidence has shown that sub-Saharan women are at risk for infection by HPV as a result of early marriages and polygamy in some societies and high parity (Bayo et al., 2002). It has been noted that in some societies, girls as young as 15 years are married to older men, which exposes them to early sexual activity, increasing their risk for contracting HPV (Anorlu, 2008). The rising incidence of cervical cancer in sub-Saharan Africa may also be fueled by the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. Research has shown that cervical cancer progresses faster in women whose immune systems have been compromised by HIV infection, and that survival rates for these women are poor (Denny et al., 2014). Research has also found that HPV types 16 and 18 are the most common in women with invasive cervical cancer, and were the most common infections in HIV-positive women (Denny et al., 2014). It is further noted that sub-Saharan women tend not to seek medical attention until their cancer is in advanced stages, leading to high mortality. Such deaths could be prevented by early detection with Pap smear screening. Other screening techniques, specifically visual inspection with acetic acid wash, could also be used as alternatives for the Pap smear.Cervical cancer screening in developing countries is very complex and has been hampered by many barriers. For instance, it has been found that most women in developing countries do not screen regularly because the screening services are either unavailable or ineffective (Denny, Quinn, & Sankaranarayanan, 2006). Evidence further suggests that where services are available, they are largely accessible to younger women through postnatal and family planning services, or to a smaller percentage of women through private practitioners (Sherris, Herdman, & Elias, 2001). It is also noted that barriers to establishing screening programs and the pitfalls encountered may differ from country to country. In many sub- Saharan countries, cervical cancer screening programs have not been effective due to a number of barriers, including inadequate health services, poor laboratory infrastructure, and a myriad of service delivery challenges (Moodley, Med, Kawonga, Bradley, & Hoffman, 2006). Researchers also indicate that the magnitude of the problem in sub-Saharan Africa has been under-recognized and underprioritized compared to competing health priorities such as HIV/AIDS, tuberculosis, and malaria. The aim of this integrative review was therefore to review published studies to identify and describe barriers to Pap smear screening among women in sub-Saharan Africa. The information obtained could guide effective interventions and further research. The review was conducted from August 2015 to December 2015. …

The metastrongyloid nematode Aelurostrongylus abstrusus is a worldwide occurring feline lungworm. The spectrum of clinical signs in infected cats ranges from mild (e.g. nasal discharge or cough) to severe respiratory distress. The aim of this seroepidemiological study was to define prevalence and risk factors for A. abstrusus infections in Swiss cats, to assess the biogeographic distribution and to investigate the influence of temperature and altitude on the occurrence of this parasite. Sera of 4067 domestic cats were collected from all over Switzerland, tested for the presence of antibodies against A. abstrusus by a novel ELISA and the results correlated with biogeographic aspects. A subsample of 1000 datasets was used for risk factor analyses. Overall, 10.7% (434/4067, 95% confidence intervals [CI]: 9.7-11.7%) of the cats were tested positive, with variations from 0.0% to 20.0% among ten different biogeographic regions. Differences were significant between the Western (13.9%, CI: 11.4-16.7%) and the Eastern (9.2%, CI: 8.0-10.5%) Swiss Plateau, possibly attributable to the suitability of the areas for intermediate hosts. In total 90.3% (392/434) of the seropositive cats originated from regions lower than 700 m above sea level. Correspondingly, 98.9% (429/434) of positive samples were obtained from regions with a mean temperature higher than -2 °C in January, suggesting altitude and temperature being limiting factors for A. abstrusus infections in Switzerland. Concerning individual risk factors, prevalence was higher in intact (15.5%, CI: 9.5-23.4%) than in neutered cats (5.8%, CI: 7.9-10.4%). Young adult cats (aged 11-22 months) were significantly more often seropositive (10/76, 13.2%, CI: 6.5-22.9%) than kittens aged 1-10 months (1/34, 2.9%, CI: 0.1-15.3%) or adult and senior cats > 22 months (58/889, 6.5%, CI: 5-8.4%). Outdoor cats and cats presenting respiratory signs tend to be more often positive than indoor cats (p = 0.077) and animals without respiratory signs (p = 0.086), respectively. We here confirm that the use of a serological test can contribute to improve the identification of infected animals, through evaluation of risk factors on a population level and for a better management on an individual level, overcoming the challenges represented by faecal examinations and the correlated underestimation of the occurrence of A. abstrusus in cats.

