Factors of resilience in informal caregivers of people with dementia from integrative international data analysis

Background/Aims: Although caring for a person with dementia can be stressful, some caregivers appear to experience few negative consequences to their well-being. This study aimed to examine what proportion of caregivers demonstrates resilience under different challenging circumstances and to identify factors related to their resilience. Methods: Baseline data from 4 studies from the Netherlands and UK among informal caregivers of people with dementia were harmonized and integrated. Caregiver resilience was defined as high levels of psychological well-being despite different types of high caregiving demands. Multivariate regression analyses identified factors significantly related to caregiver resilience. Results: The integrated data set included 15 harmonized variables with data from 1,048 caregivers facing a high care demand. The prevalence of resilience varied between 35 and 43%, depending on the demand for high care. Being a male caregiver, caring for a female, living apart from your relative, and low caregiver burden were positively related to caregiver resilience. Conclusion: Caregivers have the capacity to demonstrate resilience despite significant challenges. This study demonstrates how harmonization of data from multiple existing studies can be used to increase power and explore the consistency of findings. This contributes to a better understanding of which factors are likely to facilitate caregiver resilience and offers insights for developing services

Production and characterization of monoclonal antibodies raised against recombinant human granzymes A and B and showing cross reactions with the natural proteins

The human serine proteases granzymes A and B are expressed in cytotoplasmic granules of activated cytotoxic T lymphocytes and natural killer cells. Recombinant granzyme A and granzyme B proteins were produced in bacteria, purified and then used to raise specific mouse monoclonal antibodies. Seven monoclonal antibodies (mAb) were raised against granzyme A, which all recognized the same or overlapping epitopes. They reacted specifically in an immunoblot of interleukin-2 (IL-2) stimulated PBMNC with a disulfide-linked homodimer of 43 kDa consisting of 28 kDa subunits. Seven mAb against granzyme B were obtained, which could be divided into two groups, each recognizing a different epitope. On an immunoblot, all mAb reacted with a monomer of 33 kDa protein. By immunohistochemistry, these mAb could be used to detect granzymes A and B expression in activated CTL and NK cells. The availability of these mAb may facilitate studies on the role of human cytotoxic cells in various immune reactions and may contribute to a better understanding of the role of granzmes A and B in the cytotoxic response in vivo

Multi-state mark-recapture models as a novel approach to estimate factors affecting attendance patterns of lactating subantarctic fur seals from Marion Island

Observer-based studies often underestimate key ecological parameters. Here a fresh approach was used to analyse six years (2006–11) of attendance cycles to estimate foraging trip lengths of a lactating flipper-tagged otariid: subantarctic fur seals at Marion Island. Multi-state mark-recapture models were used to calculate detection failures of females, correct estimates accordingly, and investigate the effects of year, season, pup sex and the presence of a telemetry device on attendance cycle parameters. There were no differences between corrected and uncorrected attendance data. This is attributed to the high capture probability across all seasons (range: 83–98%). This illustrates that observer-based studies are useful to augment telemetry studies. Only season and pup sex had a significant impact on female provisioning rates. In winter, foraging trip durations were longer (t-value = 25.22, P <0.0001) and attendance durations shorter (t-value = -2.15, P = 0.01) than during summer. Females with female pups spent a higher proportion of their time on land (χ2 = 6.6, P < 0.05). Male pups have higher growth demands and are larger which suggests they can deplete female milk-stores faster.Department of Science and Technology,through the National Research Foundation (NRF), in support of the Marion Island Marine Mammal Programme (MIMMP) of the MRI.http://journals.cambridge.org/action/displayJournal?jid=ANS2015-12-31hb201

Cyclic fluctuations in acetone concentrations in the blood and milk of clinically healthy dairy cows

Milk samples were taken daily or twice weekly, and blood samples twice weekly, from six clinically healthy dairy cows. Acetone concentration was determined by a new headspace gas-chromatographic method that proved to be suitable in terms of practicality, sensitivity and precision. The concentration of acetone in milk was closely correlated with that in blood (r² = 0,967). There was no relationship between lacteal acetone concentration and either somatic cell count or bacterial infection. In both blood and milk there were fluctuations in acetone concentration that were synchronous between the six cows. The fluctuations were apparently cyclic, with a period of approximately 10 d. Such fluctuations have not previously been reported.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat XI Pro was used to OCR the text and also for the merging and conversion to the final presentation PDF-format.mn201

Long-term follow-up of incomplete stent apposition in patients who received sirolimus-eluting stent for de novo coronary lesions: an intravascular ultrasound analysis.

