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Plants of Begonia x tuberhybrida ‘Nonstop’, ‘Clips’, and ‘Musical’ were exposed to 1, 2, 3, or 4 weeks of short days (SD, 9 hours day length) initiated at 3 stages of plant development (immediately upon germination, 4 or 8 weeks after germination). Prior to and succeeding short days, plants were exposed to long days (LD, 16 hours day length). Musical flowered on average 68 days, Clips 78 days and Nonstop 83 days after germination under continuous LD conditions. In Nonstop, SD for 1, 2, 3, or 4 weeks delayed plant development by an average 12 days compared to LD grown plants. One, 2, or 3 weeks of SD resulted in 1 week slower flowering and 4 weeks of SD resulted in 2 weeks later flowering in Clips. The sensitivity to SD varied with plant stage in Musical. Three or 4 weeks of SD initiated at germination or 4 weeks after germination resulted in an average delayed flowering of 13 days compared to LD plants. SD initiated 8 weeks after germination had no effect on rate of development in Musical

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The growth regulators chlormequat (Cycocel), paclobutrazol (Bonzi), daminozide (B-Nine) and Bayleton 25WP (triadimefon) were studied for their ability to control plant height in seed propagated tuberous begonia (‘Nonstop’ begonias). Bayleton is a fungicide used for powdery mildew control that also has growth regulator effects. Two ml growth regulator solution was evenly sprayed on each plant two weeks after transplanting. Cycocel (500 parts per million [ppm], 1 mg active ingredient [a.i.] per plant) resulted in 23% shorter plants than the control plants 15 weeks after transplant. Bonzi (5 ppm, 0.01 mg a.i. per plant) treated begonias were 65% and Bayleton (150 mg•liter-1, 0.3 mg per plant) treated plants 43% shorter than the control plants. The number of flowers and shoots was severely reduced on plants treated with Bonzi or Bayleton. BNine was ineffective at the rate of 3000 ppm (6 mg a.i. per plant) for controlling plant height of seed propagated tuberous begonia

Live and let live:Residents' perspectives on alcohol and tobacco (mis)use in residential care facilities

Background Alcohol and tobacco use could cause health problems in older adults. Older adults who become in need of 24/7 care due to physical and/or neurological disabilities may need to move to a Residential Care Facility (RCF). RCFs aim to provide person-centred care (PCC) to enhance quality of life (QoL) of residents. Objectives This study aims to explore perspectives of residents on alcohol and tobacco use, which is essential to provide PCC. Methods A qualitative research design was chosen, and semi-structured interviews were conducted. Residents who use alcohol and/or tobacco and those who do not use these substances were purposively selected in two organisations on two types of units: psychogeriatric units and units providing care for residents with mainly physical disabilities. The results were analysed using thematic analysis. Results Thematic analysis resulted in five themes: Current use and self-reflection, knowledge and attitudes, addiction or habit, policies and availability, dependency versus autonomy. Conclusion Residents in this study value their autonomy regarding alcohol and tobacco use. They experience dependency on their (in)formal caregivers to use these substances and acknowledge that their use could cause a nuisance to others, challenging the ability of caregivers to implement PCC. Future research could assess how to integrate providing PCC to residents by offering choices and autonomy, while considering the addictive component of these substances, health and safety risks for all

Health impact of the first and second wave of COVID-19 and related restrictive measures among nursing home residents:A scoping review

Abstract Background and objectives COVID-19 disproportionally affects older adults living in nursing homes. The purpose of this review was to explore and map the scientific literature on the health impact of COVID-19 and related restrictive measures during the first and second wave among nursing home residents. A specific focus was placed on health data collected among nursing home residents themselves. Research design and methods In this study, best practices for scoping reviews were followed. Five databases were systematically searched for peer-reviewed empirical studies published up until December 2020 in which data were collected among nursing home residents. Articles were categorized according to the type of health impact (physical, social and/or psychological) and study focus (impact of COVID-19 virus or related restrictive measures). Findings were presented using a narrative style. Results Of 60 included studies, 57 examined the physical impact of COVID-19. All of these focused on the direct impact of the COVID-19 virus. These studies often used an observational design and quantitative data collection methods, such as swab testing or reviewing health records. Only three studies examined the psychological impact of COVID-19 of which one study focused on the impact of COVID-19-related restrictive measures. Findings were contradictory; both decreased and improved psychological wellbeing was found during the pandemic compared with before. No studies were found that examined the impact on social wellbeing and one study examined other health-related outcomes, including preference changes of nursing home residents in Advanced Care planning following the pandemic. Discussion and implications Studies into the impact of the first and second wave of the COVID-19 pandemic among nursing home residents predominantly focused on the physical impact. Future studies into the psychological and social impact that collect data among residents themselves will provide more insight into their perspectives, such as lived experiences, wishes, needs and possibilities during later phases of the pandemic. These insights can inform policy makers and healthcare professionals in providing person-centered care during the remaining COVID-19 pandemic and in future crisis periods

