Establishing an evidenced-based dietetic model of care in haemodialysis using implementation science

To establish an evidence-based dietetics service in an in-centre haemodialysis unit utilising implementation science.The service was developed through the Knowledge-to-Action Framework. The steps of the Action Cycle were addressed through a literature review, identification of evidence-based guidelines, benchmarking and local staff engagement. The theoretical domains framework (TDF) was used to identify barriers/enablers, and behaviour change wheel to determine appropriate interventions. To monitor, evaluate outcomes and assess sustained knowledge use we employed multidisciplinary team engagement and database use. Audit data were collected at baseline, 6 and 12 months on nutrition assessment (Patient-Generated Subjective Global Assessment), intervention timeliness and alignment to dietetic workforce recommendations. Descriptive statistics, McNemar tests and a linear mixed model were applied.Barriers existed in the knowledge, skills, environmental context and resources TDF domains. Suitable interventions were identified with training on nutritional management of haemodialysis patients delivered to 148 nurses, and nutrition management recommendations summarised into local procedural resources. A database to prompt and monitor outcome measures was created and indicated that over 18 months post-service commencement, eligible patients received nutrition assessment at least 6-monthly, aligning with recommendations. Prevalence of malnutrition was 28% (n = 9/32) at baseline, 23% (n = 5/22) at 6 months and 20% (n = 4/20) at 12 months (P = 0.50).We demonstrated benefits to service development and implementation with implementation science providing a structured and methodical approach to translating guidelines into practice. Development of training, resources and prompts for outcome measures has supported the establishment of an evidence-based dietetics service in a haemodialysis unit

Засади та історія становлення соціального вчення Українського католицизму

In equine medicine the use of Botox® is experimental. Dosages are determined from human treatment-protocols and limited numbers of equine studies. Determination of target-muscle volume can be helpful to extrapolate human dosages. The aim of the study was to calculate a formula enabling the estimation of the deep digital flexor muscle (DDFM) volume based on distances between anatomical landmarks. Nineteen cadaveric limbs were collected and distance A (top of olecranon to Os carpi accessorium) and B (circumference of limb) were measured. Converting mathematical formulas, C was calculated: π × (((0.5B)/π)(2)) × A. DDFM volume was determined by water displacement. Linear Regression Analysis was used to analyse data. The line best fitting the observed points was: Ln(volume[ml]) = -1.89 + 0.98 × Ln(value C[cm(3)]). Correlation was highest when natural logarithm was applied to both variables and was 0.97. The calculated formula enables estimating DDFM volume of a living horse. This estimated volume can be useful to apply human Botox® treatment-protocols

Presence or Absence of Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease is Associated With Distinct Phenotypes

Introduction: Reduced skeletal muscle function and cognitive performance are common extrapulmonary features in Chronic Obstructive Pulmonary Disease (COPD) but their connection remains unclear. Whether presence or absence of skeletal muscle dysfunction in COPD patients is linked to a specific phenotype consisting of reduced cognitive performance, comorbidities and nutritional and metabolic disturbances needs further investigation. Methods: Thirty-seven patients with COPD (grade II–IV) were divided into two phenotypic cohorts based on the presence (COPD dysfunctional, n = 25) or absence (COPD functional, n = 12) of muscle dysfunction. These cohorts were compared to 28 healthy, age matched controls. Muscle strength (dynamometry), cognitive performance (Trail Making Test and STROOP Test), body composition (Dual-energy X-Ray Absorptiometry), habitual physical activity, comorbidities and mood status (questionnaires) were measured. Pulse administration of stable amino acid tracers was performed to measure whole body production rates. Results: Presence of muscle dysfunction in COPD was independent of muscle mass or severity of airflow obstruction but associated with impaired STROOP Test performance (p = 0.04), reduced resting O saturation (p = 0.003) and physical inactivity (p = 0.01), and specific amino acid metabolic disturbances (enhanced leucine (p = 0.02) and arginine (p = 0.06) production). In contrast, COPD patients with normal muscle function presented with anxiety, increased fat mass, plasma glucose concentration, and metabolic syndrome related comorbidities (hypertension and dyslipidemia). Conclusion: COPD patients with muscle dysfunction show characteristics of a cognitive – metabolic impairment phenotype, influenced by the presence of hypoxia, whereas those with normal muscle function present a phenotype of metabolic syndrome and mood disturbances

Morphology and reproduction in the Hapalocarcinus marsupialis Stimpson, 1859 species complex (Decapoda: Brachyura: Cryptochiridae)

Symbiotic relationships contribute considerably to the high biodiversity found on coral reefs. Coral-dwelling gall crabs (Cryptochiridae) represent a prime example of coral-associated invertebrates that exhibit obligate relationships with their host. The induction of a skeletal modification in the coral, used as a dwelling by the crab, is the most remarkable aspect of this close association. Here we examined Hapalocarcinus marsupialisStimpson, 1859, collected from Pocillopora and Stylophora corals in the Saudi Arabian Red Sea. Specimens were DNA barcoded, and five distinct clades were revealed, providing further evidence for the hypothesis that H. marsupialis is a species complex. Divergence (COI) between the clades ranged from 3.2 to 15.7%. The putative species were tested for differences in morphology and reproduction. Crabs were examined regarding morphometric characters (carapace length and width, pleon (abdomen), chelae, and growth patterns) and reproductive traits. The data were pooled and analysed by host genus and putative species, which revealed significant differences for most of the measured variables in female crabs. Specimens retrieved from Pocillopora were significantly larger (up to 49 %) and had higher fecundity than those inhabiting Stylophora. For reproductive output (RO) no differences at species- or host-genus level were detected. The average RO of ~70% over all specimens is high compared to other brachyurans, supporting the assumption that symbiotic brachyurans invest more energy in reproduction than their free-living counterparts. Discrepancies with published data on growth and reproduction of Hapalocarcinus are discussed. Our results demonstrate the usefulness of morphometric traits and fecundity in separating the clades in the H. marsupialis complex, and prepare the ground for further morphometric studies on the genus and other symbiotic brachyurans. Moreover, it highlights the need to check for the presence of cryptic species when studying aspects of the biology of a species

