What makes stroke rehabilitation patients complex? Clinician perspectives and the role of discharge pressure

Background: Approximately 80% of people who survive a stroke have on average five other conditions and a wide range of psychosocial issues. Attention to biopsychosocial issues has led to the identification of ‘complex patients’. No single definition of ‘patient complexity’ exists, therefore applied health researchers seek to understand ‘patient complexity’ as it relates to a specific clinical context. Objective: To understand how ‘patient complexity’ is conceptualized by clinicians, and to position the findings within the existing literature on patient complexity. Methods: A qualitative descriptive approach was utilized. Twenty-three rehabilitation clinicians participated in four focus groups. Results: Five elements of patient complexity were identified: medical/functional issues, social determinant factors, social/family support, personal characteristics, and health system factors. Using biopsychosocial factors to identify complexity results in all patients being complex; operationalization of the definition led to the identification of systemic elements. A disconnect between acute, inpatient rehabilitation and community services was identified as a trigger for increased complexity.Conclusions: Patient complexity is not a dichotomous state. If applying existing complexity definitions, all patients are complex. This study extends the understanding by suggesting a structural element of complexity from manageable to less manageable complexity based on ability to discharge. Journal of Comorbidity 2016;6(2):35–4

Palaeoenvironment of Eocene prodelta in Spitsbergen recorded by the trace fossil Phycosiphon incertum

Ichnological, sedimentological and geochemical analyses were conducted on the Eocene Frysjaodden Formation in order to interpret palaeoenvironment prodelta sediments in the Central Basin of Spitsbergen. Phycosiphon incertum is the exclusive ichnotaxon showing differences in size, distribution, abundance and density, and relation to laminated/bioturbated intervals. Large P. incertum mainly occur dispersed, isolated and randomly distributed throughout the weakly laminated/non-laminated intervals. Small P. incertum occur occasionally in patches of several burrows within laminated intervals or as densely packed burrows in thin horizons in laminated intervals or constituting fully bioturbated intervals that are several centimetres thick. Ichnological changes are mainly controlled by oxygenation, although the availability of benthic food cannot be discarded. Changes in oxygenation and rate of sedimentation can be correlated with the registered variations in the Bouma sequence of the distal turbiditic beds within prodeltal shelf sediments.Funding for this research was provided by Project CGL2012-33281 (Secretaría de Estado de Investigación, Desarrollo e Innovación, Spain), Project RYC-2009-04316 (Ramón y Cajal Programme) and Projects RNM-3715 and RNM-7408 and Research Group RNM-178 (Junta de Andalucía). The authors benefited from a bilateral agreement between the universities of Granada and Oslo, supported by the University of Granada

Crop losses in Brazilian cassava varieties induced by the Cassava common mosaic virus

ABSTRACT Despite the widespread distribution of the Cassava common mosaic virus (CsCMV) in Brazil, little is known about the losses it causes in yield. The effect of CsCMV on different varieties was evaluated by reference to several agronomic traits. Four field trials were established in 2012/2013 and 2013/2014 using six varieties of cassava. Following mechanical inoculation with CsCMV, the presence of the virus was confirmed using the ELISA assay. The evaluated traits were plant height (PH), dry matter content (DMC), harvest index (HI), aerial part yield (APY), root yield (RoY), and starch yield (StY) in both inoculated and non-inoculated plants. Overall, the presence of the virus contributed little to the reduction in PH, HI, and DMC across the varieties, with PH being significantly reduced by 9.2 and 7.0 % in the BGM0212 and BRS Kiriris varieties, respectively. In contrast, APY, RoY, and StY were reduced by 30.2, 29.3, and 30.0 %, in the virus-infected plants respectively. While the BRS Kiriris and BRS Jari varieties suffered the highest reductions overall and were considered highly susceptible to CsCMV, none of the traits suffered reductions in the inoculated BRS Formosa plants. Although RoY and StY were reduced in inoculated plants of BRS Tapioqueira, crop yield for this variety was the highest. Thus, BRS Formosa and BRS Tapioqueira exhibited tolerance against CsCMV, which warrants further investigation

Charged-particle nuclear modification factors in PbPb and pPb collisions at √=sNN=5.02 TeV

