This system has already delivered

This system has already delivered learn more detailed information on the cellular processes accompanying early morphogenesis and allowed direct connections to be established between events occurring at the two developmental phases. This review discusses the potential of this novel technology and its possible applications that could have not only impact on basic science but also practical implications for human medicine. (C) 2013, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.”
“The objective of this study was to test the validity, in the Chinese population, of the Lifting The Burden diagnostic questionnaire for the purpose of a population-based survey

of the burden of headache in China. From all regions of China, a population-based sample of 417 respondents had completed the structured questionnaire in a door-to-door survey conducted by neurologists from local hospitals calling unannounced. They were contacted for re-interview by telephone by headache specialists who were unaware of the questionnaire diagnoses. A screening

question ascertained whether headache had AZD5363 datasheet occurred in the last year. If they had, the specialists applied their expertise and ICHD-II diagnostic criteria to make independent diagnoses which, as the gold standard, were later compared with the questionnaire diagnoses. There were 18 refusals; 399 interviews were conducted in 202 women and 197 men aged 18-65 years (mean age 44.4 +/- A 12.6 years). In comparison to the specialists’ diagnoses, the sensitivity, specificity, positive predictive value, negative predictive

value and Cohen’s kappa (95% CI) of the questionnaire for the diagnosis of migraine check details were 0.83, 0.99, 0.83, 0.99 and 0.82 (0.71-0.93), respectively; for the diagnosis of tension-type headache (TTH), they were 0.51, 0.99, 0.86, 0.92 and 0.59 (0.46-0.72), respectively. In conclusion, the questionnaire was accurate and reliable in diagnosing migraine (agreement level excellent), less so, but adequate, for TTH (sensitivity relatively low, false negative rate relatively high and agreement level fair to good). The non-specific features of TTH do not lend themselves well to diagnosis by questionnaire.”
“We report the temperature dependence of the thermal conductivity kappa(T) of bulk polycrystalline composite samples containing a magnetoresistive manganite (La0.7Ca0.3MnO3) and an electrically insulating phase (Mn3O4). The sample porosity is shown to be a significant parameter affecting the experimental data: after porosity correction the curves display the characteristics of an ideal composite. A fit of the kappa(T) curves at low temperature using the Debye model enables the mean free path of phonons scattered on “”boundaries”" to be determined. The values are on the order of the grain size but are influenced by the grain arrangement and the presence of twins.

Moreover, it has been proved that this technology can be useful t

Moreover, it has been proved that this technology can be useful to decompose some toxins that are not affected by thermal processing. In this piece of work, the effect of UV irradiation on all of these contaminants and components of liquid food has been reviewed.

(C) 2011 Elsevier Ltd. All rights reserved.”
“A novel and simple method for the preparation of chemically bonded poly(vinyl alcohol) (PVA) coating to silica capillary inner wall was developed, and the PVA-coated Selleck GSK2399872A capillary columns were employed for capillary electrophoresis (CE). The coating procedure included pretreatment of the capillary inner wall, silanization, aldehyde group functionalization and PVA immobilization. Electroosmotic flow of the coated capillary was almost suppressed over a wide pH range (pH 3-10). High-efficiency separations of cationic proteins (including cytochrome c, lysozyme, a-chymotrypsinogen A) at pH 3.0-5.0 and of anionic proteins (including myoglobin and trypsin inhibitor)

at pH 10.0 were achieved with the PVA-coated capillary. Moreover, a “”dual-opposite-injection”" approach was adopted for simultaneous separations of both cationic and anionic proteins at neutral pH with the prepared column. In this CE mode, positively charged proteins migrated from one end of the column to the detector while negatively this website charged proteins from the other end to the detection window. Good run-to-run repeatability was obtained in all of the protein CE separations performed in this work. The PVA-coated column can also afford long-term stable uses for protein separations, as demonstrated in 100 repeated uses using a single capillary with the relative standard deviation values of the retention times less than 0.9%. Moreover, good column-to-column reproducibility was demonstrated by protein CE separation selleck compound with 10 different

