Improving the Quality of Elder Care: The Continuing Care Retirement Community

Includes bibliographical references.By 2020, the segment of the population 65 and older will have increased by 42% to reach over one million persons and those 85 and older will number roughly 129,000. These trends indicate an increase in the demands for social services, such as housing and formal health care, including long-term nursing care. One option that provides for the needs of the elderly is the Continuing Care Retirement Community (CCRC)

The ultrasonographic medullary 'rim sign' versus medullary 'band sign' in cats and their association with renal disease

Background Medullary rim sign (MRS) refers to a hyperechoic line in the renal medulla, reported on ultrasound examination (US) in both dogs and cats with and without kidney disease (KD). Objective To describe the different aspects of MRS in cats and to assess its association with KD. Animals Cats that underwent US examination, with MRS (study group) with and without KD and without MRS with and without KD (control groups). Methods Retrospective case-control study: cats with MRS, with or without KD (rim sign groups) and cats without MRS, with or without KD (control groups). Ultrasonographic images were blindly reviewed with attention given to the thickness and margins of the MRS recorded. Results Eighty-four cats with MRS were included and 60 cats recruited for each control group. The MRS had 2 distinct aspects: a thin hyperechoic line with well-defined margins (MRS-line) in 50/84 cats (59%) and a thick hyperechoic band with ill-defined margins (MRS-band) in 34/84 cats (41%). Twenty of 50 (40%) cats with MRS-lineand 25/34 (74%) of cats with MRS-bandhad KD. The frequency of MRS-linewas higher in cats without KD, whereas the presence of MRS-bandwas more frequent in cats with KD (P= .003). Conclusions and Clinical Importance A thick hyperechoic ill-defined band (for which the term medullary band sign is proposed) was more frequently associated with KD, whereas a thin hyperechoic well-defined line (true MRS) may be seen in cats with or without KD

Placement of an artificial urethral sphincter in 8 male dogs with urethral diverticulum.

BACKGROUND: Urethral diverticulum (UD) is a poorly defined anomaly consisting of an outpouching of the urethra. Management without surgical resection is not previously reported in dogs. HYPOTHESIS/OBJECTIVES: Report the outcome of male dogs presented for urinary incontinence with UD treated with an artificial urethral sphincter (AUS). ANIMALS: Eight client-owned dogs with UD treated with an AUS. METHODS: Multicenter retrospective study. Medical records from male dogs with urinary incontinence were reviewed. INCLUSION CRITERIA:  diagnosis of a UD by retrograde cystourethrography, cystoscopy, abdominal ultrasonography or contrast computed tomodensitometry (CT) or a combination of these modalities, AUS placement, and at least 1 follow-up. Urinary continence score (UCS) was attributed retrospectively. RESULTS: Median UCS at presentation was 1/5. A contrast cystourethrogram was diagnostic in 8/8 dogs. All diverticula were saccular, and 7/8 were within the prostatic urethra and 1/8 extended up to the membranous urethra. A congenital origin was suspected in 7 dogs and acquired in 1. Concurrent anomalies included renal dysplasia or chronic pyelonephritis (n = 4), bilateral cryptorchidism (n = 3), and pelvic urinary bladder (n = 3). All dogs were poorly/moderately responsive to phenylpropanolamine. Artificial urethral sphincter placement resulted in improvement in continence in all dogs with a median UCS of 4/5 (5/5 in 2/8 dogs, 4/5 in 5/8 dogs, 3/5 in 1/8 dogs). CONCLUSION: Urethral diverticulum should be considered in male dogs with persistent urinary incontinence not responding to medical management. Artificial urethral sphincter placement is an effective therapeutic option that improved continence scores in all dogs

Antepartal Bed rest: Conflicts, Costs, Controversies and Ethical Considerations

Currently, more than 90% of obstetricians prescribe bed rest for antepartal women who are experiencing complications in pregnancy. Even though researchers have found that bed rest is not effective in reducing preterm births, 20 percent of pregnant women will spend at least one week during pregnancy on bed rest. Preterm premature rupture of membranes (PPROM) accounts for 33% of all preterm births and is significantly associated with maternal, fetal, and neonatal morbidity and mortality risks. Antenatal bed rest creates physical, emotional and financial costs for the patient, families, and third-party payers. National health care dollars spent in 2001 for short gestation was $1,887, 716,535. Treatment decisions are often made on an emotional basis or medical litigation issues rather than ethical outcomes surrounding the threshold of fetal/neonatal viability

Predicting invasive species impacts: a community module functional response approach reveals context dependencies

