Psychosocial Experiences That Support Positive Self-Concept in Children with Cleft Lip and Palate Adopted From China.

OBJECTIVE: Existing psychosocial research offers little information on the unique challenges and strengths of children adopted from China with cleft lip and/or palate (CL/P). The present study aimed to understand biopsychosocial factors that support positive self-concept in this population. DESIGN: Qualitative, semistructured interviews were conducted with children and their parents. Interpretive phenomenological analysis of transcribed interviews was utilized for data analysis. SETTING: Participants were recruited in an outpatient, pediatric multidisciplinary cleft clinic during a standard team visit. PATIENTS, PARTICIPANTS: Participants were ages 8 to 12 years with a diagnosis of isolated cleft lip-palate who were internationally adopted from China before the age of 2 years and English-speaking. Participants also included English-speaking parents. RESULTS: Themes reflecting data from the child and parent subsamples include: (1) child's characteristics, (2) family strengths, (3) adoption identity, (4) cultural identity, (5) coping with a cleft, and (6) social factors. Additional 2 to 3 subthemes were identified for the parent and child subsamples within each broader theme. CONCLUSIONS: Findings from this sample suggested factors supporting positive self-concept included pride and self-efficacy in activities, family support, instilment of family values, strategies for coping with a cleft, family belonging, cultural exposure, and normalization of differences. Medical providers can support patients and families by providing education on surgeries, CL/P sequelae and outcomes, and pediatric medical stress. Mental health providers can screen for social and emotional challenges and provide psychoeducation on racial/ethnic socialization, identity development, and coping.

Ex vivo investigation of the effect of the transverse arytenoid ligament on abduction of the arytenoid cartilage when performing equine laryngoplasty.

Aims: To investigate the effect of the transverse arytenoid ligament (TAL) on abduction of the arytenoid cartilage when performing laryngoplasty. Methods: Modified prosthetic laryngoplasty was performed on right and left sides of 13 cadaver larynges. Increasing force was sequentially applied to the left arytenoid cartilage at 3 N intervals from 0-24 N, when the force on the right arytenoid cartilage was either 0 or 24 N, before and after TAL transection. Digital photographs of the rostral aspect of the larynx were used to determine the left arytenoid abduction angles for these given force combinations and results compared before and after TAL transection. Longitudinal and transverse sections of the TAL from seven other equine larynges were also examined histologically. Results: Increasing force on the left arytenoid cartilage from 0-24 N produced a progressive increase in the angle of the left arytenoid cartilage (p < 0.001) and increasing force on the right arytenoid cartilage from 0-24 N reduced the angle of the left arytenoid cartilage (p < 0.001). Following transection of the TAL the mean angle of the left arytenoid increased from 36.7 (95% CI = 30.5-42.8)° to 38.4 (95% CI = 32.3-44.5)°. Histological examination showed that the TAL was not a discrete ligament between the arytenoid cartilages but was formed by the convergence of the ligament and the left and right arytenoideus transversus muscles. Conclusions: Transection of the TAL in ex vivo equine larynges enabled greater abduction of the left arytenoid cartilage for a given force. These results indicate that TAL transection in conjunction with prosthetic laryngoplasty may have value, but the efficacy and safety of TAL transection under load in vivo, and in horses clinically affected with recurrent laryngeal neuropathy must be evaluated. Abbreviations: Fmax: Force needed to maximally abduct the left or right arytenoid; TAL: Transverse arytenoid ligament.

First Report of Downy Mildew on Blackberry Caused by Peronospora sparsa in Arkansas.

In March of 2014, blackberry (Rubus fruticosus) greenhouse seedlings with leaf symptoms that included yellowing on the leaf surface and reddish brown angular lesions with necrotic centers and chlorotic margins were detected in the University of Arkansas Fruit Research Station in Clarksville, AR (35°32.065' N, 93°24.3564' W). Symptoms were observed on multiple blackberries in the greenhouse, with an estimated prevalence of 25%. Three symptomatic samples of the affected plants were submitted to the Plant Health Clinic in Fayetteville, AR, for diagnosis. Sporulation was observed on the underside of the symptomatic leaf tissue. Hyaline sporangiophores were observed emerging from stomata on the undersides of leaves, 295 to 620 × 4 to 6 µm with long, straight trunks and were branched 3 to 4 times with bifurcated tips, with a length of 5 to 23 µm. Typically, one branch of each pair curved inward and one reflexed. Sporangiophores ended with sporangia that were round or slightly ovoid, colorless to yellowish-brown, and 14 to 22 × 11 to 18 µm. The causal agent was morphologically identified as Peronospora sparsa Berk (1,2). The identification was confirmed using a molecular method directly from plant tissue. DNA was extracted from two samples (~3 × 3 mm) from each of three symptomatic leaves, followed by PCR amplification using P. sparsa-specific rDNA-ITS region primers P1: 5'-CACGTGAACCGTATCAACC-3' and P2: 5'-GATAGGGCTTGCCCAGTAG-3' (GenBank Accession No. Y15816) (4). DNA amplification was successful, resulting in a product of 94 bp, confirming that P. sparsa was present in the symptomatic blackberry tissue. Sporulating leaf tissue was laid on the underside of surface sterilized blackberry leaves from three plants with a similar genetic background and incubated at 17°C with a 12-h photoperiod in a moist chamber. Sporangiophores and sporangia developed on the underside of lesions on previously uninfected leaves 16 days after inoculation. As a control, leaves from the same three plants were surface sterilized and placed in a moist chamber and incubated at 17°C with a 12-h photoperiod and examined 16 days later. No lesions or sporulation developed on the controls. Previously, P. sparsa has been reported on blackberry in California (3) and Mexico (5). To our knowledge, this is the first report of P. sparsa causing downy mildew on blackberry in Arkansas. References: (1) M. J. Berkeley. Gardeners' Chronicle 14:307, 1861. (2) M. A. Ellis. Page 15 in: Compendium of Raspberry and Blackberry Diseases and Insects. APS Press, St. Paul, MN, 1989. (3) D. Farr et al. Page 486 in: Fungi on Plants and Plant Products in the United States. APS Press, St. Paul, MN, 1989. (4) A. Hukkanen et al. Eur. J. Plant Pathol. 116:225, 2006. (5) A. Rebollar-Alviter et al. Plant Dis. 93:674, 2009.