columns. The results indicate that the present method for PVA-coated capillary preparation is promising for protein CE applications. (C) 2010 Elsevier B.V. All rights reserved.”
“. miR-122 is a liver-specific microRNA, which also circulates in the blood. The levels of miR-122 in serum and plasma correlate with hepatic necroinflammation in patients with hepatitis B virus (HBV) infection. Here, we investigated whether miR-122 levels correlate with surrogate markers for viral replication and translation. Furthermore, we examined whether miR-122 levels differ in the different groups of HBV-infected patients and whether miR-122 levels may be useful to identify patients with higher or lower risk for liver disease progression. Therefore, RNA was extracted from sera of therapy-naive patients with HBV infection (n = 89) and from healthy volunteers (n = 19). The concentration of miR-122 was assessed by quantitative real-time reverse-transcription PCR. HBs antigen and HBV DNA levels were quantified as surrogate parameters for HBV replication and translation.

The transient response of sap flow was described using the resist

The transient response of sap flow was described using the resistance-capacitance model. The steady sap flow rate increased as the wind speed increased at low wind speeds. Once the wind speed exceeded 8.0 m s(-1), the steady sap flow rate did not increase further. The transpiration rate, measured gravimetrically, https://www.selleckchem.com/small-molecule-compound-libraries.html showed a similar trend. The response of nocturnal sap flow to wind speed variation was also measured and compared with the results in the daytime. Under the same wind speed, the steady sap flow rate

was smaller than that in the daytime, indicating differences between diurnal and nocturnal hydraulic function, and incomplete stomatal closure at night. In addition, it was found that the temporal response of the Granier sensor is fast enough to resolve the transient Belnacasan mouse behaviour of water flux in plant tissue.”
“Objective-To evaluate the disease-free interval (DFI) and median survival time (MST) in dogs with idiopathic and neoplastic pericardial effusion surgically treated by a thoracoscopic pericardial window procedure or subtotal pericardectomy via thoracotomy and to compare DFI and MST in dogs with and without a mass on preoperative

echocardiography that underwent either surgical technique.

Design-Retrospective cohort study.

Animals-58 dogs with pericardial effusion.

Procedures-Medical BI-D1870 ic50 records between 1985 and 2010 were evaluated. Dogs were included in the study if they had confirmed pericardial effusion and underwent a thoracoscopic pericardial window procedure or subtotal pericardectomy via thoracotomy.

Results-Clinical

signs of dogs at initial evaluation were similar, with the exception of lethargy, between dogs treated by subtotal pericardectomy via thoracotomy or the pericardial window procedure. Dogs with idiopathic pericardial effusion that underwent the thoracoscopic pericardial window procedure had significantly shorter DFI and MST than did those treated by subtotal pericardectomy via thoracotomy. For neoplastic pericardial effusion, DFI and MST were not significantly different between dogs treated with either surgical technique.

Conclusions and Clinical Relevance-Dogs with idiopathic pericardial effusion treated with a subtotal pericardectomy via thoracotomy had a significantly longer DFI and MST, compared with dogs treated by the thoracoscopic pericardial window procedure. This difference in outcome may be related to inaccuracy of the initial diagnosis or ineffectiveness of the pericardial window to palliate the signs of idiopathic pericardial effusion long term.

Results: Separation of adduct from PNA was better achieved on rev

Results: Separation of adduct from PNA was better achieved on reversed phase thin layer chromatography (TLC) using acetonitrile : water (60: 50) or on high performance liquid chromatography (HPLC) with retention times of 2.8 min for PNA

and 5.8 min for the adduct. The limit of detection was 6 mu g/mL. The method was precise and accurate in the range 100.70 – 100.96 %, with intraday and interday precisions of less than 2 % at concentrations of 40 and 80 mu g/mL, respectively. The new method was applied to the assay of two brands of dihydroartemisinin tablets with accuracy similar to that of the International Pharmacopoeia (IP) UV-spectrophotometric method (p > 0.05).