Objective To demonstrate the safety and efficiency of holmium laser-assisted lithotripsy during sialendoscopy of the submandibular gland using a retrospective, interventional consecutive case series. Methods We performed 374 sialendoscopies between 2008 and 2015 and evaluated all patients regarding clinical symptoms, clinical findings, therapy and outcome. We performed 109 procedures of holmium laser-assisted lithotripsy in 64 patients whose sialoliths measured 5 mm or more in diameter. In addition to retrospective case note reviews, we performed telephone interviews of all patients in January 2017. Results We performed 374 consecutive submandibular gland sialendoscopy procedures in 276 patients between 2008 to 2015. Sialolithiasis had either previously been diagnosed, or symptoms highly suggestive of sialolithiasis of the submandibular gland presented in 197 patients. Holmium laser-assisted Laser lithotripsy was performed in 109 cases (64.9%). Smaller mobile concrement was removed directly either by forceps or wire basket, or following marsupialisation of the submandibular duct. This was the case in 88 patients (29.1%). Three patients (0.8%) required surgical removal of the submandibular gland due to early abscess. The majority of patients (n = 374 procedures; 90.1%) remained symptom-free after two or more years following intervention. In the remaining procedures (n = 37 procedures; 9.9%), patients reported discreet postprandial problems but did not seek medical attention. In total, we managed to preserve the submandibular gland and avoid open surgery in 99% of patients through endoscopic management of submandibular concrement and duct stenosis. Conclusion Holmium laser-assisted lithotripsy is a simple, safe, and effective procedure for treating patients with sialolithiasis of the submandibular gland. Removal of the gland is rarely required, and removing the gland without prior sialendoscopy is no longer recommended. It should be offered to all patients with submandibular gland sialolithiasis, or such patients should be referred to the appropriate centre for sialendoscopy before submandibulectomy is considered.

This paper presents the design of IGBT-based switching modules for a nitrogen gas laser. First, the CC-topology, which drives the laser, is discussed and simulated. Simple models of the laser tube and the switch are presented. The comparison of the simulation with experimental data shows good accuracy. The results are used to discuss the influence of the parasitic inductance and the capacitances on the laser tube behavior. Cascades with an 11-cell series connection based on different IGBT-chips (1700 V and 1200 V) have been built up and measured. The focus of the design is the high speed synchronous switching of all switching cells. Therefore, the design of a pulse transformer-based gate drive and a symmetrization network is presented. The module equipped with the four parallel 1200 V/35 A-IGBTs per cell produces the highest switching power. Among the variants, the switch peak current is up to 700 A at blocking voltages of up to 13.2 kV in the real environment of the nitrogen laser. The switch current slope reaches up to 30 A/ns and the laser tube current up to 1.8 kA. The variant with 1200 V/35 A-IGBTs produces an output energy which is about 15 % higher compared to the former MCT-based switch. Furthermore, a modified CCtopology for lower blocking voltage is investigated. The IGBT-based switches are able to replace the MCT-switches in this application. Between the different switches a tradeoff has to be done between high output energy and the effort for the assembly.

Mindfulness-based practices (MBP) are being applied in school settings with growing interest and increasing frequency. Social and emotional learning (SEL) is a paradigm in which schools are planning and implementing prevention and intervention programming to mitigate risk factors and positively affect the well-being of all students. MBP can be used with SEL programming as a novel adjunctive approach to fostering resilience. This article reviews SEL and highlights the theoretical basis for and the practical integration of MBP into existing SEL curricula, Strong Kids and Strong Teens. Recommendations for the continued use of MBP in school settings and within a SEL framework are discussed.

