Managing \u27shades of grey\u27: a focus group study exploring community-dwellers’ views on advance care planning in older people

Background: Community-dwelling consumers of healthcare are increasing, many aging with life-limiting conditions and deteriorating cognition. However, few have had advance care planning discussions or completed documentation to ensure future care preferences are acted upon. This study examines the awareness, attitudes, and experiences of advance care planning amongst older people and unrelated offspring/caregivers of older people residing in the community. Methods: Qualitative descriptive research, which included focus groups with older people (55+ years) and older people’s offspring/caregivers living in an Australian city and surrounding rural region. Data was analysed using an inductive and comparative approach. Sampling was both convenience and purposive. Participants responded to web-based, newsletter or email invitations from an agency, which aims to support healthcare consumers, a dementia support group, or community health centres in areas with high proportions of culturally and linguistically diverse community-dwellers. Results: Eight focus groups were attended by a homogenous sample of 15 older people and 27 offspring/ caregivers, with 43% born overseas. The overarching theme, ‘shades of grey’: struggles in transition, reflects challenges faced by older people and their offspring/caregivers as older people often erratically transition from independence and capacity to dependence and/or incapacity. Offspring/caregivers regularly struggled with older people’s fluctuating autonomy and dependency as older people endeavoured to remain at home, and with conceptualising “best times” to actualise advance care planning with substitute decision maker involvement. Advance care planning was supported and welcomed, x advance care planning literacy was evident. Difficulties planning for hypothetical health events and socio-cultural attitudes thwarting death-related discussions were emphasised. Occasional offspring/caregivers with previous substitute decision maker experience reported distress related to their decisions. Conclusions: Advance care planning programs traditionally assume participants are ‘planning ready’ to legally appoint a substitute decision maker (power of attorney) and record end-of-life treatment preferences in short time frames. This contrasts with how community dwelling older people and offspring/caregivers conceive future care decisions over time. Advance care planning programs need to include provision of information, which supports older people’s advance care planning understanding and management, and also supports offspring/caregivers’ development of strategies for broaching advance care planning with older people, and preparing for potential substitute decision maker roles. Development and integration of strategies to support older people’s decision making when in the ‘grey zone’, with fluctuating cognitive capacities, needs further consideration. Findings support an advance care planning model with conversations occurring at key points across a person’s lifespan

Prevalence of BoHV-1 seropositive and BVD virus positive bulls on Irish dairy farms and associations between bull purchase and herd status

peer-reviewedBackground BVD and IBR are contagious viral diseases highly prevalent in Irish cattle. Despite their significant reproductive and economic impact very little is known about the BVD and IBR status of stock bulls (a bull used for breeding purposes). There are still a high proportion of dairy farms in Ireland that rely on the use of a bull for breeding cattle and ensuring the fertility of the bulls is of paramount importance for the efficiency of the farms. The prevalence of BoHV-1 and BVD in stock bulls in Irish dairy herds has never been investigated. The objectives of this study therefore were: (i) to provide descriptive, observational data on the use of stock bulls on Irish dairy farms; (ii) to investigate the BVD and BoHV1 status of a sub-set of stock bulls; (iii) to investigate factors associated with BVD and BoHV1 status of stock bulls and (iv) to investigate factors associated with dairy herd status for BVD and BoHV1, including any associations with the use of stock bull. A total of 529 blood samples from bulls involved in the dairy breeding process were analysed for BVD virus using RT-PCR, and BoHV-1 antibodies by ELISA test. A total of 305 different dairy herds took part in the study and the overall BVD and BoHV-1 herd status was determined by ELISA using four bulk tank milk samples over the 2009 lactation. Logistic regression was used to investigate the associations between the stock bulls and BVD and BoHV-1 herd and individual status. Results Of the 305 total participating farms, 235 farms (77 %) had at least one bull and 167 farms had purchased bulls. Two bulls (0.4 %) out of 529 tested were found positive for BVD virus and 87 (16.7 %) tested seropositive for BoHV-1. Some significant associations were identified between the purchase of bulls and both viral diseases. Purchased bulls were three times more likely to be seropositive for BoHV-1 than homebred bulls. In the same way, herds with purchased bulls were three times more likely to be classified as seropositive for BVD and four times more likely to have evidence of recent BoHV-1 circulation than farms where all the bulls were homebred. Conclusions The prevalence of BoHV-1 and BVD in stock bulls in Irish dairy herds has never been investigated. This study highlights the widespread use of stock bulls in Irish dairy herds, as well as the high rate of exchange of bulls between farms. Significant associations were found between the origin of the bull and their serological BoHV-1 status. In keeping with these results, bulls with higher number movements between farms were more likely to be seropositive for BoHV-1

HTR4 gene structure and altered expression in the developing lung

Background: Meta-analyses of genome-wide association studies (GWAS) have identified single nucleotide polymorphisms (SNPs) spanning the 5-hydroxytryptamine receptor 4 (5-HT4R) gene (HTR4) associated with lung function. The aims of this study were to i) investigate the expression profile of HTR4 in adult and fetal lung tissue and cultured airway cells, ii) further define HTR4 gene structure and iii) explore the potential functional implications of key SNPs using a bioinformatic approach

