Background: Stroke remains a major public health burden. Few studies have focused on the age differences in the associations of behavioral and psychosocial factors with stroke while no study focusing on the effect of severe psychological distress (SPD) on stroke has been conducted. The aim of this study was to examine the age differences in these risk factors for stroke as young (18-44 years), middle aged (45-64 years), and elderly (65 years or older). Methods: A total of 1,258 adults with stroke and 39,985 controls were selected from the 2005 California Health Interview Survey. Multiple logistic regression analyses were used to estimate the associations of the factors with stroke at different ages. Results: The prevalence of SPD was 10% in cases and 3.6% in controls, respectively. Overall, current smoking, lack of physical activity, alcohol consumption, SPD, type II diabetes, male, older age, and unemployment were all associated with a higher prevalence of stroke. Practically, we found that smoking and SPD were associated with the prevalence of stroke in young adults, lack of physical activity was associated with the prevalence of stroke in middle-aged adults, and lack of physical activity and SPD were associated with the prevalence of stroke in the elderly. Conclusions: Appropriate intervention for reducing stroke and eliminating its disparities may be developed separately at each age.

An anti-inflammatory phenotype with pronounced immunosuppression develops during sepsis, during which time neutrophils and monocytes/macrophages limit their Toll-like receptor 4 responses to bacterial lipopolysaccharide (LPS/endotoxin). We previously reported that during this endotoxin-tolerant state, distinct signaling pathways differentially repress transcription and translation of proinflammatory cytokines such as TNFα and IL-6. Sustained endotoxin tolerance contributes to sepsis mortality. While transcription repression requires chromatin modifications, a translational repressor complex of Argonaute 2 (Ago2) and RNA-binding motif protein 4 (RBM4), which bind the 3′-UTR of TNFα and IL-6 mRNA, limits protein synthesis. Here, we show that Dcp1 supports the assembly of the Ago2 and RBM4 repressor complex into cytoplasmic processing bodies (p-bodies) in endotoxin-tolerant THP-1 human monocytes following stimulation with LPS, resulting in translational repression and limiting protein synthesis. Importantly, this translocation process is reversed by Dcp1 knockdown, which restores TNFα and IL-6 protein levels. We also find this translational repression mechanism in primary macrophages of septic mice. Because p-body formation is a critical step in mRNA translation repression, we conclude that Dcp1 is a major component of the translational repression machinery of endotoxin tolerance and may contribute to sepsis outcome.

A single subject alternating treatment design was used to compare the relative effectiveness of one-to-one embedded instruction in the general education classroom and one-to-one massed practice instruction in a special education class. Four middle school students with developmental disabilities, their special education teacher, and paraprofessional participated in the study. The results indicate that embedded instruction is an effective instructional strategy for students with developmental disabilities being served in inclusive settings. However, the results indicate that there was some difference in the efficiency of the two instructional formats. Two students reached criterion more rapidly in the one-to-one massed instructional intervention while the one-to-one embedded instruction was more efficient for one student. There was no difference between the interventions for the fourth student. Finally, the study validated previous research that found that both special education teachers and paraprofessionals can, with minimal training, accurately implement embedded instructional interventions in the general education classroom. Implications for practitioners and researchers are discussed.

Introduction Severe hypercalcemia from chronic gout is a rare phenomenon seen after the advent of newer drugs for its treatment. The hypercalcemia is secondary to either granuloma formation around the tophi or chronic immobilization from severe gouty arthritis. We present a patient with chronic tophaceous gout presenting with severe hypercalcemia and acute kidney injury. Case presentation A 63-year-old male patient with a past medical history of hypertension and chronic gout presented to the office with chronic, severe left knee pain. Initial evaluation of the knee with X-rays revealed destruction of the knee joint with cystic changes, and subsequent MRI with contrast showed soft tissue mass in the suprapatellar pouch with intraosseous extension and involvement of medial and lateral collateral ligament involvement. After interdisciplinary evaluation between radiology, orthopedic surgery, and oncology, this was concerning for highly aggressive pigmented villonodular synovitis of the knee, and a decision was made for the patient to undergo complete knee replacement. Perioperative workup was significant for severe hypercalcemia with a total calcium level of 13.2 mg/dl with ionized calcium of 7.2 mg/dl. Further evaluation into the cause of hypercalcemia revealed a low normal intact parathyroid hormone (PTH) level with normal phosphorus, calcidiol, and calcitriol levels. Other etiologies of hypercalcemia such as multiple myeloma, malignancies, metastatic disease, autoimmune, granulomatous, and infectious processes are excluded with extensive workup. The hypercalcemia is treated with fluids, diuretics, and bisphosphonates, eventually normalizing the calcium levels. The patient underwent total left knee replacement, and the mass identified was sent for biopsy. Biopsy revealed a prominent granulomatous reaction to amorphous crystals containing birefringent crystals under polarised light. Uniquely during our evaluation, vitamin D metabolites, uric acid, and PTH levels were normal despite the biopsy findings. The patient's calcium continued to be normal (8.4 to 10.4 mg/dl) over six months after the surgery. Thus, the scenario is supportive of hypercalcemia secondary to granulomatous inflammation around the large tophi. Conclusion Although rare, the knee joint is a site of severe tophaceous gout, and deposition of uric acid crystals can invoke a granulomatous reaction presenting with severe hypercalcemia as in our patient. Unique to our case, the patient can have benign lab findings on evaluation of hypercalcemia. Only a few case reports are illustrated in the literature, making our case and patient presentation unique.

