Measuring carer burden in informal carers of patients with long-term conditions.

INTRODUCTION: The aim of this literature review is to identify the most common tools used to measure burden in carers of people with Parkinson's disease (PD), heart failure (HF), multiple sclerosis (MS) and chronic obstructive pulmonary disease (COPD). METHOD: Databases such as Medline, PsycINFO, CINAHL and Academic Search Complete were searched. Studies in which carer burden was measured were included. RESULTS: Zarit Burden Inventory and Caregiver Reaction Assessment were most commonly used to measure carer burden, regardless of the chronic condition. A wide range of other instruments were also used. CONCLUSIONS: Even though a range of tools are available, further improvements are necessary in order to enable healthcare professionals to identify carers experiencing high burden

Learning beyond a single field of nursing through a virtual case-based approach to pre-registration nurse education.

Ensuring that pre-registration student nurses gain the richness of clinical practice to allow them to feel confident and knowledgeable to care for patients of the 21st century is often a challenge. Clinical practice challenges often mean that students will be strategic learners. This article discusses the development of a virtual case-based learning site to provide a rich experience for students to learn

A review of compliance with pain assessments within a UK ICU

Background: Clinical audits highlight areas where care may not be of the desired quality; they are essential to ensure care is safe and effective. Effective assessment and management of pain have been shown to improve patient wellbeing and clinical outcomes. Aim: This audit aimed to identify compliance with pain assessment tools and documentation within intensive care and make recommendations to improve practice. Discussion: Compliance with documenting pain assessments was poor, a finding that is consistent with the literature. Although a wealth of evidence has shown pain assessments are not being completed effectively, this continues to be a problem. Intensive care has significant areas for improvement in this area, which would improve patients' experiences and outcomes. Nurses should be educated in the use of pain assessment tools and compliance. Conclusion: Providing patients in intensive care with appropriate analgesia benefits their physical and psychological health. Areas for improvement identified in this audit include that pain assessments need to be carried out and documented regularly. The audit has implications for practice in that it shows a need for reinforced education for staff, better communication and updates to promote pain assessment and the implementation of guidelines

Microstructural and Rheological Transitions in Bacterial Biofilms

Abstract Biofilms are aggregated bacterial communities structured within an extracellular matrix (ECM). ECM controls biofilm architecture and confers mechanical resistance against shear forces. From a physical perspective, biofilms can be described as colloidal gels, where bacterial cells are analogous to colloidal particles distributed in the polymeric ECM. However, the influence of the ECM in altering the cellular packing fraction (ϕ) and the resulting viscoelastic behavior of biofilm remains unexplored. Using biofilms of Pantoea sp. (WT) and its mutant (ΔUDP), the correlation between biofilm structure and its viscoelastic response is investigated. Experiments show that the reduction of exopolysaccharide production in ΔUDP biofilms corresponds with a seven‐fold increase in ϕ, resulting in a colloidal glass‐like structure. Consequently, the rheological signatures become altered, with the WT behaving like a weak gel, whilst the ΔUDP displayed a glass‐like rheological signature. By co‐culturing the two strains, biofilm ϕ is modulated which allows us to explore the structural changes and capture a change in viscoelastic response from a weak to a strong gel, and to a colloidal glass‐like state. The results reveal the role of exopolysaccharide in mediating a structural transition in biofilms and demonstrate a correlation between biofilm structure and viscoelastic response

Platelet CD36 Signaling Through ERK5 Promotes Caspase-Dependent Procoagulant Activity and Fibrin Deposition In Vivo