Estimating construction and demolition debris generation using a materials flow analysis approach.

The magnitude and composition of a region's construction and demolition (C&D) debris should be understood when developing rules, policies and strategies for managing this segment of the solid waste stream. In the US, several national estimates have been conducted using a weight-per-construction-area approximation; national estimates using alternative procedures such as those used for other segments of the solid waste stream have not been reported for C&D debris. This paper presents an evaluation of a materials flow analysis (MFA) approach for estimating C&D debris generation and composition for a large region (the US). The consumption of construction materials in the US and typical waste factors used for construction materials purchasing were used to estimate the mass of solid waste generated as a result of construction activities. Debris from demolition activities was predicted from various historical construction materials consumption data and estimates of average service lives of the materials. The MFA approach estimated that approximately 610-78 × 10(6)Mg of C&D debris was generated in 2002. This predicted mass exceeds previous estimates using other C&D debris predictive methodologies and reflects the large waste stream that exists.

The psychosocial aspects of osteoporosis in women.

Osteoporosis has been documented to be a physiologically and psychologically debilitating disease. Health perceptions can be improved through both psychosocial support and specific intervention programs. These programs can improve independence and the quality of life of many people afflicted with this disease.

Dyspepsia on withdrawal of ranitidine in previously asymptomatic volunteers.

OBJECTIVE: H2 receptor antagonist therapy has been shown to produce rebound acid hypersecretion. The clinical significance of this phenomenon is not known. We performed this study to determine whether withdrawal of H2 receptor antagonist therapy results in dyspepsia in previously asymptomatic volunteers. METHODS: Thirty-five Helicobacter pylori-positive asymptomatic volunteers were randomized in double-blind fashion to receive 2 months' treatment with either ranitidine 300 mg nocte or placebo. Dyspeptic symptoms were measured before starting treatment and over the course of 10 days after stopping treatment by means of a validated questionnaire. RESULTS: Thirty-one subjects completed the study; 17 were randomized to ranitidine. The pretreatment median aggregate dyspepsia score of the placebo group was 0 (0-4), as was that of the ranitidine group (0-8) (N.S.). During the 10 days after completion of ranitidine, the median aggregate dyspepsia score was 1.4 (0-30), compared with 0 (0-6.3) after placebo (p < 0.01). Of those given ranitidine, 59% experienced dyspepsia after treatment, compared with only 14% who took placebo. In the subgroup that developed dyspepsia after active therapy, the median duration of symptoms was 2 days, symptom severity being maximal on the second day after completion of the tablets. On the days when dyspepsia was experienced, the median daily dyspepsia score was 5 (range, 2-10), which was similar to that of a control group with active duodenal ulcer disease (5; range, 0-11). CONCLUSIONS: Withdrawal of a 2-month course of ranitidine 300 mg nocte results in the development of dyspeptic symptoms in a proportion of previously asymptomatic subjects. Patients receiving ranitidine should be warned about this rebound dyspepsia and advised not to immediately resume treatment, as rebound symptoms are likely to improve within a few days.

Distance learning for hospital managers.

Telemedicine technology enabled this class to meet. The Chapel Hill instructor could not have traveled to Scotland Neck for the classes, and the class members could not have taken time away from their jobs to travel to Chapel Hill. The technology allowed the participants to fit the classes into their schedules. For the group of managers at this small, isolated hospital, the experience of participating in a management class with an expert was a positive one. They were introduced to standard management practices, learned new skills, and formed a support group/team onsite. The students felt close to the leader, yet the physical distance made her an outsider in a way that encouraged frankness. The technology seemed to foster the best of both worlds--intimacy, yet physical distance and, thus, safety. These new managers were able to take part in a course that taught tangible skills for improving their job performance and, more important, afforded access to resources outside of Halifax County. They were able to step away from their daily routine and interact with outsiders and each other in new ways, without the stress and expense of travel. The results of this pilot study indicate that distance learning is feasible for courses of this kind. Staff burnout and turnover are chronic problems in rural facilities, with isolation contributing to job dissatisfaction. Distance learning offers exciting possibilities for addressing these problems in healthcare settings across the country.

Floating patterns of metered dose inhalers.

As long as metered dose inhalers have existed, patients have sought a reliable method to determine if a given canister was still potent. Concerning beta agonists, the answer to this question may be lifesaving. Issues of compliance have made dating canisters or counting doses impractical. Likewise, previous claims of floating characteristics are unreliable. In tap water, we float-tested 13 commonly used inhalers three times each, observing variations as they were incrementally actuated, emptying their contents. One essential pattern was observed. Almost all prescription-size canisters sink when full; all float by the time one-third of their contents is gone. Orientation of prescription-size canisters changes in a distinct pattern especially near 90% depletion. Sample-size canisters showed some variance. Results suggest that the pharmaceutical industry should include individual floating characteristics as part of the package insert as they provide a reproducible means of gauging contents.