Conclusion: The derivatization method is simple, direct, devoid of dilutions buy MLN4924 and inexpensive in terms Nutlin-3 mw of reagent requirements and analyte volume, and has a shorter reaction time, cpmpared with IP method. Based on the foregoing, the method can be adopted as an alternative to the official assay method for routine quality control of dihydroartemisinin tablets.”
“D-003

is a mixture of higher fatty acids purified from sugarcane wax with antiosteoporotic effects in ovariectomized (ovx) rats. Omega-3 fatty acids (Omega-3FA) have shown bone-protective effects. This study compared the effect of D-003 and Omega-3 FA on bones of ovx rats. Rats were randomized into 4 groups: one GSK1904529A research buy false-operated and three ovx groups: a positive control treated orally with the vehicle, one with D-003 (50 mg/kg) and other with Omega-3FA (160 mg/kg) for 3 months. Ovariectomy decreased trabecular volume, number and thickness in the fifth vertebrae, distal femur and femur neck, and increased trabecular separation, osteoclast number and surface versus the false-operated group. D-003 and Omega-3 FA prevented all changes induced by ovariectomy, but the effects of D-003 were significantly greater than those of Omega-3FA. Concluding, D-003 (50 mg/kg) and Omega-3FA (160 mg/kg) prevented osteoporotic changes in ovx rats, but D-003 was more effective than the Q-3FA preparation assayed.”
“There are approximately

20 million students in U.S. colleges and universities. Although this population is characterized as having good health, 600,000 students report some form of disability or some type of medical problem, including attention-deficit/hyperactivity disorder, learning disabilities, psychiatric disorders, and chronic illnesses, among others. Physicians can enhance youth transition to an adult model of health care; the use of self-care skills checklists is one recommended method to assist with the transition. Stimulant medications are effective for treating adults with attention-deficit/hyperactivity disorder, but physicians should use caution when prescribing stimulants to college students because of the high rates of medication diversion in this population.

Methods: This prospective study included 405 patients (from newbo

Methods: This prospective study included 405 patients (from newborn to age 18 years, 53% male) referred for assessment of cardiac murmurs. Patients with confirmed cardiac or any other disease were excluded. We collected TAPSE measurements by M-mode echocardiography and recorded anthropometric variables. We analyzed the intra- and interobserver reproducibility of these measurements.

Results: Mean TAPSE values were 17.09 +/- 5.09 cm with nonsignificant differences between sexes. A curvilinear regression model proved appropriate, with values increasing in proportion to age group, height, weight, body mass index, and body surface. 4EGI-1 nmr Body surface showed a strong positive correlation

with TAPSE values (r = 0.81), whereas frequency had

a negative correlation (r = -0.74). Multivariate analysis confirmed these correlations and the interactions between variables (age, height, weight, body surface). Graphs of estimated normal population-based TAPSE values adjusted by age and body surface are provided.

Conclusions: We present reference values for TAPSE in Spanish children and adolescents. The TAPSE measurement was reproducible and associated directly with age and body surface. These reference values could guide decision buy Copanlisib making in daily clinical practice. (C) 2011 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S. L. All rights reserved.”
“Patients with epilepsy are frequently confronted with complex treatment decisions. Communicating treatment risks is often difficult because patients may have difficulty with basic statistical concepts (i.e., low numeracy) or might misconceive the statistical information based on the way information is presented, a phenomenon known as “”framing bias.”" We assessed numeracy and framing bias in 95 adults with chronic epilepsy and explored cognitive correlates of framing bias. Compared with normal controls, patients with epilepsy had significantly poorer performance on the Numeracy scale (P=0.02), despite a higher level of education than normal controls (P<0.001). Compared with patients with higher numeracy, patients with lower numeracy were significantly more likely to exhibit framing bias.

Abstract problem solving performance correlated with the degree of framing bias (r=0.631, P<0.0001), suggesting a relationship between FDA approval PARP inhibitor aspects of executive functioning and framing bias. Poor numeracy and susceptibility framing bias place patients with epilepsy at risk for uninformed decisions. (c) 2010 Elsevier Inc. All rights reserved.”
“Most of the cases of non-fulminant hepatitis A carry good renal and overall prognosis. Here we present a case of acute renal failure associated with acute non-fulminant hepatitis A, for which kidney biopsy showed interstitial nephritis and tubular necrosis. We also review the literature and possible pathogenesis.”
“beta-Cyclodextrin microspheres (beta-CDMs) were prepared and then bonded to guar gum (GG).