1. Predatory functional responses play integral roles in predator–prey dynamics, and their assessment promises greater understanding and prediction of the predatory impacts of invasive species. . 2. Other interspecific interactions, however, such as parasitism and higher-order predation, have the potential to modify predator–prey interactions and thus the predictive capability of the comparative functional response approach. . 3. We used a four-species community module (higher-order predator; focal native or invasive predators; parasites of focal predators; native prey) to compare the predatory functional responses of native Gammarus duebeni celticus and invasive Gammarus pulex amphipods towards three invertebrate prey species (Asellus aquaticus, Simulium spp., Baetis rhodani), thus, quantifying the context dependencies of parasitism and a higher-order fish predator on these functional responses. . 4. Our functional response experiments demonstrated that the invasive amphipod had a higher predatory impact (lower handling time) on two of three prey species, which reflects patterns of impact observed in the field. The community module also revealed that parasitism had context-dependent influences, for one prey species, with the potential to further reduce the predatory impact of the invasive amphipod or increase the predatory impact of the native amphipod in the presence of a higher-order fish predator. . 5. Partial consumption of prey was similar for both predators and occurred increasingly in the order A. aquaticus, Simulium spp. and B. rhodani. This was associated with increasing prey densities, but showed no context dependencies with parasitism or higher-order fish predator. . 6. This study supports the applicability of comparative functional responses as a tool to predict and assess invasive species impacts incorporating multiple context dependencies.

Objective Church Environment Audits and Attendee Perceptions of Healthy Eating and Physical Activity Supports within the Church Setting

Interventions in faith-based settings are increasingly popular, due to their effectiveness for improving attendee health outcomes and behaviors. Little past research has examined the important role of the church environment in individual-level outcomes using objective environmental audits. This study examined associations between the objectively measured physical church environment and attendees’ perceptions of physical activity (PA) and healthy eating (HE) supports within the church environment, self-efficacy for PA and HE, and self-reported PA and HE behaviors. Data were collected via church audits and church attendee surveys in 54 churches in a rural, medically underserved county in South Carolina. Multi-level regression was used to analyze associations between the church environment and outcomes. Physical elements of churches were positively related to attendees’ perceptions of church environment supports for PA (B = 0.03, 95% CI = 0.01, 0.05) and HE (B = 0.05, 95% CI = 0.01, 0.09) and there was a significant interaction between perceptions of HE supports and HE church environment. Self-efficacy and behaviors for PA and HE did not show an association with the church environment. Future research should establish a temporal relationship between the church environment and these important constructs for improving health. Future faith-based interventions should apply infrastructure changes to the church environment to influence important mediating constructs to health behavior

The Iowa Homemaker vol.32, no.2

To a Bride, Salli Hearst, page 9 Happily Ever After, Donald C. Charles, page 10 The Bride Wore, Marilyn Bergeson and Patricia Keast, page 11 Here Comes the Bride, Marilyn Wright, page 12 Marriage and College - Yes, Gloria Sheehe, page 13 It’s All In the Family, Floramae Gates, page 14 With This Ring, Jean McGhie, page 15 Veiled In Loveliness, Evelyn Toulouse, page 16 Pots ‘n Pans, Maryann Meldrum, page 17 Proper Thing To Do, Marian Skinner, page 18 For Remembering, Marian Anderson, page 19 Weddings Without Worries, Nancy Voss, page 20 Showers, Joanne Ryals, page 21 Your Highest Hopes, Gayle Dunn, page 22 Bouquet for You, Maryann Meldrum, page 23 Your Trip to the Moon, Alane Baird, page 24 What’s New, Evelyn Toulouse and Dorothy Will, page 28 Information Please, Susan Brown and Mary Doherty, page 32 She Doesn’t Like Surprises and Neither Does He, Ruth Anderson, page 34 Breaking In the Groom, Alice Irvine, page 37 Trends, Joanne Ryals, page 3

Gαq-containing G proteins regulate B cell selection and survival and are required to prevent B cell–dependent autoimmunity

Survival of mature B cells is regulated by B cell receptor and BAFFR-dependent signals. We show that B cells from mice lacking the Gαq subunit of trimeric G proteins (Gnaq−/− mice) have an intrinsic survival advantage over normal B cells, even in the absence of BAFF. Gnaq−/− B cells develop normally in the bone marrow but inappropriately survive peripheral tolerance checkpoints, leading to the accumulation of transitional, marginal zone, and follicular B cells, many of which are autoreactive. Gnaq−/− chimeric mice rapidly develop arthritis as well as other manifestations of systemic autoimmune disease. Importantly, we demonstrate that the development of the autoreactive B cell compartment is the result of an intrinsic defect in Gnaq−/− B cells, resulting in the aberrant activation of the prosurvival factor Akt. Together, these data show for the first time that signaling through trimeric G proteins is critically important for maintaining control of peripheral B cell tolerance induction and repressing autoimmunity