Social Support Predicts Self-Care Confidence in Patients with Heart Failure

Background: Self-care for patients with heart failure includes engaging in behaviours that maintain medical stability and manage problematic symptoms, as well as the confidence in one’s ability to carry out such behaviours. Given the social context of self-care behaviours in heart failure, there has been increasing interest in social support as a predictor of self-care. Aim: The goal of the present study was to examine the role of social support in self-care across time for persons with heart failure. Methods: Using data from an observational study of patients with chronic heart failure (n = 280), we examined the role of three types of support – instrumental support, emotional support and assistance with self-care – in the longitudinal course of self-care maintenance, management and confidence. Self-report questionnaire data were collected at baseline and at three and six months later. Results: We found that instrumental and emotional support predicted better self-care confidence on average and that self-care confidence improved at a faster rate for those with less instrumental support. Emotional support was positively associated with self-care management and self-care confidence, and assistance with self-care was positively associated with self-care maintenance. Conclusion: These findings highlight the contribution of social support to self-care in heart failure and provide guidance for future family-based interventions to improve self-care

Students Creating Change

The article presents Bishop Grosseteste University’s (BGU) experience of introducing and embedding an innovative whole-University student engagement initiative into a small, traditional, University. The article describes the development of an institutional wide ‘students creating change’ scheme where staff and students were coached and supported to research and create change to the learning opportunities and experiences for students. The scheme also includes the development of a ‘students creating change’ framework, designed to identify and embed institutional enhancement in student representation, ensure that the Learning, Teaching, and Assessment Strategy is meeting the needs of students, and embed student engagement as a key part of the student experience. The article highlights the challenges, benefits, lessons learned and approaches to gaining the support and participation of the Students’ Union, student body, senior University leaders and academic and professional services staff in the process

Emerging Roles for Neuropilin-2 in Cardiovascular Disease

Cardiovascular disease, the leading cause of death worldwide, is predominantly associated with atherosclerosis. Atherosclerosis is a chronic inflammatory disease characterised by the narrowing of large to medium-sized arteries due to a build-up of plaque. Atherosclerotic plaque is comprised of lipids, extracellular matrix, and several cell types, including endothelial, immune, and vascular smooth muscle cells. Such narrowing of the blood vessels can itself restrict blood flow to vital organs but most severe clinical complications, including heart attacks and strokes, occur when lesions rupture, triggering the blood to clot and obstructing blood flow further down the vascular tree. To circumvent such obstructions, percutaneous coronary intervention or bypass grafts are often required; however, re-occlusion of the treated artery frequently occurs. Neuropilins (NRPs), a multifunctional family of cell surface co-receptors, are expressed by endothelial, immune, and vascular smooth muscle cells and are regulators of numerous signalling pathways within the vasculature. Here, we review recent studies implicating NRP2 in the development of occlusive vascular diseases and discuss how NRP2 could be targeted for therapeutic intervention

An overview of the planned CCAT software system

CCAT will be a 25m diameter sub-millimeter telescope capable of operating in the 0.2 to 2.1mm wavelength range. It will be located at an altitude of 5600m on Cerro Chajnantor in northern Chile near the ALMA site. The anticipated first generation instruments include large format (60,000 pixel) kinetic inductance detector (KID) cameras, a large format heterodyne array and a direct detection multi-object spectrometer. The paper describes the architecture of the CCAT software and the development strategy.Comment: 17 pages, 6 figures, to appear in Software and Cyberinfrastructure for Astronomy III, Chiozzi & Radziwill (eds), Proc. SPIE 9152, paper ID 9152-10

JOINT MOMENTS DURING INSTEP KICKS IN FOOTBALL PLAYERS WITH AND WITHOUT PREVIOUS GROIN PAIN

This study examined how previous groin pain and approach angle affects stance leg and lumbar moments during instep kicks. Male football players with and without previous groin pain (n=11, and n=10) performed instep kicks from 45° and 60° angles while kinetic and kinematic data were recorded (1000Hz and 500Hz respectively). 3D stance leg net joint moments of the hip, knee, and ankle were calculated at peak swing knee flexion and ball contact and the sagittal L5/S1 joint moment was examined throughout the kick. Foot speed at ball contact indicated performance. Players with previous groin pain had lower moments during the kick compared to uninjured controls, but there was no difference in performance. This suggests that the players with previous groin pain utilized an aberrant kicking pattern that offloads certain joints but may cause compensations elsewhere in the kinetic chain

Insect Management in Seed Corn Production

Corn grown for seed is often affected by the same pests as are found in corn grown for grain. However, integrated pest management (IPM) decisions can be considerably different from those in grain production. This is because inbreds are typically less tolerant than hybrids to stress from pests and the value of the seed is considerably greater than corn for grain. European corn borer and corn earworm are probably the two most significant economic insect pests in seed corn production fields. Following is a summary of the highlights of research conducted at Pioneer Hi-Bred International and experience from seed production fields regarding key components of IPM decision making for these insects