No / Epidemiological evidence suggests that nonsteroidal, anti-inflammatory drugs (NSAIDs) may retard the progression of Alzheimer's disease (AD). In the present study, we have chronically treated adult (4¿5 months old) and aged (20+ months) rats with water adulterated with aspirin, and examined spatial learning in a swim maze. Adult rats (n=40) and aged rats (n=20) were divided into separate groups assigned to receive either normal drinking water or water with 2 mg/ml of aspirin dissolved in it. For 6 weeks, we monitored daily water and/or drug intake before testing all rats in a standard swim maze over an 8-day period. On average, each rat drank approximately 25 ml of water/day with no apparent control versus aspirin group differences. There was no effect of aspirin in young adult rats except during a visible platform trial where aspirin-treated rats performed better than controls. In contrast, aspirin markedly improved performance in the aged rats during hidden and visible platform trials. Such group differences abated by the eighth test day when all rats performed equally well. The improvements in performance were not correlated with changes in swim speeds indicating that the enhancement was not due to facilitated motor output. These data reveal that a modest, 6-week treatment regimen with aspirin in aged rats is sufficient to induce improvements in both speed of learning and strength of the learned response. We have yet to address the key question as to underlying physiological mechanism(s) that might underpin this augmented cognitive performance. Moreover, it would be useful to ascertain whether or not chronic NSAID treatment might reduce the extent of learning impairments in aged, cognitively impaired animals.

No / Agents which increase intracellular cyclic adenosine monophosphate (cAMP) may have an antagonistic effect on pro-inflammatory molecule production so that inhibitors of the cAMP degrading phosphodiesterases have been identified as promising drugs in chronic inflammatory disorders. Although many such inhibitors have been developed, their introduction in the clinic has been hampered by their narrow therapeutic window with side effects such as nausea and emesis occurring at sub-therapeutic levels. The latest generation of inhibitors selective for phosphodiesterase 4 (PDE4), such as apremilast and roflumilast, seems to have an improved therapeutic index. While roflumilast has been approved for the treatment of exacerbated chronic obstructive pulmonary disease (COPD), apremilast shows promising activity in dermatological and rheumatological conditions. Studies in psoriasis and psoriatic arthritis have demonstrated clinical activity of apremilast. Efficacy in psoriasis is probably equivalent to methotrexate but less than that of monoclonal antibody inhibitors of tumour necrosis factor (TNFi). Similarly, in psoriatic arthritis efficacy is less than that of TNF inhibitors. PDE4 inhibitors hold the promise to broaden the portfolio of anti-inflammatory therapeutic approaches in a range of chronic inflammatory diseases which may include granulomatous skin diseases, some subtypes of chronic eczema and probably cutaneous lupus erythematosus. In this review, the authors highlight the mode of action of PDE4 inhibitors on skin and joint inflammatory responses and discuss their future role in clinical practice. Current developments in the field including the development of topical applications and the development of PDE4 inhibitors which specifically target the subform PDE4B will be discussed.

No

No

Black Americans are one of the largest minority groups in the United States and were estimated to be 35 million (13%) by the 2000 U.S. Census. In that same year, the American Cancer Society reported that Black Americans are at higher risk of dying from the nations leading causes of death, such as cardiovascular diseases, cerebrovascular disease, cancer, accidents, and diabetes. Whereas the five leading causes of death among Black American women include cardiovascular diseases, cancer, diabetes, accidents, and kidney-related diseases as reported by the American Heart Association in 2002. Black American women, in general, are less likely to engage in health promoting activities, such as physical activity and proper dietary intake. Black American women consume diets that are high in fat and in 1998, only 15.2% of Black American women reported engaging in regular, moderate exercise. The lack of physical activity and poor nutrition has also been correlated with the occurrence of overweight and obesity among Black American women. The 1999-2000 National Health and Nutrition Examination Survey (NHANES) showed that 49.7% of Black American women are obese. The purpose of this study is to assess the perceptions of Black American women regarding their health and nutrition practices, concerns, and solutions. Qualitative (focus groups and key informant interviews) and quantitative (participatory activities) research data were collected from Black American women within the faith community of the Commonwealth of Virginia. Five focus group sessions were conducted with a total of 25 Black American church women. The participants answered focus group questions and engaged in visual participatory activities to rank top nutrition and health concerns and barriers. Key informant interviews were conducted with health professionals within the faith community. Overweight/obesity, diabetes, heart disease/stroke, high blood pressure were predominate health themes raised in the focus group sessions. Also, the women ranked overweight /obesity, diabetes, heart disease/stroke, and high blood pressure as their top health concerns. The key informant interview also confirmed that overweight/obesity, diabetes, and hypertension (high blood pressure) were the main health concerns among Black American women. The predominate nutrition themes were the reluctance in giving up traditional foods, not eating enough of the right foods, and the time of day when they ate. The top nutrition concerns ranked by the women were not drinking enough water, not eating enough fruit and vegetables, and eating too many sugars. Major barriers raised by the participants were not having enough time, conflicting schedules, and familial commitments prohibited proper nutrition and health activities. The key informants agreed that a major barrier for Black American women was not prioritizing their health and nutrition practices. The preferred learning method by the women was workshops or programs that were sponsored by the community using the church as a venue. Data obtained from this study will be used to develop useful nutrition education strategies to improve the dietary habits and overall status among women in this segment of the population. / Master of Science

