Surgical menopause and frailty risk in older community dwelling women: the study of osteoporotic fractures

BACKGROUND: Low testosterone levels in older women have been shown to be associated with frailty. Whether older postmenopausal women with a history of bilateral oophorectomy before natural menopause resulting in lower testosterone levels (surgical menopause) have higher risk for frailty is not known. This prospective study investigated whether women who had surgically-induced menopause had a greater risk of frailty than naturally menopausal women. Furthermore, we also determined whether lower serum testosterone levels would be associated with frailty in our study population of older postmenopausal women. METHODS: The sample included 7699 community-dwelling white women aged ≥ 65 years from the Study of Osteoporotic Fractures (SOF). Participants were determined to have undergone surgical versus natural menopause based on whether or not they reported retrospectively having undergone a bilateral oophorectomy before or after menopause. Frailty status was classified as not frail, somewhat frail (hereafter referred to as Intermediate stage), frail or death at four interviews, conducted 6-18 years post-baseline. Baseline serum total testosterone concentrations were available on a subset of 541 participants. RESULTS: Approximately 12.6% of the participants reported surgical menopause. A total of 39.7% were classified as somewhat frail (intermediate stage) and 10.1% as frail. Twenty-two (22.0%) of the participants died during the interview period when frailty was assessed. Mean age at baseline was 71.2 years. Total serum testosterone levels were significantly lower among surgically menopausal women compared to naturally menopausal women (p<0.01). Surgical menopause was not significantly associated with an increased risk of frailty (Odds Ratio=0.94; 95% CI=0.72-1.22), intermediate stage frailty (Odds Ratio=0.96; 95% CI=0.80-1.10) or death (Odds Ratio=1.17 ; 95% CI=0.97-1.42) after adjusting for age, BMI and number of IADL impairments. Stratified analyses showed that oral estrogen use did not modify these associations. CONCLUSION: Among postmenopausal women, surgical menopause was not associated with a higher risk for frailty compared to naturally menopausal women, even in the absence of estrogen therapy. Future prospective studies are needed to investigate hormonal mechanisms involved in the development of frailty in older postmenopausal women.2017-11-05T00:00:00

How does the patient to nurse ratio relate to the quality of patient care and nurse burnout in the hospital?

The patient-to-nurse ratio is a topic that affects all nurses. A review of the research literature was performed to study this vital issue. Data was obtained from surveys conducted in numerous countries, including the United States, Canada, the United Kingdom, Taiwan, and Chile. The evidence showed that an increased patient-to-nurse ratio motivated nurses’ intention to leave their job. A higher patient-to-nurse ratio was found to have been associated with higher levels of personal burnout, client-related burnout, and job dissatisfaction in nurses. Currently in California, in medical-surgical units, the registered nurse staffing mandate is at one nurse to five patients. When nurses’ workloads were in line with California’s mandated ratios, nurses’ burnout and job dissatisfaction were lower, and nurses reported consistently better quality of care. Furthermore, there was a decrease in nurses receiving verbal abuse from patients or other staff and complaints from patients and their family. In addition, a theoretical model is presented, which offers a hypothesis that nurses’ level of education may be a factor in affecting patient outcomes. In this paper, I propose a study to examine how a baccalaureate degree in nursing may affect patient mortality and failure to rescue

Book Review: Promising Practices for Engaging Families in Literacy

Book Review: Promising Practices for Engaging Families in Literacy by Holly Kreider, Margaret Caspe, and Diana B. Hiatt-Michael. Charlotte, NC: Information Publishing, Inc., 2013, 146 pp., $45.99 (paperback)

Cryogenic Characterization of 180 nm CMOS Technology at 100 mK

Conventional CMOS technology operated at cryogenic conditions has recently attracted interest for its uses in low-noise electronics. We present one of the first characterizations of 180 nm CMOS technology at a temperature of 100 mK, extracting I/V characteristics, threshold voltages, and transconductance values, as well as observing their temperature dependence. We find that CMOS devices remain fully operational down to these temperatures, although we observe hysteresis effects in some devices. The measurements described in this paper can be used to inform the future design of CMOS devices intended to be operated in this deep cryogenic regime

Progress Towards Engineering Microbial Surfaces to Degrade Biomass

Lignocellulosic biomass is a promising feedstock to sustainably produce useful biocommodities. However, its recalcitrance to hydrolysis limits its commercial utility. One attractive strategy to overcome this problem is to use consolidated bioprocessing (CBP) microbes to directly convert biomass into chemicals and biofuels. Several industrially useful microbes possess desirable consolidated bioprocessing characteristics, yet they lack the ability to degrade biomass. Engineering these microbes’ surfaces to display cellulases and cellulosome‐like structures could endow them with potent cellulolytic activity, enabling them to be used in CBP. In this chapter, we discuss recent progress in engineering the surfaces of Saccharomyces cerevisiae, Escherichia coli, Bacillus subtilis, Corynebacterium glutamicum, and lactic acid bacteria. We discuss the techniques used to display cellulases on their surfaces, their recombinantly achieved cellulolytic activities, and current obstacles that limit their utility

