Fiabilidad y validez del EASYCare-2010 Standard para evaluar a las personas mayores en Atención Primaria de Salud en Portugal

Introduction The EASYCare is a multidimensional assessment tool for older people, which corresponds to the concerns and priorities of older people in relation to their needs, health, and quality of life. The EASYCare instrument has been used in many countries worldwide. Lack of reliability evidence has recently been raised by researchers. This study aimed to test the validity and reliability of the EASYCare-2010 instrument in community-dwelling Portuguese older people attended in Primary Health Care centres. Methods The sample for this transversal study (N = 244) was collected from Portuguese Primary Health Care Centers. Categorical Principal Component Analysis was used to assess the underlying dimensions of EASYCare-2010. Construct validity was evaluated through correlation with the World Health Organization Quality of Life Assessment Instrument-Short Form. Results A two-factor model (labelled “mobility and activities of daily life”, and “general well-being and safety”) was found. The EASYCare-2010 instrument showed acceptable levels for internal consistency (≥0.70). The EASYCare-2010 factors were correlated with measures of quality of life. Results showed that in most polytomous items, some of the more extreme categories were not considered at all or only by a residual number of participants. Conclusion EASY Care -2010 version is a valid and reliable instrument for holistic assessment of the older people attended in Primary Health Care centres in Portugal

Treating and Preventing Influenza in Aged Care Facilities: A Cluster Randomised Controlled Trial

PMCID: PMC3474842This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Reducing the risk of iatrogenic Creutzfeldt–Jakob disease by improving the cleaning of neurosurgical instruments

Background: In all, there have been 178 variant Creutzfeldt–Jakob disease (vCJD) patients diagnosed in the UK, with an estimated maximum 1:2000 carriage rate based on archived appendix and tonsil tissue, implying that infection may be rare but carriage relatively frequent. Previous workers have identified that maintenance of surgical instruments in a humid atmosphere after use and prior to cleaning assists cleaning efficacy. Recently the Department of Health/Advisory Committee on Dangerous Pathogens UK have recommended a surgical instrument cleanliness threshold post cleaning of <5 μg protein per instrument side. Aim: To quantify cleanliness of neurosurgical instruments and to investigate cost-effective measures for improved cleaning. Methods: Two instrument protein quantification methods were used: one based on the International Standard (15883 series) using sodium dodecyl sulphate elution and ortho-phthalaldehyde reaction, and a second in-situ protein fluorescence detection system (ProReveal) providing results per instrument side. In-vitro investigation of the efficacy of some commercial and in-house pre-clean wetting agents was undertaken using artificial test soil and stainless steel discs under standard conditions. In-vivo evaluation of best-performing in-vitro agents was undertaken on craniotomy sets. Findings: ProReveal technology demonstrated that 163 out of 187 (87%) neurosurgical instruments had <5 μg residual protein per instrument side. The use of proprietary National Health Service plastic bags and sterile water-soaked wound pads were equivalent in efficacy to commercial pre-cleaning wetting products and significantly less expensive. Conclusion: Although we demonstrate low in-situ protein levels on neurosurgical instruments and the beneficial effects of keeping instruments moist, other cleaning critical-control points such as instrument loading patterns should also be monitored

Inhibition of the sodium-dependent HCO₃ - transporter SLC4A4, produces a cystic fibrosis-like airway disease phenotype

\ua9 2022, eLife Sciences Publications Ltd. All rights reserved. Bicarbonate secretion is a fundamental process involved in maintaining acid-base homeostasis. Disruption of bicarbonate entry into airway lumen, as has been observed in cystic fibrosis, produces several defects in lung function due to thick mucus accumulation. Bicarbonate is critical for correct mucin deployment and there is increasing interest in understanding its role in airway physiology, particularly in the initiation of lung disease in children affected by cystic fibrosis, in the absence of detectable bacterial infection. The current model of anion secretion in mammalian airways consists of CFTR and TMEM16A as apical anion exit channels, with limited capacity for bicarbonate transport compared to chloride. However, both channels can couple to SLC26A4 anion exchanger to maximise bicarbonate secretion. Nevertheless, current models lack any details about the identity of the basolateral protein(s) responsible for bicarbonate uptake into airway epithelial cells. We report herein that the electrogenic, sodium-dependent, bicarbonate cotransporter, SLC4A4, is expressed in the basolateral membrane of human and mouse airways, and that it’s pharmacological inhibition or genetic silencing reduces bicarbonate secretion. In fully differentiated primary human airway cells cultures, SLC4A4 inhibition induced an acidification of the airways surface liquid and markedly reduced the capacity of cells to recover from an acid load. Studies in the Slc4a4-null mice revealed a previously unreported lung phenotype, characterized by mucus accumulation and reduced mucociliary clearance. Collectively, our results demonstrate that the reduction of SLC4A4 function induced a CF-like phenotype, even when chloride secretion remained intact, highlighting the important role SLC4A4 plays in bicarbonate secretion and mammalian airway function