User-centered design of a gamified mental health app for adolescents in sub-Saharan Africa: multicycle usability testing study

Background: There is an urgent need for scalable psychological treatments to address adolescent depression in low-resource settings. Digital mental health interventions have many potential advantages, but few have been specifically designed for or rigorously evaluated with adolescents in sub-Saharan Africa. Objective: This study had 2 main objectives. The first was to describe the user-centered development of a smartphone app that delivers behavioral activation (BA) to treat depression among adolescents in rural South Africa and Uganda. The second was to summarize the findings from multicycle usability testing. Methods: An iterative user-centered agile design approach was used to co-design the app to ensure that it was engaging, culturally relevant, and usable for the target populations. An array of qualitative methods, including focus group discussions, in-depth individual interviews, participatory workshops, usability testing, and extensive expert consultation, was used to iteratively refine the app throughout each phase of development. Results: A total of 160 adolescents from rural South Africa and Uganda were involved in the development process. The app was built to be consistent with the principles of BA and supported by brief weekly phone calls from peer mentors who would help users overcome barriers to engagement. Drawing on the findings of the formative work, we applied a narrative game format to develop the Kuamsha app. This approach taught the principles of BA using storytelling techniques and game design elements. The stories were developed collaboratively with adolescents from the study sites and included decision points that allowed users to shape the narrative, character personalization, in-app points, and notifications. Each story consists of 6 modules (“episodes”) played in sequential order, and each covers different BA skills. Between modules, users were encouraged to work on weekly activities and report on their progress and mood as they completed these activities. The results of the multicycle usability testing showed that the Kuamsha app was acceptable in terms of usability and engagement. Conclusions: The Kuamsha app uniquely delivered BA for adolescent depression via an interactive narrative game format tailored to the South African and Ugandan contexts. Further studies are currently underway to examine the intervention’s feasibility, acceptability, and efficacy in reducing depressive symptoms

Update of the CHIP (CT in Head Injury Patients) decision rule for patients with minor head injury based on a multicenter consecutive case series

OBJECTIVE: To update the existing CHIP (CT in Head Injury Patients) decision rule for detection of (intra)cranial findings in adult patients following minor head injury (MHI).METHODS: The study is a prospective multicenter cohort study in the Netherlands. Consecutive MHI patients of 16 years and older were included. Primary outcome was any (intra)cranial traumatic finding on computed tomography (CT). Secondary outcomes were any potential neurosurgical lesion and neurosurgical intervention. The CHIP model was validated and subsequently updated and revised. Diagnostic performance was assessed by calculating the c-statistic.RESULTS: Among 4557 included patients 3742 received a CT (82%). In 383 patients (8.4%) a traumatic finding was present on CT. A potential neurosurgical lesion was found in 73 patients (1.6%) with 26 (0.6%) patients that actually had neurosurgery or died as a result of traumatic brain injury. The original CHIP underestimated the risk of traumatic (intra)cranial findings in low-predicted-risk groups, while in high-predicted-risk groups the risk was overestimated. The c-statistic of the original CHIP model was 0.72 (95% CI 0.69-0.74) and it would have missed two potential neurosurgical lesions and one patient that underwent neurosurgery. The updated model performed similar to the original model regarding traumatic (intra)cranial findings (c-statistic 0.77 95% CI 0.74-0.79, after crossvalidation c-statistic 0.73). The updated CHIP had the same CT rate as the original CHIP (75%) and a similar sensitivity (92 versus 93%) and specificity (both 27%) for any traumatic (intra)cranial finding. However, the updated CHIP would not have missed any (potential) neurosurgical lesions and had a higher sensitivity for (potential) neurosurgical lesions or death as a result of traumatic brain injury (100% versus 96%).CONCLUSIONS: Use of the updated CHIP decision rule is a good alternative to current decision rules for patients with MHI. In contrast to the original CHIP the update identified all patients with (potential) neurosurgical lesions without increasing CT rate.</p

Effect of combination glipizide GITS/metformin on fibrinolytic and metabolic parameters in poorly controlled type 2 diabetic subjects