The effectiveness of the Jail-Based Public Inebriate Treatment and Intervention Program, in the city of Roanoke, VA, is evaluated. This program targets those who have violated their interdiction status, ordered by the Circuit Court, to not consume, possess or purchase beverages containing alcohol. A voluntary treatment program has been set up to treat those interdicted housed within the jail. This treatment program hopes to rehabilitate the offender, decrease the number of arrests within the City of Roanoke and improve the attractiveness of the downtown area. The typical participant in this program is a 51-year-old homeless male who has been drinking for approximately 33 years. Methods of evaluation include the analysis of arrest data collected from January 1996 to June of 2000, as well as interviews conducted in local day shelters, within the jail, with a court community corrections representative, in the court house, at the Blue Ridge Community Treatment Center and with a representative of the downtown business community. The goals of the program are evaluated for their effectiveness. Some goals are found to be more effective than others and Richard Hall’ s Contradiction Model is used to explain this variation. / Master of Science

Background: Asthma is a chronic inflammatory lung disease that most often emerges in childhood and affects millions of children around the world. Asthma can affect parents and their children more or less depending on how severe asthma is. When children are cared for, parents are an important and necessary resource for the child's well-being. That´s why it´s important to support not only the child but also parents in the care process. Aim: The purpose of this literature study is to describe experiences of parents who care for a child with asthma. Method: This study was based on systematic literature search which was based on ten qualitative articles that responded to the purpose of the study. Results: The results showed that parents caring for a child with asthma often experienced concern, frustration, hope and need for knowledge about asthma. Parents experienced great deal of concern before child was diagnosed, during deterioration periods and concern about negative side effects medication could cause in the future for the children. Frustration emerged when dealing with health care professionals and school/preschool staff. Despite everyday concern, frustration, lack of knowledge parents still felt hope for the future. Conclusion: Nurses have continuous contact with parents that care for children with asthma. Parents caring for child with asthma need a great deal of support from health care system to be able to manage child's illness best way they can. Increased understanding and knowledge about parents experience makes it possible for nurses to have an open dialog with parents and include them better in their child's care.

Patients with chronic kidney disease are at increased risk of cardiovascular disease. These patients are often excluded in randomized controlled trials of treatments for cardiovascular disease, leading to greater uncertainty behind treatment effects in this population. Further, patients with kidney disease experience unique complications from accepted therapies for the general population, e.g.; long-term anticoagulation may be result in further kidney injury called anticoagulation-related nephropathy. However, incidence and magnitude of this acute kidney injury are not adequately measured in past randomized controlled trials of anticoagulation. Chapters in this thesis aim to increase our understanding the relationship between cardiac and kidney disease. Chapters 2 and 3 focus on the optimal prosthetic valve in dialysis patients requiring valve replacement surgery. Chapter 2 is a systematic review and meta-analysis comparing the short and long-term outcomes of two prosthetic valves implanted in dialysis patients. Chapter 3 is a survey of physicians aiming to understand the current practice of nephrologists, cardiologists, and cardiac surgeons caring for dialysis patients requiring valve replacement surgery and their preference for either prosthetic valve based on patient factors. Chapter 4 explores the interaction between an individual’s baseline kidney function and the effect on stroke reduction of occluding the left atrial appendage. This is accomplished by a secondary analysis of the Left Atrial Appendage Occlusion Study 3 (LAAOS III). Chapter 5 is a rationale and study design of LIMIT-Renal, a substudy of Low INR to Minimize Bleeding with Mechanical Valves Trial (LIMIT). This substudy aims to validate the existence of anticoagulation-related nephropathy, a form of acute kidney injury in patients receiving long-term anticoagulation, and its magnitude on renal health. Chapter 6 is the conclusion of the thesis and discusses key findings, strengths and limitations, future directions, and potential obstacles. / Thesis / Doctor of Science (PhD) / Individuals with chronic kidney disease are at an increased risk of heart disease and those receiving treatment for heart disease may be at an increased risk of developing kidney disease. Chapters in this thesis investigate the understudied interplay of heart disease and renal disease, for which an overview is presented in chapter 1. Chapter 2 addresses the uncertainty surrounding an optimal prosthetic valve in dialysis patients requiring surgical valve replacement surgery. Chapter 3 aims to understand the perceptions and preferences of physicians caring for dialysis patients needing valve replacement surgery. Chapter 4 explores the interaction between occluding the left atrial appendage and baseline kidney function on stroke reduction using data from the Left Atrial Appendage Occlusion Study 3 (LAAOS III). Chapter 5 is the design and rationale for a substudy of Low INR to Minimize Bleeding with Mechanical Valves Trial (LIMIT) exploring a form of acute kidney injury in patients receiving blood-thinning medications. Chapter 6 discusses the key findings from each chapter, their strengths and limitations, future directions, and potential obstacles.