BACKGROUND: Incomplete stent apposition (ISA) has been previously documented after sirolimus-eluting stent (SES) implantation. The aim of this study was to investigate the long-term intravascular ultrasound (IVUS) findings of ISA in patients who received SES. METHODS AND RESULTS: A total of 13 patients who received SES and showed ISA at follow-up IVUS (follow-up I) were investigated. IVUS was performed on all of these patients 12 months later (follow-up II). Quantitative ISA area measurement was also performed at follow-up I and II. No vascular remodeling was observed in the vessel segment with ISA; external elastic membrane area was 19.4+/-6.6 versus 19.5+/-6.4 mm2 at follow-up I and II, respectively. There was also no significant change in external elastic membrane area between vessel segment with ISA and without ISA (+1.5% versus -3.0%, respectively; P=0.27) at late follow-up. The ISA area, either including (2.5+/-1.7 versus 3.8+/-6.3 mm2; P=NS) or excluding (2.5+/-1.8 versus 2.4+/-1.7 mm2; P=NS) a single patient with aneurysm formation, was not significantly different between follow-up I and II. One patient manifested a coronary aneurysm in the stented segment at late follow-up that was probably present at the initial follow-up but masked by thrombus. It was successfully treated with a covered stent. All patients were asymptomatic, and no patient experienced late thrombotic occlusion. CONCLUSIONS: Vessel dimensions and area of ISA did not change over time, except for 1 coronary aneurysm that became apparent. ISA after implantation of a SES was not associated with adverse events at late follow-up

You escaped! How did you learn during gameplay?

This study investigates the influence of the educational game design elements immersion, collaboration and debriefing, on fostering learning with educational escape rooms. We based the design of the escape room on an educational game design framework that aligns the learning goal and the game goal, that is, escaping from the room. One-hundred-and-twenty-six students, aged between 16 and 20 played the escape room. Measures for learning were pre-and post-tests. The game experience was measured through questionnaires, classroom observations and interviews with students and teachers. The results show a knowledge gain between pre-and post-test. Correlational analysis showed that all three design elements contributed to students' appreciation of the escape room, whereas only immersion had a direct contribution to knowledge gain. Based on the qualitative data it appeared that the used escape boxes contributed most to perceived immersion. Immersion helps students focus on each other and the tasks. Also, a narrative with distinct roles for each student helped to evoke immersion. Unexpectedly, these roles also scaffolded collaboration except for students in the school that engaged in a collaborative learning pedagogy. The study confirms the usability of the framework for game designs, based on theories for the design of physical and hybrid educational games. Practitioner notes What is already known about this topic The escape room as a learning environment appeals to teachers of different disciplines, ages, gender and teaching experiences. Teachers implement escape rooms to create active (hybrid) learning spaces, where learners need a combination of knowledge and skills to solve the subject-based activities. Students and teachers perceive that while participating in escape rooms, students are more engaged, active and learn more compared to regular classes. The assumption is that escape rooms support collaboration and automatically collaborative learning. Review studies on educational escape rooms show that a systematic evaluation is usually absent, disputable or indicates no knowledge gain. Teachers design their educational escape rooms based on digital escape games and/or their experience as players of escape rooms. For digital educational games, important game design aspects are researched. Three main challenges in designing educational games are (1) the participants' transition from the real world to the game world, (2) the alignment of game design aspects and educational aspects and (3) the transfer from attained experiences and knowledge back into the real world. What this paper adds This paper evaluates an educational game design framework for escape rooms, focussing on the above-mentioned main challenges in designing educational games. It investigates the influence of the educational game design elements immersion, collaboration and debriefing, on fostering learning with a hybrid educational escape room. It informs that all three design elements contributed to students' appreciation of the escape room, whereas only immersion had a direct contribution to knowledge gain. The used hybrid escape boxes contributed most to the immersion; scaffolding students to focus on each other and the tasks. Students' collaboration was successfully fostered. However, it scarcely led to collaborative learning during gameplay, due to lack of discussion and reflection needed for deeper understanding. Implications for practice and/or policy The educational escape game framework would help educators creating immersive games, which not only confront learners with meaningful contexts but also give learning gains. The educational escape game framework would help researchers focussing on important and difficult aspects of designing and implementing educational escape rooms to develop and research more effective escape rooms. In guidelines on creating immersion in educational escape games, the notion of physical objects is lacking. In this hybrid escape room, the physical objects such as escape boxes were the most powerful in creating immersion. In addition, the use of sound design in escape games in classrooms seems overrated. Debriefing after the gameplay is perceived necessary to discuss common misunderstandings, to make connections between the topics in various puzzles and to add more content to interest high-achieving students

Association between initiation of adjuvant chemotherapy beyond 30 days after surgery and overall survival among patients with triple-negative breast cancer

