Acupressure for agitation in nursing home residents with dementia: study protocol for a randomized controlled trial

BACKGROUND: Agitation is prevalent among people with dementia (PWD) in nursing homes. It frustrates both the PWD and their caregivers. Acupressure is a non-pharmacological intervention whose effectiveness is supported by preliminary studies. However, there is still a dearth of evidence to explain its effect for clinical use and further research. The present study is being conducted primarily to investigate the effects of acupressure as compared with sham-acupressure and usual care. METHODS/DESIGN: This study is a multicenter, assessor/participant/statistician-blinded, parallel group, randomized controlled trial taking place in Hong Kong nursing homes. We have been recruiting PWD over 65 years of age in nursing homes, who are experiencing agitation; 99 participants will be recruited in order to demonstrate a significant effect difference (that is, f =0.27) with a power of 0.8 and a significance level of 0.05 among the three groups. Participants are assigned by permuted block randomization into three groups in a 1:1:1 ratio. In the acupressure group, participants receive acupressure at the Fengchi (GB20), Baihui (GV20), Shenmen (HT7), Niguan (PC6) and Yingtang (EX-HN3) acupoints. In the sham-acupressure group, participants receive pressure on five non-acupoints. In the usual-care group, participants receive no intervention apart from the care provided by the nursing homes. Participants assigned to the sham-acupressure and usual-care groups receive free acupressure, like those in the acupressure group, after completion of the study. The whole study lasts for 30 weeks, and its primary outcome measure is agitation. The general estimated equation model will be used to compare the effects among groups and time points. The trial is currently recruiting participants. DISCUSSION: This trial will provide a higher quality of evidence than previous studies on the use of acupressure for agitation in PWD. It will also provide newer evidence on acupressure in the population of PWD with agitation for clinical application and further research, including the effect on moderating stress, the delayed effect, the added effect on the placebo, and the effect on moderating the participant’s use of psychotropic drugs. TRIAL REGISTRATION: Centre for Clinical Trials Clinical Trials Registry: CUHK_CCT00347 (Registration date: 13 December 2012)

Does regular walking improve lipid levels in adults?

Q: Evidence-based answer: Minimally. Regular moderateintensity walking for a period of 4 or more weeks minimally decreased total cholesterol (TC) and low-density lipoprotein (LDL) levels by about 7 mg/dL in women with overweight or obesity (strength of recommendation [SOR]: C, systematic review and meta-analysis on disease-oriented evidence). For adults ages 40 to 65 years, regular walking for 3 or more months inconsistently affected cholesterol and triglyceride levels (SOR: C, based on 3 randomized controlled trials [RCTs] with disease-oriented evidence).Kayla Hatchell, MD; Emily Chin, DO; Brian Vukelic, MD; Katherine Fortenberry, PhD; Dominick Ose, DrPH; Eliza Taylor, MPH, BS, CHES; Rachel Goossen, MD (University of Utah), Rick Guthmann, MD, MPH (Advocate Health Care Illinois Masonic Medical Center Program)Includes bibliographical reference

GRM7 variants associated with age-related hearing loss based on auditory perception

Age-related hearing impairment (ARHI), or presbycusis, is a common condition of the elderly that results in significant communication difficulties in daily life. Clinically, it has been defined as a progressive loss of sensitivity to sound, starting at the high frequencies, inability to understand speech, lengthening of the minimum discernable temporal gap in sounds, and a decrease in the ability to filter out background noise. The causes of presbycusis are likely a combination of environmental and genetic factors. Previous research into the genetics of presbycusis has focused solely on hearing as measured by pure-tone thresholds. A few loci have been identified, based on a best ear pure-tone average phenotype, as having a likely role in susceptibility to this type of hearing loss; and GRM7 is the only gene that has achieved genome-wide significance. We examined the association of GRM7 variants identified from the previous study, which used an European cohort with Z-scores based on pure-tone thresholds, in a European–American population from Rochester, NY (N = 687), and used novel phenotypes of presbycusis. In the present study mixed modeling analyses were used to explore the relationship of GRM7 haplotype and SNP genotypes with various measures of auditory perception. Here we show that GRM7 alleles are associated primarily with peripheral measures of hearing loss, and particularly with speech detection in older adults

