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A quantitative approach descriptive study was conducted to assess depression and its risk factors among 150 subjects diagnosed with chronic medical conditions like diabetes mellitus, COPD and CAD. The objectives of the study were to identify depression among patients with chronic medical conditions, find out the risk factors for depression among patients with chronic medical conditions and find out the association between depression and its risk factors among patients with chronic medical conditions. The data was collected using socio demographic sheet and Beck's depression inventory (structured interview). The major findings of the study were, among the 150 patients, 42% of them had clinical depression at varying levels and one third of the patients i.e.34% had mild mood disturbance. The major risk factors for causing depression among patients with chronic medical conditions were low education, existence of co-morbid diseases, age, monthly income and use of medications. Significant association was found between depression and its risk factors like marital status, education, occupation, monthly income, family support, history of maternal deprivation and stressful life events. These findings necessitate the need for strategies to improve the patients well being and there by reducing the illness burden.

A descriptive study was undertaken to assess the adjustment problems among adolescents residing in selected orphanage at Kerala, India. This study was aimed to identify adjustment problems of adolescents residing in orphanage as well as to find out the association between adjustment problems of adolescents residing at orphanage with their socio-demographic variables. An information booklet was also developed on adjustment problems of adolescents residing in the orphanage and it's coping strategies. A quantitative research approach has been used. The data was collected using socio demographic profile and self administered rating scale on adjustment problems among adolescents residing in the orphanage. The data was analyzed using descriptive (frequency, percentage) and inferential (chi-square test and fisher exact probability test) statistics. Among 100 adolescents in the orphanage, 71% of subjects had good adjustment and the remaining 29% had moderate adjustment. None of them had poor level of adjustment. There were significant association between three demographic variables, education level of the adolescents ((χ2 = 3.918, df = 1, p< 0.05), parents living (χ2=8.114, df = 3, p

The ability to rationally modify enzymes to perform novel chemical transformations is essential for the rapid production of next-generation protein therapeutics. Here we describe the use of chemical principles to identify a naturally occurring acid-active peptidase, and the subsequent use of computational protein design tools to reengineer its specificity toward immunogenic elements found in gluten that are the proposed cause of celiac disease. The engineered enzyme exhibits a k(cat)/K(M) of 568 M(-1) s(-1), representing a 116-fold greater proteolytic activity for a model gluten tetrapeptide than the native template enzyme, as well as an over 800-fold switch in substrate specificity toward immunogenic portions of gluten peptides. The computationally engineered enzyme is resistant to proteolysis by digestive proteases and degrades over 95% of an immunogenic peptide implicated in celiac disease in under an hour. Thus, through identification of a natural enzyme with the pre-existing qualities relevant to an ultimate goal and redefinition of its substrate specificity using computational modeling, we were able to generate an enzyme with potential as a therapeutic for celiac disease.

Two established field populations of bed bugs were sampled using host-mimicking traps baited with a combination of CO2, heat and a synthetic kairomone. The proportion of first instar nymphs (between 52% and 78% of all captured insects) was significantly higher than reported in previous studies, which had employed different sampling methods. The proportion of adults was correspondingly much lower than previously reported, between 5% and 7% of total capture. As many as 120 bed bugs were captured in a single trap in one night, the variation in catches between sampling locations within the same room and between days at the same location indicates that multiple nights of trapping may be required to obtain an accurate representation of population structure.

