A comparison of sleep assessment tools by nurses and patients in critical care

Aim The aim of this critical care sleep assessment pilot study was to evaluate the usefulness of three sleep assessment tools to identify which, if any, provided the closest comparison between the nurses’ judgement and the patients’ experience of their sleep. The study objectives were to: (i) compare patients' and nurses' assessment of sleep using three different rating tools. (ii) Ascertain patients’ preferences with non-interventional, user friendly, practical tools in critical care. (iii) Recommend changes and improvements to the way that sleep is assessed and documented. Background Sleep is important for promoting critical care recovery and sleep disturbance is known to cause irritability, aggression and increased stress levels. The availability and use of valid critical care sleep assessment tools is limited. Design A descriptive comparative study using three sleep assessment-rating scales were constructed to provide easy to understand tools for completion by both patients and nurses in critical care. Methods Structured interviews were undertaken with 82 patients and 82 nurses using a convenience sample from four multispecialty critical care units in one large teaching trust. Patients were included in the study if they met a list of pre-defined criteria to obtain responses from lucid orientated patients. Results No tool produced a close association between the nurses’ assessment of the patients sleep and the patients’ assessment of their sleep. Patients found two of the three tools easy to use when rating their sleep. Discussion Objective invasive measurements of sleep as well as complex subjective tools appear inappropriate to be used as a part of daily critical care practice. The application of simple rating scores has a high degree of error when nurses assess patients’ sleep, even though high levels of patient observation and assessment are practiced in critical care. Conclusions More research is needed to examine the assessment of sleep in critical care, particularly linking rating scales to alternative methods of physiological assessment of sleep. Findings indicate nurses are unable to accurately assess critical care patients’ sleep using rating assessment tools. However patients were found to prefer two sleep assessment tools, one banded in hours to assess sleep quantity and one as a comparison against normal sleep to assess sleep quality. Relevance to clinical practice This study reviews the importance of sleep assessment and the diverse methods available for assessing sleep focussing on the critically ill patient. More noteworthy it highlights how nurses sole judgements of patients sleep is not a reliable method in clinical practice, however it provides some indication on the application of ‘easy to use’ tools to assist in the patients assessments of their sleep

An Evaluation of African American Fathers’ Perceptions and Influences on Child Food Choices and Physical Activity Behaviors

Child obesity is affecting children’s health nationwide. Rates are highest among African Americans (AA) in the South. Research has explored parents’ influence on child eating and activity, but most has reported on mothers’ influences. The purpose of this research was to investigate perceptions about AA fathers’ influences on their children’s eating and physical activity. Using a structured focus group questionnaire based on the parent layer constructs of Birch and Ventura’s Ecological Model for Child Overweight (2009), four focus groups were conducted with 28 AA fathers with children 6- to 11-years-old in a rural and an urban church setting in southeast Louisiana. Data was coded using deductive content analysis and a matrix based on model constructs. Most fathers were knowledgeable about healthy eating, but indicated that fathers’ typical focus in feeding their children was simply making sure they were not hungry. Cultural food preferences influenced rural fathers’ diets more than urban, but both groups agreed that their children’s diets were more influenced by the fast food environment. Fathers were involved with food shopping, with food preferences, health, and cost affecting their food purchases. Most affirmed providing support for their children’s physical activity and monitoring their children’s screen time as important. Participants believed that AA fathers intensely influence their children, especially boys, in many aspects of their lives, including eating and physical activity. Fathers stated that study participation made them more aware of their responsibility and potential influences on their children’s eating and physical activity habits, and of the importance of role modeling and educating their children about healthy lifestyles, so that their children did not experience the burden of chronic disease typical for their own generation. Findings suggest the relevance of the parent constructs of the Child Overweight Ecological Model to the population of interest, and support a body of literature indicating that fathers should be an intervention focus. Future research should explore AA fathers’ knowledge and practices related to child feeding, the specific ways in which they provide support for children’s activity and monitor sedentary behavior, and ways to support fathers’ role modeling of healthy eating and physical activity

Fisher choice may increase prevalence of green turtle fibropapillomatosis disease

