Notes from the Field: Cluster of Tuberculosis Cases Among Marshallese Persons Residing in Arkansas - 2014-2015.

During early September 2014, the Arkansas Department of Health identified an increased number of tuberculosis (TB) cases among a unique population in a well-circumscribed geographical area in northwest Arkansas. The Compact of Free Association Act of 1985 (Public Law 99-239, amended in 2003 by Public Law 108-188) established the Republic of the Marshall Islands (RMI) as an independent nation, and persons from the RMI can travel freely (with valid RMI passport) to and from the United States as nonimmigrants without visas (1). Marshallese started settling in northwest Arkansas during the early 1990s because of employment and educational opportunities (2). According to the 2010 Census, an estimated 4,300 Marshallese resided in Arkansas (2), mostly within one county which ranked 6th in the United States for counties with the highest percentage of Native Hawaiians and Other Pacific Islanders (3). It is estimated that this number has been growing steadily each year since the 2010 Census; however, obtaining an accurate count is difficult. The RMI is a TB high-incidence country, with a case-rate of 212.7 per 100,000 persons for 2014, whereas the case-rate was 3.1 per 100,000 persons in Arkansas and 2.9 per 100,000 persons in the United States (4,5). Screening for either active TB or latent TB infection (LTBI) is not required for Marshallese entry to the United States (1).

Effects of Controlled Breathing, With or Without Aromatherapy, in the Treatment of Postoperative Nausea.

PURPOSE: The purpose of this study was to compare the effectiveness of controlled breathing (CB), with and without aromatherapy (isopropyl alcohol [IPA]), in the treatment of postoperative nausea (PON) in adult females undergoing elective outpatient laparoscopic procedures. DESIGN: A prospective randomized two-group quasi-experimental design was used. METHODS: A convenience sample was used. Patients were consented and assigned to either a control (CB) or treatment (IPA) group. Symptomatic patients rated nausea severity before and at 2 and 5 minutes after receiving either CB or CB with IPA. FINDINGS: Complete data for one episode of nausea were obtained on 82 patients (41 in each group). Results showed that although nausea severity decreased significantly over time, there was no significant difference in PON treatment effectiveness between the two groups, nor was there a difference in requests for rescue medications. CONCLUSIONS: Patients who experience PON should be encouraged to take slow deep breaths as an initial response to symptoms. This approach has no side effects or costs and could also aid the patient to self-manage symptoms after discharge.

Coping with stress: a survey of Murdoch University veterinary students.

Students in veterinary schools can experience stress in balancing the different demands on them-academic, interpersonal, intrapersonal, and professional or work related-as well as managing potential conflict between animal and human interests. Practicing veterinarians report many similar stressors and reactions. Stressful stimuli produce stress reactions that can be inimical to physical and psychological well-being, and students' performance in veterinary programs can be adversely affected if they do not have coping resources. While there has been some research into stress among university students in general, and among medical students in particular, there is little on the experience of veterinary students. This article describes a study by the School of Psychology, commissioned by the Department of Veterinary Clinical Sciences, at Murdoch University in Western Australia. It was designed to investigate the levels and causes of stress among, and the frequency and type of coping strategies used by, fourth- and fifth-year students. Results indicate that the students in this cohort faced frequent stressors and felt at least moderately stressed but did not routinely and systematically use a range of coping strategies. Academic stressors and perceived responsibilities attached to moving into practical or professional areas figured strongly and were associated with higher levels of stress in the students, in particular physical sequelae. Though the numbers were small, it is of concern that some students were using measures that were potentially harmful. Some recommendations are made here about measures that veterinary programs may be able to incorporate to address stress in their students. Information is included on current strategies within the curriculum to manage potential stressful situations as part of students' professional development.

Quantitative PCR tissue expression profiling of the human SGLT2 gene and related family members.