The VLT-FLAMES Tarantula Survey III: A very massive star in apparent isolation from the massive cluster R136

VFTS 682 is located in an active star-forming region, at a projected distance of 29 pc from the young massive cluster R136 in the Tarantula Nebula of the Large Magellanic Cloud. It was previously reported as a candidate young stellar object, and more recently spectroscopically revealed as a hydrogen-rich Wolf-Rayet (WN5h) star. Our aim is to obtain the stellar properties, such as its intrinsic luminosity, and to investigate the origin of VFTS 682. To this purpose, we model optical spectra from the VLT-FLAMES Tarantula Survey with the non-LTE stellar atmosphere code CMFGEN, as well as the spectral energy distribution from complementary optical and infrared photometry. We find the extinction properties to be highly peculiar (RV ~4.7), and obtain a surprisingly high luminosity log(L/Lsun) = 6.5 \pm 0.2, corresponding to a present-day mass of ~150Msun. The high effective temperature of 52.2 \pm 2.5kK might be explained by chemically homogeneous evolution - suggested to be the key process in the path towards long gamma-ray bursts. Lightcurves of the object show variability at the 10% level on a timescale of years. Such changes are unprecedented for classical Wolf-Rayet stars, and are more reminiscent of Luminous Blue Variables. Finally, we discuss two possibilities for the origin of VFTS 682: (i) the star either formed in situ, which would have profound implications for the formation mechanism of massive stars, or (ii) VFTS 682 is a slow runaway star that originated from the dense cluster R136, which would make it the most massive runaway known to date.Comment: 5 pages, 5 figures, accepted by A&A Letter

Arendt and political realism: towards a realist account of political judgement

This article argues that Hannah Arendt’s thought can offer significant insights on political judgement for realism in political theory. We identify a realist position which emphasises the need to account for how humans judge politically, contra moralist tendencies to limit its exercise to rational standards, but which fails to provide a sufficient conception of its structure and potential. Limited appeals to political judgement render the realist defence of the political elusive, and compromise the endeavour to offer a meaningful alternative to the moralist tendency to displace politics. The potential and limitations of realist discussions on judgement are made visible in relation to proto-realists Judith Shklar and Isaiah Berlin. In seeking to enrich the realist conception of the political, the article introduces the displacement critique found in the neglected Arendtian ‘realism’. It also provides the foundations for a distinctly realist account of political judgement which, we argue, requires elaboration along two dimensions: the social coding of political judgement and the political capacities that help judgement build a suitable political sphere

Nutrition Strategies for Triathlon

Contemporary sports nutrition guidelines recommend that each athlete develop a personalised, periodised and practical approach to eating that allows him or her to train hard, recover and adapt optimally, stay free of illness and injury and compete at their best at peak races. Competitive triathletes undertake a heavy training programme to prepare for three different sports while undertaking races varying in duration from 20 min to 10 h. The everyday diet should be adequate in energy availability, provide CHO in varying amounts and timing around workouts according to the benefits of training with low or high CHO availability and spread high-quality protein over the day to maximise the adaptive response to each session. Race nutrition requires a targeted and well-practised plan that maintains fuel and hydration goals over the duration of the specific event, according to the opportunities provided by the race and other challenges, such as a hot environment. Supplements and sports foods can make a small contribution to a sports nutrition plan, when medical supplements are used under supervision to prevent/treat nutrient deficiencies (e.g. iron or vitamin D) or when sports foods provide a convenient source of nutrients when it is impractical to eat whole foods. Finally, a few evidence-based performance supplements may contribute to optimal race performance when used according to best practice protocols to suit the triathlete’s goals and individual responsiveness

The Evolution of Compact Binary Star Systems

We review the formation and evolution of compact binary stars consisting of white dwarfs (WDs), neutron stars (NSs), and black holes (BHs). Binary NSs and BHs are thought to be the primary astrophysical sources of gravitational waves (GWs) within the frequency band of ground-based detectors, while compact binaries of WDs are important sources of GWs at lower frequencies to be covered by space interferometers (LISA). Major uncertainties in the current understanding of properties of NSs and BHs most relevant to the GW studies are discussed, including the treatment of the natal kicks which compact stellar remnants acquire during the core collapse of massive stars and the common envelope phase of binary evolution. We discuss the coalescence rates of binary NSs and BHs and prospects for their detections, the formation and evolution of binary WDs and their observational manifestations. Special attention is given to AM CVn-stars -- compact binaries in which the Roche lobe is filled by another WD or a low-mass partially degenerate helium-star, as these stars are thought to be the best LISA verification binary GW sources.Comment: 105 pages, 18 figure