Letteratura scientifica selezionata sul tema "329999 Medical and Health Sciences not elsewhere classified"

Abstract Background Retention in care is critical for treatment and prevention of HIV. Many HIV care clinics measure retention rate, but data are often incomplete for patients who are classified as lost to follow-up but may be actually in care elsewhere, moved, or died. The Data to Care (D2C) initiative supports data sharing between health departments and HIV providers to confirm patient care status and facilitate reengagement efforts for out of care HIV patients. Methods The University of Chicago Medicine (UCM) provided an electronic list to the Chicago Department of Public Health (CDPH) of adult HIV-positive patients whose retention status was not certain. Retention in care was defined as at least 2 visits >90 days apart within the prior 12 months. CDPH matched this list of patients with data from the Chicago electronic HIV surveillance database. Matches were based on patient name, including alternative spellings and phonetics, and birth date. CDPH also cross-checked patient names with the CDC’s national enhanced HIV-AIDS Reporting System (eHARS) database. CDPH provided UCM with patient current care status, i.e., patient was in care elsewhere (as verified by lab data), moved out of state, or deceased. Results 780 HIV-positive patients received care in the UCM adult HIV clinic from January 1, 2013 to March 31, 2017. Of these, 360 were retained in care as of March 2017. We shared data with CDPH for 492 patients. Of these, 294 (59.8%) were matched, and 168 (34.1%) had a date of last medical care provided. See Table 1 for patient dispositions, before and after data sharing. 24 (13.4%) of patients believed to be lost to follow up according to UCM records were confirmed either transferred care or deceased according to health department data. Conclusion Data sharing between the health department and HIV providers can improve data accuracy regarding retention in care among people living with HIV. Disclosures J. P. Ridgway, Gilead FOCUS: Grant Investigator, Grant recipient; D. Pitrak, Gilead Sciences FOCUS: Grant Investigator, Grant recipient

This action research project examines the researcher’s journey of establishing a therapeutic relationship with a child with autism spectrum disorder during her practicum. Children with ASD present difficulty in communication and social relationship skills. As a student in training with a limited experience, the researcher had uncertainty and low confidence with regard to her clinical and professional skills which affected her work. In this project, the researcher has examined her own process of music therapy with a child with ASD and shows how she was able to improve her practice and therefore establish meaningful and effective therapeutic relationships with this client population and obtain valuable learning through the training. The study was conducted at a dedicated therapy centre in New Zealand where the researcher was in placement. A total of seven, thirty-minute weekly individual music therapy sessions and four supervision sessions were employed. This process was adapted into the design of action cycles which involved the repeated process of planning, action and evaluation. In-depth analysis of the researcher’s work was carried out throughout the cycles, using clinical notes, journal excerpts, supervision notes and video recordings of the sessions. The findings suggest that the researcher was able to improve her practice while attempting to build a therapeutic relationship with the client. Various clinical and personal issues arose such as uncertainty about improvisation, and lack of confidence in professional skills including communicating with parents, which led to disjunction and burnout symptoms. Discussions in supervision aided in in-depth reflection of the researcher’s work as well as emotional support. The researcher could ultimately develop ‘internal supervisor’ and was able to use independent strategies to help develop her work. Implications for training include making personal therapy a compulsory course requirement, providing training on professional skills, and student support groups. Future research may investigate the effectiveness of verbal input in music therapy and the emotional stages of parents.

The thesis proposes and defends a maxim which can serve as a foundation and guideline for professional ethics in nursing, the maxim that nurses should act so far as possible to promote patient's self-determination. The thesis is informed by philosophical ethics and by knowledge of professional nursing practice.