Cardiopulmonary nematodes in cats include different parasite species affecting feline lungs and the heart, with the metastrongyloid Aelurostrongylus abstrusus being the most frequent feline lungworm worldwide. The present case report describes an 11-month-old male neutered European short hair cat which presented with generalised subcutaneous oedema and pleural and peritoneal effusions. According to clinical examination, abdominal imaging and laboratory analyses, a tentative diagnosis of severe glomerulopathy with massive proteinuria was made. Due to worsening of the clinical signs despite therapeutic interventions and a poor prognosis, the cat was euthanised. Necropsy and histological examinations revealed severe bilateral collagenofibrotic glomerulopathy, generalised oedema and a focal verminous pneumonia with thrombosis in arterial lung vessels containing nematode cross sections. A serum sample was tested for the presence of antibodies against the cat lungworm A. abstrusus, resulting negative. Genetic analyses confirmed the presence of nematode DNA; after exclusion of common lung and heart parasites occurring in cats, DNA of the canid heart worm nematode Angiostrongylus vasorum was identified. This is the first description of a naturally occurring infection with A. vasorum in a cat. Previous experimental studies demonstrated the development of adult male and female A. vasorum worms containing eggs in cats, but no larval excretion in the faeces. Although cats did not become patent, A. vasorum infections were clinically relevant. As A. abstrusus and A. vasorum are both gastropod transmitted nematodes, they may share the same intermediate hosts within overlapping areas. In addition, especially chronic A. abstrusus infected cats become non-patent and do not excrete L1. Considering that patent A. vasorum infections are widespread in the dog and fox population in Switzerland (and several other countries) but are apparently not patent in cats, we cannot exclude that infections with A. vasorum may occur more frequently than expected., Highlights • Angiostrongylus vasorum is a cardiopulmonary nematode of dogs and other canids • First natural infection of a cat (Felis catus) with Angiostrongylus vasorum • Histological nematode sections identified in pulmonary arteries, confirmed by PCR • Aberrant, non-patent infection in the cat with clinical relevance • Such infections may occur more frequently particularly in highly endemic areas

Non-gaseous oxygen therapeutics are emerging technologies in regenerative medicine that aim to sidestep the undesirable effects seen in traditional oxygen therapies, while enhancing tissue and wound regeneration. Using a novel oxygenating therapeutic (Ox66™) several in vitro models including fibroblast and keratinocyte monocultures were evaluated for potential drug toxicity, the ability of cells to recover after chemical injury, and cell migration after scratch assay. It was determined that in both cell lines, there was no significant cytotoxicity found after independent treatment with Ox66™. Similarly, after DMSO-induced chemical injury, the health parameters of cells treated with Ox66™ were improved when compared to their untreated counterparts. Particles were also characterized using scanning electron microscopy and electron dispersive spectroscopy both individually and in conjunction with fibroblast growth. The data in this study showed that the novel wound healing therapeutic has potential in advancing the treatment of various types of acute and chronic wounds.

The development of dc transmission and distribution technologies are gaining traction. With renewable energy being fed to the grid constantly increasing, there is growing interest in development of dc grids. A major hindrance for their development is attributed to the lack of protection during short-circuit fault. Hybrid circuit breakers, a combination of mechanical and semi-conductor devices are understood to be the most effective method to protect dc grids against such faults. Several of such hybrid breakers are published and patented but still a practical high voltage dc breaker has not been developed. In this paper a novel modular hybrid circuit breaker is presented. This paper tries to address limitations present in existing breakers and a scalable model which can be used for both medium and high voltage dc networks is proposed.

The aim of this study was to review published studies to identify and describe barriers to Papanicolaou (Pap) smear screening among women in sub-Saharan Africa.Guided by Cooper's integrative review methodology, studies published between 2006 and 2015 were identified by searching electronic databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, MEDLINE, ProQuest, and PsycINFO using specified search terms. Using this strategy, 224 articles were identified and screened for duplication and by reading titles, abstracts, and full texts. Seventeen articles met the inclusion criteria and were appraised using relevant tools for qualitative and quantitative designs. No relevant articles published in 2006, 2007, and 2014 were found.All 17 articles had good methodological quality and were included in the review. The studies were from 10 sub-Saharan countries and from different settings. Content analysis of the data revealed three major themes coded as client, provider, and system barriers. The most common client barriers were lack of knowledge and awareness about Pap smear screening, fear of cancer, belief of not being at risk for cervical cancer, and that a Pap smear is not important unless one is ill and cultural or religious factors. Provider barriers were failure to inform or encourage women to screen. Major system barriers were unavailability and inaccessibility of the Pap test.The review provided evidence of barriers to Pap smear screening among sub-Saharan women. Although there were some variations from country to country, sub-Saharan countries share similar constraints to Pap smear screening. These findings have important implications for practice and policy.Understanding the client, provider, and system barriers to cervical cancer screening could guide development of effective interventions.