Results: Fifty-four patients

had a median of two prior tr

Results: Fifty-four patients

had a median of two prior transrectal ultrasonographic biopsies with negative findings. Each patient had a median of three suspicious lesions. Prostate cancer was demonstrated in 21 of 54 patients. Biopsy was performed in 178 lesions; 53 were positive for prostate cancer. Detection rates and test negative results, respectively, were as follows: T2-weighted imaging, 70% and 50%; T2-weighted buy MLN2238 imaging and (1)H MR spectroscopy, 81% and 32%; T2-weighted imaging and contrast-enhanced MR imaging, 83% and 29%; T2-weighted imaging and DW imaging, 85% and 30%; T2-weighted imaging, (1)H MR spectroscopy, and contrast-enhanced MR imaging, 91% and 13%; T2-weighted imaging, (1)H MR spectroscopy, and DW imaging, 94% and 15%; T2-weighted imaging, DW imaging, and contrast-enhanced MR imaging, 94% and 13%; T2-weighted imaging, (1)H MR spectroscopy, DW imaging, and contrast-enhanced MR imaging, 100% and 0%.

Conclusion: Only the combination of T2-weighted imaging Selleck ALK inhibitor with all three multiparametric techniques depicts all identifiable prostate cancers;

a double combination with DW imaging and (1)H MR spectroscopy or contrast-enhanced MR imaging misses 6%, while reasonably reducing the number of areas needing biopsy. (C) RSNA, 2011″
“There are two types of vitamin D dependent rickets (VDDR) that cause rickets in children. Vitamin D dependent rickets type 1 (VDDR-I) is caused by an inborn error of vitamin D metabolism, which interferes with renal conversion of calcidiol (25OHD) to calcitriol (1,25(OH)(2)D) by the enzyme see more 1 alpha-hydroxylase. Vitamin D dependent rickets type 2 (VDDR-II) is caused by a defect in the vitamin D receptor (VDR). We report cases of two African children affected by VDDR-I and VDDR-II, respectively. Establishing an early diagnosis of these genetic forms of rickets is challenging, especially in developing

countries where nutritional rickets (NR) is the most common variety of the disease. A prompt diagnosis is necessary to initiate adequate treatment, resolve biochemical features and prevent complications, such as severe deformities that may require surgical intervention.”
“The strongest evidence in medical clinical literature is represented by randomized controlled trials (RCTs). This study was designed to evaluate neurosurgically relevant RCTs published recently by neurosurgeons.

A literature search in MEDLINE and EMBASE included all clinical studies published up to 30 June 2006. RCTs with neurosurgical relevance published by at least one author with affiliation to a neurosurgical department were selected.

Secondary outcomes were postoperative urinary tract infection and

Secondary outcomes were postoperative urinary tract infection and hospital length of stay. Results. A total of 281 patients completed the study, 141 in the intervention group and 140 in the control group. Postoperative bladder distension was significantly higher in the control group (27.1% vs 17.0%; p = 0.045, 95% confidence interval 4.9-19.8) in the intention-totreat, per-protocol selleck products and as-treated analyses. No statistical difference was found between the intervention group and the control group regarding the secondary outcomes. Conclusions.

Frequent bladder monitoring starting in the ER can reduce postoperative bladder distension among acute orthopaedic patients. A preoperative bladder monitoring protocol should be implemented early in the ER for all patients admitted for acute orthopaedic procedures.”
“The possible regulation of amino acid remobilization via the phloem in wheat (Triticum aestivum L.) by the primary enzyme in nitrogen (N) assimilation and re-assimilation, glutamine synthetase (GS, E.C. 6.3.1.2) was studied using two conditions known to alter

N phloem transport, N deficiency and cytokinins. The plants were grown for 15 days in controlled conditions with optimum N Supply and then N was depleted from and/or 6-benzylaminopurine was added to the nutrient solution. Both treatments generated an induction of GS1, monitored at the level of gene expression, protein accumulation and enzyme activity, and a decrease in the exudation of amino acids this website to the phloem, obtained with EDTA technique, which correlated negatively. GS inhibition by metionine sulfoximide (MSX) produced an increase of amino acids exudation and the inhibitor successfully reversed the effect of N deficiency and cytokinin addition Over phloem exudation. Our results point to an important physiological role for GS1

in the modulation of amino acids export levels in wheat plants. (C) 2009 Elsevier Masson SAS. All rights reserved”
“Background: Previous research on frailty in older adults has focused on morbidity and mortality. The purpose of this study was to elicit the relationship between being non-frail, pre-frail, or frail and health related quality of life in a selleck screening library representative sample of older Mexican Americans surveyed in 2005-2006.

