Chronic Fatigue Syndrome or myalgic encephalopathy (CFS/ME) has a negative impact on a child and their parents. It is not known what the impact is for the siblings of children with CFS/ME. Nine siblings participated in semi-structured interviews. Siblings identified a number of negative impacts to their family and to themselves, as well as describing some protective family factors. These findings have implications for current practice in CFS/ME paediatric services.

The aim of this thesis was to assess whether platelet, endothelial and coagulation biomarkers of thrombotic risk are increased in ECKD-HD patients. Five individual studies were performed (1) venous blood samples between controls and resting HD patients, (2) simultaneous blood samples between vascular access (VA) and venous samples in HD patients (3) pre and post dialysis from the VA, (4) samples pre and post dialysis in venous samples, (5) a retrospective study of VA thrombosis in HD patients. Venous blood samples were taken from 78 resting healthy volunteers and from 78 HD patients immediately before and 30 minutes after dialysis. We also took blood samples from the VA of 55 patients immediately before and after dialysis. In 26 patients venous and VA samples were taken simultaneously. Our results have shown HD patients potentially have evidence of a prothrombotic state compared to controls. This is further increased by each session of dialysis and is present in both VA and venous samples distant from the site of haemodialysis. We have shown some differences in platelet activation and inflammatory markers between simultaneous VA and venous samples. Furthermore, some of these biomarkers may be associated with a retrospective history of VA occlusion. Our study has shown that in patients with ECKD on HD there may be evidence of an underlying prothrombotic tendency. There is a need to determine the optimal anti-platelet and anti-coagulation therapy in these patients.

No description available.

A 41-year-old woman presented with burning and erythema in her extremities triggered by warmth and activity, which was relieved by applying ice. Extensive workup was consistent with adult-onset primary erythromelalgia (EM). Several pharmacological treatments were tried including local anesthetics, capsaicin, ziconotide, and dantrolene, all providing 24-48 hours of relief followed by symptom flare. Interventional therapies, including peripheral and sympathetic ganglion blocks, also failed. Thus far, clonidine and ketamine have been the only effective agents for our patient. Genetic testing was negative for an EM-associated mutation in the SCN9A gene, encoding the Na(V)1.7 sodium channel, suggesting a mutation in an alternate gene.

Class of 2017 Abstract / Objectives: Specific Aim 1: Pharmacist will use pharmacological pain self-management strategies over non- pharmacological strategies. Specific Aim 2: Pharmacist pain self-management strategies will differ based on whether or not the pharmacist has chronic pain. Specific Aim 3: Pharmacist pain self-management strategies will differ across age. Specific Aim 4: Pharmacist pain self-management strategies will differ across gender. Methods: A survey was sent to all pharmacists with an email address registered with the State Board of Pharmacy in a single Southwestern state. The survey asked about characteristics of pain, strategies for managing pain, outcomes, and demographics. The primary outcome was severity of pain after treatment. Results: Responses were received from 417 pharmacists; 219 reported acute, 206 reported chronic pain, and 55 reported no pain. The chronic pain group was more likely to have a disability with poor/fair health status (P<0.006) and to report higher levels of pain before treatment (6.9 versus 5.8). Both groups reported similar relief from all strategies (76% versus 78% ; P equals 0.397), but the chronic pain group reported higher levels of pain after treatment (3.2 versus 2.0), less confidence in pain management, and less satisfaction (P less than 0.004). Conclusions: Age and gender did not affect the use of specific pain management strategies or the amount of pain relief received from all strategies used by participants with either acute or chronic pain. However, participants with chronic pain had higher levels of pain before and after treatment.

Approved for public release; distribution is unlimited / The Marine Aviation Weapons and Tactics Squadron One (MAWTS-1) command requested a sleep and performance study of the instructors and students of Weapons and Tactics Instructor (WTI) course 2- 16. Specifically, MAWTS-1 leadership wanted to know whether crew rest periods were being used for sleep and whether fatigue posed a risk to personnel during the course. This thesis expanded upon prior studies in military educational environments. The WTI 2-16 study collected sleep and performance data via wrist-worn actigraphy and psychomotor vigilance tests (PVT). Sleep duration and efficiency remained high throughout the course, but participation waned before the study ended. Both instructors and students appeared to receive adequate sleep of good quality (overall mean 7.4 hrs/night). There was little variability in the sleep patterns (i.e., WTI participants were abiding by the crew rest regulations). Compliance posed a significant challenge and limited the ability to correlate sleep to performance. We also measured self-reported fatigue and mood using standardized questionnaires. Results from subjective assessments showed a significant increase in self-reported fatigue as the course progressed. This thesis outlines a detailed methodology and lessons learned for follow-on studies of this type and recommends improvements to future studies. / Major, United States Marine Corps