Ethanol is metabolized by Alcohol Dehydrogenase (ADH) to acetaldehyde and then irreversibly oxidized by Aldehyde Dehydrogenase (ALDH) to nontoxic acetate. In individuals expressing the ALDH2*2 variant enzyme, the rate of conversion from acetaldehyde to acetate is reduced and leads to flushing, nausea, and tachycardia due to increased blood levels of acetaldehyde. The ALDH2*2 variant has a lowered NAD+ coenzyme binding affinity, which results in a lowered clearance capacity toward acetaldehyde. This polymorphism is caused by the substitution of glutamate for lysine at position 487 within the catalytic active site of ALDH2, resulting in effects on subunit and quaternary complex activity. ALDH2*2 alleles are dominant over ALDH2*1 and therefore are expected to contribute to the formation of inactive heterotetramers decreased enzymatic activity in both homozygous and heterozygous individuals. Consequently, a higher susceptibility to various diseases such as Alzheimer’s, osteoporosis, and acute coronary syndrome has been associated with ALDH2*2 carriers. Additionally, the polymorphism seems to affect the efficacy of Glyceryl Trinitrate (GTN), a drug intended to treat coronary heart disease, in carriers of ALDH2*2 alleles. However, the polymorphism is believed to afford a protective effect against alcoholism as the side effects of acetaldehyde build-up are undesirable. Disulfiram, a drug historically used to treat alcohol dependency, induces the same undesirable physiological effects as the variant enzyme in non-carriers by inhibiting the normal functioning of ALDH2 enzyme.

Evaluating well-being in non-Western populations has been hampered by the fact that most psychometric instruments are not culturally sensitive. One possible way to remove cultural biases is by eliminating the verbal content from the assessment. The Well-Being Picture Scale (WPS) is a ten item conceptual assessment that has been used to evaluate well-being in a variety of populations. The purpose of this study was to examine its utility in a sample of nursing students and staff from the University of Botswana in Gaborone, Botswana. The WPS and a traditional English language based depression scale, the Zung Self-rated Depression Scale (SDS) were distributed to students and staff at the school of nursing; 71 (31 male, 40 female (mean age= 28.2 years) returned the questionnaires. Reliability of the scales was assessed using Cronbach’s alpha. Validity of the WPS was evaluated by examining its sensitivity and specificity using the SDS as a referent, with previously published cut-points denoting either well-being or depression from the scales. The results show that the WPS has good reliability (α=0.863) and that when compared to the SDS depression scale, has excellent specificity in identifying positive well-being, but poor sensitivity in detecting depression. The poor sensitivity could be the result of the WPS being a state indicator, while the SDS is a trait measure, or that sociocultural and linguistic factors are affecting the scale comparisons. Nonetheless, the results suggest that the WPS may be useful as way to measure an emotional state of well-being that is independent of cultural context.

This pilot randomized-controlled trial was designed to evaluate the effectiveness of an over-the-counter multistep herbal smoking cessation regimen, SmokeRx, that employs four different herbal formulations taken at different times during the program. Twenty-two subjects were randomized to a placebo group and 20 to the SmokeRx program. The results show that the odds of reduced or validated cessation of smoking were not significantly different between the groups at any juncture over the 6 months of the trial but that there was a trend for higher odds in the SmokeRx group. Subjects were also more likely to drop out of the placebo group (p = .06), suggesting a possible positive effect of the SmokeRx regimen. Overall, early dropouts (at 2 week follow-up) appeared less motivated to quit smoking, as they were more likely to be younger, had smoked more than 5 years, had greater difficulty refraining from smoking in places where it is forbidden, had fewer previous quit attempts, did not intend to quit smoking in the next month, and exercised fewer hours per week. These results suggest that a larger trial of SmokeRx may be warranted and that more studies that assess the efficacy of herbal formulas are needed to provide valid data for non-nicotine smoking cessation options.

Purpose: This Orem-based study examined the relationships among functional health literacy, asthma knowledge, the ability to care for asthmatic children and sociodemographic factors among rural parent/guardians. Method: A descriptive correlation design was used. The convenience sample of 57 parents and one guardian who cared for asthmatic children was recruited from three rural health districts in the eastern United States (Virginia, North Carolina, and upstate New York). Subjects completed the Test of Functional Health Literacy in Adults (TOFHLA) and the Asthma Questionnaire-Parent Survey (AQ-P) and provided additional demographic and health status information. Findings: The results show that TOFHLA scores were directly related to asthma knowledge (AQ-P scores), p=.04. Subjects who had not completed high school had significantly lower TOFHLA scores than those who had completed high school, and their children were hospitalized more often (p=.05). Those with higher income also had higher health literacy (TOFHLA scores) (p=.008) and regression analysis revealed that smoking status was also directly associated with functional health literacy (p=.004). Conclusions: The findings confirm that rural health care providers need to be diligent in assuring that health education materials and verbal instructions are presented in the most simple and easy to read format in order to maximize understanding. Keywords: Health Literacy, Asthma Knowledge, Orem’s Theory of Dependent Care Agency