Yes / / Chronic low back pain (CLBP) is a global musculoskeletal challenge, resulting in pain and disability on individuals. Laser therapy can be used to treat CLBP. This review evaluates the effectiveness of laser therapy including high level laser therapy (HLLT) and low level laser therapy (LLLT) on CLBP in relation to pain or functional disability. Methods: The authors conducted a systematic review of randomised controlled trials (RCTs) and searched the Cochrane Library, MEDLINE, CINAHL, AMED and PEDro from their start to June 2015. All studies that met predetermined inclusion and exclusion criteria were appraised with The Cochrane Collaboration’s tool for assessing risk of bias and Critical Appraisal Skills Programme Tools in June, 2015. Findings: Six RCTs met the inclusion criteria: two RCTs reported significant improvement in pain and functional disability with the use of HLLT but with small sample size (n=103); one RCTs (n=61) reported significant improvement and three RCTs (n=215) reported insignificant improvement in pain and functional disability with the use of LLLT. Conclusion: On the strength of the evidence available HLLT and LLLT are not currently recommended to be replaced or be offered in addition to conventional treatment. Further rigorous research is required to confirm the potential use of laser therapy on individuals presenting with CLBP.

Yes / The increasing prevalence and associated cost of treating chronic obstructive pulmonary disease (COPD) is unsustainable, and focus is needed on self-management and prevention of hospital admissions. Telehealth monitoring of patients’ vital signs allows clinicians to prioritise their workload and enables patients to take more responsibility for their health. This paper reports the results of a pilot randomised controlled trial (RCT) of Telehealth-supported care within a community-based COPD supported-discharge service. Methods: A two-arm pragmatic pilot RCT was conducted comparing the standard service with a Telehealth-supported service and assessed the potential for progressing into a full RCT. The co-primary outcome measures were the proportion of COPD patients readmitted to hospital and changes in patients’ self-reported quality of life. The objectives were to assess the suitability of the methodology, produce a sample size calculation for a full RCT, and to give an indication of cost-effectiveness for both pathways. Results: Sixty three participants were recruited (n = 31 Standard; n = 32 Telehealth); 15 participants were excluded from analysis due to inadequate data completion or withdrawal from the Telehealth arm. Recruitment was slow with significant gaps in data collection, due predominantly to an unanticipated 60% reduction of staff capacity within the clinical team. The sample size calculation was guided by estimates of clinically important effects and COPD readmission rates derived from the literature. Descriptive analyses showed that the standard service group had a lower proportion of patients with hospital readmissions and a greater increase in self-reported quality of life compared to the Telehealth-supported group. Telehealth was cost-effective only if hospital admissions data were excluded. Conclusions: Slow recruitment rates and service reconfigurations prevented progression to a full RCT. Although there are advantages to conducting an RCT with data collection conducted by a frontline clinical team, in this case, challenges arose when resources within the team were reduced by external events. Gaps in data collection were resolved by recruiting a research nurse. This study reinforces previous findings regarding the difficulty of undertaking evaluation of complex interventions, and provides recommendations for the introduction and evaluation of complex interventions within clinical settings, such as prioritisation of research within the clinical remit.