Stroke recovery is complex and poorly understood. As a legacy of pervasive pessimism in the face of limited treatment, it is conceptualised and researched from biomedical and psychosocial perspectives that address impairment, problems of performance, quality of life, burden and disruption. Little stroke research is conducted once professional input has ceased, and yet considerable change occurs after this period with evidence that post-stroke wellbeing is independent of impairment and function -- many people do well in the face of poor prognoses, while others remain miserable despite 'good recovery'. Current advances in acute stroke management are generating increasing optimism, but lack of understanding about individuals' post-stroke experiences and long-term outcomes continues. While it is recognised that the impact of stroke on the lives of survivors and families is profound, rehabilitation focuses on recovery as task achievement and measured functional outcomes. For many survivors and their families 'recovery' is contested, ambiguous and extended. For some, it becomes a lifetime marathon because stroke represents an assault, not only to the body, but to the self and the lifeworld -- it is a 'life' event. This narrative inquiry into life after stroke explores recovery as a process taking place over time and conceptualised as a life transition. The work is grounded in narrative theory with the concept of transition providing the lens and focus for the research, its processes and analyses. Individuals' stories remain intact enabling evocation of diverse stroke meanings and the mapping of individual experience. Bringing these whole stories into conversation with each other elucidates post-stroke transition which is interpreted in light of theories of response to traumatic loss and informed by narrative theory. The thesis presents stories of trauma, loss and grief, situated in past lives and selves where assumptions about selves and future lives are shattered. The future makes no sense in terms of participants' past and present lives; life plots are lost and stroke therefore represents 'lost futures'. Stories of moving on to new lives are focused on being and doing in the present and have an expectant view of life. Although mindful of past lives and enduring losses, survivors actively engage in processes to reconfigure their lives with hope for a meaningful future. Transition is interpreted as 'reconfiguring the future'. The life tasks of reconfiguration are embedded in dynamic models of traumatic loss where grief is conceptualised as recursive movement between loss and meaning reconstruction evident in narratives that slowly move towards wellbeing. Despite broad recognition that loss and grief are part of the stroke experience, they are rarely addressed; where attention is paid it is likely embedded in explanatory models of staged response that oversimplify human experience. This thesis offers a new framework. It represents a fresh interpretation that highlights the ongoing traumatic impact of stroke. The post-stroke journeys of survivors and families are affected by individual circumstances and meanings. Although their stories are permeated with loss, many people move forward towards lives worth living. This interpretation suggests ways of reconfiguring lives in the face of devastation and ongoing traumatic loss. The work identifies a complex interaction of individual, emotional and social factors contributing to transitions to wellbeing following stroke and thus adds to a prospective vision of post-stroke life that can inform rehabilitation, discharge and stroke support strategies. Post-stroke transition will be enhanced when we use narrative framing and understanding to guide rehabilitative practice that uses meaning-centred models to prepare survivors and their families for a return to the lifeworld.
Thesis (PhD)--University of South Australia, 2009

In the skeletal muscle cell membrane, the voltage gated chloride channel, CIC-1, maintains as unusually high resting membrane conductance and thereby prevents myotonic skeletal muscle disease. Protein crystallization experiments with bacterial CIC proteins, provide the information for the three dimensional (3D) structure of CIC chloride channels.
PhD Doctorate

The way in which we perceive and interpret the causes of situations is likely to have a profound influence on our subsequent behaviour. It has been well established that the experience of anger is likely to systematically influence the cognitive processing style and cognitive skills that the individual will use in understanding, and responding to, interpersonal situations. One important process that may be affected by the regular experience of intense anger (trait anger), is the dispositional propensity to attempt to understand the thoughts, feelings, and point of view of another person in an interpersonal interaction (i.e., perspective taking). A study was conducted to test this theoretical hypothesis. In addition, the study attempted to examine the influence of perspective taking on anger experience, control, and expression.

Aluminum (Al) is the third most abundant metal on the earth’s surface. An association of Al with Alzheimer’s disease has been suggested, but, given limited human evidence, is controversial. It is possible that exploration of long-term, or cumulative, exposure to Al will help clarify this debate. Therefore, our study hypothesis was that occupational exposure to Al, particularly long-term exposure, is associated with adverse cognitive and olfactory outcomes.

Biomarkers are important tools in epidemiologic research; however, the reliability and quality of various biomarkers may vary. Therefore, in Chapter 2, we reviewed current evidence on Al biomarkers with the goal to synthesize current understanding regarding their utility for use in research. Our review evaluated 78 papers which discussed various biomarkers of Al exposure. Limited evidence is currently available for Al in nails, hair, breastmilk, saliva and semen. Although they have more daily variation than other biomarkers, blood Al concentrations may differentiate between exposed and non-exposed groups. Unlike blood Al, Al concentrations in both urine and bone are not subject to daily fluctuations. Bone Al appears able to quantify long term Al exposure. Therefore, the use of in vivoneutron activation analysis (IVNAA), a novel bone biomarker, can potentially represent cumulative Al exposure.

