Consensus definition of advance care planning in dementia: A 33-country Delphi study.

Existing advance care planning (ACP) definitional frameworks apply to individuals with decision-making capacity. We aimed to conceptualize ACP for dementia in terms of its definition and issues that deserve particular attention. Delphi study with phases: (A) adaptation of a generic ACP framework by a task force of the European Association for Palliative Care (EAPC); (B) four online surveys by 107 experts from 33 countries, September 2021 to June 2022; (C) approval by the EAPC board. ACP in dementia was defined as a communication process adapted to the person's capacity, which includes, and is continued with, family if available. We identified pragmatic boundaries regarding participation and time (i.e., current or end-of-life care). Three interrelated issues that deserve particular attention were capacity, family, and engagement and communication. A communication and relationship-centered definitional framework of ACP in dementia evolved through international consensus supporting inclusiveness of persons with dementia and their family. This article offers a consensus definitional framework of advance care planning in dementia. The definition covers all stages of capacity and includes family caregivers. Particularly important are (1) capacity, (2) family, (3) engagement, and communication. Fluctuating capacity was visualized in relation to roles and engaging stakeholders

Vitamin C in plasma is inversely related to blood pressure and change in blood pressure during the previous year in young Black and White women

BackgroundThe prevalence of hypertension and its contribution to cardiovascular disease risk makes it imperative to identify factors that may help prevent this disorder. Extensive biological and biochemical data suggest that plasma ascorbic acid may be such a factor. In this study we examined the association between plasma ascorbic acid concentration and blood pressure (BP) in young-adult women.MethodsParticipants were 242 Black and White women aged 18-21 yr from the Richmond, CA, cohort of the National Heart, Lung and Blood Institute Growth and Health Study. We examined the associations of plasma ascorbic acid with BP at follow-up year 10, and with change in BP during the previous year.ResultsIn cross-sectional analysis, plasma ascorbic acid at year 10 was inversely associated with systolic BP and diastolic BP after adjusting for race, body mass index, education, and dietary intake of fat and sodium. Persons in the highest one-fourth of the plasma ascorbic acid distribution had 4.66 mmHg lower systolic BP (95% CI 1.10 to 8.22 mmHg, p = 0.005) and 6.04 mmHg lower diastolic BP (95% CI 2.70 to 9.38 mmHg, p = 0.0002) than those in the lowest one-fourth of the distribution. In analysis of the change in BP, plasma ascorbic acid was also inversely associated with change in systolic BP and diastolic BP during the previous year. While diastolic blood pressure among persons in the lowest quartile of plasma ascorbic acid increased by 5.97 mmHg (95% CI 3.82 to 8.13 mmHg) from year 9 to year 10, those in the highest quartile of plasma vitamin C increased by only 0.23 mmHg (95% CI -1.90 to +2.36 mmHg) (test for linear trend: p < 0.0001). A similar effect was seen for change in systolic BP, p = 0.005.ConclusionPlasma ascorbic acid was found to be inversely associated with BP and change in BP during the prior year. The findings suggest the possibility that vitamin C may influence BP in healthy young adults. Since lower BP in young adulthood may lead to lower BP and decreased incidence of age-associated vascular events in older adults, further investigation of treatment effects of vitamin C on BP regulation in young adults is warranted

Food Groups Associated with a Composite Measure of Probability of Adequate Intake of 11 Micronutrients in the Diets of Women in Urban Mali