In this paper the authors report the development and preliminary evaluation of the Rogerian-based Well-Being Picture Scale-Children’s Version in a sample of 19 fourth and fifth grade students. Data was collected in conjunction with a larger study that examined childhood overweight and depression, and other measurements in the data set included the Child Depression Inventory. Scores on the Child Depression Inventory indicated that 20% of the children in the study were at risk for depression. A significant statistical inverse correlation ( p < .05) was found between the post-test scores on the Well-Being Picture Scale-Children’s Version and the Child Depression Inventory indicating that as depression scores increase well-being scores decrease.

We have developed the means to recycle 3He exhaled by patients after imaging the lungs using magnetic resonance of hyperpolarized 3He. The exhaled gas is collected in a helium leak proof bag and further compressed into a steel bottle. The collected gas contains about 1–2% of 3He, depending on the amount administered and the number of breaths collected to wash out the 3He gas from the lungs. 3He is separated from the exhaled air using zeolite molecular sieve adsorbent at 77 K followed by a cold head at 8 K. Residual gaseous impurities are finally absorbed by a commercial nonevaporative getter. The recycled 3He gas features high purity, which is required for repolarization by metastability exchange optical pumping. At present, we achieve a collection efficiency of 80–84% for exhaled gas from healthy volunteers and cryogenic separation efficiency of 95%. Magn Reson Med, 2011. © 2011 Wiley-Liss, Inc.

The prevention of and early intervention with internalizing problems are vital to children's overall health and development. Schools are strongly considered a venue where these services can be provided. The Strong Kids program was developed to increase youths' resiliency. This study examined the efficacy of Strong Kids with middle school students in terms of knowledge of healthy social-emotional behaviors, reduction in internalizing symptoms, and the exploratory use of performance feedback with features of motivational interviewing. Students who participated in the program significantly increased their knowledge. Negative symptoms did not change. Teachers implemented the program with strong fidelity. It is unclear at this time the extent to which it is necessary to use performance feedback with features of motivational interviewing to improve the implementation of highly structured social-emotional learning programs.

Families have health experiences that become enfolded within their life patterns. Based within Newman's conceptualization of health as expanding consciousness, the purpose of this study was to develop knowledge about the nurse-client process of facilitating health in families who have a child with special healthcare needs. The research as praxis method was used to answer the research question, What is the evolving pattern of the nurse-client process that facilitates health as expanding consciousness in families who have a child with special healthcare needs?

A survey study was conducted to examine teachers’ knowledge, perceptions, and practices regarding social and emotional learning (SEL) in the classroom. Teachers from two states (N = 263) provided a range of responses regarding how to promote SEL in their classrooms, increase the effectiveness of SEL, and reduce barriers to implementation. Results indicated that many teachers believe that SEL is important, schools should take an active role, receiving training/support from a variety of professionals would be helpful, and current academic demands decrease the opportunity for SEL. In addition to broadening the very limited research in this area, this study provides important new information regarding teachers’ knowledge and practices of SEL in classrooms. This information is useful to school psychologists, other specialists, and administrators in helping set the stage for establishing social–emotional learning practices in schools.

