3,095 research outputs found
A collaborative approach in dementia care to improve clinical effectiveness and priorities for research through audit
Cytotoxic clinical isolates of Pseudomonas aeruginosa identified during the Steroids for Corneal Ulcers Trial show elevated resistance to fluoroquinolones.
BackgroundTo determine the relationship between type three secretion genotype and fluoroquinolone resistance for P. aeruginosa strains isolated from microbial keratitis during the Steroids for Corneal Ulcers Trial (SCUT) and for two laboratory strains, PA103 and PAO1.MethodsConfirmed P. aeruginosa isolates from the SCUT were divided into exoU(+) or exoU(-). The exoU(+) strains contained the gene encoding ExoU, a powerful phospholipase toxin delivered into host cells by the type three secretion system. Isolates were then assessed for susceptibility to fluoroquinolone, cephalosporin, and aminoglycoside antibiotics using disk diffusion assays. Etest was used to determine the MIC of moxifloxacin and other fluoroquinolones. Laboratory isolates in which the exoU gene was added or deleted were also tested.ResultsA significantly higher proportion of exoU(+) strains were resistant to ciprofloxacin (p = 0.001), gatifloxacin (p = 0.003), and ofloxacin (p = 0.002) compared to exoU(-) isolates. There was no significant difference between exoU(+) or exoU(-) negative isolates with respect to susceptibility to other antibiotics except gentamicin. Infections involving resistant exoU(+) strains trended towards worse clinical outcome. Deletion or acquisition of exoU in laboratory isolates did not affect fluoroquinolone susceptibility.ConclusionsFluoroquinolone susceptibility of P. aeruginosa isolated from the SCUT is consistent with previous studies showing elevated resistance involving exoU encoding (cytotoxic) strains, and suggest worse clinical outcome from infections involving resistant isolates. Determination of exoU expression in clinical isolates of P. aeruginosa may be helpful in directing clinical management of patients with microbial keratitis
40,000 memories in young teenagers: Psychometric properties of the Autobiographical Memory Test in a UK cohort study
Although the Autobiographical Memory Test (AMT) is widely used its psychometric properties have rarely been investigated. This paper utilises data gathered from a 10-item written version of the AMT, completed by 5792 adolescents participating in the Avon Longitudinal Study of Parents and Children, to examine the psychometric properties of the measure. The results show that the scale derived from responses to the AMT operates well over a wide range of scores, consistent with the aim of deriving a continuous measure of over-general memory. There was strong evidence of group differences in terms of gender, low negative mood, and IQ, and these were in agreement when comparing an item response theory (IRT) approach with that based on a sum score. One advantage of the IRT model is the ability to assess and consequently allow for differential item functioning. This additional analysis showed evidence of response bias for both gender and mood, resulting in attenuation in the mean differences in AMT across these groups. Implications of the findings for the use of the AMT measure in different samples are discussed
The conceptual models and mechanisms of action that underpin advance care planning for cancer patients: A systematic review of randomised controlled trials
Background: No systematic review has focused on conceptual models underpinning advance care planning for patients with advancedcancer, and the mechanisms of action in relation to the intended outcomes.Aim: To appraise conceptual models and develop a logic model of advance care planning for advanced cancer patients, examining thecomponents, processes, theoretical underpinning, mechanisms of action and linkage with intended outcomes.Design: A systematic review of randomised controlled trials was conducted, and was prospectively registered on PROSPERO. Narrativesynthesis was used for data analysis.Data sources: The data sources were MEDLINE, CINAHL, PsycINFO, EMBASE, CENTRAL, PROSPERO, CareSearch, and OpenGreywith reference chaining and hand-searching from inception to 31 March 2017, including all randomised controlled trials withadvance care planning for cancer patients in the last 12 months of life. Cochrane quality assessment tool was used for qualityappraisal.Results: Nine randomised controlled trials were included, with only four articulated conceptual models. Mechanisms through whichadvance care planning improved outcomes comprised (1) increasing patientsā knowledge of end-of-life care, (2) strengtheningpatientsā autonomous motivation, (3) building patientsā competence to undertake end-of-life discussions and (4) enhancing shareddecision-making in a trustful relationship. Samples were largely highly educated Caucasian.Conclusion: The use of conceptual models underpinning the development of advance care planning is uncommon. When used, theyidentify the individual behavioural change. Strengthening patientsā motivation and competence in participating advance care planningdiscussions are key mechanisms of change. Understanding cultural feasibility of the logic model for different educational levels andethnicities in non-Western countries should be a research priority
Agronomic Traits in Oilseed Rape (Brassica napus) Can Predict Foraging Resources for Insect Pollinators
Mass-flowering crops, such as oilseed rape (OSR; Brassica napus), provide pulses of nectar and pollen, helping to support pollinators and their pollination services in agricultural landscapes. Despite their value to declining pollinators, varietal in-field OSR testing focusses on agronomic traits, with floral resources being largely overlooked. OSR has a high varietal turnover, and consequently, floral resource data collected for a specific variety quickly become redundant. Here, we explore the potential to predict floral resource availability using agronomic trait data routinely collected in varietal trials. To build predictive models, we investigated the relationships between agronomic traits and pollen and nectar availability in 19 OSR varieties. Nectar quality was positively influenced by early vigour, as well as winter hardiness in conventional varieties and stem stiffness in hybrid varieties. Pollen quantity was driven by different traits, with early maturation having a negative impact in conventional varieties and resistance to lodging having a positive impact in hybrid varieties. Our study highlights the potential to predict floral resources using agronomic trait data, enabling the rapid assessment of these key resources in future OSR varieties without costly sampling. Agronomic traits relating to increased nectar quality were also agronomically favourable, indicating benefits to both pollinators and growers. The inclusion of modelled floral resource data in recommended varietal lists would enable growers to make informed decisions about varietal selection based on local pollinator populations
