Efficacy of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in the Preventative Treatment of Episodic Migraine in Adults.

PURPOSE OF REVIEW: Systematic review of angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARB) in the prophylactic treatment of adults with migraine. To identify gaps in research and provide guidance for future clinical trials. RECENT FINDINGS: A search was completed using PubMed, MEDLINE, Embase, and the Cochrane Library January 1, 1990 through December 31, 2017. The following are keywords used in the search: migraine, migraine prophylaxis/prevention, renin-angiotensin-aldosterone system, RAAS, ACE inhibitors, angiotensin-converting enzyme inhibitors: quinapril, perindopril, ramipril, captopril, enalapril, lisinopril, benazepril, fosinopril. Angiotensin receptor blockers, ARB, angiotensin II receptor antagonists: candesartan cilexetil, irbesartan, olmesartan, valsartan, losartan, azilsartan medoxomil, telmisartan, and eprosartan. The search included randomized controlled trials (RCT), systemic reviews and open-label studies of ACE inhibitors and ARB for the prevention of migraine attacks in adults 18-70 years old. Of 2461 retrieved articles, 18 included RCT, meta-analysis, systemic reviews, or guidelines published on ACE inhibitors or ARB in the prevention of migraine. Three RCT with telmisartan 80 mg, candesartan 16 mg, and enalapril 10 mg, and two open-label trials with lisinopril 5 mg and ramipril 5 mg found a high number of responders with greater than 50 % reduction in migraine attack frequency when compared to a 4-week baseline period. Candesartan was superior to placebo while telmisartan and enalapril were not. Lipophilic ACE inhibitors and ARBs can be effective prophylactic agents for reduction of migraine frequency in adults. Based on the limited number of published trials and small sample size, they are not recommended as first-line prophylactic agents. However, in populations with co-morbidities such as hypertension, they may be useful as first- or second-line prophylactics. Additional trials following the International Headache Society's guidelines on RCT are warranted.

Effect of particle size distribution of maize and soybean meal on the precaecal amino acid digestibility in broiler chickens.

1. Herein, it was investigated whether different particle size distributions of feed ingredients achieved by grinding through a 2- or 3-mm grid would have an effect on precaecal (pc) amino acid (AA) digestibility. Maize and soybean meal were used as the test ingredients. 2. Maize and soybean meal was ground with grid sizes of 2 or 3 mm. Nine diets were prepared. The basal diet contained 500 g/kg of maize starch. The other experimental diets contained maize or soybean meal samples at concentrations of 250 and 500, and 150 and 300 g/kg, respectively, instead of maize starch. Each diet was tested using 6 replicate groups of 10 birds each. The regression approach was applied to calculate the pc AA digestibility of the test ingredients. 3. The reduction of the grid size from 3 to 2 mm reduced the average particle size of both maize and soybean meal, mainly by reducing the proportion of coarse particles. Reducing the grid size significantly (P < 0.050) increased the pc digestibility of all AA in the soybean meal. In maize, reducing the grid size decreased the pc digestibility of all AA numerically, but not significantly (P > 0.050). The mean numerical differences in pc AA digestibility between the grid sizes were 0.045 and 0.055 in maize and soybean meal, respectively. 4. Future studies investigating the pc AA digestibility should specify the particle size distribution and should investigate the test ingredients ground similarly for practical applications.

Prececal amino acid digestibility of soybean cake in fast- and slow-growing broiler chickens.

The objective of the present study was to determine whether there are differences in prececal amino acid digestibility between commonly used slow- and fast-growing broiler strains when the regression approach is applied. ISA J-275 and Ross 308 were selected as common representatives of slow- and fast-growing broiler strains, respectively. The experimental diets with soybean cake at levels of 0, 100, and 200 g/kg were offered for ad libitum consumption between 22 and 29 d post-hatch. Titanium dioxide was used as an indigestible marker. Each treatment was tested with six pens comprising 10 birds each. Digesta samples were collected on a pen basis from the distal two-thirds of the intestine section between Meckel's diverticulum and 2 cm anterior to the ileocecal-colonic junction. The prececal amino acid digestibility of soybean cake was calculated by linear regression simultaneously for both strains. There was no significant interaction between broiler strain and inclusion level of soybean cake with respect to the prececal CP and amino acid digestibility of complete diets; there was a significant strain effect for 5 out of the 16 measured amino acids. The prececal CP and amino acid digestibility of soybean cake did not differ significantly between strains and was numerically almost identical. The results of the present study provide evidence of the transferability between broiler strains of prececal amino acid digestibility data, determined using the regression approach, thus improving the accuracy of diet formulation without drawbacks.

Cinematic technology: the role of visual learning.

Using movies as a classroom teaching strategy can provide a dynamic learning experience that engages students in learning complex material and enhances and visually illustrates lecture content. The authors discuss their use of movies and its outcomes in teaching psychiatric and mental health nursing.

Alzheimer's care and service utilization: generating practice concepts from empirical findings and narratives.

Despite evidence of stress and strain, many of those who take care of relatives with Alzheimer's disease seem to resist using support services. Existing studies of the use of formal care by families of Alzheimer's sufferers are reviewed with special attention to findings relevant to access, particularly perceptions of appropriateness and acceptability or consistency with other needs and values. The conceptual model represented by these findings is then applied to a narrative that serves as a proxy for a real case that might confront a social worker. Viewed together, both the review of empirical findings and the narrative suggest that theoretical frameworks that take into account meanings attached to relationships and personal moral assessments of whether the duties of caregiving can or should be entrusted to others may offer promising alternatives to traditional psychological or psychoeconomic views of supportive service utilization.

The micropolitics of elder care in Memento Mori, Diary of a Good Neighbor, and A Taste for Death.

Using three novels--Muriel Spark's Memento Mori, Doris Lessing's Diary of a Good Neighbor, and P. D. James' A Taste for Death--we examine themes relating to the social construction of caregiving. In our reading of the stories we found numerous instances of the political in the personal, and of how care can be shaped by inequalities of class and gender, by organizational practices and attitudes rooted in cultural assumptions, and by the social idealization of care provided by relatives and friends.