Deletion of the trpc4 gene and its role in simple and complex strategic learning

The TRPC4 ion channel is expressed extensively in corticolimbic and a subpopulation of midbrain dopamine neurons. While TRPC4 knockout (KO) rats exhibit reduced sociability and social exploration, little is known about the role of TRPC4 in motivation and learning. To identify a function for TRPC4 channels in learning processes  we tested TRPC4 KO and normal wild type (WT) rats. TRPC4 KO and WT rats exhibited no differences in Y-­maze learning or simple discrimination learning. Furthermore, on a more complex serial reversal shift task designed  to assess strategic learning where the reward and non-­reward cues were repeatedly reversed between training sessions both TRPC4 KO and WT rats   performed equally well. Finally, we found no   performance differences when using a conditional reversal shift task where a tone signals the reversal of reward and non-reward cues within sessions. These data suggest that although TRPC4 channels may play a role in social interaction/anxiety  they exert a minimal role in simple and complex strategic learning

Emergency and Scheduled Respite Care for Caregivers of Persons with Dementia: A Proposed Program

Introduction: Respite care is defined as providing the primary caregiver with relief or a reprieve from care commitments on a short-term or emergency basis. Despite a demonstrated interest in and need for respite care programs, our research has shown that scarce resources exist via a statewide dementia respite program administered by Vermont’s five Area Agencies on Aging. Grants are small and many families do not fall within the eligibility requirements. In FY2010, only 290 families across the state met eligibility requirements (physicians’ diagnosis of dementia, income less than 300% of poverty line, unpaid caregiver, primary residence in VT) and were awarded limited funding for the provision of outside care (up to $750.00 each). For many of these families, this money is typically used to provide substitute care when the primary caregiver is not available. To date, there is no true emergency respite program in place for caregivers. This has placed a strain on families and day facilities, particularly when situations arise in which a caregiver is unable to pick up their family member due to an emergency situation. Our goal was to demonstrate the feasibility of a respite program to address this need.https://scholarworks.uvm.edu/comphp_gallery/1061/thumbnail.jp

The Relationship Between Exercise Self-Efficacy, Fear-Avoidance Beliefs, and Exercise in Individual’s with Postural Orthostatic Tachycardia Syndrome

Postural orthostatic tachycardia syndrome (POTS) is a form of dysautonomia in which the autonomic nervous system malfunctions. An effective treatment for POTS is exercise; however, many individuals with POTS are unable to complete a standardized exercise regimen. The purpose of this study was to improve the understanding of why individuals with POTS may or may not engage in the beneficial practice of exercise by exploring factors such as low exercise self-efficacy (ESE) and elevated fear-avoidance beliefs (FAB). The theoretical foundation that grounded this study was the social learning theory (SLT) and social cognitive theory (SCT). The research questions explored the relationship between ESE, FAB, and the number of days an individual with POTS exercises. A regression analysis and mediation analysis were conducted to explore this relationship. A statistically significant relationship was found between ESE, FAB, and exercise engagement, with no mediating effects. Three subscales of the Sources of Self-Efficacy for Physical Activity Scales (SSEPAS) were statistically significant, with FAB including negative affect, mastery experiences, and self-persuasion. The implications for positive social change include developing interventions to improve exercise adherence in individuals with POTS, enhance quality of life, and decrease disability rates

The repeatability and reproducibility of four techniques for measuring horizontal heterophoria: Implications for clinical practice

PURPOSE: Convergence insufficiency, the most common binocular vision anomaly, is characterised by a receded near point of convergence and an exophoria which is at least 4 prism dioptres (Δ) larger at near than at distance. However, the repeatability of standard heterophoria measures are poorly understood. This study assessed the ability of four common heterophoria tests to detect differences of 4Δ by evaluating the inter- and intra-examiner variability of the selected techniques. METHODS: Distance and near horizontal heterophorias of 20 visually-normal adults were measured with the alternating prism cover test, von Graefe prism dissociation, Howell Card and Maddox Rod by two examiners at two separate visits using standardised instructions and techniques. We investigated inter- and intra-examiner variability using repeatability and reproducibility indices, as well as Bland-Altman analysis with acceptable limits of agreement defined as ±2Δ. RESULTS: The Howell card test had the lowest intra-examiner variability at both distance and near, as well as the best 95% limits of agreement (±1.6Δ for distance and ±3.7Δ for near). Inter-examiner reproducibility results were similar, although at near the alternating prism cover test had better repeatability (1.1Δ, 95% confidence intervals −1.1Δ to 4.0Δ) than the Howell card (1.4Δ, 95% confidence intervals −1.9Δ to 5.9Δ). CONCLUSION: The low repeatability of many standard clinical heterophoria tests limits the ability to reliably detect a 4Δ difference. The Howell Card provided the most repeatable and reproducible results indicating that this technique should be used to detect small changes in heterophoria magnitude and direction

Assessment of Soil-Transmitted Helminth Infections among Pregnant Women in Western Kenya: A Cross-Sectional Study

