Companion animals and well-being in palliative care nursing: a literature review

Aims and objectives To evaluate and critique current knowledge regarding the role of animals in palliative care. To explore the impact that animals may have on the well-being of individuals and to identify gaps in the evidence base. Background There is recognition that having a companion animal will affect patient experience. Similarly, there has been some previous exploration on the use of specific animal assisted therapies for patients with different healthcare needs. Design A literature review was conducted to identify published and unpublished research about companion animals or animal-assisted therapy in palliative and/or end-of-life care. The primary objective was to explore the impact of animals on well-being at the end of life. Methods A search for literature was carried out using a variety of databases and different combinations of search terms linked to animals in palliative care. Included works were critically appraised and thematically analysed. Results A limited range of literature was identified. From the small number of studies included in the review (n = 4), it appears that there is some evidence of animals (either companion animals or those used specifically to enhance care) having a positive impact on the patient experience. Conclusion This study suggests that animals play a large part in the lives of people receiving palliative care. Using animals to support care may also offer some benefits to the patient experience. However, there appears to be a dearth of high-quality literature in this area. More research is therefore required. Relevance to clinical practice Nurses providing palliative care need to be aware of the part that a companion animal may play in the life of patients. There may also be the opportunity for nurses in some settings to integrate animal therapy into their provision of palliative care

Not so private lives

Not So Private Lives is the first national study to examine same-sex attracted Australians’ preferences for various forms of relationship recognition since the introduction of de facto status for same-sex couples at a federal level. It is also the first major study to investigate preferences for relationship recognition while taking into account the current legal status (in Australia or overseas) of an individual’s same-sex relationship. Findings from the relationship recognition measures of this survey demonstrate that same-sex attracted individuals, like other Australians, differ in the way they prefer their relationships to be formally recognised. However, the results show that the majority of same-sex attracted participants in this survey selected marriage as their personal choice. A federally recognised relationship documented at a registry other than marriage was the second most popular option, and de facto status was the third. The preference for a relationship without any legal status was selected by only 3% of the overall sample. Interestingly, marriage was still the majority choice irrespective of the current legal status of participants’ same-sex relationships (including no legal status). For example, of those currently in a de facto relationship, 55.4% stated they preferred marriage for themselves, 25.6% stated that they preferred a federally recognised relationship other than marriage, 17.7% selected de facto and 1.3% chose no legal status. Participants were also given the opportunity to select which forms of legal relationship recognition they would like to see remain and/or become available in this country for same-sex couples in general. Responses to this measure (which allowed for multiple selections) show that 77.4% would like to see marriage become available as an option, 59.9% would like to see a federally recognised relationship other than marriage be made available and 48% would like to see de facto recognition remain. These numbers indicate that many participants selected multiple options, suggesting that simply having a choice was an important factor. Although the data from this survey indicate that marriage is not for everyone, the majority of same- sex attracted participants in this national survey selected this type of relationship recognition as their personal choice and as a choice to be made available for their fellow same-sex attracted Australians

Evidence for elevated emissions from high-latitude wetlands contributing to high atmospheric CH4 concentration in the early Holocene

The major increase in atmospheric methane (CH4) concentration during the last glacial-interglacial transition provides a useful example for understanding the interactions and feedbacks among Earth\u27s climate, biosphere carbon cycling, and atmospheric chemistry. However, the causes of CH4 doubling during the last deglaciation are still uncertain and debated. Although the ice-core data consistently suggest a dominant contribution from northern high-latitude wetlands in the early Holocene, identifying the actual sources from the ground-based data has been elusive. Here we present data syntheses and a case study from Alaska to demonstrate the importance of northern wetlands in contributing to high atmospheric CH4concentration in the early Holocene. Our data indicate that new peatland formation as well as peat accumulation in northern high-latitude regions increased more than threefold in the early Holocene in response to climate warming and the availability of new habitat as a result of deglaciation. Furthermore, we show that marshes and wet fens that represent early stages of wetland succession were likely more widespread in the early Holocene. These wetlands are associated with high CH4 emissions due to high primary productivity and the presence of emergent plant species that facilitate CH4 transport to the atmosphere. We argue that early wetland succession and rapid peat accumulation and expansion (not simply initiation) contributed to high CH4 emissions from northern regions, potentially contributing to the sharp rise in atmospheric CH4 at the onset of the Holocene