It is estimated that over 200 million people worldwide have osteoporosis. The prevalence of osteoporosis is continuing to escalate with the increasingly elderly population. The major complication of osteoporosis is an increase in fragility fractures leading to morbidity, mortality, and decreased quality of life. This investigation aimed at profiling the incidence and risk of osteoporosis in adult women from a rural setting using ultrasonic bone scanning technology. Peri- and postmenopausal female subjects (n=234) were drawn from a convenience sample. After a non-radiative dual X-ray absorptiometric scanning, the bone mineral density was measured from the heel of the subjects using bone ultrasonometry, and their T-scores were recorded. Results of these scans indicate that in adult women in the age range of 32 and 87, 23.5% of the population had a heel ultrasonic T-score ≤ -1.0, implying a 1.5 to 2.0 fold increase in risk ratio of hip or spinal fracture for each standard deviational decrease. Age at menopause was positively correlated with T-scores (p= 0.032); the higher the age at menopause, the higher the T scores. Additionally, women who had taken estrogen had significantly higher T-scores (p = 0.038) than those who had not. That approximately 25% of this sample has low bone mass or osteoporosis underscores the importance of early screening in order to develop awareness and provide education on bone health management. on the quality of life. In the United States and the European Union, about 30% of all postmenopausal women have osteoporosis, and it has been predicted that more than 40% of them will suffer one or more fragility fractures during their remaining lifetime (3). Osteoporotic fragility fractures impose a considerable financial burden on health services due to reduced mobility, hospitalization, and nursing home requirements (9). In the European Union, in 1998, osteoporosis patients occupied 500,000 hospital bed-nights per year, and this was expected to double by 2050 (10). Despite these impacts, osteoporosis is frequently not diagnosed even after the first vertebral fracture has occurred. Here, we investigate the prevalence and risk of osteoporosis in females from a rural population using portable heel ultrasonometry.

Research on effectiveness of school bullying interventions has lagged behind descriptive studies on this topic. The literature on bullying intervention research has only recently expanded to a point that allows for synthesis of findings across studies. The authors conducted a meta-analytic study of school bullying intervention research across the 25-year period from 1980 through 2004, identifying 16 studies that met our inclusion criteria. These studies included 15,386 K through 12 student participants from European nations and the United States. Applying standard meta-analysis techniques to obtain averaged effect size estimates across similar outcomes, the authors found that the intervention studies produced meaningful and clinically important positive effects for about one-third of the variables. The majority of outcomes evidenced no meaningful change, positive or negative. The authors conclude that school bullying interventions may produce modest positive outcomes, that they are more likely to influence knowledge, attitudes, and self-perceptions rather than actual bullying behaviors; and that the majority of outcome variables in intervention studies are not meaningfully impacted.

This article describes a research study designed to investigate the influence of short term quality intergenerational contact on the attitudes of children toward older adults. Glass and Trent's (1982) Typology of Approaches to change attitudes and Amir's (1969) Contact Hypothesis guided the development of this study. Glass and Trent reported that there are three primary ways that attitudes change: through discussion with others about the attitudinal object, direct experiences with attitudinal objects, and the acquisition of more knowledge about the attitudinal object. If attitudes are a reflection of internal and external influences, then it is assumed they can change. The study revealed that children who participated in the treatment had a more positive attitude toward older adults. Both inclusion in the intergenerational activities and time spent with related older adults were significant in explaining the changes in the children's attitudes toward older adults.

This chapter describes options and limitations for the selection of animal species that should be considered before resorting to the nonhuman primate as a model in nonclinical research and development, with a focus on regulatory toxicology. Situations in which conventional non-nonhuman primate species can be used are discussed. Genetically modified animal models and disease models also are considered. The advantages and drawbacks of the most commonly used species are considered with regard to comparative biology, genetics, physiology, pathology, animal welfare, and practical considerations. The main focus is general and reproductive toxicity with biopharmaceuticals in the minipig, dog, and rabbit. Rodent models and alternatives to conventional animal testing also are described.

A working party, comprising two animal welfare organisations and some 12 pharmaceutical companies in Europe, was established to minimise the use of the dog in safety testing. As first step, the participants defined the major objectives of preliminary dose-range finding/MTD toxicity studies in non-rodents, defined the principles and requirements for this study type and agreed on a proposal for an optimised study design, based on collective experience of conducting such studies in industry, involving an evaluation of 100 individual study data sets. The suggested study design is explained and described, and reflects current best practice in the pharmaceutical industry in Europe. The implementation of such an optimised design is believed to result in a reduction in the overall numbers of animals used for this purpose, without jeopardising the scientific rationale and usefulness of the studies for informing the conduct of later regulatory studies.

This paper reports the development and psychometric properties of the Well-Being Picture Scale, a 10-item non-language based pictorial scale that measures general well-being, based on Martha Rogers’view of human beings as energy fields in continual mutual process with their environment. The Well-Being Picture Scale was designed for use with the broadest possible range of adult populations, including persons who are unable to respond to English-based text or lengthy, complex measurement instruments. Psychometric properties were established in a sample of more than 2,000 individuals from the United States, Taiwan, Japan, and Africa. The overall Cronbach’s alpha is .8795.