Anxious/depressed symptoms are related to microstructural maturation of white matter in typically developing youths
AbstractThere are multiple recent reports of an association between anxious/depressed (A/D) symptomatology and the rate of cerebral cortical thickness maturation in typically developing youths. We investigated the degree to which anxious/depressed symptoms are tied to age-related microstructural changes in cerebral fiber pathways. The participants were part of the NIH MRI Study of Normal Brain Development. Child Behavior Checklist A/D scores and diffusion imaging were available for 175 youths (84 males, 91 females; 241 magnetic resonance imagings) at up to three visits. The participants ranged from 5.7 to 18.4 years of age at the time of the scan. Alignment of fractional anisotropy data was implemented using FSL/Tract-Based Spatial Statistics, and linear mixed model regression was carried out using SPSS. Child Behavior Checklist A/D was associated with the rate of microstructural development in several white matter pathways, including the bilateral anterior thalamic radiation, bilateral inferior longitudinal fasciculus, left superior longitudinal fasciculus, and right cingulum. Across these pathways, greater age-related fractional anisotropy increases were observed at lower levels of A/D. The results suggest that subclinical A/D symptoms are associated with the rate of microstructural development within several white matter pathways that have been implicated in affect regulation, as well as mood and anxiety psychopathology.</jats:p
What is the impact of population ageing on the future provision of end-of-life care? Population-based projections of place of death.
BACKGROUND: Population ageing represents a global challenge for future end-of-life care. Given new trends in place of death, it is vital to examine where the rising number of deaths will occur in future years and implications for health and social care. AIM: To project where people will die from 2015 to 2040 across all care settings in England and Wales. DESIGN: Population-based trend analysis and projections using simple linear modelling. Age- and gender-specific proportions of deaths in hospital, care home, home, hospice and 'other' were applied to numbers of expected future deaths. Setting/population: All deaths (2004-2014) from death registration data and predicted deaths (2015-2040) from official population forecasts in England and Wales. RESULTS: Annual deaths are projected to increase from 501,424 in 2014 (38.8% aged 85āyears and over) to 635,814 in 2040 (53.6% aged 85āyears and over). Between 2004 and 2014, proportions of home and care home deaths increased (18.3%-22.9% and 16.7%- 21.2%) while hospital deaths declined (57.9%-48.1%). If current trends continue, numbers of deaths in care homes and homes will increase by 108.1% and 88.6%, with care home the most common place of death by 2040. If care home capacity does not expand and additional deaths occur in hospital, hospital deaths will start rising by 2023. CONCLUSION: To sustain current trends, end-of-life care provision in care homes and the community needs to double by 2040. An infrastructure across care settings that supports rising annual deaths is urgently needed; otherwise, hospital deaths will increase.The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This work is independent research funded by Cicely Saunders International and The Atlantic Philanthropies (grant number 24610). This research was supported by the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, which is part of the National Institute for Health Research (NIHR), and is a partnership between Kingās Health Partners, St. Georgeās, University London and St Georgeās Healthcare NHS Trust. I.J.H. is an NIHR Senior Investigator. C.J.E. is funded by a Health Education England (HEE)/NIHR Senior Clinical Lectureship. B.G. is funded by the Calouste Gulbenkian Foundation. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health
Non-oxidative modification of low density lipoprotein by ruptured myocytes
AbstractIn this study, the interaction of ruptured cardiac myocytes with low density lipoprotein (LDL) has been investigated and the consequent extent of uptake by macrophages. The results show that lysate released from ruptured myocytes is capable of inducing LDL oxidation and that the resulting modified form is recognised and degraded by macrophages. Peroxyl radical scavengers inhibit the LDL oxidation but not the macrophage uptake suggesting that LDL can be modified by mechanisms that are independent of oxidative processes by intracellular constituents of cardiac myocytes
Outfoxing the fox: effect of prey odor on fox behavior in a pastoral landscape
Invasive mammalian predators have had a devastating effect on native species globally. The European red fox (Vulpes vulpes) is one such species where it has been introduced in Australia. A novel but unexplored tactic to reduce the impact of mammalian predators is the use of unrewarded prey odors to undermine the effectiveness of olfactory hunting behavior. To test the viability of unrewarded prey odors in an applied setting we investigated how foxes responded to the odors of three different prey species. We used the odors of two locally extinct native Australian marsupials; the eastern quoll (a smaller carnivore) and eastern bettong (a fungivore), and the European rabbit, an introduced herbivore. Conducting our research over a period of 3āweeks in a pastoral environment in South-eastern Australia, we used video observations of foxes' behaviors, as they encountered the different odors. We found a reduction in the number of fox visits to bettong odors in the third week. In contrast, we observed a sustained number of visits to rabbit odors. Foxes also spent more time investigating rabbit odors and displayed longer durations of vigilance behavior at quoll odors. Our results support the hypothesis that the exposure of wild foxes to unrewarded odors of novel prey species can reduce their interest in these odors, which might translate to a reduction in predation pressure. Our results also suggest, however, that olfactory pre-exposure may not be as effective at reducing fox interest in a competitor species' odor
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