Dyslipidemia is a risk factor for clinically significant thrombotic events. In this condition, scavenger receptor CD36 potentiates platelet reactivity through recognition of circulating oxidized lipids. CD36 promotes thrombosis by activating redox-sensitive signaling molecules, such as the MAPK extracellular signal-regulated kinase 5 (ERK5). However, the events downstream of platelet ERK5 are not clear. In this study, we report that oxidized low-density lipoprotein (oxLDL) promotes exposure of procoagulant phosphatidylserine (PSer) on platelet surfaces. Studies using pharmacologic inhibitors indicate that oxLDL-CD36 interaction–induced PSer exposure requires apoptotic caspases in addition to the downstream CD36-signaling molecules Src kinases, hydrogen peroxide, and ERK5. Caspases promote PSer exposure and, subsequently, recruitment of the prothrombinase complex, resulting in the generation of fibrin from the activation of thrombin. Caspase activity was observed when platelets were stimulated with oxLDL. This was prevented by inhibiting CD36 and ERK5. Furthermore, oxLDL potentiates convulxin/glycoprotein VI–mediated fibrin formation by platelets, which was prevented when CD36, ERK5, and caspases were inhibited. Using 2 in vivo arterial thrombosis models in apoE-null hyperlipidemic mice demonstrated enhanced arterial fibrin accumulation upon vessel injury. Importantly, absence of ERK5 in platelets or mice lacking CD36 displayed decreased fibrin accumulation in high-fat diet–fed conditions comparable to that seen in chow diet–fed animals. These findings suggest that platelet signaling through CD36 and ERK5 induces a procoagulant phenotype in the hyperlipidemic environment by enhancing caspase-mediated PSer exposure

Early ultraviolet emission in the Type Ia supernova LSQ12gdj: No evidence for ongoing shock interaction

We present photospheric-phase observations of LSQ12gdj, a slowly-declining, UV-bright Type Ia supernova. Classified well before maximum light, LSQ12gdj has extinction-corrected absolute magnitude $M_B = -19.8$, and pre-maximum spectroscopic evolution similar to SN 1991T and the super-Chandrasekhar-mass SN 2007if. We use ultraviolet photometry from Swift, ground-based optical photometry, and corrections from a near-infrared photometric template to construct the bolometric (1600-23800 \AA) light curve out to 45 days past $B$-band maximum light. We estimate that LSQ12gdj produced $0.96 \pm 0.07$ $M_\odot$ of $^{56}$Ni, with an ejected mass near or slightly above the Chandrasekhar mass. As much as 27% of the flux at the earliest observed phases, and 17% at maximum light, is emitted bluewards of 3300 \AA. The absence of excess luminosity at late times, the cutoff of the spectral energy distribution bluewards of 3000 \AA, and the absence of narrow line emission and strong Na I D absorption all argue against a significant contribution from ongoing shock interaction. However, up to 10% of LSQ12gdj's luminosity near maximum light could be produced by the release of trapped radiation, including kinetic energy thermalized during a brief interaction with a compact, hydrogen-poor envelope (radius $< 10^{13}$ cm) shortly after explosion; such an envelope arises generically in double-degenerate merger scenarios.Comment: 18 pages, 10 figures, accepted to MNRAS; v2 accepted version. Spectra available on WISEReP (http://www.weizmann.ac.il/astrophysics/wiserep/). Natural-system photometry and bolometric light curve available as online tables in MNRAS versio

PRISM (Program of Resources, Information and Support for Mothers): a community-randomised trial to reduce depression and improve women's physical health six months after birth [ISRCTN03464021]

BACKGROUND: In the year after birth one in six women has a depressive illness, 94% experience at least one major health problem (e.g. back pain, perineal pain, mastitis, urinary or faecal incontinence), 26% experience sexual problems and almost 20% have relationship problems with partners. Women with depression report less practical and emotional support from partners, less social support, more negative life events, and poorer physical health and see factors contributing to depression as lack of support, isolation, exhaustion and physical health problems. Fewer than one in three seek help in primary care despite frequent health care contacts. METHODS: Primary care and community-based strategies embedded in existing services were implemented in a cluster-randomised trial involving 16 rural and metropolitan communities, pair-matched, within the State of Victoria, Australia. Intervention areas were also provided with a community development officer for two years. The primary aim was to reduce the relative risk of depression by 20% in mothers six months after birth and to improve their physical health. Primary outcomes were obtained by postal questionnaires. The analysis was by intention-to-treat, unmatched, adjusting for the correlated nature of the data. RESULTS: 6,248 of 10,144 women (61.6%) in the intervention arm and 5057/ 8,411 (60.1%) in the comparison arm responded at six months, and there was no imbalance in major covariates between the two arms. Women's mental health scores were not significantly different in the intervention arm and the comparison arm (MCS mean score 45.98 and 46.30, mean EPDS score 6.91 and 6.82, EPDS ≥ 13 ('probable depression') 15.7% vs. 14.9%, Odds ratio(adj )1.06 (95%CI 0.91–1.24). Women's physical health scores were not significantly different in intervention and comparison arms (PCS mean scores 52.86 and 52.88). CONCLUSION: The combined community and primary care interventions were not effective in reducing depression, or in improving the physical health of mothers six months after birth

