Diaper-zero program in nursing home

With an aging population, the number of older adults admitted to nursing homes has increased. Diapers are often used to manage nursing home resident urinary incontinence, yet only one-third of these required assistance from caregivers to urinate. Unnecessary diaper use was reported in 23.9% of people, mostly for precautionary purposes. In this study, the Diaper-zero program caregivers asked residents regularly (every 2-3 h) whether they required voiding and prompted them to void. Over 11 months, the effects on 38 nursing home residents’ diaper use, nursing care level, physical activity, daily energy, and water intake were measured. A higher rate of diaper wearing was initially observed with lower daily energy and water intakes at the beginning of the Diaper-zero program, but this association was not observed after 11 months of the program. The diaper usage rate decreased significantly from 71.1% to 47.4% after 11 months. During this period, for all subjects, nursing care level, physical activity, and total daily intakes of energy and water were unchanged. In conclusion, this program enhances the desire to void, minimizing diaper usage, thus protecting the human dignity of nursing home residents

Nepmucin, a novel HEV sialomucin, mediates L-selectin–dependent lymphocyte rolling and promotes lymphocyte adhesion under flow

Lymphocyte trafficking to lymph nodes (LNs) is initiated by the interaction between lymphocyte L-selectin and certain sialomucins, collectively termed peripheral node addressin (PNAd), carrying specific carbohydrates expressed by LN high endothelial venules (HEVs). Here, we identified a novel HEV-associated sialomucin, nepmucin (mucin not expressed in Peyer's patches [PPs]), that is expressed in LN HEVs but not detectable in PP HEVs at the protein level. Unlike conventional sialomucins, nepmucin contains a single V-type immunoglobulin (Ig) domain and a mucin-like domain. Using materials affinity-purified from LN lysates with soluble L-selectin, we found that two higher molecular weight species of nepmucin (75 and 95 kD) were decorated with oligosaccharides that bind L-selectin as well as an HEV-specific MECA-79 monoclonal antibody. Electron microscopic analysis showed that nepmucin accumulates in the extended luminal microvillus processes of LN HEVs. Upon appropriate glycosylation, nepmucin supported lymphocyte rolling via its mucin-like domain under physiological flow conditions. Furthermore, unlike most other sialomucins, nepmucin bound lymphocytes via its Ig domain, apparently independently of lymphocyte function–associated antigen 1 and very late antigen 4, and promoted shear-resistant lymphocyte binding in combination with intercellular adhesion molecule 1. Collectively, these results suggest that nepmucin may serve as a dual-functioning PNAd in LN HEVs, mediating both lymphocyte rolling and binding via different functional domains