Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review

Objective: To assess the efficacy of interventions and environmental factors on increasing fluid intake or reducing dehydration risk in older people living in long-term care facilities. Design: Systematic review of intervention and observational studies. Data Sources: Thirteen electronic databases were searched from inception until September 2013 in all languages. References of included papers and reviews were checked. Eligibility criteria: Intervention and observational studies investigating modifiable factors to increase fluid intake and/or reduce dehydration risk in older people (≥65 years) living in long-term care facilities who could drink orally. Review methods: Two reviewers independently screened, selected, abstracted data and assessed risk of bias from included studies, narrative synthesis was performed. Results: 4328 titles and abstracts were identified, 325 full-text papers obtained and 23 included in the review. Nineteen intervention and 4 observational studies from 7 countries investigated factors at resident, institutional or policy level. Overall the studies were at high risk of bias due to selection and attrition bias and lack of valid outcome measures of fluid intake and dehydration assessment. Reported findings from six of the nine intervention studies investigating the effect of multi-component strategies on fluid intake or dehydration described a positive effect. Components included greater choice and availability of beverages, increased staff awareness, increased staff assistance with drinking and toileting. Implementation of the US Resident Assessment Instrument reduced dehydration prevalence from 3% to 1%, p=0.01. Two smaller studies reported positive effects, one on fluid intake in 9 men with Alzheimer's Disease using high-contrast red cups, the other involved supplementing 13 mildly dehydrated residents with oral hydration solution over 5 days to reduce dehydration. Modifications to the dining environment, advice to residents, presentation of beverages and mode of delivery (straw vs beaker; pre-thickened drinks vs those thickened at the bedside) were inconclusive. Two large observational studies with good internal validity investigated effects of ownership; in Canada, for-profit ownership was associated with increased hospital admissions for dehydration; no difference was seen in dehydration prevalence between US for-profit and not-for-profit homes, although chain facilities were associated with lower odds of dehydration. This US study did not suggest any effect of staffing levels on dehydration prevalence. Conclusions: A wide range of interventions and exposures were identified, but the efficacy of many strategies remains unproven due to the high risk of bias present in many studies. Reducing dehydration prevalence in long-term care facilities is likely to require multiple strategies involving policymakers, management and care staff, but these require further investigation using more robust study methodologies. Systematic review registration: The review protocol was registered with the International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO/display_record.asp? ID=CRD42012003100)

Toward a better understanding of fish‐based contribution to ocean carbon flux

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Transcriptional upregulation of c-MET is associated with invasion and tumor budding in colorectal cancer

c-MET and its ligand HGF are frequently overexpressed in colorectal cancer (CRC) and increased c-MET levels are found in CRC liver metastases. This study investigated the role of the HGF/c-MET axis in regulating migration/invasion in CRC, using pre-clinical models and clinical samples. Pre-clinically, we found marked upregulation of c-MET at both protein and mRNA levels in several invasive CRC cells. Down-regulation of c-MET using RNAi suppressed migration/invasion of parental and invasive CRC cells. Stimulation of CRC cells with rh-HGF or co-culture with HGF-expressing colonic myofibroblasts, resulted in significant increases in their migratory/invasive capacity. Importantly, HGF-induced c-MET activation promoted rapid downregulation of c-MET protein levels, while the MET transcript remained unaltered. Using RNA in situ hybridization (RNA ISH), we further showed that MET mRNA, but not protein levels, were significantly upregulated in tumor budding foci at the invasive front of a cohort of stage III CRC tumors (p < 0.001). Taken together, we show for the first time that transcriptional upregulation of MET is a key molecular event associated with CRC invasion and tumor budding. This data also indicates that RNA ISH, but not immunohistochemistry, provides a robust methodology to assess MET levels as a potential driving force of CRC tumor invasion and metastasis

How well do global ocean biogeochemistry models simulate dissolved iron distributions?