Delayed time to chemotherapy (TTC) is associated with decreased outcomes of breast cancer patients. Recently, studies suggested that the association might be subtype-dependent and that TTC within 30 days should be warranted in patients with triple-negative breast cancer (TNBC). The aim of the current study is to determine if TTC beyond 30 days is associated with reduced 10-year overall survival in TNBC patients. We identified all TNBC patients diagnosed between 2006 and 2014 who received adjuvant chemotherapy in the Netherlands. We distinguished between breast-conserving surgery (BCS) vs. mastectomy given the difference in preoperative characteristics and outcomes. The association was estimated with hazard ratios (HRs) using propensity-score matched Cox proportional hazard analyses. In total, 3,016 patients were included. In matched patients who underwent BCS (n = 904), 10-year overall survival was favorable for patients with TTC within 30 days (84.4% vs. 76.9%, p = 0.001). Patients with TTC beyond 30 days were more likely than those with TTC within 30 days to die within 10 years after surgery (HR 1.69 (95% CI 1.22–2.34), p = 0.002). In matched patients who underwent mastectomy (n = 1,568), there was no difference in 10 years overall survival between those with TTC within or beyond 30 days (74.5% vs. 74.7%, p = 0.716), nor an increased risk of death for those with TTC beyond 30 days (HR 1.04 (95% CI 0.84–1.28), p = 0.716). Initiation of adjuvant chemotherapy beyond 30 days is associated with decreased 10 years overall survival in TNBC patients who underwent BCS. Therefore, timelier initiation of chemotherapy in TNBC patients undergoing BCS seems warranted

Usage of TCRAV and TCRBV gene families in human fetal and adult TCR rearrangements

We have investigated fetal and adult T-cell receptor (TCR) A and B V-gene repertoires both by fluorescence-activated cell sorter (FACS) analysis with the avialable TCR V region-specific mAbs and by the polymerase chain reaction (PRC) with TRC V gene family-specific oligonucleotides. Among the low number of CD3+ T cells, most of the TRC V region tested for could be detected by FACS analysis in liver, bone marrow, and spleen derived from a 14-week-old fetus and two 15-weeks-old fetuses. Similarly, the PCR analysis showed that the majority of the TCRAV and TCRBV families were expressed in the peripheral organs of the 13-week-old fetus, although an apparent absence of particular TCR V families was found in liver and bone marrow. This was most probably the consequence of the low number of CD3+ T cells in these organs. In 17-week-old week-old fetal thymi the level of expression of some TCRAV and TCRBV gene families, in particular those that contain single member, was lower compared to post-partum thymi and adult peripheral blood mononuclear cells. The combined data of FACS and PCR analysis demonstrate that TCR genes belonging to the majority of TCR V gene families can be used in TCR α and β chain rearrngements during early human fetal life. Our data also suggest that the expression levels of some of the single member TCR V gene families may be influenced by the development stage

The role of dynamical polarization of the ligand to metal charge transfer excitations in {\em ab initio} determination of effective exchange parameters

The role of the bridging ligand on the effective Heisenberg coupling parameters is analyzed in detail. This analysis strongly suggests that the ligand-to-metal charge transfer excitations are responsible for a large part of the final value of the magnetic coupling constant. This permits to suggest a new variant of the Difference Dedicated Configuration Interaction (DDCI) method, presently one of the most accurate and reliable for the evaluation of magnetic effective interactions. This new method treats the bridging ligand orbitals mediating the interaction at the same level than the magnetic orbitals and preserves the high quality of the DDCI results while being much less computationally demanding. The numerical accuracy of the new approach is illustrated on various systems with one or two magnetic electrons per magnetic center. The fact that accurate results can be obtained using a rather reduced configuration interaction space opens the possibility to study more complex systems with many magnetic centers and/or many electrons per center.Comment: 7 pages, 4 figure

Intravascular ultrasound findings in the multicenter, randomized, double-blind RAVEL (RAndomized study with the sirolimus-eluting VElocity balloon- expandable stent in the treatment of patients with de novo native coronary artery Lesions) trial

BACKGROUND: The goal of this intravascular ultrasound investigation was to provide a more detailed morphological analysis of the local biological effects of the implantation of a sirolimus-eluting stent compared with an uncoated stent. METHODS AND RESULTS: In the RAVEL trial, 238 patients with single de novo lesions were randomized to receive either an 18-mm sirolimus-eluting stent (Bx VELOCITY stent, Cordis) or an uncoated stent (Bx VELOCITY stent). In a subset of 95 patients (sirolimus-eluting stent=48, uncoated stent=47), motorized intravascular ultrasound pullback (0.5 mm/s) was performed at a 6-month follow-up. Stent volumes, total vessel volumes, and plaque-behind-stent volumes were comparable. However, the difference in neointimal hyperplasia (2+/-5 versus 37+/-28 mm3) and percent of volume obstruction (1+/-3% versus 29+/-20%) at 6 months between the 2 groups was highly significant (P<0.001), emphasizing the nearly complete abolition of the proliferative process inside the drug-eluting stent. Analysis of the proximal and distal edge volumes showed no significant difference between the 2 groups in external elastic membrane or lumen and plaque volume at the proximal and distal edges. There was also no evidence of intrastent thrombosis or persisting dissection at the stent edges. Although there was a higher incidence of incomplete stent apposition