Learning to pop blisters in epidermolysis bullosa with a simple model

Epidermolysis bullosa (EB) is a genetic disorder with skin fragility resulting in easy blistering of skin and mucous membranes. A plane of cleavage exists even where there is no visible blister, so new blisters should be drained as soon as possible to prevent their expansion. Although, learning how to drain blisters safely and painlessly without introducing infection is essential, it can be a major challenge, especially for new parents and children. To avoid demonstrating the technique directly on patient's skin, we have devised a simple teaching aid simulating a hand and forearm with multiple blisters, created with readily available materials. In our experience, we have found this low-cost model to be extremely useful to teach patients, families, and professional groups, how to drain EB blisters and it provides an effective, low-cost, painless substitute for real-life blisters, empowering parents and engaging children.     

Wireless Connectivity for People with Hearing Loss: Between the Listener and the Talker: Connectivity Options

Hearing aids are often not sufficient for optimal communication between a listener and a talker. Therefore, numerous options for wireless connectivity between the listener and the talker designed to improve communication have become widely available. From the original wireless option of the induction loop system, most of the current solutions involve a digital signal with high quality and limited interference. Many are proprietary and only operate with a given manufacturer''s devices, while others are more universal as long as the digital receiver can be connected to the listener''s personal device. In addition, connectivity options to assist those with hearing loss are now readily available on the smartphone which can be used as a remote microphone. Therefore, it is paramount that the available wireless protocols be considered relative to the listener''s experience with wireless technology so that solutions may be offered that are efficient, economical, and effective.     

Recent experiences in the management of visual impairment in albinism

One hundred patients with albinism seen within two years in the Low Vision Clinic at Moorfields Eye Hospital are reviewed. They are predominantly young people within the definition of 'Partially-sighted' rather than blind. Clinical methods are described and the distribution of alternative types of appliance loaned surveyed. Emmetropia and low ametropia are rare in the group. Most patients are using telescopic lenses for distance vision, tending to select binocular devices. Over half are able to read print of newsprint size in a clinical situation without extra magnification, but often elect to use extra magnification for some tasks. The need for near vision aids increases with age.     

The Relationship Between Out-of-Hospital Airway Management and Outcome Among Trauma Patients with Glasgow Coma Scale Scores of 8 or Less

Abstract

Background. Airway management remains a fundamental component of optimal care of the severely injured patient, with endotracheal intubation representing the definitive strategy for airway control. However, multiple studies document an association between out-of-hospital intubation and increased mortality for severe traumatic brain injury. Objectives. To explore the relationship between out-of-hospital intubation attempts and outcome among trauma patients with Glasgow Coma Scale (GCS) scores ≤8 across sites participating in the Resuscitation Outcomes Consortium (ROC). Methods. The ROC Epistry–Trauma, an epidemiologic database of prehospital encounters with critically injured trauma victims, was used to identify emergency medical services (EMS)-treated patients with GCS scores ≤8. Multiple logistic regression was used to explore the association between intubation attempts and vital status at discharge, adjusting for the following covariates: age, gender, GCS score, hypotension, mechanism of injury, and ROC site. Sites were then stratified by frequency of intubation attempts and chi-square test for trend was used to associate the frequency of intubation attempts with outcome. Results. A total of 1,555 patients were included in this analysis; intubation was attempted in 758 of these. Patients in whom intubation was attempted had higher mortality (adjusted odds ratio [OR] 2.91, 95% confidence interval [CI] 2.13–3.98, p < 0.01). However, sites with higher rates of attempted intubation had lower mortality across all trauma victims with GCS scores ≤8 (OR 1.40, 95% CI 1.15–1.72, p < 0.01). Conclusions. Patients in whom intubation is attempted have higher adjusted mortality. However, sites with a higher rate of attempted intubation have lower adjusted mortality across the entire cohort of trauma patients with GCS scores ≤8.     