As a family and sports physician, I care for many young women affected by the female athlete triad. Typically, they present with low body mass index (BMI), oligomenorrhea or amenorrhea, and, oftentimes, low bone mineral density or stress fractures. Sometimes, the low BMI stems from intentional restriction of dietary intake; other times, it is a consequence of an unintentional mismatch of caloric intake relative to high calorie expenditure related to training and/ or sport participation. Menstrual dysfunction may take the form of delayed menarche, short infrequent menses (oligomenorrhea), or complete absence of menstruation (amenorrhea). In this setting, bone health alterations are thought to be related to changes in one’s hormonal milieu, in addition to nutritional deficiencies. The mainstay of clinical management for patients affected by the female athlete triad is to correct the negative energy balance or low energy availability that leads to menstrual dysfunction and alterations in bone health. However, as many clinicians know, this can be challenging. Competitive female athletes often are resistant to recommendations to increase dietary intake and body weight and/or reduce their exercise or training. A common practice has been to place amenorrheic women, especially athletes, on oral contraceptives (OCP) in an effort to provide estrogen replacement, in hopes of protecting against bone loss and/or stress fracture. However, there is emerging evidence that this practice is not beneficial and may even lead to harm. The amenorrhea that occurs within the spectrum of the female athlete triad is referred to as functional hypothalamic amenorrhea. It is an adaptive mechanism that reduces a woman’s fertility when the body perceives that there is inadequate energy to support the substrate, let alone a fetus (2). While this may seem beneficial to many athletes, as they may not be seeking pregnancy, the adverse effects of this hormonal disruption is manifest in negative impacts on bone health, 1) in the form of inadequate bone mineral acquisition, 2) in the loss of existing bone mineral density, or 3) in increased risk of stress fracture, even in the setting of normal BMD. Combined OCP, consisting of estrogen and progesterone, have been recommended for use in treating women affected by the female athlete triad (1). However, the evidence supporting a role for OCP in treatment is inconclusive at best (5). This likely is related to the fact that combined OCP containing only estrogen and progesterone cannot overcome the alterations in hormone levels associated with low energy availability, including decreased total triiodothyronine, leptin, insulin, insulin-like growth factors, glucose, luteinizing hormone pulsatility, and follicle-stimulating hormone, as well as an increase in growth hormone and cortisol (5). Not only are OCP unable to counter the impact these hormone alterations have on bone health; they may contribute, in fact, to worsening bone health. Exogenous estrogen replacement in young athletes may lead to premature closure of physes (growth plate) (4), and early OCP use has been associated with lower BMD in the spine and femoral neck among female distance runners (6). So what is a clinician to do when faced with the challenge of treating an athlete with the female athlete triad? The first step is to perform a comprehensive history and physical examination to confirm the diagnoses. Second, engage a multidisciplinary team, which often includes a physician, sports dietician, and mental health professional, to guide and support the athlete’s recovery. The cornerstone of treatment is to reverse the situation of low energy availability, which is typically a consequence of both inadequate stored energy (low BMI) and low energy intake relative to expenditure. The goal is to increase caloric intake above 30-kcalIkg fat-free mass (FFM); some would recommend upward of 45-kcalIkg FFM to produce changes in bone mineral density (3,7). What this translates into practically is approximately 1,912 cal for a 110-lb female distance runner with 15% body fat (110 lb 0.85 = 93.5-lb FFM Y 42.5-kg FFM 45-kcalIkg FFM = 1,912 kcal). Assuming she was continuing to train throughout this recovery period, adding additional calories to cover exercise-related expenditures would be required to replace the deficit (~100 kcalImile). The role of the sports dietician is to help the athlete consume the required amount of calories while minimizing INVITED COMMENTARY

Context: Methicillin-resistant Staphylococcus aureus (MRSA) infections are increasingly common in athletic settings. The MRSA knowledge and infection-control practices of certified athletic trainers (ATs) and the cleanliness of the athletic training room are important factors in preventing MRSA infections. Objective: To assess knowledge of MRSA and the use of common disinfectants among ATs and to explore their infection-control practices. Design: Cross-sectional study. Setting: High school and collegiate athletic training rooms. Patients or Other Participants: A total of 163 ATs from National Collegiate Athletic Association Divisions I, II, and III and high schools, representing all 10 National Athletic Trainers' Association districts. Main Outcome Measure(s): Frequencies, analyses of variance, and χ2 tests were used to assess current practices and opinions and relationships between factors. Results: Methicillin-resistant Staphylococcus aureus was perceived as a national problem by 92% of respondents; 57% perceived MRSA as a problem in their practice setting. Most respondents had treated general infections (88%), staphylococcal infections (75%), and MRSA infections (57%). Male sex was associated with treating all 3 types of infections (χ2 test, P < .05). Noncurriculum education was associated with a lack of recognition of environmental issues as risk factors and with the use of isopropyl alcohol for disinfection (χ2 test, P < .05). For example, 10% of respondents did not recognize that contaminated whirlpools can be a source of MRSA infection. Respondents also incorrectly identified effective cleaning solutions. Thirty percent of respondents cleaned their hands frequently or sometimes before treating each athlete and 35% cleaned their hands sometimes, occasionally, or never after seeing each athlete. Conclusions: The majority of ATs were informed about MRSA and made correct disinfection choices. However, improvements are still needed, and not all ATs were using proper disinfection practices.

