Experimental verification of dynamical diffraction focusing by a bent crystal wedge in Laue geometry

Recent X-ray optical experiments have validated previous theoretical work on focusing by bent crystals in Laue geometry. It was shown that a suitable choice of the crystal thickness significantly improves the focusing performance of the crystal by combining the dynamical focusing of the Borrmann triangle with the geometrical focusing obtained by the crystal bending. The best focus size achieved during the experiments was less than 5 µm and is in practice limited by the source demagnification for the considered setup.

Adapted Couple Therapy (ACT) for pathological gamblers: a promising avenue

The study of the effectiveness of treatment for pathological gambling constitutes a field that is still largely unexplored. To date, the models assessed primarily target the individual and include little or no involvement of the family circle. Yet, the deleterious effects of gambling on loved ones and especially spouses are well recognized. Further, the addition of a couple modality to individual treatment has been shown to be effective on many levels in the treatment of substances use disorders. This article therefore proposes a critical review of (1) the literature providing a better understanding of the complex interactions between the couple relationship and pathological gambling, (2) studies on the effects of couple therapies on gamblers and their partners. We then present the therapeutic model developed by our team of clinician-researchers in collaboration with actors from Québec clinical settings: Adapted Couple Therapy (ACT) for pathological gamblers. In the Québec context, this model will serve as a complement to an individual cognitive-behavioral treatment model that has been proven effective and is employed throughout the Canadian province. The assessment of couple therapies could reveal avenues of solutions to better assist pathological gamblers who tend to drop-out of treatment and relapse.

Some effects of melatonin and the control of its secretion in humans

Whether or not the pineal gland has a significant physiological role in humans is not known. There has nevertheless been speculation about the potential therapeutic use of melatonin (in view of its hypnotic and possible zeitgeber properties) in conditions such as insomnia and jet lag, and in shift-workers. Our work concerns the effects of melatonin administration in humans and the interactions between melatonin and other circadian variables. Chronic (one month), timed (1700 h), low-dose (2 mg daily) melatonin administration to normal subjects without environmental control consistently increased evening fatigue and slightly modified the 24 h prolactin rhythm without effect on cortisol, growth hormone, luteinizing hormone, thyroxine, testosterone or self-rated mood. In five out of 11 subjects the endogenous melatonin rhythm was advanced by one to three hours. During fractional desynchronization of circadian rhythms by increasing imposed 'day' length (26-29 h, 24 days, 500 lux), 5 mg melatonin per os at lights-out in two subjects resulted in better entrainment of the fatigue rhythm to the zeitgeber than in five out of six control subjects, without major consistent effects on other measured circadian variables. Using a new radioimmunoassay for 6-hydroxymelatonin sulphate (aMT6s), the major melatonin metabolite, we have shown that the urinary aMT6s rhythm is closely correlated to that of melatonin in plasma and is completely suppressed by an acute dose of atenolol (100 mg per os), a peripheral beta-adrenergic antagonist. During fractional desynchronization by increasing imposed 'day' length in one subject and decreasing imposed 'day' length in two subjects, the urinary aMT6s rhythm behaved similarly to that of core temperature. The results suggest that fatigue (or alertness) may be entrained by melatonin, but whether critical performance rhythms can be suitably manipulated remains to be clarified. It is likely that melatonin production is linked to the so-called 'strong' circadian oscillator.

Medullary thyroid cancer: targeting the RET kinase pathway with sorafenib/tipifarnib

Medullary thyroid carcinoma (MTC) is an uncommon malignancy of hereditary and sporadic presentation. Mutations in the RET proto-oncogene are involved in the pathogenesis of familial MTC and >50% of the sporadic cases. Currently, there is no effective treatment for recurrent or metastatic MTC. We report here a rapid response to a sorafenib (RET and RAF kinase and vascular endothelial growth factor receptor inhibitor)--based regimen in a patient with sporadic MTC who had advanced, progressive disease and a novel RET kinase aberration at exon 11 shown in tumor tissue.

Information provision for stroke patients and their caregivers

BACKGROUND

Research shows that stroke patients and their families are dissatisfied with the information provided and have a poor understanding of stroke and associated issues.

OBJECTIVES

To assess the effectiveness of information provision strategies in improving the outcome for stroke patients and/or their identified caregivers.

SEARCH STRATEGY

We searched the Cochrane Stroke Group Trials Register (last searched May 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2007), MEDLINE (1966 to March 2007), EMBASE (1980 to March 2007), CINAHL (1982 to March 2007), PsycINFO (1974 to March 2007), Science Citation Index and Social Science Citation Index (1981 to March 2007), Assia (1987 to March 2007), Index to UK theses (1970 to March 2007), Dissertation Abstracts (1961 to March 2007), ongoing trials and research registers, bibliographies of retrieved papers, relevant articles and books, and the Journal of Advanced Nursing. We also contacted researchers for additional information.

