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Human Parainfluenza Virus Infections
Published in Sunit K. Singh, Human Respiratory Viral Infections, 2014
Eric T. Beck, Kelly J. Henrickson
The nucleocapsid protein (abbreviated as N or NP) ranges from 509 to 557 amino acids in length (roughly 66–70 kDa) and is fairly conserved between HPIVs. The N protein encapsidates both genomic and antigenomic (positive-sense) HPIV RNAs with each molecule of N protein interacting with six nucleotides.5 This likely has some direct correlation with the recent discovery, through the use of reverse genetics, of the HPIV “rule of six.” The “rule of six” indicates that HPIV replication and transcription are most efficient when the length of the genome is divisible by six.14–16 N protein encapsidation of HPIV RNA is required for RNA replication; however, the N protein can only properly associate with genomic RNA when it is available as a soluble complex with the P protein.17,18 The N terminus is the more conserved domain and is responsible for binding to the P protein to form soluble complexes, binding the HPIV RNA, and also binding to other copies of the N protein in the completed ribonucleocapsids.18,19 The carboxy-terminus of the N protein, meanwhile, allows for association with the P protein during RNA replication.20 Sendai viruses (mouse PIV-1) contain approximately 2564 molecules of the N protein in each mature virion.5
Sailing on the ‘7 Cs’: teaching junior doctors how to redirect patients during difficult consultations in primary care
Published in Education for Primary Care, 2018
Heidi Allespach, Erin N. Marcus, Kassandra M. Bosire
In summary, a strong doctor-patient relationship depends on respect, trust, and effective communication [10]. Without maintaining a good relationship with a patient, everything else that follows – obtaining an accurate history, making an accurate diagnosis, formulating an effective treatment regimen – will be unsuccessful. In addition, if junior doctors do not feel they have satisfactory relationships with their patients, symptoms of burnout and even depression may ensue. By weaving in the 7 Cs with other helpful clinical teaching frameworks, such as the Rule of Six 2s [11] to balance efficiency without sacrificing the doctor-patient relationship and practising the CALMER Approach [4] to help decrease physician distress during difficult consultations, it is proposed that junior doctors will be better able to develop and maintain excellent relationships with their patients, even with those seen as problematic.
The targeting rule does not increase the rate of lower extremity injuries in NFL players over two seasons
Published in The Physician and Sportsmedicine, 2022
Hayden P. Baker, Alexander Satinsky, Cody S. Lee, Henry Seidel, Emma Dwyer, Aravind Athiviraham
NFL players were first to voice concerns regarding the targeting rule; they speculated that the rule change may lead to an unintentional increase in the rate of lower extremity injuries as players, out of self-preservation and in an attempt to avoid head-on collisions, would opt to dive at the ball carriers’ legs in order to make a tackle [11,12]. Following this public criticism of the rule, in 2016 Westermann et al. investigated this claim and examined the rate of lower extremity injuries in NCAA football players following implementation of the targeting rule over six seasons. The findings of Westermann et al. suggested that lower extremity injury rates increased among NCAA football players after implementation of the targeting rule. Specifically, they noted that knee and ankle injuries resulting from player contact increased significantly [3]. The findings of Westermann et al. supported NFL players speculations that the targeting rule may increase the rate of lower extremity injuries. However, their study was not without limitation, to which they acknowledge and highlight potential confounders. The most significant confounder being the unintended effects of other policy changes made by the NCAA during the study period. For example in 2012 the NCAA moved the kickoff up to the 35-yd line (previously at the 30-yd line) in an attempt to decrease the rate of contact-related injuries. Although one can assume that this rule change would likely lead to more touchbacks, which in theory would reduce the risk of all contact related injuries. However, given these potential confounders further investigation in a cohort of NFL players is warranted.
Thrombophilic risk factors and ABO blood group profile for arteriovenous access failure in end stage kidney disease patients: a single-center experience
Published in Renal Failure, 2022
Sunnesh Reddy Anapalli, Harini Devi N., Pvgk Sarma, Lokanathan Srikanth, Siva Kumar V.
This was a mono-centric, cross-sectional observational study on 100 ESKD patients undergoing HD, who were selected during the study period 2017–18 from the Department of Nephrology. All 100 patients at the time of study were receiving intermittent HD using a functioning AVF. Of these 100 patients, Group 1 (n = 50) represented the controls who never had a history of fistula failure, and Group 2 (n = 50) included patients with a past history of fistula failure. Patients in Group 2 (n = 50) were further grouped as those with single AVF failure (n = 19) and those with multiple AVF failures≥ 2 (n = 31). Among the 31 multiple AVF failure subjects, two patients have had four AVF failures, seven patients had three AVF failures, and 22 patients had two AVF failures. This study was reviewed and approved by the institutional ethics committee (IEC No: 643/2017) and all participants provided written informed consent. The subjects included in the study were those with ESKD receiving HD treatment for at least six months through an arteriovenous fistula and had an age range of 18–80 years. All the AVFs were created at our hospital, in the theater, under the guidance of senior faculty in the Department of Urology. Concerning to the maturation and suitability of AVF for cannula initiation for MHD, the criteria applied were 12 weeks duration and the rule of six [19]. In the present study, fistula failure was considered in those cases in which AVF never went to the point that it can be used or it failed within the first three months of usage [20]. All AVF cannulations were done by trained and qualified dialysis technicians under the supervision of a senior dialysis technologist. All the patients and their personal caregivers were educated about AVF care before and after the procedure. MHD was performed thrice weekly for 4 h in addition to low flux conventional intermittent HD with heparin anticoagulation and bicarbonate dialysate. All the patients received erythropoietin (EPO). The exclusion criteria for subjects pertained to patients with unusable vascular accesses due to other reasons like infection besides thrombosis.