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Hereditary angioedema (HAE) is an autosomal dominant disorder caused by a mutation in the C1 esterase inhibitor gene. HAE affects 1/50,000 people worldwide. Three main types of HAE exist: type I, type II, and type III. Type I is characterized by a deficiency in C1-INH. C1-INH is important in the coagulation complement, contact systems, and fibrinolysis. Most HAE cases are type I. Type I and II HAE result from a mutation in the SERPING1 gene, which encodes C1-INH. Formally known as type III HAE is typically an estrogen-dependent or hereditary angioedema with normal C1-INH activity. Current guidelines now recommend subdividing hereditary angioedema with normal C1 esterase inhibitor gene (HAE-nl-C1-INH formerly known as HAE type III) based on underlying mutations such as in kininogen-1 (HAE-KNG1), plasminogen gene (PLG-HAE), myoferlin gene mutation (MYOF-HAE), heparan sulfate-glucosamine 3-sulfotransferase 6 (HS3ST6), mutation in Hageman factor (factor XII), and in angiopoietin-1 (HAE-ANGPT-1). The clinical presentation of HAE varies between patients, but it usually presents with nonpitting angioedema and occasionally abdominal pain. Young children are typically asymptomatic. Those affected by HAE usually present with symptoms in their early 20s. Symptoms can arise as a result of stress, infection, or trauma. Laboratory testing shows abnormal levels of C1-INH and high levels of bradykinin. C4 and D-dimer levels can also be monitored if an acute HAE attack is suspected. Acute treatment of HAE can include IV infusions of C1-INH, receptor antagonists, and kallikrein inhibitors. Short- and long-term prophylaxis can also be administered to patients with HAE. First-line therapies for long-term prophylaxis also include IV infusion of C1-INH. This review aims to thoroughly understand HAE, its clinical presentation, and how to treat it.

Background: No investigation has analyzed the time from injury to operative intervention and its effect on complications and functional outcomes in distal radius fractures. This investigation aimed to establish whether the time to surgical intervention from injury was associated with the observed rate of complications in distal radius fractures. Methods: A retrospective review of all orthopedic trauma patients who came to our center was conducted from 2008 through 2014. Patients who sustained closed distal radius fractures were included. A postoperative complication following distal radius fracture was defined as reoperation, superficial or deep infection, complex regional pain syndrome, new-onset carpal tunnel syndrome, tendon irritation, and symptomatic hardware. Results: In all, 190 patients were included in the study with a mean age of 48 years (SD ±14.7). According to the AO-Müller/Orthopaedic Trauma Association classification, radiographs revealed 80 A fractures, 15 B fractures, and 95 C fractures. Thirty distal radii were fixed within 0 to 3 days after injury, 91 patients within 4 to 10 days, and 69 patients after 10 days. Overall, 28 complications (14.7%) were identified. There was no statistical difference in the rate of complications between the time interval groups ( P = .17). Conclusions: Despite the increased popularity of surgical intervention for distal radius fractures, the optimal parameters to maximize patient outcomes have yet to be clearly defined. Time to intervention did not affect the rate of postoperative complication and range of motion.

Herein we describe an outer cannula sleeve-sheath with a coaxially inserted exchangeable drainage catheter (SCDC) for effective evacuation of recurrent symptomatic fluid collections in the thorax and abdomen on patients in lieu of, or failed, current evacuation catheters and methods. The design is an alternative to existing commercially available devices and adds distinct enhancements with the possibility of intrathoracic or intrabdominal trans outer sleeve-sheath diagnostic or therapeutic interventions. This device aims at requiring a single invasive procedure (thoracentesis and paracentesis) while offering catheter exchange and repositioning if malfunction or malposition occurs during the patient's lifetime. The SCDC outer sheath in the subcutaneous tissues of the thorax or abdomen has built-in two antibacterial cuffs to prevent infection. At the same time, the exchangeable coaxially inserted drainage catheter is deployed over a guidewire within the thoracic or abdominal cavities. The drainage catheter has a fluid dynamic proven efficient design to facilitate drainage and can recanalize its lumen if occluded by fibrin or tissue.

Although catheters are commonplace in hospital settings, there is scarce literature discussing the internal and external retention mechanisms used to aid in catheter fixation. Additionally, exact definitions and detailed information on internal and external retention mechanisms are almost non-existent in the literature. This article serves three primary purposes. The first purpose is to define internal and external catheter retention mechanisms, describe how they work, and provide examples of each that are routinely used in healthcare settings. The second goal of this paper is to provide a literature review comparing various aspects of the different types of internal and external catheter retention mechanisms discussed in the paper, including performance variance and the advantages and disadvantages of each. The third aim of this article is to provide a brief overview of catheter dislodgment, including the rates at which this occurs, the problems that can arise, and the best treatment option when this does occur.