The three Ds of disease, disability, and discomfort negatively affect hospice patient's energy, intelligence, and organization. Music therapy is a studied, learned, credentialed behavioral intervention. It is specific, prescribed, and delivered therapeutically. At a time when trust and belief are compromised by the three Ds, the utilization of the complementary alternative medical intervention of music therapy, with its positive effect on social relationships, may enhance weakened trust and belief abilities. The research to date regarding music therapy presents positive results from studies and surveys of nurses, music therapists, families, and patients. Recommendations for using music therapy and music therapists will establish the use of this intervention, giving increased numbers to sample sizes for further study.

Hydrocephalus is a disorder of cerebrospinal fluid dynamics within the central nervous system. Although symptoms of hydrocephalus are often relieved by shunt implantation, complications are common and underlying pathology remains. Understanding the molecular mechanisms of hydrocephalus is critical for development of new therapeutics; however few experimental models allow early events to be studied. Originally designed to study astrocytic Gi signaling, we developed a transgenic mouse line expressing the Gi-coupled RASSL (receptor activated solely by synthetic ligand) Ro1 in GFAP-positive cells by crossing the hGFAP-tTA (tet transactivator behind the human glial fibrillary acidic protein promoter) mouse line with the tetO-Ro1/tetO-LacZ mouse line. Surprisingly, we found that all double-transgenic mice developed hydrocephalus by postnatal day 15, while single-transgenic littermate controls appeared normal. Hydrocephalic Ro1 mice had enlarged lateral and third ventricles, thinned cortex, partial denudation of the ependymal cell layer, abnormal subcommissural organ, and obliteration of the cerebral aqueduct. Severely affected mice had increased phosphoErk and GFAP expression. Giving breeding pairs doxycycline prevented the expression of Ro1 and onset of hydrocephalus in double-transgenic offspring. Double transgenic mice taken off dox at weaning developed enlarged ventricles within 7 weeks, indicating that Ro1 expression also induces hydrocephalus in adults. Double-transgenic mice injected with a Ro1 inverse agonist when taken off dox did not develop enlarged ventricles or have ependymal detachment, demonstrating that signaling through Ro1 is required for hydrocephalus. We have discovered a new model that allows onset of hydrocephalus to be controlled, providing the unique ability to study the earliest events in juvenile and adult-onset hydrocephalus. Ependymal denudation is a common feature of hydrocephalus that appears to occur early in the disease. Positive GFAP and Ro1 staining was detected in a subset of ependymal cells from double transgenic mice off dox. Timed studies showed that Ro1 expression began within three days of dox removal and ependymal denudation began within ten days. Affymetrix gene arrays were utilized to screen for changes in ependymal gene expression at five and nine days after dox removal. No differentially expressed genes were detected between double-transgenic mice and controls at either timepoint; RT-PCR also failed to detect significant changes.

This study evaluated the effectiveness of a structured teaching programme on knowledge regarding home care of intellectually disabled children among caregivers in a selected special school, Ernakulam district, Kerala. All over the world 83 million people are intellectually disabled. In India, 5 out of 1000 children are intellectually disabled. The researcher used a quantitative approach with quasi experimental one group pre test post test design was done on 40 caregivers who were selected by simple random sampling. The tool used in the present study was a self administered, structured knowledge assessment questionnaire. The result showed that there was statistically significant increase in knowledge score obtained by subjects regarding homecare of intellectually disabled children, in all the six dimensions after exposure to structured teaching programme. There is no significant association between the pre-test knowledge of caregivers and their selected demographic variables and the child variables.

