The Health and Well-being of Service User and Carer Educators: a Narrative Enquiry into the Impact of Involvement in Healthcare Education

Service user and carer involvement is increasing in health and social care educationas a result of UK policy directives and Professional Statutory and Regulatory Body requirements. The study aimed to elicit the accounts of service user and carer educators' experiences in practice-based healthcare education in the UK. The overall aim was to illustrate the impact this has had on their health and well-being. A narrative inquiry approach was adopted in order to give a clearer and stronger voice to service users and carers by making their experience the primary focus of enquiry.Narratives were collected from five service users and carers who had extensive experience of involvement in healthcare education. The individual narrative material obtained was distilled into key points following a naturalistic perspective, ensuring that the findings and final story were a re-presentation of the narrator's experience.Participating in the research enabled the service users and carers to articulate specifically how involvement had positively affected their health and well-being. An additional outcome included the personal artefacts that can be utilised in teaching and learning in order to bring the service user and carer voice to life.This study contributes to the emerging knowledge and understanding that service user and carer involvement in health education can be a truly collaborative, enriching experience,producing profound personal change, with improvements in health and well-being. Effective involvement is dependent upon appropriate support networks whereby service users and carers develop connections with staff and other service users and carers that result in a sense of belonging

Child Care Arrangements in Affluence and Poverty

A study of the attitudes of 40 mothers toward their child care arrangements tested hypotheses concerning the conditions of economic and child care necessity under which mothers of two socio-economic groups would be satisfied with their arrangements. It was hypothesized that the satisfaction with an arrangement would be associated inversely with economic necessity and child care necessity. A prediction was also made that the mothers\u27 expressive satisfactions with the child care arrangements (benefits to the child and relationship to the sitter) would only be realized after the instrumental necessities of convenience and dependability of the arrangement were met. Interest in this study developed from Perry et al. (1967) where satisfaction with child care arrangements of employed mothers was studied. However, this study broadened the area of investigation to include all mothers using child care arrangements. A sample of 40 mothers was chosen, 20 from an upper middle class residential area, and 20 women receiving Aid to Dependent Children. The attitudes of these women were assessed through an interview schedule, a Likert scale of satisfaction items, and an independent rating by the interviewer. Four case studies of two mothers from each group were used to enrich the study with further descriptive data on the respective life styles of the two socioeconomic groups. No difference was found between the two samples in the level of satisfaction with the child care arrangement. However, the groups did differ in the pattern of satisfactions reported. Guttman scale patterns of the four subscales (convenience, money, benefits to child, and relationship to sitter) were reversed for the two groups. This difference in patterns was interpreted as a reflection of the socioeconomic standing and life circumstances of the mothers

Effects of a multicomponent wellness intervention on dyslipidemia in an overweight adolescent population

Epidemiologic studies suggest that atherosclerotic processes begin in childhood and are associated with abnormal lipid levels. Behavioral changes are the first line of treatment for dyslipidemia in adolescents but outcome data on the effectiveness of this approach are inconsistent. This study aimed to assess the effect of a 13-week multicomponent wellness intervention program on dyslipidemia in lean and overweight/obese adolescents enrolled at a public high school in Boston, Massachusetts. The intervention was conducted at a university-based youth fitness center where 9 overweight/obese adolescents (body mass index [BMI]≥85th percentile for age and sex) and 9 lean adolescents (BMIsex) participated in weekly nutrition classes and structured cardiovascular, flexibility and strength training 2 times/week for 5 weeks, followed by up to 4 times/week for 8 weeks. Clinical measurements (BMI, percent body fat, blood pressure [BP]) and lipid profile assessment (total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], and low-density lipoprotein cholesterol [LDL-C]) were performed at baseline and at completion of the intervention. At the completion of the study, the overweight/obese adolescents demonstrated a 15% increase in HDL-C levels (mean, 47 mg/dL vs 54 mg/dL) while there was no improvement in BMI, percent body fat, BP,TG, TC and LDL-C. The participants in the lean group showed no change in their anthropometric and serum parameters. A multicomponent wellness intervention resulted in a significant increase of cardioprotective HDL-C levels which has been associated with coronary health in adulthood. The long-term effects of this intervention on indicators of cardiometabolic health and others like it require further study

Dominant factors associated with microcystins in nine midlatitude, maritime lakes

