Patients' and partners' health-related quality of life before and 4 months after coronary artery bypass grafting surgery

Background: Patients having coronary artery bypass grafting (CABG) often depend on their partners for assistance before and after surgery. Whilst patients' physical and mental health usually improves after surgery little is known about the partners' health-related quality of life (HRQoL) in CABG. If the partners' physical and emotional health is poor this can influence their caregiving role and ability to support the patient. This study aimed: to increase understanding of patients' and partners' HRQoL before and after CABG; to explore whether patients' and partners' pre-operative socio-demographics and HRQoL predict their own, and also partners' HRQoL 4 months after CABG. Methods: This prospective study recruited 84 dyads (patients 84% males, aged 64.5 years; partners 94% females, aged 61.05 years). Patients' and partners' perceived health status was assessed using the Short-Form 12 Health Survey. Patients' physical limitation, angina symptoms and treatment satisfaction were assessed using the Seattle Angina Questionnaire. Partners' emotional, physical and social functioning was assessed using the Quality of Life of Cardiac Spouses Questionnaire. Data were analysed using hierarchical multiple (logistic) regressions, repeated measures analysis of variance, paired t test and Chi square. Results: Patients most likely to have poorer physical health post-operatively were associated with partners who had poorer pre-operative physical health. Partners most likely to have poorer emotional, physical and social functioning post-operatively were associated with patients who had poorer pre-operative mental health. Patients" and partners' poorer post-operative HRQoL was also explained by their poorer pre-operative HRQoL. Conclusion: The partners' involvement should be considered as part of patients' pre-operative assessment. Special attention needs be paid to patients' pre-operative mental health since it is likely to impact on their post-operative mental health and the partner's emotional, physical and social functioning

Is your patient FIT & SAFE? A quality improvement project on the discharge of asthmatic patients from the Emergency Department: a UK based study project

Objective: The aim of the quality improvement project was to ensure that 80% of patients discharged from the Emergency Department received the Royal College of Emergency Medicine (RCEM) standards of asthma care.Methodology: We used the model for improvement’s plan, do, study, act (PDSA) methodology to accomplish this aim. 5 adult patients (>16 years) who presented with an asthma exacerbation and were discharged were selected per week. Patient notes were reviewed to see if they complied with the RCEM standards. Six PDSA cycles were carried out using a mixture of outcome, process and balancing measures. Various change ideas were introduced, tested an iterated including: a discharge mnemonic for asthma patients (FIT & SAFE) was derived and introduced, tailored teaching sessions for doctors and nurses, regular updates to staff using email and social media, and an electronic, asthma clerking pro-forma. Data was entered into run charts.Results: Baseline data was collected for 62 patients prior to the introduction of the change ideas. The results 12 weeks post PDSA cycles were as follows: psychosocial factors (25.8% vs 81.3%), inhaler technique (14.5% vs 53.3%), inhaler type (17.7% vs 84.2%), correct dose of prednisolone for 5 days (59.6% vs 81.5%), written advice (4.8%  vs 21.1%), and to see GP/clinic follow-up in 2 working days (37% vs 60.8%).Conclusion: There was a significant increase across most domains of the discharge process as recommended by the RCEM, after 12 weeks of implementation of various change ideas in the department

Is your patient FIT & SAFE? A quality improvement project on the discharge of asthmatic patients from the Emergency Department: a UK based study project

Objective: The aim of the quality improvement project was to ensure that 80% of patients discharged from the Emergency Department received the Royal College of Emergency Medicine (RCEM) standards of asthma care.Methodology: We used the model for improvement’s plan, do, study, act (PDSA) methodology to accomplish this aim. 5 adult patients (>16 years) who presented with an asthma exacerbation and were discharged were selected per week. Patient notes were reviewed to see if they complied with the RCEM standards. Six PDSA cycles were carried out using a mixture of outcome, process and balancing measures. Various change ideas were introduced, tested an iterated including: a discharge mnemonic for asthma patients (FIT & SAFE) was derived and introduced, tailored teaching sessions for doctors and nurses, regular updates to staff using email and social media, and an electronic, asthma clerking pro-forma. Data was entered into run charts.Results: Baseline data was collected for 62 patients prior to the introduction of the change ideas. The results 12 weeks post PDSA cycles were as follows: psychosocial factors (25.8% vs 81.3%), inhaler technique (14.5% vs 53.3%), inhaler type (17.7% vs 84.2%), correct dose of prednisolone for 5 days (59.6% vs 81.5%), written advice (4.8%  vs 21.1%), and to see GP/clinic follow-up in 2 working days (37% vs 60.8%).Conclusion: There was a significant increase across most domains of the discharge process as recommended by the RCEM, after 12 weeks of implementation of various change ideas in the department

Impairment in Theory of Mind in Parkinson’s Disease Is Explained by Deficits in Inhibition

Objective. Several studies have reported that people with Parkinson's disease (PD) perform poorly on tests of 'Theory of Mind' (ToM), suggesting impairment in the ability to understand and infer other people's thoughts and feelings. However, few studies have sought to separate the processes involved in social reasoning from those involved in managing the inhibitory demands on these tests. In this study, we investigated the contribution of inhibition to ToM performance in PD. Methods. 18 PD patients and 22 age-matched healthy controls performed a ToM test that separates the ability to infer someone else's perspective from the ability to inhibit one's own. Participants also completed a battery of standard measures of social and executive functioning, including measures of inhibition. Results. The PD patients performed worse on the ToM test only when the inhibitory demands were high. When the level of inhibition required was reduced, there were no significant group differences. Furthermore, executive impairments in PD patients were limited to measures of inhibition, with disadvantages associated with poorer ToM performance in this group. Conclusions. This study provides convincing evidence that the apparent impairment observed on ToM tests in PD is explained by deficits in inhibition