In Chapter 3, we evaluated the hypothesis that the correlation between bone and CEI measurements will be higher than the correlation between bone with fingernail. A cross-sectional cohort of 61 ferroalloy and manufacturing factory workers from Zunyi, China were used in this secondary analysis. Correlations of bone Al with other Al measures (fingernail and cumulative exposure index (CEI)) were assessed for 43 of the factory workers who had bone Al samples. Fingernail samples were analyzed using inductively coupled plasma mass spectrometry. Bone measurements were taken with a compact IVNAA developed by our research team. CEI was calculated as CEI_i=, where C_iis estimated Al exposure based on job title (low/medium/high) and Y_iis the years employed. The CEI was calculated for the prior 5, 10, 15, 20 years and lifetime work history. Median Al values were: 34.4 mg/g (IQR=46) fingernail; 15 mg/g (IQR=28) bone; and 26 (IQR=21) total CEI. Adjusting for age and education, the linear regression model suggests that bone Al is reflective of 15 years of exposure based off the significant association between bone Al and 15-year CEI (b=0.91, p<0.02). Other models with CEI were not statistically significant.

In Chapter 4, we evaluated the association between bone, CEI and fingernail Al measurements with olfactory and cognitive function. The relationship between cognitive and olfactory function was compared with bone Al (N=43), fingernail Al (FnAl) (N=56), 5 year Al CEI and lifetime Al CEI (N=61) measurements. Olfactory function was assessed with the University of Pennsylvania Smell Identification Test and cognitive function was assessed with the WHO/UCLA Auditory Verbal Learning Test (AVLT). Verbal fluency was assessed using Fruit Naming and Animal Naming. Additional variables were assessed via questionnaire. Linear regression models, adjusted for age, education, current alcohol consumption and current smoking status, showed a significant association between higher BnAl and higher recall on the AVLT interference list (b=0.04, 95% Confidence interval (CI)=0.01, 0.08) and higher 5-year CEI with higher recall on the fifth AVLT trial (b=-0.23, 95% CI=-0.45, -0.01). No significant association between FnAl and lifetime CEI with olfactory and cognitive function was observed.

In Chapter 5, we explored the potential for interactions of Al with another metal to impact the potential association of Al with cognitive and olfactory function. Interaction models used the natural log of fingernail Al with each of copper (Cu), manganese (Mn), lead (Pb) and zinc (Zn) for the 56 male workers. The linear regression models controlled for age, education current alcohol consumption, current smoking status, and all five fingernail metals. Higher ln(FnMn) was associated with lower recall for several AVLT trials. The interaction term for ln(FnAl) and ln(FnZn) was significantly associated with AVLT Trial 1 (β= 1.99, 95% CI=0.07, 3.93), AVLT Trial 5 (β= 2.71, 95% CI= 0.02, 5.41) and AVLT average (β=2.11, 95% CI=0.01, 4.21).

Overall, this research presents valuable information regarding noninvasive, in vivoassessment of BnAl and its relationship with other Al biomarkers and measures of cognitive function. To the best of our knowledge, this is the largest study to use INVAA BnAl measurements to quantify long-term aluminum exposures within an occupational population, the first to compare BnAl with an estimate of cumulative Al exposure. Additionally, we are not aware of prior studies which have examined the interaction of fingernail metals, including Al, with olfactory and cognitive tests. Our results suggest BnAl is significantly associated with the prior 15-years of Al exposure and that IVNAA to assess BnAl can be used in field epidemiology studies. For our study, there was limited evidence of an association of BnAl and 5-year CEI with cognitive function. Most comparisons did not show any evidence of an association of Al with cognitive or olfactory function, but a statistically significant interaction between Al and Zn with some measures of cognitive function was observed. It is recommended that our findings be confirmed with larger studies.

This thesis describes a series of studies in which ultrasound was used to measure muscle activity around the shoulder. The preliminary studies used professional musicians as subjects because the chronic nature of their problems with shoulder muscles offered an opportunity to test the usefulness of ultrasound in a changing physical environment. Once protocols, reliability, validity and sensitivity to change were established, the main study focused on ?normal? subjects in order to explore ?normal? variability.

Lipids and sodium (²³Na) are two essential components of the human body. They play a role in almost all biological systems. However, an increase in their levels is associated with metabolic diseases. The elevation of their contents can cause similar health disorders. Examples of prevalent disorders that share an increase of musculoskeletal lipids and ²³Na are hypertension and diabetes. However, the relationship between in vivo lipid and sodium levels in pathophysiology has not been studied enough and therefore is still unclear. Additionally, the available quantification methods to facilitate such a study may not be practical. They are either invasive, not sensitive enough, or require an impractical measurement time.

Therefore, in this work, our aims were to develop practical in vivo methods to quantify the absolute sodium concentration as well as the concentration of each lipid component individually, and to study the correlation between them within the skeletal muscles.

