Beliefs About Child TV Viewing in Low-Income Mexican American Parents of Preschoolers: Development of the Beliefs About Child TV Viewing Scale (B-TV)

Objectives Parental beliefs about child television viewing may affect the way parents regulate child television viewing. Despite this, little research has focused on the development of measures of parental beliefs about child television viewing, particularly among ethnic minority parents and parents of young children. This study’s objective was to develop and test a culturally-based measure of parental beliefs about television viewing in low-income Mexican American mothers of preschoolers. Methods Using a cross-sectional study design, 22 items reflecting parental beliefs about influences of TV on children were developed and assessed for psychometric properties in a sample of 312 low-income Mexican American mothers of preschoolers. Results Using exploratory factor analysis, we identified four factors reflecting four domains of parental beliefs: positive general beliefs, positive sleep-related beliefs, positive functional beliefs, and negative general beliefs. Internal reliabilities were acceptable (Cronbach’s alpha?=?0.70–0.89) for all factors except negative general beliefs (Cronbach’s alpha?=?0.61). Positive sleep-related beliefs and Positive Functional Beliefs were correlated with children’s average daily hours of TV (r?=?0.16, p?<?.01; r?=?0.22, p?<?.001, respectively) and with mother’s average daily hours of TV (r?=?0.14, p?<?.05; r?=?0.22, p?<?.001, respectively), providing initial support for construct validity. Conclusions for Practice The Beliefs about Child TV viewing scale measures four domains of parental beliefs regarding child TV viewing, and has good initial reliability and validity for three factors. Future use will allow investigators to conduct more in-depth evaluations on the influence of parental beliefs on the way parents shape their child’s use of the TV.     

Use of a New Hybrid Heparin-Bonded Nitinol Ring Stent in the Popliteal Artery: Procedural and Mid-term Clinical and Anatomical Outcomes

Purpose

To report the immediate and mid-term clinical and anatomical outcomes of a novel, hybrid, heparin-bonded, nitinol ring stent (TIGRIS; Gore Medical) when used for the treatment of lesions located in the popliteal artery.

Materials and Methods

This was a prospective single-centre registry. Patients eligible for inclusion were individuals suffering from symptomatic popliteal arterial occlusive disease (Rutherford–Becker stage 3–6; P1–P3 segments) and treated with placement of the TIGRIS stent(s). Patients were prospectively scheduled for clinical review and duplex ultrasound follow-up after 6 and 12 months. Outcome measures included immediate technical success, primary vessel patency, in-stent binary restenosis (evaluable by Duplex at 50 % threshold; PSVR > 2.0), freedom from target lesion revascularization (TLR) and amputation-free survival (AFS) estimated by Kaplan–Meier (K–M) survival analysis. Cox proportional-hazards regression analysis was also performed to adjust for confounders and search for independent predictors of outcomes.

Results

From August 2012 to March 2014, a total of 54 popliteal TIGRIS stents were implanted in 50 limbs of 48 patients (27 men and 21 women; mean age 76.0 ± 1.7 years). Median Rutherford–Becker stage was five at baseline and 37/50 (74.0 %) were chronic total occlusions. Technical success was achieved in all cases (100 %). Stented lesion length was 114.2 ± 36.9 mm (range 6–20 cm). Median follow-up was 11.8 ± 0.8 months. After 12 months, primary patency of the TIGRIS stent was 69.5 ± 10.2 % with an 86.1 ± 5.9 % freedom from TLR and 87 ± 5.0 % AFS (K–M estimates).

Conclusion

The TIGRIS hybrid heparin-bonded nitinol ring stent is a safe and effective endovascular option for complex occlusive disease of the popliteal artery.

     

Anti-amoebic activity of plant compounds from Virgilia oroboides and Chlorophora excelsa

The anti-amoebic activity of four plant extracts: maackiain and formononetin from Virgilia oroboides and chlorophorin and Iroko from Chlorophora excelsa, were evaluated. Anti-protozoal tests conducted on trophozoites of Entamoeba histolytica established that all four compounds had an affect on the trophozoites to some degree. Chlorophorin showed the highest anti-protozoal activity with an MIC of 0.25 microg/ml followed by maackiain and Iroko with MICs of 1 microg/ml. Chlorophorin and Iroko induced the release of acid phosphatase. Chlorophorin reduced alpha amylase levels by 89%. Formononetin and maackiain had a minimal effect on the enzyme levels. Ultrastructural changes occurred in trophozoites treated with plant compounds. The degree of destruction of the trophozoites increased with an increase in compound concentration. Trophozoite destruction was initiated by the disintegration of the nucleus and culminated with the rupture of the cytoplasmic membrane. Maackiain was the only compound that showed some level of mutagenicity. Formononetin and Iroko were very slightly mutagenic, while chlorophorin was non-mutagenic. In addition, none of the compounds tested showed cytopathic effects on any of the cell lines tested. Chlorophorin and Iroko exhibit the potential to be exploited as natural multi-functional safe control agents in the treatment of bacterial, fungal and protozoal infections.     