Feasibility of Tomotherapy-Based Image-Guided Radiotherapy to Reduce Aspiration Risk in Patients with Non-Laryngeal and Non-Pharyngeal Head and Neck Cancer

PURPOSE: The study aims to assess the feasibility of Tomotherapy-based image-guided radiotherapy (IGRT) to reduce the aspiration risk in patients with non-laryngeal and non-hypopharyngeal cancer. A retrospective review of 48 patients undergoing radiation for non-laryngeal and non-hypopharyngeal head and neck cancers was conducted. All patients had a modified barium swallow (MBS) prior to treatment, which was repeated one month following radiotherapy. Mean middle and inferior pharyngeal dose was recorded and correlated with the MBS results to determine aspiration risk. RESULTS: Mean pharyngeal dose was 23.2 Gy for the whole group. Two patients (4.2%) developed trace aspiration following radiotherapy which resolved with swallowing therapy. At a median follow-up of 19 months (1-48 months), all patients were able to resume normal oral feeding without aspiration. CONCLUSION AND CLINICAL RELEVANCE: IGRT may reduce the aspiration risk by decreasing the mean pharyngeal dose in the presence of large cervical lymph nodes. Further prospective studies with IGRT should be performed in patients with non-laryngeal and non-hypopharyngeal head and neck cancers to verify this hypothesis

Validation of a case definition to define chronic dialysis using outpatient administrative data

<p>Abstract</p> <p>Background</p> <p>Administrative health care databases offer an efficient and accessible, though as-yet unvalidated, approach to studying outcomes of patients with chronic kidney disease and end-stage renal disease (ESRD). The objective of this study is to determine the validity of outpatient physician billing derived algorithms for defining chronic dialysis compared to a reference standard ESRD registry.</p> <p>Methods</p> <p>A cohort of incident dialysis patients (Jan. 1 - Dec. 31, 2008) and prevalent chronic dialysis patients (Jan 1, 2008) was selected from a geographically inclusive ESRD registry and administrative database. Four administrative data definitions were considered: at least 1 outpatient claim, at least 2 outpatient claims, at least 2 outpatient claims at least 90 days apart, and continuous outpatient claims at least 90 days apart with no gap in claims greater than 21 days. Measures of agreement of the four administrative data definitions were compared to a reference standard (ESRD registry). Basic patient characteristics are compared between all 5 patient groups.</p> <p>Results</p> <p>1,118,097 individuals formed the overall population and 2,227 chronic dialysis patients were included in the ESRD registry. The three definitions requiring at least 2 outpatient claims resulted in kappa statistics between 0.60-0.80 indicating "substantial" agreement. "At least 1 outpatient claim" resulted in "excellent" agreement with a kappa statistic of 0.81.</p> <p>Conclusions</p> <p>Of the four definitions, the simplest (at least 1 outpatient claim) performed comparatively to other definitions. The limitations of this work are the billing codes used are developed in Canada, however, other countries use similar billing practices and thus the codes could easily be mapped to other systems. Our reference standard ESRD registry may not capture all dialysis patients resulting in some misclassification. The registry is linked to on-going care so this is likely to be minimal. The definition utilized will vary with the research objective.</p

Effect of Coral-Algal Interactions on Early Life History Processes in Pocillopora acuta in a Highly Disturbed Coral Reef System