SN 2013ai: a link between Hydrogen-rich and Hydrogen-poor Core-collapse Supernovae

We present a study of the optical and near-infrared (NIR) spectra of SN 2013ai along with its light curves. These data range from discovery until 380 days after explosion. SN 2013ai is a fast declining Type II supernova (SN II) with an unusually long rise time, 18.9 2.7 days in the V-band, and a bright V-band peak absolute magnitude of -18.7 0.06 mag. The spectra are dominated by hydrogen features in the optical and NIR. The spectral features of SN 2013ai are unique in their expansion velocities, which, when compared to large samples of SNe II, are more than 1,000 km s-1 faster at 50 days past explosion. In addition, the long rise time of the light curve more closely resembles SNe IIb rather than SNe II. If SN 2013ai is coeval with a nearby compact cluster, we infer a progenitor zero-age main-sequence mass of ∼17 M o˙. After performing light-curve modeling, we find that SN 2013ai could be the result of the explosion of a star with little hydrogen mass, a large amount of synthesized 56Ni, 0.3-0.4 M o˙, and an explosion energy of 2.5-3.0 1051 erg. The density structure and expansion velocities of SN 2013ai are similar to those of the prototypical SN IIb, SN 1993J. However, SN 2013ai shows no strong helium features in the optical, likely due to the presence of a dense core that prevents the majority of γ-rays from escaping to excite helium. Our analysis suggests that SN 2013ai could be a link between SNe II and stripped-envelope SNe.Fil: Davis, Scott. University of California; Estados UnidosFil: Pessi, Priscila Jael. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Astrofísica La Plata. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas. Instituto de Astrofísica La Plata; ArgentinaFil: Fraser, M.. University College Dublin; IrlandaFil: Ertini, Keila Yael. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Astrofísica La Plata. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas. Instituto de Astrofísica La Plata; ArgentinaFil: Martinez, Veronica Laura. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Astrofísica La Plata. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas. Instituto de Astrofísica La Plata; ArgentinaFil: Hoeflich, Peter. Florida State University; Estados UnidosFil: Hsiao, Eric. Florida State University; Estados UnidosFil: Folatelli, Gaston. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Astrofísica La Plata. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas. Instituto de Astrofísica La Plata; ArgentinaFil: Ashall, Chris. University of Hawaii at Manoa; Estados UnidosFil: Phillips, Mark. Carnegie Observatories. Las Campanas Observatory; ChileFil: Anderson, J. P.. European Southern Observatory Chile; ChileFil: Bersten, Melina Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Astrofísica La Plata. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas. Instituto de Astrofísica La Plata; ArgentinaFil: Englert, B.. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas; ArgentinaFil: Fisher, A.. Florida State University; Estados UnidosFil: Benetti, S.. Osservatorio Astronomico di Padova; ItaliaFil: Simaz Bunzel, Adolfo. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Instituto Argentino de Radioastronomía. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto Argentino de Radioastronomía; ArgentinaFil: Burns, Christopher R.. Observatories of the Carnegie Institution for Science; Estados UnidosFil: Chen, T. W.. Stockholm University; SueciaFil: Contreras, Carlos. 9Carnegie Observatories. Las Campanas Observatory; ChileFil: Elias Rosa, N.. Osservatorio Astronomico di Padova; ItaliaFil: Falco, E.. Harvard-Smithsonian Center for Astrophysics; Estados UnidosFil: Galbany, Lluís. Harvard-Smithsonian Center for Astrophysics; Estados UnidosFil: Kirshner, Robert. Harvard-Smithsonian Center for Astrophysics; Estados UnidosFil: Kumar, S.. Florida State University; Estados UnidosFil: Lu, J.. Florida State University; Estados UnidosFil: Lyman, D.. University of Warwick; Reino UnidoFil: Marion, G. H.. University of Warwick; Reino UnidoFil: Mattila, S.. University of Turku; FinlandiaFil: Maund, J.. University of Sheffield; Reino UnidoFil: Morrell, Nidia Irene. Carnegie Observatories. Las Campanas Observatory; ChileFil: Serón, J.. University of Sheffield; Reino UnidoFil: Stritzinger, Maximilian. Aarhus University; DinamarcaFil: Shahbandeh, Melissa. Florida State University; Estados UnidosFil: Sullivan, Mark. Aarhus University; DinamarcaFil: Suntzeff, N. B.. Texas A&M University; Estados UnidosFil: Young, D. R.. Texas A&M University; Estados Unido

