Changes in couples' communication as a result of a male-involvement family planning intervention

Research suggests that spousal communication and male involvement in decision making can positively influence family-planning use and continuation. However, few existing studies explore the dynamics of this communication and how they factor into family-planning decision making. Building upon a recent evaluation of a theory-based male-involvement intervention in Malawi, this study aimed to fill this gap by examining the role of communication in the intervention's success, through semi-structured in-depth interviews with male participants and female partners of study participants. Results support the idea that communication is an integral component of successful interventions to increase male involvement in family planning. Participants reported improvements in spousal communication, increased frequency of communication, and an increase in shared decision making as a result of the study, which directly contributed to their family-planning use. This effect was often mediated through increased knowledge or reduced male opposition to family planning. Further analysis of communication and decision-making dynamics revealed shifts in gendered communication norms, leading to improvements in spousal relationships in addition to contraceptive uptake. This study shows that interventions can and should encourage spousal communication and shared decision making, and it provides an effective model for involving men in family-planning use.     

Interatrial Shunting for Heart Failure: Early and Late Results From the First-in-Human Experience With the V-Wave System

Objectives

This was a first-in-human study to assess the feasibility, safety, and exploratory efficacy of interatrial shunting for treating high-risk heart failure (HF) in patients with reduced and preserved ejection fraction.

Infective endocarditis resulting from CardioSEAL closure of a patent foramen ovale.

Patent foramen ovale and atrial septal aneurysm are associated with an increased risk of cryptogenic stroke and recurrent thromboembolic events. Percutaneous closure is a therapeutic option to medical therapy and surgical closure. We present the first case of endocarditis associated with a CardioSEAL device closing a patent foramen ovale.     

Studies on the pathogenesis of the dawn phenomenon in insulin-dependent diabetic patients

To assess the role of hormonal factors in the pathogenesis of the dawn phenomenon, nocturnal (9:00 PM to 9 AM) concentrations of blood glucose, free insulin, and counterregulatory hormones were determined in eight insulin-dependent diabetic patients under feedback-controlled and continuous insulin infusions after previous blood glucose normalization. Under feedback control, mean insulin requirements, necessary for maintenance of euglycemia rose significantly in the early morning (11:00 PM to 3 AM: 8.4 +/- 1.4; 5 AM to 9 AM: 12.6 +/- 1.5 mU/kg/h; P less than 0.01). Mean free-insulin concentrations did not increase simultaneously. Correspondingly, mean insulin-clearance rates under continuous insulin infusion were higher in the morning (11:00 AM to 3 AM: 359 +/- 58; 5 AM to 9 AM: 459 +/- 72 mL/min/m2; P less than 0.05). Increases of insulin clearance rates were most marked (greater than 15%) in patients whose blood glucose rose during continuous insulin administration. Glucagon and norepinephrine concentrations were stable throughout both parts of the study. Cortisol and growth hormone exhibited the known nocturnal rhythms. Epinephrine levels were at the lower limit of detection at night and rose to normal basal concentrations at 9:00 AM. We conclude that increases of insulin clearance rates may be an important factor for the development of the dawn phenomenon while the role of most counter-regulatory hormones is still uncertain.     

Excess triiodothyronine as a risk factor of coronary events

BACKGROUND: Abnormalities in cardiac function, eg, arrhythmias and congestive heart failure, often accompany thyrotoxicosis. A relationship between thyroid hormone excess and the cardiac complications of angina pectoris and myocardial infarction (MI) remains largely speculative. METHODS: The results of thyroid function studies on blood samples drawn from a total of 1049 patients (aged 40 years or older) immediately on emergency medical admission were related to frequencies of angina pectoris and myocardial infarction as determined according to current diagnostic algorithms. After 3 years, those patients who had initially presented with angina pectoris or acute MI were observed for subsequent coronary events; of these (n=185), 98% of the subjects (n=181) could be reevaluated. RESULTS: On hospital admission, the relative rate of angina pectoris and MI was markedly high (odds ratio, 2.6; 95% confidence interval, 1.3-5.2; P=.007) in patients with elevated serum free and total triiodothyronine (T(3)) levels. An initially elevated free T(3) level was a risk factor for subsequent coronary events during the 3-year follow-up (adjusted odds ratio, 4.8; 95% confidence interval, 1.3-17.4; P=.02). CONCLUSIONS: An elevation of serum free T(3) levels at hospital admission is associated with a 2.6-fold greater likelihood of the presence of a coronary event. Moreover, an initially elevated T(3) level is associated with a 3-fold higher risk of developing a subsequent coronary event during the next 3 years. Excess T(3) seemed to be a factor associated with the development and progression of acute myocardial ischemia.     

