Knowledge, attitudes and practices of medical staff towards obesity management in patients with spinal cord injuries: an International survey of four western European countries

Objective: To (1) examine the opinions of medical staff working in spinal cord injury (SCI) centres (SCICs); (2) evaluate their knowledge, attitudes and practices towards obesity prevention and management; (3) report the number of beds and dietitians available at each SCIC. Methods: A 37-item questionnaire was sent to 23 SCICs in the UK, the Netherlands, Belgium and the Republic of Ireland between September 2012 and January 2013. Results: Eighteen SCICs returned the questionnaires for analysis. All respondents stated that they had an interest in obesity treatment but only 2.3% of the respondents received training in obesity management. Sixty-one percent of staff did not consider body mass index (BMI) to be appropriate for use in SCI patients and subsequently less than half of the respondents use BMI routinely. The majority of respondents reported that they are confident in dealing with overweight (74.5%) and obese (66.1%) SCI adults, less than half (44.1%) are confident in treating overweight and obese SCI children. Respondents also indicated the need for nationally adopted guidelines and a lack of physical activity provision. There were 17.5 whole-time equivalent (WTE) dietitians recorded in 22 SCICs, equivalent to 47.8 beds per WTE dietitians (range 10–420). Non-UK SCIC dietitians are significantly better resourced than in UK SCICs (beds per WTE dietitian: 36 vs 124, P=0.035). Conclusion: Medical staff expressed the need to participate in obesity prevention and management. Appropriate training should be considered for all medical staff and the development of specific weight management guidelines and dietetic provision should be considered

Wanneer zijn verrolbare glasopstanden economisch verantwoord?

In de winter van 1948/49 werd in de Veenstreek een verrolbare kas gebouwd, welk voorbeeld in dit gebied op vrij grote schaal navolging heeft gevonden. De laatste jaren is de belangstelling voor de verrolbare glasopstanden ook elders in Nederland gegroeid. In het Kennemerland, de Bommelerwaard en Rijnsburg zijn verschillende verrolbare kassen van het z.g. Veense type gebouwd, een constructie met een brede kapspanning en vast glas. Daarnaast heeft zich in Noord-Limburg de verrolbare bak ontwikkeld, die wat hoogte betreft nogal varieert en die in het algemeen het midden houdt tussen platglas en warenhuis. Deze beide verrolbare glasopstanden staan dermate in het centrum van de belangstelling, dat het zinvol is eens te bezien of het bouwen van verrolbare glasopstanden al of niet economisch verantwoord is

Long survival of primary diffuse leptomeningeal gliomatosis following radiotherapy and temozolomide: case report and literature review

<p>Abstract</p> <p>Objective</p> <p>Primary diffuse leptomeningeal gliomatosis (PDLG) is a rare neoplasm with a short survival time of a few months. there is currently no standardized therapeutic approach for PDLG.</p> <p>Materials and methods</p> <p>We report on a 53-year-old male patient who presented with epileptic seizures, gait disturbance, paraparesis and sensory deficits in the dermatomes T8-10.</p> <p>Results</p> <p>Magnetic resonance imaging (MRI) revealing numerous spinal and cranial gadolinium-enhancing nodules in the meninges and histopathology led us to diagnose primary diffuse leptomeningeal gliomatosis with WHO grade III astrocytic cells. Consecutively, the patient underwent craniospinal radiotherapy (30 Gy) and 11 sequential cycles of temozolomide. This regimen led to partial tumor regression. Thirteen months later, spinal MRI revealed tumor progression. Second-line chemotherapy with 5 cycles of irinotecan and bevacizumab did not prevent further clinical deterioration. The patient died twenty-two months after diagnosis, being the longest survival time described thus far with respect to PDLG consisting of astrocytic tumor cells.</p> <p>Conclusions</p> <p>Radiochemotherapy including temozolomide, as established standard therapy for brain malignant astrocytomas, might be valid as a basic therapeutic strategy for this PDLG subtype.</p

Local ecosystem feedbacks and critical transitions in the climate

Global and regional climate models, such as those used in IPCC assessments, are the best tools available for climate predictions. Such models typically account for large-scale land-atmosphere feedbacks. However, these models omit local vegetationenvironment 5 feedbacks that are crucial for critical transitions in ecosystems. Here, we reveal the hypothesis that, if the balance of feedbacks is positive at all scales, local vegetation-environment feedbacks may trigger a cascade of amplifying effects, propagating from local to large scale, possibly leading to critical transitions in the largescale climate. We call for linking local ecosystem feedbacks with large-scale land10 atmosphere feedbacks in global and regional climate models in order to yield climate predictions that we are more confident about

Семантика имен и поэтика их перечислений

Описаны факторы, влияющие на содержательность и эстетическую значимость перечислений поэтонимов в художественных текстах. На ряде примеров из творчества А. С. Пушкина представлены перемены, происходящие в совокупной семантике и поэтике рядов собственных имен в различных контекстах. Показаны некоторые теоретически возможные модели реализации "списков" поэтонимов. Намечены пути дальнейшего изучения художественно значимых перечислений.Обговорюються фактори, які впливають на змістовність та естетичну значущість перерахувань поет онімів у художніх текстах. На низці прикладів з творчості О.С. Пушкіна представлені зміни, які відбуваються у сукупній семантиці й поетиці рядів власних імен у різноманітних контекстах. Показані деякі теоретичні можливості моделювання переліків онімів. Накреслені шляхи подальшого вивчення художньо значимих переліків онімів.The factors which influence pithiness and the aesthetic inventory of poetonyms in art texts are described. On a number of examples from Pushkin works the changes occurring in cumulative semantics and poetics of numbers of proper names in various contexts are presented. Some theoretically possible models of realization of "lists" of onyms are shown. Ways of the further studying of artily significant transfers are planned

