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Information about the revised guidelines for unstable angina (UA) and non-ST-segment-elevation myocardial infarction (NSTEMI) is presented. These guidelines place special emphasis on including the patient and family in the treatment plan, as treatment can be effective only if the patient understands and adheres to it.

The updated American Heart Association (AHA) guidelines for diagnostic procedures, management and care and treatment of cardiovascular disease (CVD) in women are presented.

Severe sepsis is the leading cause of death in noncoronary intensive care units, which threatens the patients of all ages. It is caused when inflammation and the normal anti-inflammatory response get out of balance, resulting in systemic inflammatory response syndrome (SIRS), which can progress to sepsis, severe sepsis, and septic shock.

Women are more prone to heart disease than men but a women's heart disease symptoms are mostly overlooked. A description of how to recognize heart disease in women and the way one can help them to get the required treatment is mentioned.

The endothelium is a single layer of cells that line the vasculature and plays an important role in cardiovascular disease and diabetes. By understanding the endothelium's crucial role in disease and health, practitioners can help the patient adopt better health habits and perhaps avoid serious disease.

Women suffering from coronary heart disease often go undiagnosed because they do not exhibit the same symptoms as men. The incidence of heart diseases in women and their risk factors are discussed along with the common symptoms of heart disease in women.

High-sugar intake may cause endothelial dysfunction. It is unknown if a bout of aerobic exercise improves endothelial dysfunction caused by a high-sugar meal in postmenopausal women. This study evaluated if prior aerobic exercise attenuates postprandial endothelial dysfunction in postmenopausal women. Twenty-two postmenopausal women (age [mean±SD]: 60.4±6.5?years; % body fat: 40.3%±7.5%) underwent an exercise (EX) or no exercise (NE) condition, in a random order, 13–16?hours prior to the high-sugar meal consumption. The EX condition included a 60?min bout of supervised aerobic exercise at 75% of age-predicted maximum heart rate. The high-sugar meal, consumed after a 12-hour fast, contained 33% of the subjects’ daily energy needs, and 75.6% energy from carbohydrates. Flow-mediated dilation (FMD) and blood concentrations of glucose, insulin, endothelin-1 (ET-1), and nitric oxide (NO) were assessed at baseline and 60 min, 120 min, and 180?min postprandially. Repeated measures analysis test showed that there were no condition by time interaction or condition effects for FMD, glucose, insulin, or NO. There was a significant condition by time interaction but no condition effect for ET-1. Area under the curve was also not different by condition for insulin sensitivity or the above variables. In conclusion, prior aerobic exercise compared with NE did not affect FMD, blood glucose, insulin, ET-1 or NO concentrations, or insulin sensitivity following a high-sugar meal in postmenopausal women. Future studies should look at the effect of different EX intensities on meal-induced endothelial dysfunction in this population.Trial Registration: ClinicalTrials.govIdentifier: NCT02919488

The World Health Organization has launched Safe Surgery Saves Lives, an initiative that aims to reduce complications arising from surgeries. The first objective in the initiative is to have the surgical team operate on the right patient at the right site. The initiative's other nine objectives are also explained.

Hospitalization for heart failure accounts for a substantial portion of the overall cost of caring for these patients and is a predictor of shortened survival in patients with chronic HF. Avoidance of readmission is critical as those hospitalized with HF face a 50 rate of readmission within 6 months and 25–35 incidence of mortality within a year.

Heart failure in the United States is a growing epidemic, with approximately 550,000 new cases per year. An increasing number of patients are treated at home with drugs that require a working knowledge of both the syndrome and the various therapeutic agents in use. New understanding of the syndrome has led to a paradigm shift from treating signs and symptoms to increasing long-term survival. This article focuses on the syndrome as it relates to common agents prescribed for the patient in the home setting.

Covering a surface area larger than the skin, the layer of tiny cells known as the endothelium is responsible for maintaining vascular homeostasis. Read on to find out all about this cellular wonder.