SGLT2 (for "Sodium GLucose coTransporter" protein 2) is the major protein responsible for glucose reabsorption in the kidney and its inhibition has been the focus of drug discovery efforts to treat type 2 diabetes. In order to better clarify the human tissue distribution of expression of SGLT2 and related members of this cotransporter class, we performed TaqMan™ (Applied Biosystems, Foster City, CA, USA) quantitative polymerase chain reaction (PCR) analysis of SGLT2 and other sodium/glucose transporter genes on RNAs from 72 normal tissues from three different individuals. We consistently observe that SGLT2 is highly kidney specific while SGLT5 is highly kidney abundant; SGLT1, sodium-dependent amino acid transporter (SAAT1), and SGLT4 are highly abundant in small intestine and skeletal muscle; SGLT6 is expressed in the central nervous system; and sodium myoinositol cotransporter is ubiquitously expressed across all human tissues.

A qualitative approach to identifying psychosocial issues faced by bipolar patients.

Many studies have examined factors influencing or associated with the outcome of bipolar disorder. However, little is known about bipolar patients' subjective experiences of their illness and the issues that are of significance to them. The use of a client-focused approach in identifying these issues is important for planning treatment and clinical medical management to address patients' specific needs. Focus group discussions and individual interviews were conducted with 18 bipolar patients and transcribed verbatim. The data were then analyzed and interpreted according to the phenomenological approach to qualitative research. The data were interpreted in terms of how patients view themselves, their lives and community, and their future. Implications for treatment and future research are discussed.

Long-term results of pediatric liver transplantation in a combined pediatric and adult transplant program.

BACKGROUND: Liver transplantation is now routine therapy for a variety of childhood liver diseases; however, there are no detailed reports of long-term results from a Canadian centre. We reviewed data from the first 16 years of a pediatric liver transplantation program to determine survival, complications and long-term outcomes. METHODS: The outcomes to December 2000 for all children (age less than 18 years) who received a liver transplant at the London Health Sciences Centre between April 1984 and December 1999 were reviewed. The recipients were grouped according to the period in which they received the transplant (period 1, April 1984 to July 1988; period 2, August 1988 to December 1993; or period 3, January 1994 to December 1999). Data were obtained from medical charts; in-person interviews, questionnaires or telephone contact with patients and their families; contact with referring physicians; and school records. Outcome measures included patient survival, retransplantation, complications and long-term outcomes (specifically steroid withdrawal and growth and development). RESULTS: A total of 116 children (29 in period 1, 46 in period 2 and 41 in period 3) (median age 5.6 years at the time of the procedure) received a total of 140 liver grafts (32 in period 1, 57 in period 2 and 51 in period 3). Of the 116 patients, 23 (20%) were less than 1 year old at the time of transplantation. Biliary atresia was the most common indication for liver transplantation (57 [49%] of the 116 patients). The number of patients surviving to 1 year after transplantation was 20 (69%) of the 29 patients from period 1, 40 (87%) of the 46 patients from period 2 and 38 (93%) of the 41 patients from period 3. The percentage of patients receiving reduced size grafts from adult donors, including live donors, increased from 2/32 (6%) in period 1 to 22/51 (43%) in period 3. Retransplantation was required for 9 (31%) of the 29 patients from period 1, 6 (13%) of the 46 patients from period 2 and 7 (17%) of the 41 patients from period 3. Among these patients, 1-year survival was 33% (3/9) for period 1, 83% (5/6) for period 2 and 100% (7/7) for period 3. Eighteen of the 22 deaths occurred within 4 months after surgery. Only 3 (3%) of the 116 patients experienced post-transplant lymphoproliferative disease. Steroids were discontinued (usually within 2 years after surgery) for the following proportions of surviving transplant recipients: 17 (89%) of the 19 patients from period 1, 29 (78%) of the 37 patients from period 2 and 21 (55%) of the 38 patients from period 3. Most of the surviving patients had normal growth (82/94 or 87%) and development (73/94 or 78%), and these outcomes were consistent across the 3 periods of study. INTERPRETATION: Survival and long-term outcomes continue to improve for most children who receive liver transplants. These improvements may be due to improved surgical technique, perioperative care and, to a lesser extent, immunosuppressive therapy.