Methods: Data were from a representative subsample of the Hispanic Established Populations Epidemiologic Studies of the Elderly (EPESE) and included 1008 older adults living in the community (mean (sd) age = 82.3(4.3)). Multiple regression analyses examined the relationship between frailty status and the eight SF-36 health related quality of life subscales and two summary scales. Models also adjusted for the participants’ sociodemographic and health status.

Results: We found that, after adjusting for sociodemographic and health related covariables, being pre-frail or frail was significantly associated (p < 0.

Nasal obstruction due to the presence of nasal crusting, hearing

Nasal obstruction due to the presence of nasal crusting, hearing loss and throat hoarseness are the most represented symptoms.

Environmental measures, including a correct air temperature and humidification, is mandatory above all in subjects affected by hypohidrotic form. (C) 2013 Elsevier Ireland Ltd. All rights reserved.”
“Lucilia nitens is a herb used in folk medicine for treating diarrhoea and popularly called in Brazil “”erva-pombinha”". Aiming to expand the knowledge on this medicinal plant, this work has dealt with anatomical analysis SNX-5422 of the leaf and stem for microscopic diagnosis. Standard procedures of light and

scanning electron microscopy were carried out. The leaf is amphistomatous

and has abundant non-glandular trichomes and few glandular ones. The mesophyll is isobilateral and the midrib, in transection, is plano-convex. It is traversed by a collateral vascular bundle presenting sclerenchymatic caps. The stem has one-layered epidermis, lacunar collenchyma and parenchymatic pith. Among the sieve elements and parenchymatic cells, there are strips of fibres in the phloem. The xylem is wholly lignified and the tracheary elements are aligned in rows. These combined characters, with emphasis on the peculiar type of the non-glandular trichomes, are useful for anatomical diagnosis of the species for pharmacognostical purposes.”
“Objective: The aim of Selleckchem GNS-1480 this prospective study was to investigate the upper airway

changes after rapid maxillary expansion utilizing CBCT.

Methods: click here 16 children (10 male, 6 female) with a mean age of 12.73 +/- 1.73 years underwent RME as part of their comprehensive orthodontic treatment with4,6-banded hyrax expanders. The screws were activated 2 turns a day. Depending on the expansion amount (2.7-6.3 mm), the activation period ranged from 2 to 3 weeks. CBCT images were taken immediately before (T1) and three months after expansion (T2) in upright position, with patients’ heads kept in consistent position. All CBCT data were processed with the software EZ3D2009. After orienting the CBCT images, a set of linear, area and volumetric parameters of the upper airway were measured and calculated. Student paired t test and one-way ANOVA were applied. The significance level of P < 0.0033 was used according to the Bonferroni correction.

Results: After expansion, with molar-to-molar width increasing 4.4 +/- 1.3 mm and molars tipping 6.2 +/- 6.2 degrees, the nasal floor width and nasal lateral width increased 1.6, +/- 1.5, and 1.6 mm and 1.3, 1.7, and 1.4 mm from the anterior to the posterior part, respectively. And there was no difference among the anterior, median and posterior part. The lower nasal volume increased 1348.5 mm(3) with the percentage change being 8.1%. The pharyngeal airway showed no positive change.

A novel method of stereotactic drug delivery was explored to make

A novel method of stereotactic drug delivery was explored to make citicoline bypass the blood brain barrier (BBB) and take effect by direct contact with ischemic neurons. A permanent middle cerebral artery occlusion (pMCAO) model of rats was prepared.

To get the optimal conditions for citicoline administration by the novel stereotactic delivery pathway, magnetic resonance imaging Ricolinostat concentration (MRI) tracer method was used, and a dose-dependent effect was given. Examinations of MRI, behavior evaluation, infarct volume assessment and histological staining were performed to evaluate the outcome. This MRI-guided stereotactic delivery of citicoline resulted in a notable reduction (>80%) in infarct size and a delayed ischemic injury in cortex 12 hours after onset of acute ischemia when compared with the systematic delivery. The improved neuroprotective efficiency was realized by a full distribution of citicoline in most of middle cerebral artery (MCA) territory and an adequate drug reaction in the involved areas of the brain. Brain lesions of treated rats by stereotactic delivery of citicoline were well predicted in the lateral ventricle and thalamus due to a limited drug deposition by MRI tracer method. Our study realized an improved neuroprotective efficiency of citicoline by stereotactic delivery, and an optimal therapeutic effect of this administration