© 2019 American Society for Surgery of the Hand Purpose: Current evidence on predictors of outcomes after distal radius fracture is often based on retrospective analyses or may be confounded by fracture type. Using data from the Wrist and Radius Injury Surgical Trial (WRIST), a 24-site randomized study of distal radius fracture treatment, in which all fractures are severe enough to warrant surgery, we set out to perform a secondary data analysis to explore predictors of better or worse hand outcomes. Methods: The primary outcome measure was the Michigan Hand Outcomes Questionnaire (MHQ) summary score 12 months after treatment. We used a regression tree analysis with recursive partitioning to identify subgroups of participants who experienced similar outcomes (ie, MHQ score) and to determine which baseline or treatment factors they had in common. Results: Factors most predictive of 12-month MHQ score were pain at enrollment, education, age, and number of comorbidities. Specifically, participants who had a high school education or less and also reported severe pain had the lowest MHQ scores. Conversely, participants with less pain and more education and who were age 87 years or younger with one or no comorbid condition had the highest MHQ scores. Treatment type or radiographic measurements assessed on post-reduction films did not affect 12-month outcomes. Conclusions: These results identified patient characteristics that can be used by surgeons to identify subgroups of patients who may experience similar hand outcomes. Type of study/level of evidence: Prognostic III.

Furthering the missions of epilepsy organizations, by either volunteering for, starting, or running an organization that serves people with epilepsy have been the goals of the advocates who have dedicated their lives to organizational advocacy.

Objective:Approximately 25 million individuals are projected to gain insurance as a result of the Affordable Care Act (ACA). This study estimated the prevalence of behavioral health conditions and their treatment among individuals likely to gain coverage.Methods:Pooled 2008–2011 National Survey on Drug Use and Health data for adults (ages 18–64) were used. Estimates were created for all adults, current Medicaid beneficiaries, and uninsured adults with incomes that might make them eligible for the Medicaid expansion or tax credits for use in the health insurance marketplace.Results:Individuals who may gain insurance under the ACA had lower rates of serious mental illnesses (5.4%, Medicaid expansion; 4.7%, marketplace) compared with current Medicaid beneficiaries (9.6%). They had higher rates of substance use disorders (13.6%, Medicaid expansion; 14.3%, marketplace) compared with Medicaid recipients (11.9%).Conclusions:There is significant need for behavioral health treatment among individuals who may gain ...

Anglo-American composer Kevin Malone wrote "Her Stories Unsung", a collection of feminist piano pieces, between 2013 and 2016 as a comment on women’s inequality in patriarchal societies and as a call for action to change the status quo through both concert hall programming and a new means of composition which is gender-aware or gender-specific. As a displaced artist, K. Malone became aware of how marginalised groups in societies are exposed to different types of oppression and inequality. Drawing upon material from USA, UK and Ukraine, K. Malone worked with Argentinian concert pianist Diana Lopszyc to create socio-political music which requires theatrical actions during performances of the music with specific attention drawn to the gender of the performer according the various programmatic narratives within the music. These narratives are drawn from key aspects of the lives of Lilith (the Biblical pre-Eve woman), Ada Lovelace, Julia Pastrana, Emmeline Pankhurst and Delia Derbyshire. K. Malone’s visually-informed gender coding of his concert music and its performance establishes a departure from the attempted (but never successful) norm of gender-neutral interpretation of purportedly gender-neutral concert music. In this way, K. Malone calls upon composers and performers to align their talents with activists who strive for social change to achieve gender equality but, in doing so, to ensure that the integrity of the musical art work (which currently is still inflected by patriarchy) be rigorous yet entertaining.

The 2007-09 recession had a dramatic effect on behavioral health spending, with the effect most prominent for private, state, and local payers. During the recession behavioral health spending increased at a 4.6 percent average annual rate, down from 6.1 percent in 2004-07. Average annual growth in private behavioral health spending during the recession slowed to 2.7 percent from 7.2 percent in 2004-07. State and local behavioral health spending showed negative average annual growth, -1.2 percent, during the recession, compared with 3.7 percent increases in 2004-07. In contrast, federal behavioral health spending growth accelerated to 11.1 percent during the recession, up from 7.2 percent in 2004-07. These behavioral health spending trends were driven largely by increased federal spending in Medicaid, declining private insurance enrollment, and severe state budget constraints. An increased federal Medicaid match reduced the state share of Medicaid spending, which prevented more drastic cuts in state-funded behavioral health programs during the recession. Federal Medicaid served as a critical safety net for people with behavioral health treatment needs during the recession.