The spectra of charged particles produced within the pseudorapidity window |η| < 1 at √ sNN = 5.02 TeV are measured using 404 µb −1 of PbPb and 27.4 pb−1 of pp data collected by the CMS detector at the LHC in 2015. The spectra are presented over the transverse momentum ranges spanning 0.5 < pT < 400 GeV in pp and 0.7 < pT < 400 GeV in PbPb collisions. The corresponding nuclear modification factor, RAA, is measured in bins of collision centrality. The RAA in the 5% most central collisions shows a maximal suppression by a factor of 7–8 in the pT region of 6–9 GeV. This dip is followed by an increase, which continues up to the highest pT measured, and approaches unity in the vicinity of pT = 200 GeV. The RAA is compared to theoretical predictions and earlier experimental results at lower collision energies. The newly measured pp spectrum is combined with the pPb spectrum previously published by the CMS collaboration to construct the pPb nuclear modification factor, RpA, up to 120 GeV. For pT > 20 GeV, RpA exhibits weak momentum dependence and shows a moderate enhancement above unity

Physiological effects of a short period of adaptation to the farrowing environment in gilts

Moving gilts from a strawed pen to a crate during farrowing profoundly inhibits oxytocin, probably as a result of a stress-induced opioid-inhibition of hypothalamic oxytocin release (Lawrence et al., 1992). Other work suggests that confinement of gilts in crates for 5 days prior to farrowing protects the gilt against stressinduced inhibition of oxytocin. As producers introduce gilts and sows into farrowing crates at variable times prior to farrowing it is important to identify the minimal period of exposure to crates required to confer adaptation. This work tested whether only a short period of adaptation (1 day) to farrowing crates prior to expected farrowing date (EFD) would be sufficient to prevent stress-induced inhibition of oxytocin.</jats:p

Physiological effects of a short period of adaptation to the farrowing environment in gilts

Moving gilts from a strawed pen to a crate during farrowing profoundly inhibits oxytocin, probably as a result of a stress-induced opioid-inhibition of hypothalamic oxytocin release (Lawrence et al., 1992). Other work suggests that confinement of gilts in crates for 5 days prior to farrowing protects the gilt against stressinduced inhibition of oxytocin. As producers introduce gilts and sows into farrowing crates at variable times prior to farrowing it is important to identify the minimal period of exposure to crates required to confer adaptation. This work tested whether only a short period of adaptation (1 day) to farrowing crates prior to expected farrowing date (EFD) would be sufficient to prevent stress-induced inhibition of oxytocin.</jats:p

Patient-focused intervention to improve long-term adherence to evidence-based medications: a randomized trial

Item does not contain fulltextBACKGROUND: Nonadherence to cardiovascular medications is a significant public health problem. This randomized study evaluated the effect on medication adherence of linking hospital and community pharmacists. METHODS: Hospitalized patients with coronary artery disease discharged on aspirin, beta-blocker, and statin who used a participating pharmacy were randomized to usual care or intervention. The usual care group received discharge counseling and a letter to the community physician; the intervention group received enhanced in-hospital counseling, attention to adherence barriers, communication of discharge medications to community pharmacists and physicians, and ongoing assessment of adherence by community pharmacists. The primary end point was self-reported use of aspirin, beta-blocker, and statin at 6 months postdischarge; the secondary end point was a >/= 75% proportion of days covered (PDC) for beta-blocker and statin through 6 months postdischarge. RESULTS: Of 143 enrolled patients, 108 (76%) completed 6-month follow-up, and 115 (80%) had 6-month refill records. There was no difference between intervention and control groups in self-reported adherence (91% vs 94%, respectively, P = .50). Using the PDC to determine adherence to beta-blockers and statins, there was better adherence in the intervention versus control arm, but the difference was not statistically significant (53% vs 38%, respectively, P = .11). Adherence to beta-blockers was statistically significantly better in intervention versus control (71% vs 49%, respectively, P = .03). Of 85 patients who self-reported adherence and had refill records, only 42 (49%) were also adherent by PDC. CONCLUSIONS: The trend toward better adherence by refill records with the intervention should encourage further investigation of engaging pharmacists to improve continuity of care