Organising case management for people with complex long-term conditions: learn from the experiences of Case Managers and Community Matrons

Case Management (CM) requires a structured and systematic approach in order to be an effective tool for managing a growing population with complex long-term conditions (LTCs). This study aims to characterise, describe and explain the complex organising work of CM in relation to the roles of community matron (CMN) and case manager (CMR), and their training and service arrangement in UK localities through Translational Mobilisation theory (TMT). A qualitative descriptive research approach was used including semi-structured interviews and framework analysis. From interviews with 32 CMNs and CMRs, the study discovered that these roles enable the realising of political aims with regards to the reduction of service usages and improved quality of life for people living with complex LTCs. Their proactive, holistic and individualised care approach in these roles was perceived to be distinctive compared to other health care professionals, but these were not well understood and supported. This was a barrier to effective CM. Secondly, CMNs found that their education programmes on advanced clinical skills improved their knowledge of general illnesses but provided insufficient clinical practice and mentorship for treating common LTCs. In comparison, CMR’s self-directed their learning of common LTCs based on inconsistent organisational funding and course availability. Thirdly, the participants working in different service arrangements in rural and urban areas contributed different benefits and barriers in delivering their role. From the findings, this study proposed a standardised CMN and CMR training based on their common learning needs. Their role requires detailed practice guidelines and a practice-based CM approach with detailed plans to organise CM. Thus, a more standardised and systematic approach to CM is indicated by this study. Therefore, this approach needs extensive research

Terahertz quantum plasmonics at nanoscales and angstrom scales

Through the manipulation of metallic structures, light-matter interaction can enter into the realm of quantum mechanics. For example, intense terahertz pulses illuminating a metallic nanotip can promote terahertz field-driven electron tunneling to generate enormous electron emission currents in a subpicosecond time scale. By decreasing the dimension of the metallic structures down to the nanoscale and angstrom scale, one can obtain a strong field enhancement of the incoming terahertz field to achieve atomic field strength of the order of V/nm, driving electrons in the metal into tunneling regime by overcoming the potential barrier. Therefore, designing and optimizing the metal structure for high field enhancement are an essential step for studying the quantum phenomena with terahertz light. In this review, we present several types of metallic structures that can enhance the coupling of incoming terahertz pulses with the metals, leading to a strong modification of the potential barriers by the terahertz electric fields. Extreme nonlinear responses are expected, providing opportunities for the terahertz light for the strong light-matter interaction. Starting from a brief review about the terahertz field enhancement on the metallic structures, a few examples including metallic tips, dipole antenna, and metal nanogaps are introduced for boosting the quantum phenomena. The emerging techniques to control the electron tunneling driven by the terahertz pulse have a direct impact on the ultrafast science and on the realization of next-generation quantum devices

Antioxidative and Antimutagenic Activities of 70% Ethanolic Extracts from Four Fungal Mycelia-Fermented Specialty Rices

The health-promoting potential of 70% ethanolic extracts of 4 rice varieties fermented with Monascus ruber, Phellinus linteus, Cordyceps sinensis and Agaricus blazei was evaluated mainly focusing on their antioxidative and antimutagenic capacities based on the following parameters: phenolic compound and phytic acid content; inhibitory activity on lipid peroxidation; scavenging activity on DPPH radical; suppressing ability on mitomycin C-induced mutagenesis in E. coli cells; and protective effect on 4-nitroquinoline oxide-triggered DNA lesion in V79 hamster cells. The fermented rice extracts were superior in overall health-promoting parameters compared to the source material. The higher antimutagenic activity of the fermented rice extracts might be in part caused by a larger amount of antioxidant constituents such as phenolic compounds or phytic acid. Of the fungal species, Monascus ruber was found to impart a marked increase in both the antioxidative and antimutagenic abilities to the source material. The current study suggests a possibility that such fermented rice may contribute to the prevention of lifestyle-related diseases such as cancer through a daily intake of rice-based diets

Effects of a multi-herbal extract on type 2 diabetes

<p>Abstract</p> <p>Background</p> <p>An aqueous extract of multi-hypoglycemic herbs of <it>Panax ginseng </it>C.A.Meyer, <it>Pueraria lobata, Dioscorea batatas Decaisne, Rehmannia glutinosa, Amomum cadamomum Linné, Poncirus fructus </it>and <it>Evodia officinalis </it>was investigated for its anti-diabetic effects in cell and animal models.</p> <p>Methods</p> <p>Activities of PPARγ agonist, anti-inflammation, AMPK activator and anti-ER stress were measured in cell models and in <it>db/db </it>mice (a genetic animal model for type 2 diabetes).</p> <p>Results</p> <p>While the extract stimulated PPARγ-dependent luciferase activity and activated AMPK in C2C12 cells, it inhibited TNF-α-stimulated IKKβ/NFkB signaling and attenuated ER stress in HepG2 cells. The <it>db/db </it>mice treated with the extract showed reduced fasting blood glucose and HbA_1clevels, improved postprandial glucose levels, enhanced insulin sensitivity and significantly decreased plasma free fatty acid, triglyceride and total cholesterol.</p> <p>Conclusion</p> <p>The aqueous extract of these seven hypoglycemic herbs demonstrated many therapeutic effects for the treatment of type 2 diabetes in cell and animal models.</p