Placebo Effect of Caffeine on Substrate Oxidation during Exercise

By using deceptive experiments in which participants are informed that they received caffeine when, in fact, they received an inert substance (i.e., placebo), several investigations have demonstrated that exercise performance can be enhanced to a similar degree as a known caffeine dose. This ‘placebo effect’ phenomenon may be part of the mechanisms explaining caffeine’s ergogenicity in exercise. However, there is no study that has established whether the placebo effect of caffeine is also present for other benefits obtained with acute caffeine intake, such as enhanced fat oxidation during exercise. Therefore, the aim of this investigation was to investigate the placebo effect of caffeine on fat oxidation during exercise. Twelve young men participated in a deceptive double-blind cross-over experiment. Each participant completed three identical trials consisting of a step incremental exercise test from 30 to 80% of V.O_2max. In the two first trials, participants ingested either 3 mg/kg of cellulose (placebo) or 3 mg/kg of caffeine (received caffeine) in a randomized order. In the third trial, participants were informed that they had received 3 mg/kg of caffeine, but a placebo was provided (informed caffeine). Fat oxidation rates were derived from stoichiometric equations. In received caffeine, participants increased their rate of fat oxidation over the values obtained with the placebo at 30%, 40%, 50%, and 60% of V.O_2max (all p < 0.050). In informed caffeine, participants increased their rate of fat oxidation at 30%, 40%, 50% 60%, and 70% of V.O_2max (all p < 0.050) over the placebo, while there were no differences between received versus informed caffeine. In comparison to placebo (0.32 ± 0.15 g/min), the rate of maximal fat oxidation was higher in received caffeine (0.44 ± 0.22 g/min, p = 0.045) and in informed caffeine (0.41 ± 0.20 g/min, p = 0.026) with no differences between received versus informed caffeine. However, the intensity at which maximal fat oxidation rate was obtained (i.e., Fat_max) was similar in placebo, received caffeine, and informed caffeine trials (42.5 ± 4.5, 44.2 ± 9.0, and 41.7 ± 10.5% of V.O_2max, respectively, p = 0.539). In conclusion, the expectancy of having received caffeine produced similar effects on fat oxidation rate during exercise than actually receiving caffeine. Therefore, the placebo effect of caffeine is also present for the benefits of acute caffeine intake on substrate oxidation during exercise and it may be used to enhance fat oxidation during exercise in participants while reducing any risks to health that this substance may have.     

Research Digest

A single-blind within-subjects trial was used to test the efficacy of sending SMS text messages to patients with a traumatic brain injury as a means of improving their recall of rehabilitation goals. Eleven participants were recruited from two community-based rehabilitation centres and were sent text messages relating to three randomly selected goals from a selection of six current goals three times per day for 14 days. Participants’ recall of their rehabilitation goals was assessed at baseline, seven days, and 14 days via free recall and cued recall procedures. Results showed that goals in the “text” condition were recalled better than goals in the “no text” condition. Practical applications and extensions are discussed.     

浅析高校贫困学生资助管理模式存在的问题及对策

随着高校招生规模的不断扩大,家庭贫困的学生人数也在逐年攀升,这成为了国家、社会和高校共同关注的问题。2007年,国家颁布了《关于建立健全普通本科高校、高等职业学校和中等职业学校家庭经济困难学生资助政策体系的意见》。新资助政策体系的建立,虽然在实践中起到一定积极作用,但在具体实施过程中陆续暴露出界定及资助标准单一、经济困难学生自身认识不足等问题。     

Ageing as a global public health challenge: From complexity reduction to aid effectiveness

Since 2002, ageing populations worldwide have received increasing attention by global policy-makers. However, resources committed by inter-governmental donors and US-based private foundations in support of ageing-related policies and interventions in non-Organisation for Economic Co-operation and Development (OECD) countries have remained minimal during this decade and, where mobilised, have rarely responded to actual country-level demographics and institutional capacities. We argue that this lag between issue recognition and effective resource mobilisation, while mirroring known dynamics in global agenda-setting, has also been caused by a depiction of ageing as a uniform trend across the Global South. We develop and apply a comprehensive analytical framework to assess the state of ageing dynamics at the country level and uncover substantial regional and sub-regional variation. In response, we suggest replacing complexity reduction in the interest of issue recognition with targeted support for a more nuanced research agenda and policy debate on country-specific ageing dynamics in order to inform and catalyse effective international assistance.     

Antenatal care and pregnancy outcomes in a safe motherhood health voucher system in rural Kenya, 2007–2013

Setting: A rural private health facility, Ruby Medical Centre (RMC), participating in a safe motherhood health voucher system for poor women in Kiambu County, Kenya.Objectives: Between 2007 and 2013, to determine 1) the number of women who delivered at the RMC, their characteristics and pregnancy-related outcomes, and 2) the number of women who received an incomplete antenatal care (ANC) package and associated factors.Design: Retrospective cross-sectional study using routine programme data.Results: During the study period, 2635 women delivered at the RMC: 50% were aged 16–24 years, 60% transferred in from other facilities and 59% started ANC in the third trimester of pregnancy. Of the 2635 women, 1793 (68%) received an incomplete ANC package: 347 (13%) missed essential blood tests, 312 (12%) missed the tetanus toxoid immunisation and 1672 (65%) had fewer than four visits. Presenting late and starting ANC elsewhere were associated with an incomplete package. One pregnancy-related mortality occurred; the stillbirth rate was 10 per 1000 births.Conclusion: This first assessment of the health voucher system in rural Kenya showed problems in ANC quality. Despite favourable pregnancy-related outcomes, increased efforts should be made to ensure earlier presentation of pregnant women, comprehensive ANC, and more consistent and accurate monitoring of reproductive indicators and interventions.