Development of a universal psycho-educational intervention to prevent common postpartum mental disorders in primiparous women: a multiple method approach

<p>Abstract</p> <p>Background</p> <p>Prevention of postnatal mental disorders in women is an important component of comprehensive health service delivery because of the substantial potential benefits for population health. However, diverse approaches to prevention of postnatal depression have had limited success, possibly because anxiety and adjustment disorders are also problematic, mental health problems are multifactorially determined, and because relationships amongst psychosocial risk factors are complex and difficult to modify. The aim of this paper is to describe the development of a novel psycho-educational intervention to prevent postnatal mental disorders in mothers of firstborn infants.</p> <p>Methods</p> <p>Data from a variety of sources were synthesised: a literature review summarised epidemiological evidence about neglected modifiable risk factors; clinical research evidence identified successful psychosocial treatments for postnatal mental health problems; consultations with clinicians, health professionals, policy makers and consumers informed the proposed program and psychological and health promotion theories underpinned the proposed mechanisms of effect. The intervention was pilot-tested with small groups of mothers and fathers and their first newborn infants.</p> <p>Results</p> <p><it>What Were We Thinking! </it>is a psycho-educational intervention, designed for universal implementation, that addresses heightened learning needs of parents of first newborns. It re-conceptualises mental health problems in mothers of infants as reflecting unmet needs for adaptations in the intimate partner relationship after the birth of a baby, and skills to promote settled infant behaviour. It addresses these two risk factors in half-day seminars, facilitated by trained maternal and child health nurses using non-psychiatric language, in groups of up to five couples and their four-week old infants in primary care. It is designed to promote confidence and reduce mental disorders by providing skills in sustainable sleep and settling strategies, and the re-negotiation of the unpaid household workload in non-confrontational ways. Materials include a Facilitators' Handbook, creatively designed worksheets for use in seminars, and a book for couples to take home for reference. A website provides an alternative means of access to the intervention.</p> <p>Conclusions</p> <p><it>What Were We Thinking! </it>is a postnatal mental health intervention which has the potential to contribute to psychologically-informed routine primary postnatal health care and prevent common mental disorders in women.</p

SN 2017gmr: An Energetic Type II-P Supernova with Asymmetries

We present high-cadence UV, optical, and near-infrared data on the luminous Type II-P supernova SN2017gmr from hours after discovery through the first 180 days. SN2017gmr does not show signs of narrow, high-ionization emission lines in the early optical spectra, yet the optical light-curve evolution suggests that an extra energy source from circumstellar medium (CSM) interaction must be present for at least 2 days after explosion. Modeling of the early light curve indicates a ∼500 Re progenitor radius, consistent with a rather compact red supergiant, and latetime luminosities indicate that up to 0.130±0.026 Me of 56Ni are present, if the light curve is solely powered by radioactive decay, although the 56Ni mass may be lower if CSM interaction contributes to the post-plateau luminosity. Prominent multipeaked emission lines of Hα and [O I] emerge after day 154, as a result of either an asymmetric explosion or asymmetries in the CSM. The lack of narrow lines within the first 2 days of explosion in the likely presence of CSM interaction may be an example of close, dense, asymmetric CSM that is quickly enveloped by the spherical supernova ejecta