D.Phil. / Chronic pain is a devastating problem and one of the leading causes of disability internationally with an estimated 25-30% of people in industrialised nations suffering from it. Various approaches are available for the treatment of chronic pain with exercise therapy is often the last resort, after all else has failed. The present study was motivated by the growing prevalence of chronic pain patients and the recent progress in pain science. This study made use of a quasi-experimental design where randomization was a function of participant convenience. It made use of a Pre-Test Post-Test battery consisting both of self-report questionnaires and of a physical assessment evaluating components of chronic pain patients’ experience prior to and following a combined therapeutic intervention programme of 12 sessions. Follow- up was at 12 months. The objectives were to integrate patient reconceptualization of pain by means of an active approach combining pain education and exercise therapy, and to determine the effect of a change in pain cognition on the outcome compared to a control group receiving exercise therapy only. A heterogeneous group of chronic pain patients were randomized into 2 groups who both received exercise therapy twice per week: the experimental group (80) received exercise therapy and a specific 3 hour pain education session with the active control group (74) only receiving exercise therapy. There were no differences in pain related or demographic characteristics between groups at baseline. Both groups had a significant reduction in pain perception after 12 exercise therapy sessions (P<0.05). After a follow up period of 12 months the experimental group sustained the same level of pain reduction (P<0.05). The control group maintained only some the acquired reduction in pain perception. In the experimental group an increased participation in physical activity was also found 12 months after the intervention. Exercise therapy significantly reduces the perception of pain in chronic pain patients after 12 therapy sessions, but the combination of pain education and exercise therapy better maintain these effects after a year. Key Words: chronic pain, exercise, pain education.

Venous valves (VVs) are critical for unidirectional blood flow from superficial and deep veins towards the heart. Congenital valve aplasia or agenesis may, in some cases, be a direct cause of vascular disease, motivating an understanding of the molecular mechanisms underlying the development and maintenance of VVs. Three gap junction proteins (Connexins), Cx37, Cx43, and Cx47, are specifically expressed at VVs in a highly polarized fashion. VVs are absent from adult mice lacking Cx37; however it is not known if Cx37 is required for the initial formation of valves. In addition, the requirement of Cx43 and Cx47 for VV development has not been studied. Here, we provide a detailed description of Cx37, Cx43, and Cx47 expression during mouse vein development and show by gene knockout that each Cx is necessary for normal valve development. The valve phenotypes in the knockout lines exhibit Cx-specific differences, however, including whether peripheral or central VVs are affected by gene inactivation. In addition, we show that a Cx47 null mutation impairs peripheral VV development but does not affect lymphatic valve formation, a finding of significance for understanding how some CX47 mutations cause inherited lymphedema in humans. Finally, we demonstrate a striking segregation of Foxc2 and NFATc1 transcription factor expression between the downstream and upstream faces, respectively, of developing VV leaflets and show that this segregation is closely associated with the highly polarized expression of Cx37, Cx43, and Cx47. The partition of Foxc2 and NFATc1 expression at VV leaflets makes it unlikely that these factors directly cooperate during the leaflet elongation stage of VV development. (C) 2016 Elsevier Inc. All rights reserved.

The recent advancements in healthcare is extending the lives of older people. However, such advancements come at a cost: higher medical expenses with less financial resources and limited, if not truncated, monetary assistance. The dilemma is further compounded by the unreliable quality of life produced by extending life of the chronically ill. Using the RAND data, I examine three financial transaction outcomes at different points-in-time in context of the onset of a health issue: one, the probability of a transaction occurring, two, how much is given, and three, the frequency of transactions. I also examine how a health issue impacts financial transaction choices within a given year, a year after the health issue occurs, and the longer term impacts on subsequent intergenerational financial transactions. I find no change in financial behavior of an adult child immediately after the health issue occurs and minimal over the longer period of time. However, this study does show a slight and statistically significant shift in financial transactions within the first year after a health issue occurs. Additionally, the results suggest that those who can live in assisted care and near respondent children have higher transactions between family members.

Objective: To complete an integrative review of the studies on pediatric chronic illness utilizing the Children's Hope Scale to determine the association between hope and thechronically ill child. Method: A comprehensive review of PubMed, PsycINFO, Academic Search Complete, CINAHL, The Cochrane Library, ProQuest, and Dissertations Theses was completed. Titles were reviewed, selected abstracts were then assessed, and full papers were obtained. Results: Ten studies were found which met the specified inclusion criteria: participants less than or equal to 19 years of age, an illness of more than three months in duration, and hope measured by the Children's Hope Scale. The studies found some support for the positive effect of hope for children with chronic illness, but more research needs to be done with larger samples. Conclusion: This integrative review supports the positive impact of hope on the chronically ill child and the need for additional research on the role of hope in the chronically ill child.