The impact of theoretical errors on velocity estimation and accuracy of duplex grading of carotid stenosis

Two potential errors in velocity estimation, Doppler angle misalignment and intrinsic spectral broadening (ISB), were determined and used to correct recorded blood velocities obtained from 20 patients (38 bifurcations). The recorded and corrected velocities were used to grade stenoses of greater than 70% using two duplex classification schemes. The first scheme used a peak systolic velocity (PSV) of > 250 cm/s in the internal carotid artery (ICA), and the second a PSV ratio of > 3.4 (ICA PSV/common carotid artery PSV). The "gold standard" was digital subtraction angiography (DSA). The maximum error in velocity estimation due to Doppler angle misalignment was 33 cm/s, but this did not alter sensitivity of stenosis detection. ISB correction caused a reduction in PSV that decreased the sensitivity of the PSV scheme from 65% to 45%. The PSV ratio classification was not affected by ISB errors. Centres using a PSV criterion for grading stenosis should use a fixed Doppler angle and should establish velocity thresholds in-house.     

Correlation of intra-operative duplex findings during carotid endarterectomy with neurological events and recurrent stenosis at one year.

OBJECTIVES: Carotid endarterectomy has been used to treat both asymptomatic and symptomatic disease and this has meant that recurrent stenosis and its effect on late stroke risk have become increasingly important. In this study we compared anatomical defects and residual stenosis identified intra-operatively with recurrent stenosis and new symptoms developing in the first year after surgery. DESIGN, MATERIALS & METHODS: Two hundred and forty-four consecutive patients undergoing carotid endarterectomy were studied prospectively. Residual anatomical defects were noted; residual stenosis was defined by intra-operative duplex ultrasound as >50%. New stenoses and clinical events during the one-year surveillance period were documented. RESULTS: There was an increased incidence of recurrent stenosis at one year in vessels with residual stenoses (p<0.001) and in vessels containing a residual anatomical defect (p=0.037). There was no significant difference in recurrent stenosis rate with respect to closure (primary or patch) or seniority of surgeon but recurrent stenosis was increased in females (p=0.026). The majority (70%) of restenotic lesions were localised to the origin of the internal carotid artery. The late stroke rate was 0.9% and was not related to recurrent stenosis or symptoms.CONCLUSIONS: Residual stenosis and intra-luminal defects at completion increase the recurrent stenosis rate at one year. The aetiology of recurrent stenosis is multi-factorial and further studies are required to determine whether it is justified to modify the criteria for re-exploration with a view to reducing recurrent stenosis.     

Cervical spine clearance in unconscious traumatic brain injury patients: dynamic flexion-extension fluoroscopy versus computed tomography with three-dimensional reconstruction

BACKGROUND: An optimal protocol for clearing the cervical spine in unconscious patients with traumatic brain injury remains controversial. Protocols include plain radiographs and computed tomography (CT), and ligamentous injury may be identified with flexion-extension radiographs. We questioned whether cervical CT with three-dimensional (3D) reconstructions may obviate the need for flexion-extension radiology in the detection of occult ligamentous injury. METHODS: Between July 1999 and November 2001, 276 unconscious traumatic brain injured patients admitted to The Alfred Hospital received cervical spine plain radiographs, CT with 3D reconstructions, and dynamic flexion-extension X-ray studies with fluoroscopy as part of a routine protocol. These patients were identified from a prospective intensive care unit database and all radiology reports were reviewed. RESULTS: Dynamic flexion-extension X-ray studies with fluoroscopy identified no new fractures or instability; there were no instances of true-positive results. Dynamic flexion-extension was true-negative in 260 of 276 (94%) patients, falsely positive in six patients (2.2%) and falsely negative in one (0.4%) patient. In nine patients, dynamic flexion-extension was inadequate. CONCLUSION: Dynamic flexion-extension X-ray studies with fluoroscopy delayed cervical spine clearance and were almost always reported as normal. In a cervical spine clearance protocol for unconscious traumatic brain injury patients, dynamic flexion-extension X-ray studies with fluoroscopy did not identify any patients with cervical fracture or instability not already identified by plain radiographs and fine-cut CT (C0 to T2) with 3D reconstructions.     

Monitoring cerebral perfusion during carotid endarterectomy

Transcranial pulsed Doppler ultrasound was used to monitor blood velocity in the middle cerebral artery (MCA) of two patients during ipsilateral carotid endarterectomy. In the first patient the ultrasound data demonstrated a non-functioning shunt which was corrected by repositioning the distal end of the shunt. In the second patient MCA blood velocity data demonstrated that clamping of the external carotid artery would have resulted in complete cessation of MCA flow throughout endarterectomy. These cases illustrate the benefit that this technique offers to the individual patient undergoing carotid surgery.     

Cost-effective carotid endarterectomy

BACKGROUND: Although carotid endarterectomy is increasing in the UK, there is evidence that the procedure is still underused. Methods of reducing cost in a single vascular unit have been assessed using a continuous audit including outcome measures. METHODS: A consecutive series of 333 patients admitted over 7 years under a single consultant surgeon were studied. Outcome measures included the rate of perioperative neurological complication of any kind, and death. The length of hospital stay and the number of readmissions within 30 days were recorded prospectively by computerized audit. RESULTS: Over the interval of the study, the number of preoperative investigations was reduced; angiography and cerebral computed tomography were reserved for specific indications. The median duration of hospital stay decreased from 7 to 2 days. There was no change in the stroke and death rate (3 per cent) during the study and only two patients required readmission within 30 days. CONCLUSION: Carotid endarterectomy can be performed cost-effectively using non-invasive preoperative investigations for the majority of patients. In-hospital stay has been reduced and the routine use of intensive care replaced by a 2-h stay in theatre recovery. These changes have been achieved without compromising patient safety.