This document is protected by copyright and was first published by Frontiers. All rights reserved. It is reproduced with permission.Open access journalDisease in wildlife populations is often controlled through culling. But when healthy individuals are removed and diseased individuals are left in the population, it is anticipated that prevalence of disease increases. Although this scenario is presumably common in exploited populations where infected individuals are less marketable, it is not widely reported in the literature. We describe this scenario in a marine turtle fishery in the Turks and Caicos Islands (TCI), where green turtles are harvested for local consumption. During a 2-year period, we recorded the occurrence of fibropapillomatosis (FP) disease in green turtles (Chelonia mydas) captured during in-water surveys and compared it with that of turtles landed in the fishery. 13.4% (n = 32) of turtles captured during in-water surveys showed externally visible signs of FP. FP occurred at specific geographic locations where fishing also occurred. Despite the disease being prevalent in the size classes selected by fishers, FP was not present in any animals landed by the fishery (n = 162). The majority (61%) of fishers interviewed expressed that they had caught turtles with FP. Yet, 82% of those that had caught turtles with the disease chose to return their catch to the sea, thereby selectively harvesting healthy turtles and leaving those with the disease in the population. Our study illustrates that fisher choice may increase the prevalence of FP disease and highlights the importance of this widely neglected driver in the disease dynamics of exploited wildlife populations.Natural Environment Research Council (NERC) CASE PhD studentshi

Human cardiac mesenchymal stem cell like cells, a novel cell population with therapeutic potential.

Cardiac stem/progenitors are being used in the clinic to treat patients with a range of cardiac pathologies. However, improvements in heart function following treatment have been reported to be variable, with some showing no response. This discrepancy in response remains unresolved. MSCs have been highlighted as a regenerative tool as these cells display both immunomodulatory and pro-regenerative activity. The purpose of this study was to derive a cardiac MSC population to provide an alternative/support to current therapies. We derived human cardiac-mesenchymal-stem-cell-like-cells (CMSCLC) so named as they share some MSC characteristics. However, CMSCLC lack the MSC tri-lineage differentiation capacity, being capable of only rare adipogenic differentiation and demonstrating low/no osteogenic or chondrogenic potential, a phenotype that may have advantages following transplantation. Further, CMSCLC expressed low levels of p16, high levels of MHCI and low levels of MHCII. A lack of senescent cells would also be advantageous for cells to be used therapeutically, as would the ability to modulate the immune response. Crucially, CMSCLC display a transcriptional profile which includes genes associated with cardio-protective/cardio-beneficial effects. CMSCLC are also secretory and multipotent, giving rise to cardiomyocytes and endothelial cells. Our findings support CMSCLC as a novel cell population suitable for use for transplantation

Marine turtle harvest in a mixed small-scale fishery: Evidence for revised management measures

Copyright © 2013 Elsevier. NOTICE: this is the author’s version of a work that was accepted for publication in Ocean and Coastal Management. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Ocean and Coastal Management, 2013, Vol. 82, pp. 34 – 42 DOI: http://dx.doi.org/10.1016/j.ocecoaman.2013.05.004Small-scale fisheries (SSF) account for around half of the world's marine and inland fisheries, but their impact on the marine environment is usually under-estimated owing to difficulties in monitoring and regulation. Successful management of mixed SSF requires holistic approaches that sustainably exploit target species, consider non-target species and maintain fisher livelihoods. For two years, we studied the marine turtle fishery in the Turks and Caicos Islands (TCI) in the Wider Caribbean Region, where the main export fisheries are queen conch (Strombus gigas) and the spiny lobster (Panulirus argus); with fin-fish, green turtles (Chelonia mydas) and hawksbill turtles (Eretmochelys imbricata) taken for domestic consumption. We evaluate the turtle harvest in relation to the other fisheries and recommend legislation and management alternatives. We demonstrate the connectivity between multi-species fisheries and artisanal turtle capture: with increasing lobster catch-per-unit-effort (CPUE), hawksbill catch increased whilst green turtle catch decreased. With increasing conch CPUE, hawksbill catch declined and there was no demonstrable effect on green turtle catch. We estimate 176–324 green and 114–277 hawksbill turtles are harvested annually in TCI: the largest documented legal hawksbill fishery in the western Atlantic. Of particular concern is the capture of adult turtles. Current legislation focuses take on larger individuals that are key to population maintenance. Considering these data we recommend the introduction of maximum size limits for both species and a closed season on hawksbill take during the lobster fishing season. Our results highlight the need to manage turtles as part of a broader approach to SSF management

Family satisfaction with critical care in the UK: a multicentre cohort study.