The prevalence of micronutrient deficiency is high among women of reproductive age living in urban Mali. Despite this, there are little data on the dietary intake of micronutrients among women of reproductive age in Mali. This research tested the relationship between the quantity of intake of 21 possible food groups and estimated usual micronutrient (folate, vitamin B-12, calcium, riboflavin, niacin, vitamin A, iron, thiamin, vitamin B-6, vitamin C, and zinc) intakes and a composite measure of adequacy of 11 micronutrients [mean probability of adequacy (MPA)] based on the individual probability of adequacy (PA) for the 11 micronutrients. Food group and micronutrient intakes were calculated from 24-h recall data in an urban sample of Malian women. PA was lowest for folate, vitamin B-12, calcium, and riboflavin. The overall MPA for the composite measure of 11 micronutrients was 0.47 +/- 0.18. Grams of intake from the nuts/seeds, milk/yogurt, vitamin A-rich dark green leafy vegetables (DGLV), and vitamin C-rich vegetables food groups were correlated (Spearman's rho = 0.20-0.36; P 0.5, respectively. These findings can be used to further the development of indicators of dietary diversity and to improve micronutrient intakes of women of reproductive age. J. Nutr. 140: 2070S-2078S, 2010

The need for fresh blood: understanding organizational age inequality through a vampiric lens

YesThis article argues that older age inequality within and across working life is the result of vampiric forms and structures constitutive of contemporary organizing. Rather than assuming ageism occurs against a backdrop of neutral organizational processes and practices, the article denaturalizes (and in the process super-naturalizes) organizational orientations of ageing through three vampiric aspects: (un)dying, regeneration and neophilia. These dimensions are used to illustrate how workplace narratives and logics normalize and perpetuate the systematic denigration of the ageing organizational subject. Through our analysis it is argued that older workers are positioned as inevitable ‘sacrificial objects’ of the all-consuming immortal organization. To challenge this, the article explicitly draws on the vampire and the vampiric in literature and popular culture to consider the possibility of subverting existing notions of the ‘older worker’ in order to confront and challenge the subtle and persistent monstrous discourses that shape organizational life

Evolution of the knowledge economy: a historical perspective with an application to the case of Europe

The goal of the article is to explore the evolution of original concept of knowledge economy based on science intensive production sectors toward service type economies which significantly changed the role of scientific research and technological innovation for economic growth. The paper argues that this transition is due not only to the structural changes in global production, but the theoretical evolution and aradigmatic shift of the concept of “knowledge economy” in general and “knowledge” in particular has played a significant role. The paper examines the different interpretation of knowledge within new types of intangible economies (e.g., new/Internet, weightless, service, creative, cultural economies) where knowledge is perceived to be generated not as a product of scientific research but as a service or creative activity and critically examined the role of scientific research in a service led knowledge economy. Additionally the paper argue how these phenomena, which marked the global economy in the last decades, enable the transition of the standard concept of knowledge economy originated from industrial production and manufacturing to a knowledge economy equalized with various types of expanding intangible economies, primarily those based on service and creative industries

The metabolic syndrome and neuropathy: Therapeutic challenges and opportunities

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110888/1/ana23986.pd

Can pulsed ultrasound increase tissue damage during ischemia? A study of the effects of ultrasound on infarcted and non-infarcted myocardium in anesthetized pigs

BACKGROUND: The same mechanisms by which ultrasound enhances thrombolysis are described in connection with non-beneficial effects of ultrasound. The present safety study was therefore designed to explore effects of beneficial ultrasound characteristics on the infarcted and non-infarcted myocardium. METHODS: In an open chest porcine model (n = 17), myocardial infarction was induced by ligating a coronary diagonal branch. Pulsed ultrasound of frequency 1 MHz and intensity 0.1 W/cm(2 )(I(SATA)) was applied during one hour to both infarcted and non-infarcted myocardial tissue. These ultrasound characteristics are similar to those used in studies of ultrasound enhanced thrombolysis. Using blinded assessment technique, myocardial damage was rated according to histopathological criteria. RESULTS: Infarcted myocardium exhibited a significant increase in damage score compared to non-infarcted myocardium: 6.2 ± 2.0 vs. 4.3 ± 1.5 (mean ± standard deviation), (p = 0.004). In the infarcted myocardium, ultrasound exposure yielded a further significant increase of damage scores: 8.1 ± 1.7 vs. 6.2 ± 2.0 (p = 0.027). CONCLUSION: Our results suggest an instantaneous additive effect on the ischemic damage in myocardial tissue when exposed to ultrasound of stated characteristics. The ultimate damage degree remains to be clarified