Stochastic model to assess bioeconomic impact of PRRS on pig farms in Costa Rica

Despite the economic importance of PRRS and its high prevalence in Costa Rica, there are no studies on the bioeconomic impact of the disease in the country or, even, in Central America. Such studies are essential in finding cost-effective preventive measures tailored for different production circumstances. Therefore, the objective of this study was to evaluate economic and production parameters of a PRRSV-infection for a medium-sized farrow-to-finish pig farm system in Costa Rica with a farm-level stochastic Monte Carlo simulation model. The effect of PRRS was assessed by scenario analysis, in which a baseline PRRS-free situation was compared against three alternative scenarios that assumed low, medium and high PRRS effects. The PRRS effects were based on data from local farms, scientific literature and expert opinion. Sensitivity analyses were performed to assess the impact of key input parameters on output variables. Results show that at the animal level, changes between the baseline and the PRRS-high scenario were estimated as: + 25 d in age to slaughter, - 9.9 pigs to slaughter (per breeding sow/yr), + 6% annual replacement rate, - 255 d in sow productive lifetime, - 6.9 mo in age at culling of sows, and + 24 non- productive days. For a medium size local farm (n = 588 sows), a reduction of 5826 fat pigs to slaughter per farm/yr from baseline compared to PRRS-high scenario was observed. PRRS-induced loss per farm per year was estimated at -US $142,542, US$180,109 and -US $524,719 for PRRS-low, medium and high scenarios, respectively. Revenues/costs ratio changed from 1.12 in the baseline to 0.89 in the PRRS-high scenario. The production cost per kg carcass weight increased from US$2.63 for the baseline to US $3.35 in the PRRS-high scenario. PRRS-induced loss was estimated at US$77.1 per slaughtered pig/yr and US $892 per breeding sow/yr for the PRRS-high scenario. Results from the model indicate that pig farms with medium to high prevalence of PRRS will require optimal market conditions in order to have positive economic outcomes. These results can be helpful in the design of better control strategies for PRRS

Language differences in qualitative research: is meaning lost in translation?

This article discusses challenges of language differences in qualitative research, when participants and the main researcher have the same non-English native language and the non-English data lead to an English publication. Challenges of translation are discussed from the perspective that interpretation of meaning is the core of qualitative research. As translation is also an interpretive act, meaning may get lost in the translation process. Recommendations are suggested, aiming to contribute to the best possible representation and understanding of the interpreted experiences of the participants and thereby to the validity of qualitative research

How caring work of older women gets disappeared: the gendered dynamics of changing everyday occupations in an older German couple

Background: In older couples, everyday occupations need to be adjusted when one of the partners experiences a health decline. Gender dynamics will play a role in this process, yet there is little understanding about how gender can influence and shape changes in couples’ occupations. Aim: To understand the changing occupations of old, independent-living couples when becoming caregivers and care receivers, through a gender lens. Methods: A narrative-in-action methodology with a case-study design has been chosen to enable an in-depth analysis of one couple. Besides joint and individual interviews with both partners, observations were made of their everyday occupations. The analytic process was interpretative, using gender theory as a lens for understanding. Results: In the couple’s narrative there was a difference in the time spent on, and meaning given to, occupations performed by each partner to sustain everyday life. The wife was heavily enrolled in taking care of her husband, a gendered pattern that was rooted in their spousal history. While her efforts were taken-for-granted, his efforts were acknowledged as special. Conclusion: The adjustment of the everyday occupations of this older couple were gendered, and led to a disappearing of the woman’s occupations and the care she was giving. Prevention, Population and Disease management (PrePoD)Geriatrics in primary carePublic Health and primary car

Synergistic effects of drought and deforestation on the resilience of the south-eastern Amazon rainforest

The south-eastern Amazon rainforest is subject to ongoing deforestation and is expected to become drier due to climate change. Recent analyses of the distribution of tree cover in the tropics show three modes that have been interpreted as representing alternative stable states: forest, savanna and treeless states. This situation implies that a change in environmental conditions, such as in the climate, could cause critical transitions from a forest towards a savanna ecosystem. Shifts to savanna might also occur if perturbations such as deforestation exceed a critical threshold. Recovering the forest would be difficult as the savanna will be stabilized by a feedback between tree cover and fire. Here we explore how environmental changes and perturbations affect the forest by using a simple model with alternative tree-cover states. We focus on the synergistic effects of precipitation reduction and deforestation on the probability of regime shifts in the south-eastern Amazon rainforest. The analysis indicated that in a large part of the south-eastern Amazon basin rainforest and savanna could be two alternative states, although massive forest dieback caused by mean-precipitation reduction alone is unlikely. However, combinations of deforestation and climate change triggered up to 6.6 times as many local regime shifts than the two did separately, causing large permanent forest losses in the studied region. The results emphasize the importance of reducing deforestation rates in order to prevent a climate-induced dieback of the south-eastern Amazon rainforest