Experiences before and after nasogastric and gastrostomy tube insertion with emphasis on mealtimes: a case study of an adolescent with cerebral palsy

Purpose: Adolescents with cerebral palsy may need a feeding tube due to feeding challenges, since nutritional intake and mealtimes may be negatively affected. The purpose of the study was to describe and better understand how one adolescent with cerebral palsy and her parents experienced mealtimes before and after a nasogastric and gastrostomy tube insertion and how the use of these feeding tubes was experienced in daily life. Methods: Individual interviews were performed with one adolescent and each of her parents. In total, six interviews were conducted on two separate occasions. The qualitative approach known as Interpretive Description was used during the analysis. Results: Four thematic patterns were identified within the data: (i) struggling with nutritional intake, (ii) the paradox of using an aid, (iii) being different, and (iv) challenges of public mealtimes. Conclusions: The results showed that four themes influenced daily mealtimes in adolescents with cerebral palsy and a gastrostomy tube. Nutritional intake and mealtimes may be difficult, which is why using a gastrostomy tube can be a relief. However, the gastrostomy tube can also pose a challenge and a paradox. Time of change and acceptance seems necessary in order to meet these challenges

Waiting time for cancer treatment and mental health among patients with newly diagnosed esophageal or gastric cancer: a nationwide cohort study

Background Except for overall survival, whether or not waiting time for treatment could influences other domains of cancer patients’ overall well-being is to a large extent unknown. Therefore, we performed this study to determine the effect of waiting time for cancer treatment on the mental health of patients with esophageal or gastric cancer. Methods Based on the Swedish National Quality Register for Esophageal and Gastric Cancers (NREV), we followed 7,080 patients diagnosed 2006–2012 from the time of treatment decision. Waiting time for treatment was defined as the interval between diagnosis and treatment decision, and was classified into quartiles. Mental disorders were identified by either clinical diagnosis through hospital visit or prescription of psychiatric medications. For patients without any mental disorder before treatment, the association between waiting time and subsequent onset of mental disorders was assessed by hazard ratios (HRs) with 95% confidence interval (CI), derived from multivariable-adjusted Cox model. For patients with a preexisting mental disorder, we compared the rate of psychiatric care by different waiting times, allowing for repeated events. Results Among 4,120 patients without any preexisting mental disorder, lower risk of new onset mental disorders was noted for patients with longer waiting times, i.e. 18–29 days (HR 0.86; 95% CI 0.74-1.00) and 30–60 days (HR 0.79; 95% CI 0.67-0.93) as compared with 9–17 days. Among 2,312 patients with preexisting mental disorders, longer waiting time was associated with more frequent psychiatric hospital care during the first year after treatment (37.5% higher rate per quartile increase in waiting time; p for trend = 0.0002). However, no such association was observed beyond one year nor for the prescription of psychiatric medications. Conclusions These data suggest that waiting time to treatment for esophageal or gastric cancer may have different mental health consequences for patients depending on their past psychiatric vulnerabilities. Our study sheds further light on the complexity of waiting time management, and calls for a comprehensive strategy that takes into account different domains of patient well-being in addition to the overall survival.This study was partly supported by the Swedish Cancer Society (grant No: CAN 2014/417).Peer Reviewe

Affinity proteomics reveals elevated muscle proteins in plasma of children with cerebral malaria

Systemic inflammation and sequestration of parasitized erythrocytes are central processes in the pathophysiology of severe Plasmodium falciparum childhood malaria. However, it is still not understood why some children are more at risks to develop malaria complications than others. To identify human proteins in plasma related to childhood malaria syndromes, multiplex antibody suspension bead arrays were employed. Out of the 1,015 proteins analyzed in plasma from more than 700 children, 41 differed between malaria infected children and community controls, whereas 13 discriminated uncomplicated malaria from severe malaria syndromes. Markers of oxidative stress were found related to severe malaria anemia while markers of endothelial activation, platelet adhesion and muscular damage were identified in relation to children with cerebral malaria. These findings suggest the presence of generalized vascular inflammation, vascular wall modulations, activation of endothelium and unbalanced glucose metabolism in severe malaria. The increased levels of specific muscle proteins in plasma implicate potential muscle damage and microvasculature lesions during the course of cerebral malaria

Functional diversity and trait composition of vascular plant and Sphagnum moss communities during peatland succession across land uplift regions