Influence of Oryzanol and Ferulic Acid on the Lipid Metabolism and Antioxidative Status in High Fat-Fed Mice

The comparative effects of oryzanol and ferulic acid on the lipid metabolism and antioxidative status of high fat-fed mice were investigated. The mice were given a diet containing 17% fat (HF), supplemented with oryzanol (HF-O) or ferulic acid for 7 weeks. The control mice (NC) were fed with normal diet. The HF mice exhibited increased body weight gain, plasma and hepatic total cholesterol and triglyceride concentrations, and lipid peroxidation rate, and reduced high-density lipoprotein cholesterol level. In general, they also showed lower hepatic antioxidant and higher lipid-regulating enzymes activities relative to that of NC group. Addition of oryzanol or ferulic acid in the diet counteracted these high fat-induced hyperlipidemia and oxidative stress via increased faecal lipid excretion and regulation of antioxidant and lipogenic enzymes activities. This study illustrates that oryzanol and ferulic acid have relatively similar hypolipidemic actions and could be effective in lowering the risk of high fat diet-induced obesity

The efficacy of aspartate aminotransferase-to-platelet ratio index for assessing hepatic fibrosis in childhood nonalcoholic steatohepatitis for medical practice

PurposeChildhood obesity is associated with nonalcoholic fatty liver disease (NAFLD), and it has become one of the most common causes of childhood chronic liver diseases which significant as a cause of liver related mortality and morbidity in children in the United States. The development of simpler and easier clinical indices for medical practice is needed to identify advanced hepatic fibrosis in childhood NAFLD instead of invasive method like liver biopsy. FibroScan and aspartate aminotransferase (AST)-to-platelet ratio index (APRI) have been proposed as a simple and noninvasive predictor to evaluate hepatic fibrosis in several liver diseases. APRI could be a good alternative to detect pathologic change in childhood NAFLD. The purpose of this study is to validate the efficacy of APRI for assessing hepatic fibrosis in childhood NAFLD based on FibroScan.MethodsThis study included 23 children with NAFLD who underwent FibroScan. Clinical, laboratory and radiological evaluation including APRI was performed. To confirm the result of this study, 6 patients received liver biopsy.ResultsFactors associated with hepatic fibrosis (stiffness measurement >5.9 kPa Fibroscan) were triglyceride, AST, alanine aminotransferase, platelet count, APRI and collagen IV. In multivariate analysis, APRI were correlated with hepatic fibrosis (>5.9 kPa). In receiver operating characteristics curve, APRI of meaningful fibrosis (cutoff value, 0.4669; area under the receiver operating characteristics, 0.875) presented sensitivity of 94%, specificity of 66%, positive predictive value of 94%, and negative predictive value of 64%.ConclusionAPRI might be a noninvasive, simple, and readily available method for medical practice to predict hepatic fibrosis of childhood NAFLD

Ubiquitin ligase MKRN1 modulates telomere length homeostasis through a proteolysis of hTERT

Telomere homeostasis is regulated by telomerase and a collection of associatedproteins. Telomerase is, in turn, regulated by post-translational modifications of the rate-limiting catalytic subunit hTERT. Here we show that disruption of Hsp90 by geldanamycin promotes efficient ubiquitination and proteasome-mediated degradation of hTERT. Furthermore, we have used the yeast two-hybrid method to identify a novel RING finger gene (MKRN1) encoding an E3 ligase that mediates ubiquitination of hTERT. Overexpression of MKRN1 in telomerase-positive cells promotes the degradation of hTERT and decreases telomerase activity and subsequently telomere length. Our data suggest that MKRN1 plays an important role in modulating telomere length homeostasis through a dynamic balance involving hTERT protein stability

KIOM-4 Protects against Oxidative Stress-Induced Mitochondrial Damage in Pancreatic β-cells via Its Antioxidant Effects

The protective effect of KIOM-4, a mixture of plant extracts, was examined against streptozotocin (STZ)-induced mitochondrial oxidative stress in rat pancreatic β-cells (RINm5F). KIOM-4 scavenged superoxide and hydroxyl radicals generated by xanthine/xanthine oxidase and Fenton reaction (FeSO4/H2O2), respectively, in a cell-free chemical system. In addition, a marked increase in mitochondrial reactive oxygen species (ROS) was observed in STZ-induced diabetic cells; this increase was attenuated by KIOM-4 treatment. Mitochondrial manganese superoxide dismutase (Mn SOD) activity and protein expression were down-regulated by STZ treatment and up-regulated by KIOM-4 treatment. In addition, NF-E2 related factor 2 (Nrf2), a transcription factor for Mn SOD, was up-regulated by KIOM-4. KIOM-4 prevented STZ-induced mitochondrial lipid peroxidation, protein carbonyl and DNA modification. Moreover, KIOM-4 treatment restored the loss of mitochondrial membrane potential (Δψ) that was induced by STZ treatment, and inhibited the translocation of cytochrome c from the mitochondria to the cytosol. In addition, KIOM-4 treatment elevated the level of ATP, succinate dehydrogenase activity and insulin level, which were reduced by STZ treatment. These results suggest that KIOM-4 exhibits a protective effect through its antioxidant effect and the attenuation of mitochondrial dysfunction in STZ-induced diabetic cells