OBJECTIVE: To assess family satisfaction with intensive care units (ICUs) in the UK using the Family Satisfaction in the Intensive Care Unit 24-item (FS-ICU-24) questionnaire, and to investigate how characteristics of patients and their family members impact on family satisfaction. DESIGN: Prospective cohort study nested within a national clinical audit database. SETTING: Stratified, random sample of 20 adult general ICUs participating in the Intensive Care National Audit & Research Centre Case Mix Programme. PARTICIPANTS: Family members of patients staying at least 24 hours in ICU were recruited between May 2013 and June 2014. INTERVENTIONS: Consenting family members were sent a postal questionnaire 3 weeks after the patient died or was discharged from ICU. Up to four family members were recruited per patient. MAIN OUTCOME MEASURES: Family satisfaction was measured using the FS-ICU-24 questionnaire. MAIN RESULTS: A total of 12 346 family members of 6380 patients were recruited and 7173 (58%) family members of 4615 patients returned a completed questionnaire. Overall and domain-specific family satisfaction scores were high (mean overall family satisfaction 80, satisfaction with care 83, satisfaction with information 76 and satisfaction with decision-making 73 out of 100) but varied significantly across adult general ICUs studied and by whether the patient survived ICU. For family members of ICU survivors, characteristics of both the family member (age, ethnicity, relationship to patient (next-of-kin and/or lived with patient) and visit frequency) and the patient (acute severity of illness and receipt of invasive mechanical ventilation) were significant determinants of family satisfaction, whereas, for family members of ICU non-survivors, only patient characteristics (age, acute severity of illness and duration of stay) were significant. CONCLUSIONS: Overall family satisfaction in UK adult general ICUs was high but varied significantly. Adjustment for differences in family member/patient characteristics is important to avoid falsely identifying ICUs as statistical outliers. TRIAL REGISTRATION NUMBER: ISRCTN47363549

Fruit development of the diploid kiwifruit, Actinidia chinensis 'Hort16A'

<p>Abstract</p> <p>Background</p> <p>With the advent of high throughput genomic tools, it is now possible to undertake detailed molecular studies of individual species outside traditional model organisms. Combined with a good understanding of physiological processes, these tools allow researchers to explore natural diversity, giving a better understanding of biological mechanisms. Here a detailed study of fruit development from anthesis through to fruit senescence is presented for a non-model organism, kiwifruit, <it>Actinidia chinensis </it>('Hort16A').</p> <p>Results</p> <p>Consistent with previous studies, it was found that many aspects of fruit morphology, growth and development are similar to those of the model fruit tomato, except for a striking difference in fruit ripening progression. The early stages of fruit ripening occur as the fruit is still growing, and many ripening events are not associated with autocatalytic ethylene production (historically associated with respiratory climacteric). Autocatalytic ethylene is produced late in the ripening process as the fruit begins to senesce.</p> <p>Conclusion</p> <p>By aligning <it>A. chinensis </it>fruit development to a phenological scale, this study provides a reference framework for subsequent physiological and genomic studies, and will allow cross comparison across fruit species, leading to a greater understanding of the diversity of fruits found across the plant kingdom.</p

Cardiac Mesenchymal Stem Cell-Like Cells Derived from a Young Patient with Bicuspid Aortic Valve Disease Have a Prematurely Aged Phenotype.

There is significant interest in the role of stem cells in cardiac regeneration, and yet little is known about how cardiac disease progression affects native cardiac stem cells in the human heart. In this brief report, cardiac mesenchymal stem cell-like cells (CMSCLC) from the right atria of a 21-year-old female patient with a bicuspid aortic valve and aortic stenosis (referred to as biscuspid aortic valve disease BAVD-CMSCLC), were compared with those of a 78-year-old female patient undergoing coronary artery bypass surgery (referred to as coronary artery disease CAD-CMSCLC). Cells were analyzed for expression of MSC markers, ability to form CFU-Fs, metabolic activity, cell cycle kinetics, expression of NANOG and p16, and telomere length. The cardiac-derived cells expressed MSC markers and were able to form CFU-Fs, with higher rate of formation in CAD-CMSCLCs. BAVD-CMSCLCs did not display normal MSC morphology, had a much lower cell doubling rate, and were less metabolically active than CAD-CMSCLCs. Cell cycle analysis revealed a population of BAVD-CMSCLC in G2/M phase, whereas the bulk of CAD-CMSCLC were in the G0/G1 phase. BAVD-CMSCLC had lower expression of NANOG and shorter telomere lengths, but higher expression of p16 compared with the CAD-CMSCLC. In conclusion, BAVD-CMSCLC have a prematurely aged phenotype compared with CAD-CMSCLC, despite originating from a younger patient