The study objective was to identify factors most closely associated with the presence of cyanotoxins in 9 lakes in the Puget Sound lowlands region of western Washington, USA. Four cyanotoxins (microcystins, anatoxin-a, saxitoxin, and cylindrospermopsin), phytoplankton, and limnological parameters were monitored twice per month from June through October 2012. Microcystin (MC) was the most commonly detected cyanotoxin and was detected in every lake at least once. Nonparametric decision forests and classification trees were used to identify variables that best predicted MC categories for 2 models; (1) presence–absence of MC, and (2) MC concentrations. The best predictors of MC in concentration categories for both models were epilimnetic total nitrogen to total phosphorus (TN:TP) ratios and the abundance of potential MC-producing cyanobacteria. Model 1 showed that observations with TN:TP ratios ≤25.7 were associated with MC presence, while MC was generally absent when TN:TP ratios were >25.7 and MC-producing cyanobacteria were ≤330 cells mL−1. Model 2 showed that Microcystis abundance >1300 cells mL-1 captured moderate (>1 and ≤6 µg L-1) and high (>6 µg L-1) MC concentrations. Low MC concentrations (>0.05 and ≤1 µg L-1) were found when TN:TP was ≤28.8 or when Dolichospermum abundance was >110 cells mL-1. Because of their broad applicability, thresholds for these variables may be useful in evaluating public health risk in the absence of MC measurements from lakes in this and similar regions. Decision forest and classification tree models may be promising tools for lake mangers to identify dominant factors and threshold limnological values associated with cyanotoxins

Typicality versus thermality: An analytic distinction

In systems with a large degeneracy of states such as black holes, one expects that the average value of probe correlation functions will be well approximated by the thermal ensemble. To understand how correlation functions in individual microstates differ from the canonical ensemble average and from each other, we study the variances in correlators. Using general statistical considerations, we show that the variance between microstates will be exponentially suppressed in the entropy. However, by exploiting the analytic properties of correlation functions we argue that these variances are amplified in imaginary time, thereby distinguishing pure states from the thermal density matrix. We demonstrate our general results in specific examples and argue that our results apply to the microstates of black holes.Comment: 22 pages + appendices, 3 eps figure

Evaluating a Prioritization Framework for Monitoring Chemicals of Emerging Concern in the Salish Sea Based on Lessons Learned from Western States Programs

We are now approaching a tipping point where priority pollutants may no longer be the primary driver of environmental impairment. Contaminants of Emerging Concern (CECs) present a challenge to environmental monitoring and management programs because the rapidly emerging state of the knowledge requires an adaptive and transparent prioritization framework. The state of the science, treatment technologies, and regulatory policies are not well understood, CEC quantification is challenging and expensive, and the management approach is not simply a concentration based criteria, but may include biological end-points. The need for a shared responsibility and leveraging across many programs was evaluated through a series of webinars with other programs studying CECs including Columbia River Toxics Program, Washington Department of Ecology, Oregon Department of Environmental Quality, Southern California Coastal Waters Research Project, and San Francisco Bay Regional Monitoring Program. The lessons learned were articulated into a 10-step prioritization framework. The critical lesson learned included: 1) Develop clear objectives, definitions of CECs, and target audience; 2) Identify conceptual models to provide a clear target for the appropriate media to monitor for various chemicals and at what frequency; 3) Define the chemical characteristics in terms of usage, persistence, bioaccumulation, and toxicity; 4) Develop a target CEC analyte list; 5) Screen and rank the CEC analyte list based on chemical characteristics, environmental concentrations, and state of the science; 6) Create a transparent prioritization process to include input from key stakeholders and end users that builds consensus during development; 7) Prioritize the chemical categories by using specific metrics such as available data, status of analytical methods, available thresholds, costs, programmatic concerns and opportunities for leveraging with other programs; 8) Identify potential biological end-points and other indicators; 9) Create a formal review process to support data and knowledge sharing, adaptively manage prioritization to include new science and critical research gaps; and 10) Develop a working group to facilitate leveraging of funds across many programs

The Library of Babel: On the origin of gravitational thermodynamics

We show that heavy pure states of gravity can appear to be mixed states to almost all probes. For AdS_5 Schwarzschild black holes, our arguments are made using the field theory dual to string theory in such spacetimes. Our results follow from applying information theoretic notions to field theory operators capable of describing very heavy states in gravity. For half-BPS states of the theory which are incipient black holes, our account is exact: typical microstates are described in gravity by a spacetime ``foam'', the precise details of which are almost invisible to almost all probes. We show that universal low-energy effective description of a foam of given global charges is via certain singular spacetime geometries. When one of the specified charges is the number of D-branes, the effective singular geometry is the half-BPS ``superstar''. We propose this as the general mechanism by which the effective thermodynamic character of gravity emerges.Comment: LaTeX, 6 eps figures, uses young.sty and wick.sty; Version 2: typos corrected, minor rewordings and clarifications, references adde

Structural and functional analysis of the finished genome of the recently isolated toxic Anabaena sp WA102