Athletic opportunities for females have come a long way since the passage of Title IX in the USA in 1972, and the first Olympic women's marathon in 1984. More than three million girls participate in high-school sports each year in the USA; there have been consecutive increases in participation in the past 24 years. With a steady rise in participation, come the positives and negatives. The positives range from improved academic performance in school age individuals to enhanced well-being in older athletes, in addition to many other benefits that extend across the lifespan. Negative consequences are inevitable, but are largely preventable. In this issue, several articles highlight the impact of sports and exercise on the health of female athletes. Dr De Souza and colleagues1 review the existing literature and present guidelines on clearance …

The Female Athlete Triad is a medical condition often observed in physically active girls and women, and involves three components: (1) low energy availability with or without disordered eating, (2) menstrual dysfunction and (3) low bone mineral density. Female athletes often present with one or more of the three Triad components, and an early intervention is essential to prevent its progression to serious endpoints that include clinical eating disorders, amenorrhoea and osteoporosis. This consensus statement represents a set of recommendations developed following the 1st (San Francisco, California, USA) and 2nd (Indianapolis, Indiana, USA) International Symposia on the Female Athlete Triad. It is intended to provide clinical guidelines for physicians, athletic trainers and other healthcare providers for the screening, diagnosis and treatment of the Female Athlete Triad and to provide clear recommendations for return to play. The 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad expert panel has proposed a risk stratification point system that takes into account magnitude of risk to assist the physician in decision-making regarding sport participation, clearance and return to play. Guidelines are offered for clearance categories, management by a multidisciplinary team and implementation of treatment contracts. This consensus paper has been endorsed by the Female Athlete Triad Coalition, an International Consortium of leading Triad researchers, physicians and other healthcare professionals, the American College of Sports Medicine and the American Medical Society for Sports Medicine.

The Middle English romance Amis and Amiloun depicts an exclusive, privileged friendship between two knights, which scholars have long read as part of the tradition of amicitia, or ideal friendship. This thesis examines the relationship between the two knights against the context of medieval male-male relationships, suggesting that their bond should be plotted upon a continuum of relations rather than categorized within a distinct, impermeable category. The poet's manipulation of the institution of friendship allows for the inclusion of sexually-ambiguous details, making the text fertile ground for an exploration of male desire. Positing the homosocial culture of the English Middle Ages as a primary influence in the construction of male identities, a re-reading of the romance's most nuanced moments is offered.

Although 28 m~Uion in the USA are children of alcoholics, little empirical research exists; however, several scales have been standardized. The Children of Alcoholics Screening Test is a popular means of identifying these children (3). A more detailed screening test, designed for adolescents, fosters early identification, referral, and intervention (1). DiCicco and associates (2) used a single item to idenuFy children of alcoholics in a rehabilitation program. The item is statisticallv a reliable and valid identifier of such children. The Children of Alcoholics Life-Events Schedule quantifies stressful experiences specific to the caretaking environment of alcohol-abusing families. Given the paucity of empirical data on children of alcoholics, many practitioners have little knowledge about the issues these children confront (4, 7). The Children of Alcoholics Test was designed as a measure of knowledge of issues these children face (5). The present assessment of test-retest reliability was based on responses of 79 college students. In two undergraduate education classes students completed the test on two occasions, separated by two weeks. Subjects checked "true" or "false" for each of 20 statements of myths about children of alcoholics. Statements being myths, all the answers are false. A score is the sum of the number of "false" responses. The higher the score the more knowledge a respondent has about children from alcoholic families. Scores from Times 1 and 2 were correlated .76, which suggests the inventory gives reasonably consistent information over two weeks.

The ability to cross the body midline was assessed in 150 normal children, ages 4 through 8, by observing hand usage during the Space Visualization Test of the Southern California Sensory Integration Tests. A Space Visualization Contralateral Use score (SVCU) was computed for each subject and was regarded as a measure of the tendency to spontaneously cross the body midline. This score is based on a ratio of ipsilateral (uncrossed) to contralateral (crossed) responses. The percentage of time a child use the preferred hand to pick up a block was also recorded. Results indicated that spontaneous midline crossing increased with age. Although the percent of preferred hand responses increased with age, there was enough variability at each age that there were no significant differences among age groups. Perceptual, motor, and psychosocial factors that could influence midline behavior were discussed. Based on the data from this study, a preliminary reinterpretation of the SVCU score is offered.