1. Most of the carbon accumulated into peatlands is derived from Sphagnum mosses. During peatland development, the relative share of vascular plants and Sphagnum mosses in the plant community changes, which impacts ecosystem functions. Little is known on the successional development of functional plant traits or functional diversity in peatlands, although this could be a key for understanding the mechanisms behind peatland resistance to climate change. Here we aim to assess how functionality of successive plant communities change along the autogenic peatland development and the associated environmental gradients, namely peat thickness and pH, and to determine whether trait trade-offs during peatland succession are analogous between vascular plant and moss communities. 2. We collected plant community and trait data on successional peatland gradients from post-glacial rebound areas in coastal Finland, Sweden and Russia, altogether from 47 peatlands. This allowed us to analyse the changes in community-weighted mean trait values and functional diversity (diversity of traits) during peatland development. 3. Our results show comparative trait trade-offs from acquisitive species to conservative species in both vascular plant and Sphagnum moss communities during peatland development. However, mosses had higher resistance to environmental change than vascular plant communities. This was seen in the larger proportion of intraspecific trait variation than species turnover in moss traits, while the proportions were opposite for vascular plants. Similarly, the functional diversity of Sphagnum communities increased during the peatland development, while the opposite occurred for vascular plants. Most of the measured traits showed a phylogenetic signal. More so, the species common to old successional stages, namely Ericacae and Sphagna from subgroup Acutifolia were detected as most similar to their phylogenetic neighbours. 4. Synthesis. During peatland development, vegetation succession leads to the dominance of conservative plant species accustomed to high stress. At the same time, the autogenic succession and ecological engineering of Sphagna leads to higher functional diversity and intraspecific variability, which together indicate higher resistance towards environmental perturbations

Drought and Waterlogging Stress Regimes in Northern Peatlands Detected Through Satellite Retrieved Solar-Induced Chlorophyll Fluorescence

The water table depth (WTD) in peatlands determines the soil carbon decomposition rate and influences vegetation growth, hence the above-ground carbon assimilation. Here, we used satellite-observed Solar-Induced chlorophyll Fluorescence (SIF) as a proxy of Gross Primary Production (GPP) to investigate water-related vegetation stress over northern peatlands. A linear model with interaction effects was used to relate short- and long-term anomalies in SIF with WTD anomalies and the absolute WTD. Most locations showed the occurrence of drought and waterlogging stress though regions with exclusively waterlogging or drought stress were also detected. As a spatial median, minimal water-related vegetation stress was found for a WTD of -0.22 m (short-term) and -0.20 m (long-term) (+/- 0.01 m, 95% confidence interval of statistical uncertainty). The stress response observed with SIF is supported by an analysis of in situ GPP data. Our findings provide insight into how changes in WTD of northern peatlands could affect GPP under climate change.Water table depth is an important variable influencing the carbon cycle and vegetation growth in northern peatlands. In this paper, the impact of changing wetness conditions on vegetation growth over peatlands was studied through satellite measurements of solar-induced fluorescence (SIF), which is a radiation signal emitted by vegetation during photosynthesis. Previous studies over ecosystems on mineral soil, that is, not over peatland, suggested a response of SIF to drought conditions. In our study, it was shown that peatland vegetation experiences moisture-related growth stress under both very wet and very dry conditions, which might reduce the photosynthesis efficiency and the ability to capture and store CO2. Stress due to drought conditions was detected for peatlands in the south of the Western Siberian Lowlands and the Boreal Plains. Stress due to prolonged wet conditions occurred for example, in the north of the Western Siberian Lowlands and the north of the Hudson Bay Lowlands.Spaceborne Solar-Induced Fluorescence (SIF) data was used to analyze soil moisture-related vegetation stress regimes in northern peatlandsFor most locations, waterlogging as well as drought stress regimes occurred and alternated depending on peatland water level dynamicsThe SIF-based stress response observations are supported by in situ data of Gross Primary Productio

Reduced expression of OXPHOS and DNA damage genes is linked to protection from microvascular complications in long-term type 1 diabetes : the PROLONG study

Type 1 diabetes is a chronic autoimmune disease requiring insulin treatment for survival. Prolonged duration of type 1 diabetes is associated with increased risk of microvascular complications. Although chronic hyperglycemia and diabetes duration have been considered as the major risk factors for vascular complications, this is not universally seen among all patients. Persons with long-term type 1 diabetes who have remained largely free from vascular complications constitute an ideal group for investigation of natural defense mechanisms against prolonged exposure of diabetes. Transcriptomic signatures obtained from RNA sequencing of the peripheral blood cells were analyzed in non-progressors with more than 30 years of diabetes duration and compared to the patients who progressed to microvascular complications within a shorter duration of diabetes. Analyses revealed that non-progressors demonstrated a reduction in expression of the oxidative phosphorylation (OXPHOS) genes, which were positively correlated with the expression of DNA repair enzymes, namely genes involved in base excision repair (BER) machinery. Reduced expression of OXPHOS and BER genes was linked to decrease in expression of inflammation-related genes, higher glucose disposal rate and reduced measures of hepatic fatty liver. Results from the present study indicate that at transcriptomic level reduction in OXPHOS, DNA repair and inflammation-related genes is linked to better insulin sensitivity and protection against microvascular complications in persons with long-term type 1 diabetes.Peer reviewe