Scleractinian corals are vulnerable to a range of environmental disturbances, but generally suffer the highest rates of mortality during early life-history stages, i.e., from larval settlement until a few months post-settlement. Variations in survival rates of corals during this period play a key role in structuring adult coral populations. Many coral reefs have experienced reductions in herbivory rates due to overfishing and consequent increases in macroalgae, however, the effect of increased coral-algal interactions may vary between coral life-history stages and among locations. Therefore understanding the relative importance of different drivers of mortality across early life-history stages, under a range of environmental conditions, is essential to effectively manage and restore coral reefs. To date, however, relatively few studies have (a) examined coral-algal interactions across several early life-history stages (i.e., from planulae to juvenile colonies) and (b) done so in highly disturbed reefs close to large urban centers. We investigated the effect of algal-coral-herbivore interactions on early life history stages in the coral Pocillopora acuta on coral reefs off mainland Singapore, a heavily disturbed “urbanized reef environment”. Larval settlement rates were estimated in the presence of six macroalgal species ex situ. The effect of direct interaction with two macroalgal species on newly settled spat was examined in situ and the effect of reduced herbivory was tested with exclusion cages on naturally settled 9-month-old juveniles in situ. We found significant reductions in P. acuta settlement in the presence of four macroalgal species. Newly settled spat of P. acuta had significantly lower survivorship when in contact with Sargassum sp. on the reef crest but not with Bryopsis sp. on the reef flat. Herbivore exclusion reduced survivorship of juvenile corals, which was associated with increased sediment accumulation, but not with algal biomass. Our results suggest coral recruitment on heavily disturbed reefs can be impacted by species-specific macroalgal effects via reduced settlement on ephemeral substrata and reduced survivorship when in direct contact with Sargassum sp. Furthermore, recruitment may be negatively impacted by reductions in herbivory, possibly via increased abundance of epilithic algal matrix leading to sediment trapping

Nocturnal Hypoxia and Loss of Kidney Function

Background: Although obstructive sleep apnea (OSA) is more common in patients with kidney disease, whether nocturnal hypoxia affects kidney function is unknown. Methods: We studied all adult subjects referred for diagnostic testing of sleep apnea between July 2005 and December 31 2007 who had serial measurement of their kidney function. Nocturnal hypoxia was defined as oxygen saturation (SaO2) below 90 % for $12$4 ml/min/1.73 m2 per year. Results: 858 participants were included and followed for a mean study period of 2.1 years. Overall 374 (44%) had nocturnal hypoxia, and 49 (5.7%) had accelerated loss of kidney function. Compared to controls without hypoxia, patients with nocturnal hypoxia had a significant increase in the adjusted risk of accelerated kidney function loss (odds ratio (OR) 2.89, 95 % confidence interval [CI] 1.25, 6.67). Conclusion: Nocturnal hypoxia was independently associated with an increased risk of accelerated kidney function loss. Further studies are required to determine whether treatment and correction of nocturnal hypoxia reduces loss of kidney function

Ago2 Immunoprecipitation Identifies Predicted MicroRNAs in Human Embryonic Stem Cells and Neural Precursors

MicroRNAs are required for maintenance of pluripotency as well as differentiation, but since more microRNAs have been computationally predicted in genome than have been found, there are likely to be undiscovered microRNAs expressed early in stem cell differentiation.SOLiD ultra-deep sequencing identified >10(7) unique small RNAs from human embryonic stem cells (hESC) and neural-restricted precursors that were fit to a model of microRNA biogenesis to computationally predict 818 new microRNA genes. These predicted genomic loci are associated with chromatin patterns of modified histones that are predictive of regulated gene expression. 146 of the predicted microRNAs were enriched in Ago2-containing complexes along with 609 known microRNAs, demonstrating association with a functional RISC complex. This Ago2 IP-selected subset was consistently expressed in four independent hESC lines and exhibited complex patterns of regulation over development similar to previously-known microRNAs, including pluripotency-specific expression in both hESC and iPS cells. More than 30% of the Ago2 IP-enriched predicted microRNAs are new members of existing families since they share seed sequences with known microRNAs.Extending the classic definition of microRNAs, this large number of new microRNA genes, the majority of which are less conserved than their canonical counterparts, likely represent evolutionarily recent regulators of early differentiation. The enrichment in Ago2 containing complexes, the presence of chromatin marks indicative of regulated gene expression, and differential expression over development all support the identification of 146 new microRNAs active during early hESC differentiation

2016 Research & Innovation Day Program

A one day showcase of applied research, social innovation, scholarship projects and activities.https://first.fanshawec.ca/cri_cripublications/1003/thumbnail.jp