Aerobic bacterial methane synthesis

Reports of biogenic methane (CH₄) synthesis associated with a range of organisms have steadily accumulated in the literature. This has not happened without controversy and in most cases the process is poorly understood at the gene and enzyme levels. In marine and freshwater environments, CH₄ supersaturation of oxic surface waters has been termed the “methane paradox” because biological CH₄ synthesis is viewed to be a strictly anaerobic process carried out by O₂-sensitive methanogens. Interest in this phenomenon has surged within the past decade because of the importance of understanding sources and sinks of this potent greenhouse gas. In our work on Yellowstone Lake in Yellowstone National Park, we demonstrate microbiological conversion of methylamine to CH₄ and isolate and characterize an Acidovorax sp. capable of this activity. Furthermore, we identify and clone a gene critical to this process (encodes pyridoxylamine phosphate-dependent aspartate aminotransferase) and demonstrate that this property can be transferred to Escherichia coli with this gene and will occur as a purified enzyme. This previously unrecognized process sheds light on environmental cycling of CH₄, suggesting that O₂-insensitive, ecologically relevant aerobic CH₄ synthesis is likely of widespread distribution in the environment and should be considered in CH₄ modeling efforts.

The “methane paradox” is well documented and has drawn significant attention from a broad array of biologists, biogeochemists, biochemists, and physical scientists (see review in ref. 1). This supersaturation phenomenon is inconsistent with the extreme oxygen sensitivity of methanogens, a phylogenetically constrained group of archaea, which have long been viewed to be the sole source of biogenic CH₄. Work in marine waters previously suggested this is due to methanogens active within anoxic microhabitats in suspended organic debris (2–5), digestive tracts, or fecal pellets of zooplankton (5–7) and/or of fish (8, 9). Recently, strong evidence for microbial dealkylation of methylphosphonate (referred to here as MPn) in marine (10, 11) and freshwater environments (12, 13) has been presented and thus provides at least a partial explanation for this phenomenon.Pelagic methane enriched zones (PMEZ, ref. 12) are well-defined CH₄ maxima occurring as a distinct region(s) of the water column in deep freshwater lakes (1, 12, 14). PMEZ offer a tractable environment in which to study the microbiology and biogeochemistry that underpins aerobic CH₄ synthesis. Our prior efforts on Yellowstone Lake using ¹³C-labeled methanogen substrates, 16S ribosomal RNA (rRNA) gene based microbial community characterization, and methyl-coenzyme M reductase (mcrA) gene-targeted PCRs demonstrated the absence of recognizable methanogens in PMEZ waters (12). Instead, MPn metabolism was strongly associated with distinct populations of Pseudomonas sp. as being important contributors to PMEZ formation (12).Efforts presented here summarize continuing studies that now identify aerobic metabolism of methylamine (MeA) as an important contributing metabolite to biogenic CH₄. Methylotrophic methanogens anaerobically convert MeA to CH₄ by disproportionation of MeA to carbon dioxide and CH₄ (15, 16). Methylotrophic bacteria can metabolize MeA as a carbon source (17, 18), nonmethylotrophs for nitrogen (17, 19) (20), a carbon and N source (21), or methylovores can use it as an energy source (22). MeA utilization is viewed to occur as an oxidation via either MeA dehydrogenase, MeA oxidase, or involving methy group transfer to tetrahydrofolate involving the formation of formation of γ‐glutamyl‐methylamide (GMA) and N‐methylglutamate (NMG) (20, 23). In the current study, we report the discovery of an alternate, simpler route of MeA metabolism that yields CH₄, involving a reaction catalyzed by a 5′pyridoxal-phosphate–dependent aspartate aminotransferase.     

Adherence to Guidelines of Pain Assessment and Intervention in Internal Medicine Wards

Proper management of pain reduces morbidity, assists in recovery, and increases patient satisfaction. The role of a nurse in an accurate pain evaluation is pivotal. It seems that pain evaluation guidelines are not fully adhered to by nurses. The aim of this study was to assess the performance of pain evaluation and management by nurses in patients admitted in internal medicine wards and to identify groups of patients in which pain evaluation was insufficient. In this cross-sectional study medical records of 59 randomly chosen patients were reviewed: age 64.5 ± 18.5 years, 55% women, and hopitalization length 3.9 ± 1.6 days. Data relating to pain evaluation and management were obtained for every patient–hospitalization day (total 213 patient-days) and compared with the guidelines. Pain was evaluated in 176 out of 213 encounters (66.2%): 84.3% upon admission and 72.7% daily routine evaluation in accordance with guidelines. In 23.7% of evaluations, pain level warranted alleviating treatment (visual analog scale ≥3). However, such treatment was administered in only 29.3% of these cases. Reevaluation after treatment and additional evaluations thereafter were performed in 33.3% and 22% of encounters, respectively. The independent factors associated with the reduced performance of pain evaluation were: widower (odds ratio [OR] 0.88, 95% confidence interval [CI] 0.78-0.98; p = .024), reduced level of consicousnness (OR 0.77, 95% CI 0.63-0.95; p = .013), mental disorders as a cause of hospitalization (OR 0.81, 95% CI 0.71-0.94; p = .004), and isolation (OR 0.87, 95% CI 0.76-0.99; p = .03). Pain assessment and management in internal medicine wards is insufficient, especially in the above subgroups. Specific education programs targeted to the latter subgroups and to the unique pain assessment tools are warranted.