pathway can HM781-36B concentration be achieved under MRI guidance.”
“A novel, polymer-based foliated graphite/nickel nanocomposites with high thermal conductivity, mechanical properties, and low dielectric constant was developed. The network structure of polyvinyl chloride (PVC) reinforced foliate graphite and nickel nanoparticles (GN) were tested in terms of X-ray diffraction (XRD), scanning electron microscope (SEM),

energy dispersive x-ray analysis (EDX), and thermal-gravimetric analyses (TGA). Thermogravimetric analysis revealed a large improvement in the thermal stability of PVC/GN nanocomposites. Thermal conductivity and diffusivity of the composites increased with increasing GN content see more and temperature. The obtained experimental thermal conductivity result are compared with the existing theoretical models. The measured values of thermal conductivity were in excellent agreement with those calculated from the Agari model. In addition, specific heat, coefficient of thermal expansion (TEC), micro porosity, and crosslinking density (CLD) of composites were investigated. The mechanical properties such as tensile strength, tensile modulus, hardness, and elongation at break of the nanocomposites were improved with inclusion GN which is proportional to GN content. Finally, the dielectric properties of PVC/GN nanocomposites as a function of frequency have been investigated in details. (C) 2011 Wiley Periodicals, Inc.

Methods Meta-analytic procedures were used to estimate the relat

Methods. Meta-analytic procedures were used to estimate the relative risk MLN4924 concentration (RR) using random effects or fixed effects generic inverse variance model. Publication bias and study heterogeneity were assessed using Egger’s test and I-2 statistic. Results. We found no significant association between the intake of fish/seafood (pooled RR: 1.04; P = 0.63,

95% CI: 0.9 to 1.2, 549, 955 participants) or marine LC n-3 PUFA (pooled RR: 1.08, P = 0.39, 95% CI: 0.90 to 1.30, 346, 710 participants) and T2D risk. Significant study heterogeneity was observed in fish/seafood and marine LC n-3 PUFA studies (P < 0.00001). Subgroup analysis revealed no obvious sources for high heterogeneity. We also found a significant protective effect of oily fish intake on T2D risk (pooled RR = 0.89, P = 0.005, 95% CI: 0.82 to 0.96). Dose-response analysis suggested that every 80 g per day intake of oily fish may reduce 20% risk of T2D. Conclusion. We found no significant effect of fish/seafood or marine LC n-3 PUFA intake on risk of T2D but a significant effect of oily fish intake on risk of T2D.”
“Bimagnetic FePt/Fe(3)O(4) nanoparticles with core/shell or heterodimer structure have been prepared using a sequential synthetic method. The dimension of both FePt and Fe(3)O(4) Selleckchem STI571 was tuned by varying the synthesis parameters. The as-synthesized

bimagnetic nanoparticles were superparamagnetic at room temperature. After being annealed in a reducing atmosphere, the FePt/Fe(3)O(4) bimagnetic

nanoparticles were converted to a hard magnetic nanocomposite with enhanced energy products due to the exchange coupling between the hard and soft magnetic phases. It was found that the exchange coupling in nanocomposites made from the core/shell nanoparticles is stronger than that from the heterodimer nanoparticles. By tuning the dimensions of the FePt and Fe(3)O(4) phases, the energy product up to 17.8 MGOe was achieved in the annealed nanocomposites, which is 36% higher than the isotropic single-phase FePt counterpart. (C) 2009 American Institute of Physics. [DOI: 10.1063/1.3054441]“
“Objective Bucladesine cost To determine factors associated with 24-month change in quality of life in children with asthma and their parents during the Childhood Asthma Management Program (CAMP).

Methods Participants from 4 CAMP clinical centers were administered the Pediatric Asthma Quality of Life questionnaire and protocol measures of asthma symptoms, lung function, and psychological measures.

Results Multivariate logistic regression analyses determined predictors of moderate change in quality of life. Subclinical levels of depression predictedmoderate improvement in child-reported quality of life. Level of depressed affect together with clinical asthma features predicted moderate decline. Improvement in parent quality of life was predicted by perception of illness burden, whereas family features and a child missing school predicted moderate decline.