Substance use and dietary practices among students attending alternative high schools: results from a pilot study

<p>Abstract</p> <p>Background</p> <p>Substance use and poor dietary practices are prevalent among adolescents. The purpose of this study was to examine frequency of substance use and associations between cigarette, alcohol and marijuana use and selected dietary practices, such as sugar-sweetened beverages, high-fat foods, fruits and vegetables, and frequency of fast food restaurant use among alternative high school students. Associations between multi-substance use and the same dietary practices were also examined.</p> <p>Methods</p> <p>A convenience sample of adolescents (n = 145; 61% minority, 52% male) attending six alternative high schools in the St Paul/Minneapolis metropolitan area completed baseline surveys. Students were participants in the Team COOL (Controlling Overweight and Obesity for Life) pilot study, a group randomized obesity prevention pilot trial. Mixed model multivariate analyses procedures were used to assess associations of interest.</p> <p>Results</p> <p>Daily cigarette smoking was reported by 36% of students. Cigarette smoking was positively associated with consumption of regular soda (p = 0.019), high-fat foods (p = 0.037), and fast food restaurant use (p = 0.002). Alcohol (p = 0.005) and marijuana use (p = 0.035) were positively associated with high-fat food intake. With increasing numbers of substances, a positive trend was observed in high-fat food intake (p = 0.0003). There were no significant associations between substance use and fruit and vegetable intake.</p> <p>Conclusions</p> <p>Alternative high school students who use individual substances as well as multiple substances may be at high risk of unhealthful dietary practices. Comprehensive health interventions in alternative high schools have the potential of reducing health-compromising behaviors that are prevalent among this group of students. This study adds to the limited research examining substance use and diet among at-risk youth.</p> <p>Trial registration number</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01315743">NCT01315743</a></p

The Real maccoyii: Identifying Tuna Sushi with DNA Barcodes – Contrasting Characteristic Attributes and Genetic Distances

BACKGROUND:The use of DNA barcodes for the identification of described species is one of the least controversial and most promising applications of barcoding. There is no consensus, however, as to what constitutes an appropriate identification standard and most barcoding efforts simply attempt to pair a query sequence with reference sequences and deem identification successful if it falls within the bounds of some pre-established cutoffs using genetic distance. Since the Renaissance, however, most biological classification schemes have relied on the use of diagnostic characters to identify and place species. METHODOLOGY/PRINCIPAL FINDINGS:Here we developed a cytochrome c oxidase subunit I character-based key for the identification of all tuna species of the genus Thunnus, and compared its performance with distance-based measures for identification of 68 samples of tuna sushi purchased from 31 restaurants in Manhattan (New York City) and Denver, Colorado. Both the character-based key and GenBank BLAST successfully identified 100% of the tuna samples, while the Barcode of Life Database (BOLD) as well as genetic distance thresholds, and neighbor-joining phylogenetic tree building performed poorly in terms of species identification. A piece of tuna sushi has the potential to be an endangered species, a fraud, or a health hazard. All three of these cases were uncovered in this study. Nineteen restaurant establishments were unable to clarify or misrepresented what species they sold. Five out of nine samples sold as a variant of "white tuna" were not albacore (T. alalunga), but escolar (Lepidocybium flavorunneum), a gempylid species banned for sale in Italy and Japan due to health concerns. Nineteen samples were northern bluefin tuna (T. thynnus) or the critically endangered southern bluefin tuna (T. maccoyii), though nine restaurants that sold these species did not state these species on their menus. CONCLUSIONS/SIGNIFICANCE:The Convention on International Trade Endangered Species (CITES) requires that listed species must be identifiable in trade. This research fulfills this requirement for tuna, and supports the nomination of northern bluefin tuna for CITES listing in 2010