The article reports on a study to determine the effect of exercise and heat stress on the expression of heat shock protein 72 (HSP-72). Results indicated that exercising in the heat produces a higher increase in thermal load than exercising in the cold. However, there was no significant increase in the expression of HSP-72 when exercising in the heat.

We evaluated the repositioning accuracy of a commercially available stereotactic whole body immobilization system (BodyFIX, Medical Intelligence, Schwabmuenchen, Germany) in 36 patients treated by hypofractionated stereotactic body radiation therapy. CT data were acquired for positional control of patient and tumor before each fraction of the treatment course. Those control CT datasets were compared with the original treatment planning CT simulation and analyzed with respect to positional misalignment of bony patient anatomy, and the respective position of the treated small lung or liver lesions. We assessed the stereotactic coordinates of distinct bony anatomical landmarks in the original CT and each control dataset. In addition, the target isocenter was recorded in the planning CT simulation dataset. An iterative optimization algorithm was implemented, utilizing a root mean square scoring function to determine the best-fit orientation of subsequent sets of anatomical landmark measurements relative to the original treatment planning CT data set. This allowed for the calculation of the x, y and z-components of translation of the patient's body and the target's center-of-mass for each control CT study, as well as rotation about the principal room axes in the respective CT data sets. In addition to absolute patient/target translation, the total magnitude vector of patient and target misalignment was calculated. A clinical assessment determined whether or not the assigned planning target volume safety margins would have provided the desired target coverage. To this end, each control CT study was co-registered with the original treatment planning study using immobilization system related fiducial markers, and the computed isodose calculation was superimposed. In 109 control setup CT scans available for comparison with their respective treatment planning CT simulation study (2–5 per patient, median 3), anatomical landmark analysis revealed a mean bony landmark translation of −0.4 ± 3.9 (mean ± SD), −0.1 ± 1.6 and 0.3 ± 3.6 mm in x, y and z-directions, respectively. Bony landmark setup deviations along one or more principal axis larger than 5 mm were observed in 32 control CT studies (29.4%). Body rotations about the x-, y-and z-axis were 0.9 ± 0.7, 0.8 ± 0.7 and 1.8 ± 1.6 degrees, respectively. Assuming a rigid body relationship of target and bony anatomy, the mean computed absolute target translation was 2.9 ± 3.3, 2.3 ± 2.5 and 3.2 ± 2.7 mm in x, y and z-directions, respectively. The median and mean magnitude vector of target isocenter displacement was computed to be 4.9 mm, and 5.7 ± 3.7 mm. Clinical assessment of PTV/target volume coverage revealed 72 (66.1%), 23 (21.1%), and 14 (12.8%), of excellent (100% isodose coverage), good (>90% isodose coverage), and poor GTV/isodose alignment quality (less than 90% isodose coverage to some aspect of the GTV), respectively. Loss of target volume dose coverage was correlated with translations >5 mm along one or more axes (p<0.0001), rotations >3° about the z-axis (p=0.0007) and body mass index >30 (p<0.0001). The analyzed BodyFIX whole body immobilization system performed favorably compared with other stereotactic body immobilization systems for which peer-reviewed repositioning data exist. While the measured variability in patient and target setup provided clinically acceptable setup accuracy in the vast majority of cases, larger setup deviations were occasional observed. Such deviations constitute a potential for partial target underdosing warranting, in our opinion, a pre-delivery positional assessment procedure (e.g., pre-treatment control CT scan).