Specific problems of cardiosurgical implantation of biventricular devices for cardiac resynchronisation therapy are elucidated elaborately. In particular, the necessity and amount of intraoperative monitoring as well as the appropriate mode of anaesthesia are described. Furthermore, the sequence of lead placement, the technique of coronary sinus intubation using a guiding catheter as well as means to avoid thrombus formation in the coronary sinus are depicted. Biventricular ICD devices should be implanted from a left sided approach to integrate the device into the defibrillation field and to maintain the option of placing an additional subcutaneous array lead. It is of particular cardiosurgical interest that coronary vein leads are applicable for ventricular stimulation in patients after tricuspid valve replacement thus avoiding repeated surgical exposure of the heart.

Based on the recent experience of 464 patients with left ventricular pacing, we report on specific characteristics of various leads and lead types for left ventricular stimulation. In addition to describing the technique and indications for epicardial lead usage, commercially available coronary vein leads are introduced and discussed. Since there is no universally applicable coronary vein lead, the individually optimal lead choice and the sequelae of an erroneous lead selection are described in typical clinical examples.

This review of the dog, the primary nonrodent species used in toxicology, and its use in the safety evaluation of pharmaceuticals, provides data on the number used in particular projects in an effort to establish a baseline from which some minimization can be measured. Opportunities for reduction and replacement, as identified by a European Industry/Welfare Steering Group, are discussed. The three distinct areas of potential approaches to minimize dog use are categorized as industrial cooperation/data sharing, achieving best practice in study design, and assessing the need for a particular study. The Steering Group prioritized the approaches based on the impact on the number of animals used, the impact on the welfare of the remaining animals, the potential for industry's acceptance of the scientific approach, the potential for regulators' acceptance of the validated approach, and the time/cost of evaluation or implementation. Examples of each category are presented, and the work needed to facilitate industry/regulatory change is discussed.

Our experience with 121 coronary vein (CV) leads in 116 patients shows that CV leads are the leads of choice for pacing the left ventricle (LV). The information gained from pre-operative venous angiography permits individual selection of the most appropriate lead model for each case. The use of steerable electrophysiology catheters facilitates guide catheter cannulation of the coronary sinus (CS) when the anatomy is difficult and reduces the risk of complications. By selecting the CV lead model most suitable for each individual patient, we achieved successful implantation in 99.1% of patients. In this day and age, epicardial electrodes should be restricted to cases with CS anomalies which make CS cannulation impossible, and to LV lead implantation during heart surgery.

This paper presents the design of IGBT-based switching modules for a nitrogen gas laser. Cascades with a 11-cell series connections based on different IGBT-chips (1700 V and 1200 V) have been built up and measured. The focus of the design is the development of a high speed synchronous gate drive for the IGBT-gates. The module equipped with the four parallel 1200 V/35 A-IGBTs per cell produces the highest switching power. Among the variants, the peak switch current is up to 700 A at blocking voltages of up to 13.2 kV in the real environment of the nitrogen laser. The switch current slope reaches up to 30 A ns−1 and the laser tube current up to 1.8 kA. The variant with 1200 V/35 A-IGBTs produces an output energy which is about 15 % higher compared to the former MCT-based switch. Thus, the IGBT-based switches are able to replace the MCT-switches in this application. Between the different IGBT-based switches a tradeoff has to be done between high output energy and the effort for the assembly of the switch.

This paper presents the design of IGBT-based switching modules for pulsed power applications. Starting from theoretical and practical aspects for the selection of the IGBTs the required parameters for the design of a single cell are derived. Extended results of the characterization process for different IGBTs are presented. They show that by using a special gate driving method for IGBT devices it is possible to realize the required maximum values of peak current and current slope. From the design of the single cell the conditions for a multiple cell series connection for the target application follow. This includes the development of a high-speed gate drive based on a pulse transformer. The designed cascade is used in a nitrogen gas laser and switches a voltage of 12 kV and carries a peak current of 500A at a maximum current slope of about 28Ans -1 .