Abundance and Distribution of Transposable Elements in Two Drosophila QTL Mapping Resources

Here we present computational machinery to efficiently and accurately identify transposable element (TE) insertions in 146 next-generation sequenced inbred strains of Drosophila melanogaster. The panel of lines we use in our study is composed of strains from a pair of genetic mapping resources: the Drosophila Genetic Reference Panel (DGRP) and the Drosophila Synthetic Population Resource (DSPR). We identified 23,087 TE insertions in these lines, of which 83.3% are found in only one line. There are marked differences in the distribution of elements over the genome, with TEs found at higher densities on the X chromosome, and in regions of low recombination. We also identified many more TEs per base pair of intronic sequence and fewer TEs per base pair of exonic sequence than expected if TEs are located at random locations in the euchromatic genome. There was substantial variation in TE load across genes. For example, the paralogs derailed and derailed-2 show a significant difference in the number of TE insertions, potentially reflecting differences in the selection acting on these loci. When considering TE families, we find a very weak effect of gene family size on TE insertions per gene, indicating that as gene family size increases the number of TE insertions in a given gene within that family also increases. TEs are known to be associated with certain phenotypes, and our data will allow investigators using the DGRP and DSPR to assess the functional role of TE insertions in complex trait variation more generally. Notably, because most TEs are very rare and often private to a single line, causative TEs resulting in phenotypic differences among individuals may typically fail to replicate across mapping panels since individual elements are unlikely to segregate in both panels. Our data suggest that “burden tests” that test for the effect of TEs as a class may be more fruitful

Creation and Initial Validation of the International Dysphagia Diet Standardisation Initiative Functional Diet Scale

OBJECTIVE: To assess consensual validity, interrater reliability, and criterion validity of the International Dysphagia Diet Standardisation Initiative Functional Diet Scale, a new functional outcome scale intended to capture the severity of oropharyngeal dysphagia, as represented by the degree of diet texture restriction recommended for the patient. DESIGN: Participants assigned International Dysphagia Diet Standardisation Initiative Functional Diet Scale scores to 16 clinical cases. Consensual validity was measured against reference scores determined by an author reference panel. Interrater reliability was measured overall and across quartile subsets of the dataset. Criterion validity was evaluated versus Functional Oral Intake Scale (FOIS) scores assigned by survey respondents to the same case scenarios. Feedback was requested regarding ease and likelihood of use. SETTING: Web-based survey. PARTICIPANTS: Respondents (N=170) from 29 countries. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Consensual validity (percent agreement and Kendall tau), criterion validity (Spearman rank correlation), and interrater reliability (Kendall concordance and intraclass coefficients). RESULTS: The International Dysphagia Diet Standardisation Initiative Functional Diet Scale showed strong consensual validity, criterion validity, and interrater reliability. Scenarios involving liquid-only diets, transition from nonoral feeding, or trial diet advances in therapy showed the poorest consensus, indicating a need for clear instructions on how to score these situations. The International Dysphagia Diet Standardisation Initiative Functional Diet Scale showed greater sensitivity than the FOIS to specific changes in diet. Most (\u3e70%) respondents indicated enthusiasm for implementing the International Dysphagia Diet Standardisation Initiative Functional Diet Scale. CONCLUSIONS: This initial validation study suggests that the International Dysphagia Diet Standardisation Initiative Functional Diet Scale has strong consensual and criterion validity and can be used reliably by clinicians to capture diet texture restriction and progression in people with dysphagia

Urinary, Plasma, and Serum Biomarkers’ Utility for Predicting Acute Kidney Injury Associated With Cardiac Surgery in Adults: A Meta-analysis