Fisheries management has become increasingly dependent on large and complex models; however, tools and technologies for model evaluation have lagged behind model development and application. Sensitivity analyses can test the degree to which particular model inputs or internal parameters affect model outputs and are recommended in model construction, calibration, and assessment. We describe three parallel sensitivity analyses of the Ecosystem Diagnosis and Treatment (EDT) model and draw combined conclusions. The details of how each agency conducted and utilized sensitivity analyses are outlined and the trade-offs between simpler and more intensive sensitivity analyses are described. Combined insights on the EDT model include identification of input parameters to which the model is surprisingly insensitive and quantification of prediction intervals. We conclude that known uncertainties in input data and internal parameters lead to large prediction intervals around estimates of population abundance ...

Spending on psychotropic medications has grown rapidly in recent decades. Using national data on drug expenditures, patent expirations, future drug development and expert interviews, we project that spending will grow more slowly over the period 2012–2020. The average annual increase is projected to be just 3.0 % per year, continuing the steady deceleration in recent years. The main drivers of this expected deceleration include slower development of new drugs, upcoming patent expirations which will lower prices, and payers’ growing ability to manage utilization and promote generic use. The slowdown will relieve some cost pressures on payers, particularly Medicare and Medicaid.

Artistic taste is a relative quality. What one person considers music, another person may consider to be unstructured or unwanted sound: in general, noise. From the diabolus in musica to pitch clusters and beyond to white noise, there is no objective divide. In another guise, noise is ever-present in the physical action of making and recording music. Players and listeners are taught to filter it out, composers pretend it doesn't exist, and recording engineers strive to reduce it in their medium. To intentionally expose noise while producing pitch is to undermine several traditions: musicians are trained to produce pure pitches (with minor exceptions); composers expect performers to express their music through relationships between pitch, rhythm and dynamics, an equation which excludes noise. In Malone's work, these traditions are confronted, then parodied, and finally undermined. the keyboards of the harpsichord are the stage on which the drama takes place; the physical act of playing the pieces becomes a...

This chapter examines current service provision and research in the area of youth suicide from the perspective of psychosocial rehabilitation. We examine culturally tailored programmes for suicide prevention and emphasize that adopting a community-based and culturally tailored approach is crucial in meeting the needs of suicidal young people. Gaps in the research into youth suicide are highlighted, including psychosis and substance misuse. Using these two examples, we attempt to show how the research has neglected key areas pertaining to youth suicide. The second part of the chapter looks at service provision for suicidal young people. Gaps in the services are highlighted, namely the need to consult young people in service provision. We examine some promising areas of research that may be incorporated into tailoring services for suicidal young people. The use of Internet therapy is briefly examined and proposed as a means of tailoring services to young people by adopting their preferred technologies of communication. We conclude by summarizing key recommendations for future research and service provision for suicidal young people.

In 1948, a serum tonic factor released from platelets during blood clotting was first isolated, identified as a monoamine, 5-hydroxytryptamine, synthesized by Rappaport, Green, and Page (1968), and named serotonin (Page, 1968). By 1953, serotonin had been isolated from gut smooth muscle and from extracts of brain. In the 1960s a role for serotonin in the etiology of major depression was proposed. Reserpine, a drug that triggered depression in some patients, was found to deplete serotonin in brain (Pletscher, Shore & Brodie, 1955). Monoamine oxidase inhibitors (MAOI) increased serotonin content and were found to be antidepressants (Pletscher, 1991). The serotonin hypothesis of depression was developed, (Coppen, 1969; Lapin & Oxenkrug, 1969; Coppen, Prange, & Whybrow, 1972), and proposed that an increased vulnerability to either depression or mania was related to decreased serotonergic activity. Over the last 25 years, studies on blood platelets, plasma, and cerebrospinal fluid (CSF) of depressed patients reported serotonergic abnormalities. The last decade of clinical research on serotonin dysfunction in mental illness has utilized advances in neuroimaging, neuroendocrinology, neuropsychopharmacology, and molecular biology, as well as refinements in the classification of mental disorders. There has been a rapid increase in knowledge about the serotonergic system, which requires a reconsideration of the serotonin hypothesis of depression.

The transmission peak wavelength of a fibre-pigtailed arrayed-waveguide silica-on-silicon grating (AWG) demultiplexer has been shifted using a 248 nm excimer laser without penalties in crosstalk or insertion loss. The transmission peak shift and shape were monitored while trimming. A wavelength shift of 0.77 nm (94 GHz) was achieved while keeping a crosstalk of –25 dB for 400 GHz channel spacing and an insertion loss < 7 dB.