What is the effect of a decision aid in potentially vulnerable parents? Insights from the head CT choice randomized trial.

ObjectiveTo test the hypotheses that use of the Head CT Choice decision aid would be similarly effective in all parent/patient dyads but parents with high (vs low) numeracy experience a greater increase in knowledge while those with low (vs high) health literacy experience a greater increase in trust.MethodsThis was a secondary analysis of a cluster randomized trial conducted at seven sites. One hundred seventy-two clinicians caring for 971 children at intermediate risk for clinically important traumatic brain injuries were randomized to shared decision making facilitated by the DA (n = 493) or to usual care (n = 478). We assessed for subgroup effects based on patient and parent characteristics, including socioeconomic status (health literacy, numeracy and income). We tested for interactions using regression models with indicators for arm assignment and study site.ResultsThe decision aid did not increase knowledge more in parents with high numeracy (P for interaction [Pint ] = 0.14) or physician trust more in parents with low health literacy (Pint  = 0.34). The decision aid decreased decisional conflict more in non-white parents (decisional conflict scale, -8.14, 95% CI: -12.33 to -3.95; Pint  = 0.05) and increased physician trust more in socioeconomically disadvantaged parents (trust in physician scale, OR: 8.59, 95% CI: 2.35-14.83; Pint  = 0.04).ConclusionsUse of the Head CT Choice decision aid resulted in less decisional conflict in non-white parents and greater physician trust in socioeconomically disadvantaged parents. Decision aids may be particularly effective in potentially vulnerable parents

Modulation of inflammatory pathway by inflammatory inhibitor JSH-23 mitigates diabetic retinopathy.

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM). Its pathology is consisted of the breakdown of the blood-retinal barrier (BRB), particularly the inner blood-retinal barrier (iBRB). The exact mechanism that leads to the iBRB impairment and the development of DR has not been elucidated yet. However, chronic inflammation that is hallmark of the type I DM has recently become a key focus in DR study. Hyperglycemia causes dysregulation of nuclear factor-kappa B (NF-kB); and its constant activation increases the expression of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), and intercellular adhesion molecule-1 (ICAM-1) in the retina and vitreous of DR patients and animal models. This increase in inflammatory mediators leads to the degradation of junctional molecules, occludin, connexin-43, death of retinal cells via pyroptosis, and thus disruption of the iBRB. Derailment of the iBRB induces fluid accumulation into the retina of DR patients, which eventually progresses into vision impairment. The purpose of this study is to investigate whether chronic inflammation in DM induces disruption of iBRB; and whether inhibition of the expression and activity of NF-kB by Methyl-N1-(3-phenyl propyl) benzene-1, 2-diamine (JSH-23) would mitigate this iBRB disruption. Methods: Type 1 diabetic mouse model (Akita) on a C57BL/6J background along with non-diabetic littermate were used in the experiments. All mice were 22-24 weeks of age at the start of the experiments. The experimental and the control animals were treated for four weeks on alternate days with JSH-23 @5mg/Kg body weight. The intraocular pressure (IOP), blood pressure, blood glucose, and body weights of all animals were measured before and after treatment. Fluorescence angiography (FA), optical coherence tomography (OCT), and dark-adapted electroretinogram were performed before and after the treatment. Also, intraperitoneal glucose tolerance test (GTT) were performed in the animals before and after the treatment. Then, the retinas and plasma were collected. Western blotting and real-time polymerase chain reaction were performed to analyze protein expression and the mRNA levels of NF-kB p65, iNOS, COX-2, ICAM-1, occludin, connexin-43, NLRP3, caspase-1, and IL-1b. Additionally, plasma insulin levels were also analyzed via ELISA kit. Results: The body weight of Akita mice was significantly lower than the C57BL/6J mice. The treatment with JSH-23 did not have any effect on body weight. The blood glucose of Akita mice was significantly higher than the blood glucose of non-diabetic littermate control mice. The treatment substantially decreased blood glucose in Akita mice. Also, the plasma insulin level for the Akita mice was significantly lower compared to non-diabetic littermate control mice. The intraperitoneal GTT showed that the Akita mice were unable to lower their blood glucose levels. The total and phosphorylated protein expression levels of NF-kB p65 were significantly decreased after treatment with JSH-23 in Akita mice, and the gene expression of NF-kB p65 also reduced. The protein and gene expression levels of iNOS, COX-2, and ICAM-1 were reduced after treatment in Akita mice, and the treatment significantly lowered the expression of pyroptosis marker NLRP3. The gene expression of other proteins in the pyroptosis pathway were also reduced, including caspase-1 and IL-1b. On the other hand, the protein and gene expression levels of junctional molecules occludin, connexin-43 were significantly increased in Akita mice after treatment with JSH-23. The blood pressure of the animals was normal and the treatment did not have any effect on the blood pressure. FA depicted an increase in retinal capillary permeability in Akita mice, and the treatment significantly reduced that permeability. The OCT showed retinal layers thickening in the retina of Akita mice, and treatment increased the retinal layers thickness. Electroretinogram (ERG) showed an increase in the amplitude of the A-wave and the B-wave in Akita mice. Conclusions: The results showed that inhibitor (JSH-23) improved visual function by decreasing the retinal vascular permeability, IOP, and the retinal inflammation in Akita mice

Shedding Light with Trees

This multidisciplinary capstone project focuses on education of the benefits of trees to incentivize the planting of trees at stakeholder homes or businesses. The approach of taking individual action to address a large-scale issue is also highlighted as a qualitative aspect of the capstone. The goal of the project is to understand the benefits of trees, plant more trees and to utilize the approach taken to address other large-scale issues in the future. Global warming is a complex worldwide problem. The scope of the issue can be paralyzing, stymieing individual action. Tainter (2000, p 6) discusses our general aversion to complexity and states the reason behind sayings like “Keeping it simple” is universally understood. This capstone proceeds in that vein. The planting of trees at a stakeholder’s home or business provides a means to take a simple step to address a global issue on a manageable individual scale. Providing factual substantiated information about the environmental, health, and financial benefits of trees will serve as incentive to participate in the tree planting campaign

«I Do Not Understand the United States» Exploring why the gun issue is still so controversial, and why it is so difficult to enforce meaningful legislation in the wake of recent mass shootings

Master´s thesis in English (EN501

Fluid Milk or Cream for Iowa Creameries?

Iowa\u27s milk marketing machinery is being overhauled. It appears that more of Iowa\u27s milk can profitably enter fluid milk channels- because of changes in demand for dairy products, because of the rapid technical developments in processing and distributing milk and because of the development of substitutes for skimmilk in livestock feeding

The essence of psychologic and pedagogical diagnostics

Уточняется понятие «психолого-педагогическая диагностика», рассматриваются функции, принципы, этапы психолого-педагогической диагностикиIn the article the idea of «psychologic and pedagogical diagnostics» is precised, also there are facilities, values, and phases of psychologic and pedagogical diagnostic