SELECTION CRITERIA

Randomised trials involving patients or carers of patients with a clinical diagnosis of stroke or transient ischaemic attack (TIA) where an information intervention was compared with standard care, or where information and another therapy were compared with the other therapy alone.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial eligibility and methodological quality and extracted data. Primary outcomes were knowledge about stroke and stroke services, and impact on mood.

MAIN RESULTS

Seventeen trials involving 1773 patient and 1058 carer participants were included. Eight evaluated a passive and nine an active information intervention. Meta-analyses showed a significant effect in favour of the intervention on patient and carer knowledge, one aspect of patient satisfaction, and patient depression scores. There was no significant effect on number of cases of anxiety or depression in patients, carer mood or satisfaction, or death. Qualitative analyses found no strong evidence of an effect on other outcomes. Post-hoc subgroup analyses showed that active information had a significantly greater effect than passive information on patient mood but not on other outcomes.

AUTHORS' CONCLUSIONS

There is evidence that information improves patient and carer knowledge of stroke, aspects of patient satisfaction, and reduces patient depression scores. However, the reduction in depression scores was small and probably clinically insignificant. Although the best way to provide information is still unclear there is some evidence that strategies that actively involve patients and carers and include planned follow up for clarification and reinforcement have a greater effect on patient mood.

Factors influencing varicella zoster virus infection after allogeneic peripheral blood stem cell transplantation: low-dose acyclovir prophylaxis and pre-transplant diagnosis of lymphoproliferative disorders

Varicella zoster virus (VZV) infection is one of the frequent opportunistic infections after allogeneic bone marrow transplantation, with a high incidence of 30-50%. However, no data have been reported on VZV infection after allogeneic peripheral blood stem cell transplantation (PBSCT).

PATIENTS AND METHODS

We report a retrospective analysis of VZV infection in 192 allogeneic PBSCT recipients. Twenty-seven patients (14%) received long-term prophylaxis of low-dose acyclovir (200 mg twice daily orally > or =3 months) for recurrent oral (n=21) or genital herpes simplex virus infection (n=5) or for a previous history of recurrent VZV infection (n=1).

RESULTS

Forty-two patients (22%) developed VZV infections: localized (n=37) and disseminated infection (n=5). The incidence of VZV infection at 1 and 3 years was 19.3+/-3.3% and 36.8+/-5.2%, respectively. Complications included post-herpetic neuralgia (n=18, 43%), secondary bacterial infections (n=3), and intracranial hemorrhage (n=1) with 2 deaths. A higher risk factor for VZV infection was pre-transplant diagnosis of a lymphoproliferative disorder (LPD): chronic lymphocytic leukemia, Hodgkin's disease, or non-Hodgkin's lymphoma (P=0.021, 52.5% in LPD vs. 32.6% in non-LPD group). The use of low-dose acyclovir prophylaxis (P=0.043, 14.7% in acyclovir vs. 41.6% in nonacyclovir group) was found to be protective. Although no VZV infection episodes were noted during the period of acyclovir prophylaxis, 3 episodes of VZV infection were noted after acyclovir cessation.

CONCLUSION

The incidence of VZV infection after PBSCT was high at 36.8%, with patients transplanted for LPDs at higher risk. The long-term use of low-dose acyclovir may be protective for VZV infection, although it does not completely prevent rebound of late VZV infection.

Analysis of CD4+ T-cell gene expression in allergic subjects using two different microarray platforms

BACKGROUND

Allergic diseases are thought to involve dysregulated activation of T cells including CD4+ lymphocytes. T-cell activation results in changes in gene expression, but the optimal method to study gene expression profiles in T cells, and how this changes over time, are not known.

METHODS

Circulating CD4+ T cells were obtained from subjects with atopic asthma, nonatopic asthma or nonallergic controls, and total mRNA was rapidly isolated. Atopy was defined as positive skin prick test to one of nine allergens. Gene expression was analyzed using hybridization and Affymetrix oligonucleotide arrays (Hu133A and Hu133B chips, n = 84), or by reverse transcription-polymerase chain reaction (RT-PCR) with a pathway-targeted array (Human Th1-Th2-Th3 RT(2) Profiler PCR Array, Superarray, n = 16).

RESULTS

Using Affymetrix arrays, it was difficult to discern a dominant allergy-associated profile because of heterogeneity in gene expression profiles. In contrast, a Th2-like signature was evident using RT-PCR arrays with increased expression of expected genes (e.g. IL-4, 5, 9, and 13, all P < 0.05) as well as unexpected gene transcripts (e.g. osteopontin). Gene expression profiles were relatively stable over time in circulating CD4+ T cells from two subjects using both platforms.

CONCLUSIONS

Unstimulated CD4+ T cells isolated from allergic subjects express a characteristic profile of genes when analyzed using RT-PCR based microarrays.

