Persistence and Remission of Musculoskeletal Pain in Community‐Dwelling Older Adults: Results from the Cardiovascular Health Study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93534/1/jgs4082.pd

Developing the practice context to enable more effective pain management with older people: an action research approach

Background\ud \ud This paper, which draws upon an Emancipatory Action Research (EAR) approach, unearths how the complexities of context influence the realities of nursing practice. While the intention of the project was to identify and change factors in the practice context that inhibit effective person-centred pain management practices with older people (65 years or older), reflective critical engagement with the findings identified that enhancing pain management practices with older people was dependent on cultural change in the unit as a whole. \ud \ud Methods\ud \ud An EAR approach was utilised. The project was undertaken in a surgical unit that conducted complex abdominal surgery. Eighty-five percent (n = 48) of nursing staff participated in the two-year project (05/NIR02/107). Data were obtained through the use of facilitated critical reflection with nursing staff. \ud \ud Results\ud \ud Three key themes (psychological safety, leadership, oppression) and four subthemes (power, horizontal violence, distorted perceptions, autonomy) were found to influence the way in which effective nursing practice was realised. Within the theme of 'context,' effective leadership and the creation of a psychologically safe environment were key elements in the enhancement of all aspects of nursing practice. \ud \ud Conclusions\ud \ud Whilst other research has identified the importance of 'practice context' and models and frameworks are emerging to address this issue, the theme of 'psychological safety' has been given little attention in the knowledge translation/implementation literature. Within the principles of EAR, facilitated reflective sessions were found to create 'psychologically safe spaces' that supported practitioners to develop effective person-centred nursing practices in complex clinical environments

Cone synapses in macaque fovea: II. Dendrites of OFF midget bipolar cells exhibit Inner Densities similar to their Outer synaptic Densities in basal contacts with cone terminals

AbstractAs described in the companion paper, the synaptic terminal of a cone photoreceptor in macaque monkey makes an average of 35 or 46 basal contacts with the tips of the dendrites of its OFF midget bipolar cell. Each basal contact has one or more symmetrically thickened dense regions. These “Outer Densities,” averaging 48 or 67 in number, harbor clusters of ionotropic glutamate receptors and are ~0.8μm (and ~1-ms diffusion time) from active zones associated with synaptic ribbons. Here, we show similarly appearing “Inner Densities,” averaging 53 or 74 in number, located more proximally on the dendrites of these OFF midget bipolar cells, ~0.4μm inward from the tips of the dendrites and out of contact with the basal surface of the cone terminal. Compared to desmosome-like junctions, Inner Densities are closer to the terminal and are less dense and less thick. Each Inner Density is shared with another cell, the partners including diffuse bipolar cells, ON midget bipolar cells, and horizontal cells. Given the diversity of the partners, the OFF midget bipolar cells are unlikely to be in a synaptic relationship with the partners. Instead, Inner Densities are near enough to the active zones associated with synaptic ribbons to receive pulses of glutamate at concentrations effective for glutamate receptors. The role of Inner Densities is not known, but they might represent additional clusters of glutamate receptors.</jats:p

Behavioral/Systems/Cognitive

retinal histology Introduction Psychophysical results suggest that the primate visual system is equally sensitive to both the onset and offset of short-wavelength light and that these responses are carried by separate pathways (Smith et al., 1989; DeMarco et al., 1994; Chichilnisky and Wandell, 1996; McLellan and Eskew, 2000). However, physiological studies of cells in the retina and lateral geniculate nucleus (LGN) find far fewer OFF-center cells than ON-center cells whose receptive-fields are driven by short-wavelength-sensitive (S) cones (Kruger, 1977; Malpeli and Schiller, 1978; de Monasterio, 1979; Zrenner and Gouras, 1981; Zrenner, 1983) (but see Valberg et al., 1986). The scarcity of cells with S-cone OFF-center receptive fields was surprising because Golgi studies suggested that each foveal cone is presynaptic to one invaginating (ON) and one flat (OFF) midget bipolar cell and that each midget bipolar cell is presynaptic to a single midget ganglion cell (Polyak, 1941; Boyc