We analyzed the inter-user variability of patient setup for prostate radiotherapy using a stereotactic ultrasound-targeting device. Setup variations in 20 prostate cancer patients were analyzed. Users were a radiation oncologist, a medical physicist, four radiation technologists (RTT) and a radiologist. The radiation oncologist, radiologist, physicist and two RTTs were experienced users of the system (>18 months of experience); two RTTs were users new to the system. Gold standard for this analysis was a control CT acquired immediately following ultrasound targeting. For inter-user variability assessments, the radiation oncologist provided a set of axial and sagittal freeze-frames (standard freeze-frames) for virtual targeting by all users. Additionally each user acquired individual freeze-frames for target alignments. We analyzed the range of virtual setups in each patient along the principal room axes based on standard and individual freeze-frames. The magnitude of residual setup error and percentage of setup change for each user was assessed by control CT/planning CT comparison with individual virtual shifts. A total of 184 alignments were analyzed. The range of virtual shifts between users was 2.7±1.4, 3.6±1.1, and 4.4±1.4 mm (mean±SD) in x, y and z-direction for setups based on standard freeze-frames and 3.9±2.6, 6.0±4.7, and 5.4±2.7 mm for setups based on individual freeze-frames. When only virtual shifts of experienced users were analyzed, the mean ranges were reduced by up to 2.4 mm. Average magnitude of initial setup error before ultrasound targeting was 14.3 mm. Average improvement of prostate setup was 63.1±23.4% in experienced and 35.14±37.7% in inexperienced users, respectively (p<0.0001). Only 5 of 184 (2.7%) virtual alignments would have introduced new larger setup errors (mean 3.2 mm, range 0.2 to 9.5 mm) than the magnitude of the initial setup error. We conclude that ultrasound guided treatment setup for patients treated for prostate cancer can be performed with high inter-user consistency and does lead to improved treatment setup in more than 97% of attempted setups. Experienced use is correlated with a reduced range of setups between users and higher degree of setup improvement when compared with users new to the system.

The pace of knowledge development related to genetics continues to progress exponentially. Knowledge gained through the Human Genome Project will have a profound impact on the practice of nursing, and the widespread integration of genetics into nursing education, clinical practice, and research will be essential. Many nurses continue to view genetic services as relegated to a specialist in a tertiary center and not relevant to their practice. This is certainly about to change. This article reviews the major implications of Human Genome Project for changing the landscape of health care and nursing, discusses several specific examples of genetic testing, and describes strategies under way to help prepare nurses to meet these new demands. Understanding new DNA‐based genetic‐testing technologies will be important for nurses as these tests become more available and nurses assist clients in the management of their genetic health. Nurses must become active participants in embracing the challenges and opportunities related to this genetic revolution, which over the next 5 to 10 years will reach nurses in every specialty and in every practice setting.

Purpose:To present the TALON removable head frame system as an immobilization device for single-fraction intensity-modulated stereotactic radiosurgery (IMRS) and fractionated stereotactic intensity-modulated radiotherapy (FS-IMRT); and to evaluate the repositioning accuracy by measurement of anatomic landmark coordinates in repeated computed tomography (CT) examinations.

The state of Rhode Island, USA has recently embarked on a new state accountability system for public elementary and secondary education. An overview of the system is provided coupled with an understanding of accountability systems as technologies of social control. The ramifications of such technologies are discussed along with the costs, benefits, uncertainties, and necessary tensions associated with such systems.

Looks at a new field test module called "Living Responsibly with Solid Waste," formulated by the New York Science, Technology and Society Education Project (NYSTEP). Middle school science classes on solid waste in America; Steps and interventions to cut down on waste. INSET: Here is a list of selected schools rural, urban and suburban....

The computer and related technologies as tools for teaching, learning, and assessment are the latest wave of innovations in education. These technologies are neither gender neutral nor benign in effect. Available research suggests that widespread use of these technological tools raises significant issues for females and underrepresented populations in mathematics, science, and technology fields. Questionable assumptions frequently guide current implementation efforts with little consideration of the trade-offs inherent in these technologies and their possible cumulative effects.

Comments on the educational reforms implemented in Great Britain. Percentage improvement of literacy and numeracy claimed by the Labour Party-led government of Great Britain; Need to maintain educational standards across several years; Attempt of the British government to install systemic, engineered improvements in the educational system.