Children's Voices: A Review of the Literature Pertinent to Looked-After Children's Views of Mental Health Services

Service-user involvement is an essential component of mental health service provision. This review aims to synthesise literature that has attempted to elicit children's experiences of mental health services with particular reference to looked-after children. The review is limited to qualitative research with study inclusion based on a synthesis of good quality criteria. Identification of gaps in the literature, directions for further research and implications for service developments are discussed.

Do standard measures of deprivation reflect health inequalities in older people?

The objective of the study is to examine the relationship between different deprivation indicators and both self-rated health and emergency admission rates of older people to determine which indicators best predict the health of people in this age group. The method employed an ecological study design using data from all 100 neighbourhoods in Sheffield in 2004 and analysing relationships in three age groups 50-64, 65-74 and over 75 years. Analysis was performed using Pearson correlation coefficient. For people aged 50-64 years, receipt of income support was the best predictor of poor self-reported health (R=0.85). For people aged 64-75 years, lack of formal educational qualifications showed the strongest relationship with poor health (R=0.88), although there was still a significantly strong relationship between poor self-rated health and both non-property ownership (R=0.8) and receipt of income support (R=0.7) in this age group. For people aged 75 years and over, lack of formal qualifications showed the strongest relationship (R=0.6, P<0.001). This was reinforced by a strong relationship between this indicator and emergency admission rates. In conclusion, caution should be used when using conventional deprivation/poverty measures to select older populations to be targeted for services. Our analysis has shown that the deprivation indicator that correlates best with the subjective health rating of people aged 75+ is educational qualification.

Use of octreotide acetate to prevent rebound hypoglycaemia in sulfonylurea overdose

A short cut review was carried out to establish whether octreotide can prevent rebound hypoglycaemia after sulfonylurea overdose. Fourteen papers were found using the reported searches, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are summarised in table 2. It is concluded that octreotide may be safe and effective in this situation.

Prediction of compliance and completion of orthodontic treatment: are quality of life measures important?

The main aim of the present investigation was to evaluate whether there is an association between completion of orthodontic treatment and quality of life measures, i.e. age, gender, socio-economic status, type of appliance and need for orthodontic treatment. The secondary aim was to evaluate whether compliance with orthodontic treatment (missed appointments and appliance breakages) was associated with age, gender, socio-economic status, or type of appliance. This was a multi-centre longitudinal observational study carried out on 144 patients (65 males and 79 females) aged 10-19 years. Baseline data were collected: patient age, gender, socio-economic status, Index of Orthodontic Treatment Need (IOTN), and type of appliance. Quality of life information, including orthodontic utility values and oral aesthetic subjective impact score (OASIS), were also collected at the start of treatment. The main outcome measure was whether a patient completed treatment. Compliance was assessed by recording the number of failed appointments and appliance breakages. Multiple regression analysis was used to investigate the association between independent and dependent variables. None of the baseline variables, including quality of life measures, were associated with a patient completing treatment, or their compliance with treatment (P > 0.05). Thus, quality of life measures (utility values or OASIS) do not add to our knowledge of who may complete, or co-operate with, orthodontic treatment. In addition, neither age, gender, socio-economic status nor clinical treatment need (IOTN) were useful in helping a clinician to choose potentially co-operative patients.

Patient benefits from participating in an integrated delivery system: impact on coordination of care

BACKGROUND

Although the presumption in health services literature has been that integrated delivery systems (IDSs) should improve the coordination of care, the benefits have not yet been well established through empirical research.

PURPOSES

This study assesses whether receiving care from providers who belong to the same IDS improves patient-perceived coordination of care; concurrently, we develop a new approach for assessing the performance of IDS.

METHODOLOGY/APPROACH

A study was conducted of 222 patients who received primary unilateral total knee arthroplasty at a large IDS' acute care hospital. To isolate the effects of provider membership, we enrolled patients who received surgery from the same surgical department in the same acute care hospital in the IDS. We used baseline and 6-week postoperation patient surveys to assess the impact of the participation of the patients' providers in the IDS on patient-perceived coordination of care.

FINDINGS

We found no consistent effects of IDS membership on patient-perceived coordination of care. Patients with in-network rehabilitation care experienced fewer problems than patients with out-of-network rehabilitation care did, while patients with in-network home care experienced more problems than patients with out-of-network home care did. Membership of a patient's primary care physician had no observed effects.

PRACTICE IMPLICATIONS

Health care managers and administrators need to undertake a realistic examination of the care-coordinating mechanisms that exist in their IDS. This study has shown that the integration of financial, contractual, and administrative processes is not enough to improve care from the patient's perspective; to improve care, it is advised that an IDS take a patient-centered approach in its design and implementation. We discuss potential reasons for uneven integration of IDS, particularly with respect to the lack of coordinating mechanisms, and argue for the usefulness of the approach developed here for assessing IDS performance over time.