Background: Very few closed genomes of the cyanobacteria that commonly produce toxic blooms in lakes and reservoirs are available, limiting our understanding of the properties of these organisms. A new anatoxin-a-producing member of the Nostocaceae, Anabaena sp. WA102, was isolated from a freshwater lake in Washington State, USA, in 2013 and maintained in non-axenic culture. Results: The Anabaena sp. WA102 5.7 Mbp genome assembly has been closed with long-read, single-molecule sequencing and separately a draft genome assembly has been produced with short-read sequencing technology. The closed and draft genome assemblies are compared, showing a correlation between long repeats in the genome and the many gaps in the short-read assembly. Anabaena sp. WA102 encodes anatoxin-a biosynthetic genes, as does its close relative Anabaena sp. AL93 (also introduced in this study). These strains are distinguished by differences in the genes for light-harvesting phycobilins, with Anabaena sp. AL93 possessing a phycoerythrocyanin operon. Biologically relevant structural variants in the Anabaena sp. WA102 genome were detected only by long-read sequencing: a tandem triplication of the anaBCD promoter region in the anatoxin-a synthase gene cluster (not triplicated in Anabaena sp. AL93) and a 5-kbp deletion variant present in two-thirds of the population. The genome has a large number of mobile elements (160). Strikingly, there was no synteny with the genome of its nearest fully assembled relative, Anabaena sp. 90. Conclusion: Structural and functional genome analyses indicate that Anabaena sp. WA102 has a flexible genome. Genome closure, which can be readily achieved with long-read sequencing, reveals large scale (e.g., gene order) and local structural features that should be considered in understanding genome evolution and functioKeywords: PacBio, Illumina, Mobilome, Cyanobacteria, Anabaena, Long-read sequencing, Structural variation, Anatoxin-a, Synteny, Tandem repeatKeywords: PacBio, Illumina, Mobilome, Cyanobacteria, Anabaena, Long-read sequencing, Structural variation, Anatoxin-a, Synteny, Tandem repea

Interactions between Naïve and Infected Macrophages Reduce Mycobacterium tuberculosis Viability

A high intracellular bacillary load of Mycobacterium tuberculosis in macrophages induces an atypical lysosomal cell death with early features of apoptosis that progress to necrosis within hours. Unlike classical apoptosis, this cell death mode does not appear to diminish M. tuberculosis viability. We previously reported that culturing heavily infected macrophages with naïve macrophages produced an antimicrobial effect, but only if naïve macrophages were added during the pre-necrotic phase of M. tuberculosis-induced cell death. In the present study we investigated the mechanism of antimicrobial activity in co-cultures, anticipating that efferocytosis of bacilli in apoptotic bodies would be required. Confocal microscopy revealed frustrated phagocytosis of M. tuberculosis-infected macrophages with no evidence that significant numbers of bacilli were transferred to the naïve macrophages. The antimicrobial effect of naïve macrophages was retained when they were separated from infected macrophages in transwells, and conditioned co-culture supernatants transferred antimicrobial activity to cultures of infected macrophages alone. Antimicrobial activity in macrophage co-cultures was abrogated when the naïve population was deficient in IL-1 receptor or when the infected population was deficient in inducible nitric oxide synthase. The participation of nitric oxide suggested a conventional antimicrobial mechanism requiring delivery of bacilli to a late endosomal compartment. Using macrophages expressing GFP-LC3 we observed the induction of autophagy specifically by a high intracellular load of M. tuberculosis. Bacilli were identified in LC3-positive compartments and LC3-positive compartments were confirmed to be acidified and LAMP1 positive. Thus, the antimicrobial effect of naïve macrophages acting on M. tuberculosis in heavily-infected macrophages is contact-independent. Interleukin-1 provides an afferent signal that induces an as yet unidentified small molecule which promotes nitric oxide-dependent antimicrobial activity against bacilli in autolysosomes of heavily infected macrophages. This cooperative, innate antimicrobial interaction may limit the maximal growth rate of M. tuberculosis prior to the expression of adaptive immunity in pulmonary tuberculosis

A geometric analysis of hallux valgus: correlation with clinical assessment of severity

<p>Abstract</p> <p>Background</p> <p>Application of plane geometry to the study of bunion deformity may represent an interesting and novel approach in the research field of hallux valgus. For the purpose of contributing to development of a different perspective in the assessment of hallux valgus, this study was conducted with three objectives: a) to determine the position on the intersection point of the perpendicular bisectors of the longitudinal axes of the first metatarsal and proximal phalanx (IP), b) to correlate the location of this point with hallux valgus deformity according to angular measurements and according to visual assessment of the severity carried out by three independent observers, and c) to assess whether this IP correlated with the radius of the first metatarsophalangeal arc circumference.</p> <p>Methods</p> <p>Measurements evaluated were intermetatarsal angle (IMA), hallux valgus angle (HVA), and proximal phalangeal articular angle (PPAA). The Autocad^®program computed the location of the IP inside or outside of the foot. Three independent observers rated the severity of hallux valgus in photographs using a 100-mm visual analogue scale (VAS).</p> <p>Results</p> <p>Measurements of all angles except PPAA showed significantly lower values when the IP was located out of the foot more distantly and vice versa, significantly higher values for severe deformities in which the IP was found inside the foot (<it>p </it>< 0.001). The IP correlated significantly with VAS scores and with the length of the radius of the circle that included the first metatarsophalangeal arc circumference (<it>p </it>< 0.001)</p> <p>Conclusion</p> <p>The IP is a useful indicator of hallux valgus deformity because correlated significantly with IMA and HVA measurements, VAS scores obtained by visual inspection of the degree of deformity, and location of the center of the first metatarsophalangeal arc circumference.</p