A modified Delphi study to enhance and gain international consensus on the Physical Activity Messaging Framework (PAMF) and Checklist (PAMC)

Abstract Introduction Physical activity messaging is an important step in the pathway towards improving population physical activity levels, but best practice is not yet understood. A gap in the literature exists for a physical activity messaging framework to help guide creation and evaluation of messages. This study aimed to further develop and improve, and gain international expert consensus on, a standardised Physical Activity Messaging Framework and Checklist. Methods A modified Delphi study consisting of three online survey rounds was conducted. Each survey gathered feedback from an international expert panel using quantitative and qualitative methods. The framework and checklist were amended between each round based on survey results until consensus (defined a priori as 80% agreement) was reached. Results The final expert panel (n = 40, 55% female) came from nine countries and comprised academics (55%), healthcare and other professionals (22.5%) and government officials or policymakers (22.5%). Consensus was reached in survey 3 with 85 and 87.5% agreement on the framework and checklist, respectively. Conclusion This study presents an expert- and evidence-informed framework and checklist for physical activity messaging. If used consistently, the Physical Activity Messaging Framework and Checklist may improve practice by encouraging evidence-based and target audience-focused messages, as well as enhance the research base on physical activity messaging by harmonising key terminologies and improving quality of reporting. Key next steps include further refining the Physical Activity Messaging Framework and Checklist based on their use in real-world settings

The Future of U.S. Natural Gas Production, Use, and Trade

Abstract and PDF report are also available on the MIT Joint Program on the Science and Policy of Global Change website (http://globalchange.mit.edu/)Two computable general equilibrium models, one global and the other providing U.S. regional detail, are applied to analysis of the future of U.S. natural gas as an input to an MIT study of the topic. The focus is on uncertainties including the scale and cost of gas resources, the costs of competing technologies, the pattern of greenhouse gas mitigation, and the evolution of global natural gas markets. Results show that the outlook for gas over the next several decades is very favorable. In electric generation, given the unproven and relatively high cost of other low-carbon generation alternatives, gas likely is the preferred alternative to coal. A broad GHG pricing policy would increase gas use in generation but reduce use in other sectors, on a balance increasing its role from present levels. The shale gas resource is a major contributor to this optimistic view of the future of gas, but it is far from a panacea over the longer term. Gas can be an effective bridge to a lower emissions future, but investment in the development of still lower CO2 technologies remains an important priority. Also, international gas resources may well prove to be less costly than those in the U.S., except for the lowest-cost domestic shale resources, and the emergence of an integrated global gas market could result in significant U.S. gas imports.American Clean Skies Foundation, with additional support from the Hess Corporation, the Agencia Nacional de Hidrocarburos (Columbia), the Energy Futures Coalition, and the MIT Energy Initiative

Macroautophagy in lymphatic endothelial cells inhibits T cell-mediated autoimmunity.

Lymphatic endothelial cells (LECs) present peripheral tissue antigens to induce T cell tolerance. In addition, LECs are the main source of sphingosine-1-phosphate (S1P), promoting naive T cell survival and effector T cell exit from lymph nodes (LNs). Autophagy is a physiological process essential for cellular homeostasis. We investigated whether autophagy in LECs modulates T cell activation in experimental arthritis. Whereas genetic abrogation of autophagy in LECs does not alter immune homeostasis, it induces alterations of the regulatory T cell (T reg cell) population in LNs from arthritic mice, which might be linked to MHCII-mediated antigen presentation by LECs. Furthermore, inflammation-induced autophagy in LECs promotes the degradation of Sphingosine kinase 1 (SphK1), resulting in decreased S1P production. Consequently, in arthritic mice lacking autophagy in LECs, pathogenic Th17 cell migration toward LEC-derived S1P gradients and egress from LNs are enhanced, as well as infiltration of inflamed joints, resulting in exacerbated arthritis. Our results highlight the autophagy pathway as an important regulator of LEC immunomodulatory functions in inflammatory conditions

Sensitivity and specificity of the ECAS in Parkinson’s disease and Progressive Supranuclear Palsy

Disentangling Parkinson’s disease (PD) and progressive supranuclear palsy (PSP) may be a diagnostic challenge. Cognitive signs may be useful, but existing screens are often insufficiently sensitive or unsuitable for assessing people with motor disorders. We investigated whether the newly developed ECAS, designed to be used with people with even severe motor disability, was sensitive to the cognitive impairment seen in PD and PSP and able to distinguish between these two disorders. Thirty patients with PD, 11 patients with PSP, and 40 healthy controls were assessed using the ECAS, as well as an extensive neuropsychological assessment. The ECAS detected cognitive impairment in 30% of the PD patients, all of whom fulfilled the diagnostic criteria for mild cognitive impairment. The ECAS was also able to detect cognitive impairment in PSP patients, with 81.8% of patients performing in the impaired range. The ECAS total score distinguished between the patients with PSP and healthy controls with high sensitivity (91.0) and specificity (86.8). Importantly, the ECAS was also able to distinguish between the two syndromes, with the measures of verbal fluency offering high sensitivity (82.0) and specificity (80.0). In sum, the ECAS is a quick, simple, and inexpensive test that can be used to support the differential diagnosis of PSP