Neurophysiology of Avian Sleep: Comparing Natural Sleep and Isoflurane Anesthesia

Propagating slow-waves in electroencephalogram (EEG) or local field potential (LFP) recordings occur during non-rapid eye-movement (NREM) sleep in both mammals and birds. Moreover, in both, input from the thalamus is thought to contribute to the genesis of NREM sleep slow-waves. Interestingly, the general features of slow-waves are also found under isoflurane anesthesia. However, it is unclear to what extent these slow-waves reflect the same processes as those giving rise to NREM sleep slow-waves. Similar slow-wave spatio-temporal properties during NREM sleep and isoflurane anesthesia would suggest that both types of slow-waves are based on related processes. We used a 32-channel silicon probe connected to a transmitter to make intra-cortical recordings of the visual hyperpallium in naturally sleeping and isoflurane anesthetized pigeons (Columba livia) using a within-bird design. Under anesthesia, the amplitude of LFP slow-waves was higher when compared to NREM sleep. Spectral power density across all frequencies (1.5–100 Hz) was also elevated. In addition, slow-wave coherence between electrode sites was higher under anesthesia, indicating higher synchrony when compared to NREM sleep. Nonetheless, the spatial distribution of slow-waves under anesthesia was more comparable to NREM sleep than to wake or REM sleep. Similar to NREM sleep, slow-wave propagation under anesthesia mainly occurred in the thalamic input layers of the hyperpallium, regions which also showed the greatest slow-wave power during both recording conditions. This suggests that the thalamus could be involved in the genesis of slow-waves under both conditions. Taken together, although slow-waves under isoflurane anesthesia are stronger, they share spatio-temporal activity characteristics with slow-waves during NREM sleep

Universitas Tartuensis : UT : Tartu Ülikooli ajakiri 2011 nr 8

http://www.ester.ee/record=b2459950*es

To Binge or not To Binge: viewers’ moods and behaviors during the consumption of subscribed video streaming

The popularity of internet-distributed TV entertainment services, such as Netflix, has transformed TV consumption behavior. Currently, the level of control viewers have over their TV experiences, along with the release of com plete seasons at once, are some of the factors that stimulate the so-called binge watching phenomenon (the consumption of several episodes of a program in a single sitting). Most of binge-watching studies have focused on viewers’ habits and health effects. This paper presents a study that relates to viewers’ behaviors and moods. It was carried out with 13 young participants at their home, watching online content, collecting physiological, inertial, and self-reported data. We iden tify and compare binge-watching with non-binge-watching behaviors. Our results suggest that while viewers recur to online serial entertainment in pursuit of lei sure related needs, such as relaxation, relief from boredom and escapism, the act of binge-watching tends to make them feel rather unsatisfied with no change in Arousal. Nevertheless, in binge-watching the Positive Affect increases while the Negative decreases. Moreover, watching a single episode only, tends to result in increased arousal and but not necessarily in increased satisfaction. This prelimi nary finding can be the starting point of fruitful future investigations on unpack ing further motives and nuances from this outcome.info:eu-repo/semantics/publishedVersio

Triaging borderline/mild dyskaryotic Pap cytology with p16/Ki-67 dual-stained cytology testing: Cross-sectional and longitudinal outcome study

Background: Women with borderline/mildly dyskaryotic (BMD) cytology smears are currently followed up with repeat testing at 6 and 18 months. The objective of this study is to analyse the cross-sectional and longitudinal performance of p16/Ki-67 dual-stained cytology for the detection of cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) and CIN2+ in women with BMD, and to compare the results with baseline human papillomavirus (HPV) testing. Methods: Conventional Pap cytology specimens of 256 women with BMD were dual stained for p16/Ki-67 retrospectively, and compared with baseline HPV results and long-term follow-up results. Results: p16/Ki-67 dual-stained cytology showed a sensitivity of 100%, a specificity of 64.4% and a negative predictive value (NPV) of 100.% for CIN3+. Human papillomavirus testing demonstrated similar sensitivity (96.3%), and NPV (99.1%), but a significantly lower specificity (57.6%; P=0.024) for CIN3+. Sensitivity, specificity and NPV for CIN2+ of dual-stained cytology were 89.7%, 73.1% and 95.1%, respectively, which was similar when compared with HPV testing. Dual-stained cytology showed a significant lower referral rate than HPV testing (43.6% vs 49.1%; P=0.043). During long-term follow-up, no CIN3+ lesions developed in HPV-positive, dual-stained negative women. Conclusions: Comparable sensitivity and NPV of dual-stained cytology for CIN3+, combined with a significantly higher specificity, makes p16/Ki-67 dual-stained cytology a viable alternative to HPV testing for triaging BMD