WSTĘP. Wyniki badań epidemiologicznych wskazują, że podwyższone stężenie inhibitora aktywatora plazminogenu 1 (PAI-1) w surowicy krwi może być wskaźnikiem lub predyktorem przyspieszonego rozwoju choroby wieńcowej u chorych na cukrzycę typu 2. Celem pracy było określenie, czy poprawa wyrównania metabolicznego, niezależnie od rodzaju stosowanych leków doustnych, wpływa na stężenie PAI-1 u chorych ze znaczną hiperglikemią. MATERIAŁ I METODY. Do badania zakwalifikowano 91 chorych. Po okresie 4 tygodni, w którym pacjenci nie przyjmowali żadnych leków, chorych losowo przydzielono do grupy leczonej glipizydem GITS (w dawce maksymalnej 20 mg, n = 46) lub grupy otrzymującej metforminę (maksymalnie 2550 mg, n = 45) w monoterapii. Po okresie monoterapii wprowadzono leczenie skojarzone, dodając drugi lek do preparatu już stosowanego. U wszystkich pacjentów przed i po randomizacji oraz podczas badania oznaczono glikemię (na czczo i po posiłku), stężenie HbA1c, fruktozaminy oraz PAI-1. U części chorych zmierzono również wątrobową produkcję glukozy (HGO, hepatic glucose output) oraz oznaczono rozkład brzusznej tkanki tłuszczowej. WYNIKI. Wyrównanie glikemii na początku badania było niezadowalające (średnie stężenie HbA1c 10,4 &plusmn; 0,2% w grupie glipizydu GITS; 10,0 &plusmn; 0,2% w grupie metforminy), ale poprawiło się istotnie w obu grupach, stosujących monoterapię oraz w wyniku leczenia skojarzonego (p < 0,0001 vs. wyniki wyjściowe), co oceniono na podstawie badania tolerancji posiłku, stężenia fruktozaminy oraz HGO. Masa ciała oraz rozkład brzusznej tkanki tłuszczowej nie zmieniły się istotnie w żadnej z grup. Stężenie PAI-1 było wyjątkowo wysokie (5-10-krotnie wyższe od wartości prawidłowych) na początku badania (202 &plusmn; 12 ng/ml w grupie glipizydu GITS; 201 &plusmn; 13 ng/ml w grupie metforminy), ale istotnie obniżyło się podczas badania, w sposób porównywalny w monoterapii w obu grupach. Podczas leczenia skojarzonego stężenie to uległo dalszemu obniżeniu. WNIOSKI. W przypadkach nasilonej hiperglikemii stężenie PAI-1 jest również znacznie podwyższone. Obniżenie hiperglikemii za pomocą leku nasilającego wydzielanie insuliny, glipizydu GITS lub metforminy, stosowanych w monoterapii, w porównywalny sposób powoduje obniżenie stężenia PAI-1.INTRODUCTION. Epidemiological studies have implicated increased plasminogen-activated inhibitor 1 (PAI-1) as a marker or predictor of accelerated coronary atherosclerotic disease in type 2 diabetes. We sought to determine whether metabolic control, independent of its oral mode of implementation, affects PAI-1 in patients with marked hyperglycemia. MATERIAL AND METHODS. A total of 91 subjects were screened, subjected to a 4-week drug washout, and randomized to daily treatment with glipizide GITS (maximum 20 mg, n = 46) or metformin (maximum 2,550 mg, n = 45) as monotherapy. After monotherapy, combination therapy was initiated by adding the second agent to the regimen. Plasma glucose (fasting and postprandial), HbA1c, fructosamine, and PAI-1 were assayed before and after randomization and sequentially thereafter in all subjects; hepatic glucose output (HGO) and abdominal fat distribution were each measured in a subset of subjects. RESULTS. Glycemic control was markedly impaired at baseline (mean HbA1c 10.4 &#177; 0.2% glipizide GITS; 10.0 &#177; 0.2% metformin) but improved comparably with each agent as monotherapy and in combination (P < 0.0001 vs. baseline), as assessed with meal tolerance studies, fructosamine values, and HGO. Body weight and abdominal fat distribution did not change significantly in either group. PAI-1 concentrations were extraordinarily high (5- to 10-fold more than normal) at baseline (202 &#177; 12 ng/ml glipizide GITS; 201 &#177; 13 ng/ml metformin) but declined comparably, and significantly, after treatment with either agent as monotherapy and decreased further with combination therapy. CONCLUSIONS. When hyperglycemia is profound, increases in PAI-1 are also profound. Control of hyperglycemia with either glipizide GITS, an insulin secretagogue, or metformin as monotherapy comparably ameliorates elevated PAI-1

Chronic airflow obstruction and ambient particulate air pollution

Smoking is the most well-established cause of chronic airflow obstruction (CAO) but particulate air pollution and poverty have also been implicated. We regressed sex-specific prevalence of CAO from 41 Burden of Obstructive Lung Disease study sites against smoking prevalence from the same study, the gross national income per capita and the local annual mean level of ambient particulate matter (PM2.5) using negative binomial regression. The prevalence of CAO was not independently associated with PM2.5 but was strongly associated with smoking and was also associated with poverty. Strengthening tobacco control and improved understanding of the link between CAO and poverty should be prioritised