Intestinal geo-helminths are among the common human infections in the developing world. Preschool and school-age children in Kenya have been targeted for deworming strategies through the National School-Based Deworming Program leaving out vulnerable groups including pregnant women. We conducted this study to assess the prevalence and intensity of worm infections and associated risk factors among pregnant women in Western Kenya. A cross-sectional study was carried out among 250 pregnant women seeking antenatal care services from selected health facilities in Vihiga County. Stool samples were collected and examined for soil transmitted helminths (STH) using the Kato-Katz technique and structured questionnaires were administered to determine associated risk factors. Statistical analysis was done using STATA version 14.1. Differences in proportions by age and health facility were assessed using Chi-square (χ2) test and differences in means using the student t-test. Prevalence of STHs was 12.4% (95%CI: 9.1%-16.9%). Infection caused by hookworm was 2.4% (95%CI: 1.2% - 4.7%), Ascaris lumbricoides 9.6% (95%CI: 6.3% - 14.6%), Trichuris trichiura 2.0% (95%CI: 0.8% - 5.3%). The mean intensity of hookworm infection was 101 (95%CI: 8 -1355), A. lumbricoides 375 (95%CI: 107 - 1308), and T. trichiura 3 (95%CI: 0 - 29). Univariable analysis of factors associated with infection did not reveal any significant associations. Participants with primary level of education had higher odds of T. trichiura infection compared to other participants (OR=2.58, p=0.400). Farming had higher odds of STH and A. lumbricoides infections (OR=3.47, p=0.076) and (OR=3.75, p=0.089) respectively compared to other occupations. Participants in the second trimester of pregnancy had higher odds of hookworm infection (OR=3.36, p=0.272) those with children under three years had higher odds of T. trichiura infection (OR=3.60, p=0.165). The study revealed that STH infection is prevalent among pregnant women in Vihiga although there were no significant risk factors associated with the infection. Therefore, health facilities should conduct deworming and testing for STH also they should provide health education on the risks of getting infected

Understanding the Role of Health Workers in the LF Elimination Program in Kenya: Challenges Faced and Suggestions for Improved Program Performance

The Kenyan Ministry of Health and its partners through the Division of Vector-Borne and Neglected Tropical Diseases, is in charge of the Lymphatic Filariasis Mass Drug Administration programme. This is implemented through the national, county, and sub-county neglected tropical diseases coordinators. The current study sought to understand the roles, challenges faced and suggestions of how program performance can be improved by the community health extension workers, county and sub-county neglected tropical diseases coordinators. Two wards of the Kaloleni sub-county; Kilifi County were purposively selected. In 2015, Kaloleni and Kayafungo wards had a treatment coverage of 58% and 54% respectively; 62% and 39% respectively in 2016, all below the recommended minimum treatment coverage of 65%.  Qualitative data was collected through sixteen in-depth interviews with community health extension workers and two semi-structured interviews with the county and sub-county neglected tropical diseases coordinators. Data were analysed by QSR NVIVO version 10 according to identified themes. The study results show the various roles in planning and implementation of the program include; supply chain management; health information education communication and records management; health workforce training and management, leadership and governance, and service delivery. Challenges faced included insufficiency of drugs supplied and information education communication materials, the inadequacy of community drug distributors selected and trained, poor facilitation for training and supervision of community drug distributors, limited duration of the mass drug administration, and delayed reporting due to poor network coverage. The results of this study show that the community health extension workers, county and sub-county neglected tropical diseases coordinators are not fully involved in program leadership and governance, a role that is taken up at the national level. They should be involved in all the stages of the mass drug administration program to create ownership to improve the program performanc

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Aerobic exercise in obese diabetic patients with chronic kidney disease: a randomized and controlled pilot study

<p>Abstract</p> <p>Background</p> <p>Patients with obesity, diabetes, and chronic kidney disease (CKD) are generally physically inactive, have a high mortality rate, and may benefit from an exercise program.</p> <p>Methods</p> <p>We performed a 24-week randomized controlled feasibility study comparing aerobic exercise plus optimal medical management to medical management alone in patients with type 2 diabetes, obesity (body mass index [BMI] > 30 kg/m²), and stage 2-4 CKD (estimated glomerular filtration rate [eGFR] 15-90 mL/min/1.73 m²with persistent proteinuria). Subjects randomized to exercise underwent thrice weekly aerobic training for 6 followed by 18 weeks of supervised home exercise. The primary outcome variable was change in proteinuria.</p> <p>Results</p> <p>Seven subjects randomized to exercise and 4 control subjects completed the study. Exercise training resulted in an increase in exercise duration during treadmill testing, which was accompanied by slight but insignificant decreases in resting systolic blood pressure and 24-hour proteinuria. Exercise did not alter GFR, hemoglobin, glycated hemoglobin, serum lipids, or C-reactive protein (CRP). Caloric intake and body weight and composition also did not change with exercise training.</p> <p>Conclusion</p> <p>Exercise training in obese diabetic patients with CKD is feasible and may have clinical benefits. A large-scale randomized controlled trial to determine the effects of exercise on renal functions, cardiovascular fitness, inflammation, and oxidative stress in diabetic patients with CKD is planned.</p