A case report of vibration-induced hand comorbidities in a postwoman

<p>Abstract</p> <p>Background</p> <p>Prolonged exposure to hand-transmitted vibration is associated with an increased occurrence of symptoms and signs of disorders in the vascular, neurological and osteoarticular systems of the upper limbs. However, the available epidemiological evidence is derived from studies on high vibration levels caused by vibratory tools, whereas little is known about possible upper limb disorders caused by chronic exposure to low vibration levels emitted by fixed sources.</p> <p>Case presentation</p> <p>We present the case of a postwoman who delivered mail for 15 years using a low-powered motorcycle. The woman was in good health until 2002, when she was diagnosed with bilateral Raynaud's phenomenon. In March 2003 a bilateral carpal tunnel syndrome was electromyographically diagnosed; surgical treatment was ineffective. Further examinations in 2005 highlighted the presence of chronic tendonitis (right middle finger flexor).</p> <p>Risk assessment</p> <p>From 1987, for 15 years, our patient rode her motorcycle for 4 h/day, carrying a load of 20-30 kg. For about a quarter of the time she drove over country roads. Using the information collected about the tasks carried out every day by the postwoman and some measurements performed on both handles of the motorcycle, as well as on both iron parts of the handlebars, we reconstructed the woman's previous exposure to hand-arm vibration. 8-hour energy-equivalent frequency weighted acceleration was about 2.4 m/s². The lifetime dose was 1.5 × 10⁹(m²/s⁴)hd.</p> <p>Conclusions</p> <p>The particular set of comorbidities presented by our patient suggests a common pathophysiological basis for all the diseases. Considering the level of exposure to vibrations and the lack of specific knowledge on the effects of vibration in women, we hypothesize an association between the work exposure and the onset of the diseases.</p

Decreased soil moisture due to warming drives phylogenetic diversity and community transitions in the tundra

Global warming leads to drastic changes in the diversity and structure of Arctic plant communities. Studies of functional diversity within the Arctic tundra biome have improved our understanding of plant responses to warming. However, these studies still show substantial unexplained variation in diversity responses. Complementary to functional diversity, phylogenetic diversity has been useful in climate change studies, but has so far been understudied in the Arctic. Here, we use a 25 year warming experiment to disentangle community responses in Arctic plant phylogenetic β diversity across a soil moisture gradient. We found that responses varied over the soil moisture gradient, where meadow communities with intermediate to high soil moisture had a higher magnitude of response. Warming had a negative effect on soil moisture levels in all meadow communities, however meadows with intermediate moisture levels were more sensitive. In these communities, soil moisture loss was associated with earlier snowmelt, resulting in community turnover towards a more heath-like community. This process of 'heathification' in the intermediate moisture meadows was driven by the expansion of ericoid and Betula shrubs. In contrast, under a more consistent water supply Salix shrub abundance increased in wet meadows. Due to its lower stature, palatability and decomposability, the increase in heath relative to meadow vegetation can have several large scale effects on the local food web as well as climate. Our study highlights the importance of the hydrological cycle as a driver of vegetation turnover in response to Arctic climate change. The observed patterns in phylogenetic β diversity were often driven by contrasting responses of species of the same functional growth form, and could thus provide important complementary information. Thus, phylogenetic diversity is an important tool in disentangling tundra response to environmental change.This study was supported by The Swedish Research Council FORMAS (No. 942-2015-1382 to RGB and 2016-01187 to MPB), The Swedish Research Council (No. 621-2014-5315 to RGB and No. 2015-04857 to AA), the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement (No: 657627 to MPB), BECC—Biodiversity and Ecosystem services in a Changing Climate, the Swedish Foundation for Strategic Research (AA), the Royal Botanic Gardens, Kew (AA), Qatar Petroleum (JMA), and Carl Tryggers Stiftelse för Vetenskaplig Forskning (JMA and MPB)

Rapid Identification of Bio-Molecules Applied for Detection of Biosecurity Agents Using Rolling Circle Amplification

Detection and identification of pathogens in environmental samples for biosecurity applications are challenging due to the strict requirements on specificity, sensitivity and time. We have developed a concept for quick, specific and sensitive pathogen identification in environmental samples. Target identification is realized by padlock- and proximity probing, and reacted probes are amplified by RCA (rolling-circle amplification). The individual RCA products are labeled by fluorescence and enumerated by an instrument, developed for sensitive and rapid digital analysis. The concept is demonstrated by identification of simili biowarfare agents for bacteria (Escherichia coli and Pantoea agglomerans) and spores (Bacillus atrophaeus) released in field