To teach operant behaviors to individuals with severe disabilities, stimulus preference assessment (SPA) methods have been developed to accurately identify stimuli that may function as reinforcers. Previous researchers have used multiple-stimulus preference assessments without replacement (MSWO) effectively over a short time period to teach target behaviors to individuals with disabilities. The present study investigated the long-term effects of incorporating brief MSWO preference assessments into the instructional routine for students with severe disabilities on individualized education plan reading goal/objective progress. This was done by investigating the effectiveness of incorporating brief MSWO preference assessments by comparing reading goal progress when a random reinforcer is available, teacher- selected reinforcer is available, or a student-selected reinforcer (via a brief MSWO preference assessment) is available over several weeks for students with severe disabilities in a secondary public school classroom setting.

Indiana University-Purdue University Indianapolis (IUPUI) / Aim: Early psychosis has been identified as period during which rapid identification and treatment can lead to significant improvement in clinical and functional outcomes. Despite increased research, no studies have examined early psychosis in Veteran populations. It is unknown whether Veterans differ from non-Veterans at this stage of the disorder, and if the treatments offered to non-Veterans are appropriate to implement in Veteran Affairs Medical Centers. Given differences that appear between Veterans and non-Veterans in chronic psychosis, additional work is necessary to determine the best way to approach specialized treatment for Veterans experiencing early psychosis. Methods: The current study is a secondary analysis of assessment batteries collected at a community-based early intervention program and at a local Veteran Affairs Medical Center. Assessment results were compared for Veterans’ and non-Veterans’ background characteristics, symptoms, and neurocognitive deficits. Results: Significant differences were found between the two samples on age of illness onset, marital status, education level, positive symptoms of psychosis, and neurocognitive functioning. Logistic regression analyses identified age of onset as a potential underlying factor. Conclusions: While some aspects of illness presentation appear similar between Veterans and non-Veterans, there are important differences between these populations. Pre-existing treatment interventions, such as Social Skills Training, cognitive remediation approaches and cognitive behavior therapy for psychosis may be appropriate to implement with Veterans. Others– such as family based interventions or supported employment services – may need to be tailored to maximize the benefit for Veterans.

京都大学 / 0048 / 新制・課程博士 / 博士(工学) / 甲第17956号 / 工博第3804号 / 新制||工||1582(附属図書館) / 30786 / 京都大学大学院工学研究科材料工学専攻 / (主査)教授 辻 伸泰, 教授 松原 英一郎, 教授 安田 秀幸 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DFAM

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No description available.

Bakgrund   Svår akut respiratorisk sjukdom [SARS] var en ny typ av atypisk lunginflammation som orsakades av ett coronavirus som tidigare enbart var känt att smittade mellan djur. År 2002 muterade detta virus och började infektera människor. 2000-talets första epidemi drog igång och över 8000 personer konstaterades smittade. Många personer som smittades blev svårt sjuka och behövde söka vård på grund av andningssvårigheter och hypoxi.  Syfte  Syftet var att belysa sjuksköterskans upplevelser av att vårda personer med svår akut respiratorisk sjukdom på sjukhus. Metod Den valda metoden för detta arbete var en icke-systematisk litteraturöversikt där 15 vetenskapliga artiklar inkluderades. Artiklarna som användes var både kvalitativa och kvantitativa och har kvalitetsgranskats med hjälp av Sophiahemmets Högskolas bedömningsunderlag. Insamling av artiklar har gjorts från databaserna Cinahl, PubMed och PsycINFO och analyserades med integrerad dataanalys.  Resultat Resultatet visade att sjuksköterskorna upplevde stor stress, rädsla och maktlöshet. Adekvat skyddsutrustning och kunskap om smittan saknades. Sjuksköterskorna hamnade i en situation där de var tvungna att välja att antingen stanna kvar i sin profession eller leta efter arbete med mindre yrkesrisker. Många valde att stanna, detta för att de insåg att det inte fanns någon annan som kunde ta hand om dessa personer. Slutsats Trots de psykiska påfrestningarna som drabbade sjuksköterskorna kunde de med stöd av varandra ta sig igenom epidemin. Många kände att de växte i sin roll som sjuksköterska och kunde ta med sig nya lärdomar inför framtiden. Dock kunde stora brister uppdagas i sjukvården och dessa kunskapsluckor behöver fyllas med lärdomar från tidigare epidemier och pandemier inför framtida utbrott. / Background Severe acute respiratory syndrome was a new type of atypical pneumonia caused by a coronavirus that previously was known only to spread amongst animals. During late 2002 the virus mutated and started to infect people. The 21st century’s first epidemic began and over 8000 people were confirmed infected with the new disease. A lot of people became severely ill and had to seek medical care due to breathing difficulties and hypoxia. Aim The purpose was to shed light on the nurse's experiences of caring for persons with severe acute respiratory syndrome in hospitals. Method The chosen method for this paper was a non-systematic literature review in which 15 scientific articles were included. The articles included were both qualitative and quantitative and were quality reviewed with the help of Sophiahemmets University’s assessment tool. The articles were collected using the databases CINAHL, PubMed and PsycINFO and analyzed with an integrated data analysis. Results The results show that nurses experienced a high level of stress, fear and powerlessness. There was a lack of adequate protective equipment and knowledge about the disease. The nurses were forced to choose, either to stay in their profession or search for a different occupation with less risk of getting infected. A lot of nurses chose to stay, they realized that there were no one else who could take care of the patients.  Conclusions Despite the psychological symptoms that affected the nurses, they realized that they could get through the epidemic with the support of each other. Many nurses felt a growth in their profession and could bring a lot of new knowledge with them for the future. A lack of knowledge was discovered in the healthcare system and there are a lot off lessons to be learned for future epidemic and pandemic outbreaks.