BackgroundEarly accurate detection of acute kidney injury (AKI) occurring after cardiac surgery may improve morbidity and mortality. Although several novel biomarkers have been developed for the early detection of AKI, their clinical utility in the critical intraoperative and immediate postoperative period remains unclear.Study DesignSystematic review and meta-analysis.Setting & PopulationAdult patients having cardiac surgery.Selection Criteria for StudiesEMBASE, CINAHL, Cochrane Library, Scopus, and PubMed from January 1990 until January 2015 were systematically searched for cohort studies reporting the utility of novel biomarkers for the early diagnosis of AKI after adult cardiac surgery. Reviewers extracted data for study design, population, timing of biomarker measurement and AKI occurrence, biomarker performance (area under the receiver operating characteristic curve [AUROC]), and risk of bias.Index TestsNovel urine, plasma, and serum AKI biomarkers, measured intraoperatively and in the early postoperative period (<24 hours).Reference TestsAKI was defined according to the RIFLE, AKIN, or 2012 KDIGO criteria.ResultsWe found 28 studies reporting intraoperative and/or early postoperative measurement of urine (n=23 studies) or plasma or serum (n=12 studies) biomarkers. Only 4 of these studies measured biomarkers intraoperatively. Overall, intraoperative discrimination by the urine biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury marker 1 (KIM-1) demonstrated AUROCs<0.70, whereas N-acetyl-β-d-glucosaminidase (NAG) and cystatin C had AUROCs<0.75. In the immediate 24-hour postoperative period, the urine biomarkers NGAL (16 studies), KIM-1 (6 studies), and liver-type fatty acid binding protein (6 studies) exhibited composite AUROCs of 0.69 to 0.72. The composite AUROCs for postoperative urine cystatin C, NAG, and interleukin 18 were ≤0.70. Similarly, the composite AUROCs for postoperative plasma NGAL (6 studies) and cystatin-C (5 studies) were <0.70.LimitationsHeterogeneous AKI definitions.ConclusionsIn adults, known urinary, plasma, and serum biomarkers of AKI possess modest discrimination at best when measured within 24 hours of cardiac surgery

Dietary nitrate and diet quality: An examination of changing dietary intakes within a representative sample of Australian women

Dietary nitrate is increasingly linked to a variety of beneficial health outcomes. Our purpose was to estimate dietary nitrate consumption and identify key dietary changes which have occurred over time within a representative sample of Australian women. Women from the 1946–1951 cohort of the Australian Longitudinal Study on Women’s Health with complete food frequency questionnaire data for both 2001 and 2013 were included for analysis. Dietary nitrate intakes were calculated using key published nitrate databases. Diet quality scores including the Australian Recommended Food Score, the Mediterranean Diet Score and the Nutrient Rich Foods Index were calculated along with food group serves as per the Australian Dietary Guidelines. Wilcoxon matched pairs tests were used to test for change in dietary intakes and Spearman’s correlations were used to examine associations. In our sample of 8161 Australian women, dietary nitrate intakes were on average 65–70 mg/day, and we detected a significant increase in dietary nitrate consumption over time (+6.57 mg/day). Vegetables were the primary source of dietary nitrate (81–83%), in particular lettuce (26%), spinach (14–20%), beetroot (10–11%), and celery (7–8%) contributed primarily to vegetable nitrate intakes. Further, increased dietary nitrate intakes were associated with improved diet quality scores (r = 0.3, p \u3c 0.0001). Although there is emerging evidence indicating that higher habitual dietary nitrate intakes are associated with reduced morbidity and mortality, future work in this area should consider how dietary nitrate within the context of overall diet quality can facilitate health to ensure consistent public health messages are conveyed

Targeting Aquaporin-4 Subcellular Localization to Treat Central Nervous System Edema

Swelling of the brain or spinal cord (CNS edema) affects millions of people every year. All potential pharmacological interventions have failed in clinical trials, meaning that symptom management is the only treatment option. The water channel protein aquaporin-4 (AQP4) is expressed in astrocytes and mediates water flux across the blood-brain and blood-spinal cord barriers. Here we show that AQP4 cell-surface abundance increases in response to hypoxia-induced cell swelling in a calmodulin-dependent manner. Calmodulin directly binds the AQP4 carboxyl terminus, causing a specific conformational change and driving AQP4 cell-surface localization. Inhibition of calmodulin in a rat spinal cord injury model with the licensed drug trifluoperazine inhibited AQP4 localization to the blood-spinal cord barrier, ablated CNS edema, and led to accelerated functional recovery compared with untreated animals. We propose that targeting the mechanism of calmodulin-mediated cell-surface localization of AQP4 is a viable strategy for development of CNS edema therapies