Purpose: To illustrate the incongruence of ethical standards and fiscal and policy constraints on quality care for the oldest old. As the fastest growing demographic segment in the United States, care needs of the oldest old are a special challenge to the health care system. Design: Narrative analysis of interviews with centenarians who used nursing home services. The sample was three participants of the Georgia Centenarian Study who had been community dwelling and cognitively intact at the onset of participation (between 1988 and 1997). Interviews were conducted in nursing homes or after discharge. Methods: Case histories were constructed from interviews in 1997 to improve understanding of quality of care. Findings: Less-than-optimal care was provided for these elders, and little consideration was given to their input to care decisions and prospects for medical improvement. Appropriate consideration was not given to providing least-restrictive environments, appropriate restraint use, and options for community care. Conclusions: Six policy reforms are suggested for meeting the needs of the oldest-old before and after institutionalization. These include: integration of resident involvement in care decisions; development of alternate models of care; greater input from nurses concerning nursing care of special populations; more effective family and community involvement in the caring of elderly populations; increased research to promote function and independence; and increased education of personnel and nursing students to allow for more accurate assessment of cognitive and physical status.

The purpose of this study was to examine the relationship between active versus inactive lifestyle and immunocompetence in older women. A sample of 46 independently dwelling, ambulatory and mentally alert women 60–98 years was examined, 25 who rated themselves as `active' and 21 who rated themselves as `inactive'. Lymphocyte subpopulations were analyzed by flow cytometry using selected monoclonal antibodies. The self-reported active subjects (also validated by their current unsolicited participation in a formal exercise class) demonstrated significantly higher percent change in CD25 mitogen stimulated lymphocytes ( P =0.0335) than those who reported themselves to be sedentary.

This paper presents a characterization strategy and a special gate driving method for IGBT devices to use them in laser applications. The gate driving method can be used for any MOS-controlled device e.g. MOSFETs. Starting from a real laser circuit the required parameters for a single device are derived. A scaled circuit which follows from an equivalent energies approach is presented to investigate a single device. The gate drive strategy, called Gate Boosting, uses an elevated gate voltage along with a special timing for switching to increase the speed. Measurements on various IGBT-chips show that it is possible to increase the peak current and the current and voltage slope by a factor of 2 to 4 compared with a conventional gate drive strategy. So, the range of pulsed power applications with IGBTs is extended. The obtained dynamics are promising for a cascade of IGBTs to drive a nitrogen gas laser. Special attention is paid to the switching and conduction losses of the devices. Both types of losses are measured and verified.

The primary non-rodent species used in toxicology is the dog. It is generally agreed that, for ethical reasons, dog use should be reduced to the minimum consistent with maintaining the scientific quality of toxicology studies and ensuring human safety. Dog use in toxicology has been discussed widely, both from a scientific and ethical viewpoint, and there appears to be real potential for achieving significant reductions in the number of dogs used in pharmaceutical safety testing. An industry animal welfare initiative commenced in 2000, with the aim of evaluating and, where possible, putting into practice, scientifically valid approaches to minimise dog use in regulatory toxicology without increasing the use of other non-rodent species, such as non-human primates or minipigs. The study's Steering Group categorised potential reduction approaches into three distinct areas, one of which is the production of a best practice guide on aspects of study design, including: group sizes, use of control animals, single sex studies and design of maximum tolerated dose (MTD) studies. Information on current practice and experience within the pharmaceutical industry is now being analysed, and additional input is invited.

This study explored the experience and expressions of conflict/anger in nine women between the ages of 62 and 79 years. Three themes related to events of conflict were described: (1) avoidance ("just forget it"); (2) covert retaliation ("It would tickle me . . . I know a way to get back"); and (3) no acknowledgement. In addition, one feeling theme emerged and was characterized by feelings of isolation and estrangement. The women appeared to go to great lengths to avoid conflict rather than risk disruption of personal relationships. Noteworthy were the lasting and vivid memories of the interactions involving conflict and the intensity of the emotions described.

Renewable energy and high energy efficiency are big challenges today and for the future in research and development. While more than 55 % of the whole generated electric energy is used in electrical drives, lighting systems are not negligible and need up to 20 % (according to the Department of Energy in the USA even 22 %) of power going into the grid. This amount can be reduced by more than 25 % by using new lighting technologies like LED or OLED Light sources [1]. Due to European regulations, inefficient incandescent lamps will be banned from the European market by the End of 2016. By now, solid state lighting is already one of the strongest growing application markets in the electronics sector. The Paper discusses the electric parameters and aging effects of OLEDs and new drive concepts for LED/OLED. Further insights of problems arising from large lifetimes (for example: LED 105 hours [3] ) and their demands on driving circuits are discussed