Since lipids and ²³Na have different nuclear magnetic resonance properties, their quantification by magnetic resonance (MR) techniques face different challenges. Thus, we optimized different MR spectroscopic imaging (MRSI) techniques for lipids and ²³Na.

Our proposed proton MRSI was able to provide eight lipid fat fraction (FF) maps representing each musculoskeletal lipid component (fatty acid) detected by our MRSI technique, and demonstrated a superior sensitivity compared to the conventional MR imaging methods.

For ²³Na, our developed ²³Na-MRSI was able to measure and map the absolute ²³Na concentration with values agreeing with those reported previously in biopsy studies, and with a high repeatability (CV < 6 %) within significantly shorter acquisition time compared to other available techniques.

Finally, the ²³Na concentration and the fat fractions of each lipid component within healthy skeletal muscles were measured and correlated using our developed MRSI methods. Our findings suggest a positive regional relationship between ²³Na and lipids and negative correlation between ²³Na and BMI under healthy conditions.

This qualitative thesis uses discourse analysis to examine parental resistance towards medical treatment of critically ill children. It is an investigation of the 'mobile and transitory' discourses at play in instances of resistance between parents, physicians and nurses within health care institutions, and an examination of the consequences of resistance through providing alternative ways of perceiving and therefore understanding these disagreements. The philosophical perspectives, methodology and methods used in this thesis are underpinned by selected ideas taken from the works of Michel Foucault and Pierre Bourdieu and supported by relevant literature in the fields of media, law, children, parenting, caring, serious childhood illness, medicine and nursing. The thesis obtains information from a variety of texts that includes established literature (such as medical, sociological, legal, academic and philosophical), newspaper articles, radio or television interviews, internet sources, court reports and proceedings, legal experts and other commentators - and 15 interview based texts, where the focus is on analyses of narratives of parents, doctors and nurses. In the texts gathered for this thesis, there are noticeable differences between the personal experience discourses of parents, the 'in-between' discourses of nurses, and the disciplined discourses of physicians. This thesis brings these discourses into conversation with each other suggesting that parental resistance does not occur because of an infrequent and unusual set of circumstances where a few socially isolated and/or 'difficult' parents disagree with the treatment desires of paediatric physicians. Instead, it is argued that from an examination of interview based texts, parental resistance is an omnipresent but transitory occurrence that affects many of the interactions between the parents of seriously ill children and clinical staff. It is maintained that within these interactions, the seeds of this resistance are sown in both critical decision making situations and in everyday occurrences between doctors, nurses and parents within healthcare institutions. Contributing factors to parental resistance include the use of power games by staff, the language of medicine, forms of symbolic violence, the presence or absence of trust between parents and medical staff, the effects of medical habitus, and challenges to the parental role and identity. Overall, it is proposed in this thesis that parents who resist treatment for their seriously ill child are not exceptions to the normative patient-physician relationship. Instead an analysis of their discourses and practices is able to illuminate the complex interactions between patients and medical conventions. It is therefore possible to see parents who resist medical advice not as peripheral to the medical encounter but as examples of how patient-physician relationships come to be codified, constructed and crafted through everyday discourses and practices within health care settings.

Introduction: The purpose of this study was firstly to investigate whether 8 weeks of whole body vibration (WBV) training was an acceptable form of exercise for patients with Multiple Sclerosis (MS) and secondly what effect it may have on measures of functional capacity. Methods: Fifteen participants with MS volunteered for WBV training three times a week on a commercialised Galileo Sport™ vibration machine with an oscillating platform. Training consisted of two four week blocks based on an increasing stimulus training programme (overload principle). The first fours weeks involving five sets of 1-min WBV with 1-min rest in between with increasing vibration frequency (15-25Hz, 2.6mm-4.1mm amplitude); the second four weeks training increased to eight sets of 1-min WBV (15-20Hz, 6.1mm amplitude). Functional performance measures (Timed up and Go, Standing Balance, Functional Reach and Timed walk) and quality of life questionnaire (SF-36) were conducted prior to training, at 4 weeks, 8 weeks and 2 weeks (10wk) following the completion of the training. Results: The 10m walk test showed significant improvements at the 2m, 8m and 10m measure between pre vs. 8wk (P<0.05) and pre vs.10wk (P<0.05). Timed up and Go demonstrated a significant time effect (P<0.05). Standing balance showed significant improvements at pre and 4 week (p<0.05) and pre and 10 week (p<0.05). Conclusions: This is the first study to investigate WBV as an exercise training modality for MS patients. It was shown that not only is WBV training safe, well tolerated by MS patients but it also improved standing balance and walking speed in MS patients.