Resettled Refugee Families: Parenting Practices and Educational Involvement

In 2020, there are 25.9 million refugees worldwide. With the rapidly rising refugee population (over 600,000 from 2010 to 2020) in the United States, supporting resettled refugee families is a pressing issue, in which a comprehensive understanding of the refugee families is sorely needed. The purpose of this paper was to identify the challenges of resettled refugee families in their parenting practices and educational involvement. Entering a country with a different language and culture than their own, refugees, parents in particular, face numerous challenges upon relocation (e.g., refugee parents who raise their children in a new and unfamiliar environment have to balance between the new adaptation and the preservation of their original culture). This obstacle is manifested in their parenting practices and involvement in their children’s education and schooling as well as language barrier. We provided an overview of the parenting challenges and explored the cultural dissonance in parenting and its impact on family dynamics. Implications were provided to address the challenges refugee families face in the areas of systemic and personnel support, effective strategies, and family-school relations

What Drives Asian Descendent Students’ Motivation for Learning? Exploring the Key Ingredients to Nurture Achievement

This motivation project is part of a larger study of exploring the relationship between Asian parenting styles and children’s academic achievement. In light of the consistent Asian students PISA (Programme for International Student Assessment) data results and the media phenomenon created by Amy Chua’s Battle Hymn of the Tiger Mother in 2011 in U.S., our research team found that high motivation has been a reoccurring theme in children’s academic achievement in the perceptions of Asian descendent parents. The purpose of this project is to examine the Asian descendent students’ motivations for learning through the parents’ experiences and perceptions. The research methods include individual interviews and a focus group interview. Eighteen parents, including thirteen mothers and five fathers participated in this study. All participants had at least one child within the ages of 2-20 years old. Based on our findings, four themes have emerged. We learned that these parents nurtured and sustained children’s motivation for learning through the following four ingredients, including resources, communications, setting clear and high expectations, and the modeling of the parents. Implications for educators will be provided in this presentation.https://engagedscholarship.csuohio.edu/u_poster_2014/1003/thumbnail.jp

Rainfall Reliability Evaluation for Stability of Municipal Solid Waste Landfills on Slope

[[abstract]]A method to assess the reliability for the stability of municipal solid waste (MSW) landfills on slope due to rainfall infiltration is proposed. Parameter studies are first done to explore the influence of factors on the stability of MSW. These factors include rainfall intensity, duration, pattern, and the engineering properties of MSW. Then 100 different combinations of parameters are generated and associated stability analyses of MSW on slope are performed assuming that each parameter is uniform distributed around its reason ranges. In the following, the performance of the stability of MSW is interpreted by the artificial neural network (ANN) trained and verified based on the aforementioned 100 analysis results. The reliability for the stability of MSW landfills on slope is then evaluated and explored for different rainfall parameters by the ANN model with first-order reliability method (FORM) and Monte Carlo simulation (MCS).[[incitationindex]]SCI[[booktype]]紙

Developing internal medicine subspecialty fellows’ teaching skills: a needs assessment

Abstract Background For academic physicians, teaching represents an essential skill. The proliferation of educator training programs aimed at residents and medical students signals the increasing commitment of training programs to develop teaching skills in their trainees as early as possible. However, clinical fellowships represent an important opportunity to advance training as educators. In addition to enriching the pipeline of future teachers, developing fellows as teachers augments the training experience for more junior trainees and may impact patient care. Fellows’ needs for programs to improve teaching skills have been largely unexplored. Methods We conducted a multi-institutional needs assessment of internal medicine (IM) subspecialty fellows to gauge interest in teaching and improvement of teaching skills. We surveyed IM subspecialty fellows at three academic medical centers about their access to fellow-as-teacher programs and other mechanisms to improve their teaching skills during fellowship. We also elicited their attitudes towards teaching and interest in training related to teaching skills. Results One hundred eighty-three fellows representing 20 programs and nine different subspecialties responded to the survey (48% response rate). The majority of participants (67%) reported having no specific training focused on teaching skills and only 12% reported receiving regular feedback about their teaching during their fellowship. Seventy-nine percent of fellows anticipated teaching to be part of their careers, and 22% planned to participate in medical education scholarship. Fellows reported a strong interest in teaching and programs aimed at improving their teaching skills. Conclusions The majority of fellows reported a lack of mechanisms to advance their teaching skills as fellows, despite anticipating teaching to be an important aspect of their future careers and having strong interest in such programs. Our findings at three academic medical centers confirm a lost opportunity among subspecialty fellowships to accelerate teaching skills development for future educators.https://deepblue.lib.umich.edu/bitstream/2027.42/145709/1/12909_2018_Article_1283.pd