Numerical models of ocean biogeochemistry are relied upon to make projections about the impact of climate change on marine resources and test hypotheses regarding the drivers of past changes in climate and ecosystems. In large areas of the ocean, iron availability regulates the functioning of marine ecosystems and hence the ocean carbon cycle. Accordingly, our ability to quantify the drivers and impacts of fluctuations in ocean ecosystems and carbon cycling in space and time relies on first achieving an appropriate representation of the modern marine iron cycle in models. When the iron distributions from 13 global ocean biogeochemistry models are compared against the latest oceanic sections from the GEOTRACES program, we find that all models struggle to reproduce many aspects of the observed spatial patterns. Models that reflect the emerging evidence for multiple iron sources or subtleties of its internal cycling perform much better in capturing observed features than their simpler contemporaries, particularly in the ocean interior. We show that the substantial uncertainty in the input fluxes of iron results in a very wide range of residence times across models, which has implications for the response of ecosystems and global carbon cycling to perturbations. Given this large uncertainty, iron fertilization experiments based on any single current generation model should be interpreted with caution. Improvements to how such models represent iron scavenging and also biological cycling are needed to raise confidence in their projections of global biogeochemical change in the ocean

Variability in efficiency of particulate organic carbon export: A model study

The flux of organic carbon from the surface ocean to mesopelagic depths is a key component of the global carbon cycle and is ultimately derived from primary production (PP) by phytoplankton. Only a small fraction of organic carbon produced by PP is exported from the upper ocean, referred to as the export efficiency (herein e-ratio). Limited observations of the e-ratio are available and there is thus considerable interest in using remotely-sensed parameters such as sea surface temperature to extrapolate local estimates to global annual export flux. Currently, there are large discrepancies between export estimates derived in this way; one possible explanation is spatial or temporal sampling bias in the observations. Here we examine global patterns in the spatial and seasonal variability in e-ratio and the subsequent effect on export estimates using a high resolution global biogeochemical model. NEMO-MEDUSA represents export as separate slow and fast sinking detrital material whose remineralisation is respectively temperature dependent and a function of ballasting minerals. We find that both temperature and the fraction of export carried by slow sinking particles are factors in determining e-ratio, suggesting that current empirical algorithms for e-ratio that only consider temperature are overly simple. We quantify the temporal lag between PP and export, which is greatest in regions of strong variability in PP where seasonal decoupling can result in large e-ratio variability. Extrapolating global export estimates from instantaneous measurements of e-ratio is strongly affected by seasonal variability, and can result in errors in estimated export of up to ±60%

Trees Grow on Money: Urban Tree Canopy Cover and Environmental Justice

This study examines the distributional equity of urban tree canopy (UTC) cover for Baltimore, MD, Los Angeles, CA, New York, NY, Philadelphia, PA, Raleigh, NC, Sacramento, CA, and Washington, D.C. using high spatial resolution land cover data and census data. Data are analyzed at the Census Block Group levels using Spearman\u27s correlation, ordinary least squares regression (OLS), and a spatial autoregressive model (SAR). Across all cities there is a strong positive correlation between UTC cover and median household income. Negative correlations between race and UTC cover exist in bivariate models for some cities, but they are generally not observed using multivariate regressions that include additional variables on income, education, and housing age. SAR models result in higher r-square values compared to the OLS models across all cities, suggesting that spatial autocorrelation is an important feature of our data. Similarities among cities can be found based on shared characteristics of climate, race/ethnicity, and size. Our findings suggest that a suite of variables, including income, contribute to the distribution of UTC cover. These findings can help target simultaneous strategies for UTC goals and environmental justice concerns

Increased S-nitrosylation and proteasomal degradation of caspase-3 during infection contribute to the persistence of adherent invasive escherichia coli (AIEC) in immune cells

Adherent invasive Escherichia coli (AIEC) have been implicated as a causative agent of Crohn's disease (CD) due to their isolation from the intestines of CD sufferers and their ability to persist in macrophages inducing granulomas. The rapid intracellular multiplication of AIEC sets it apart from other enteric pathogens such as Salmonella Typhimurium which after limited replication induce programmed cell death (PCD). Understanding the response of infected cells to the increased AIEC bacterial load and associated metabolic stress may offer insights into AIEC pathogenesis and its association with CD. Here we show that AIEC persistence within macrophages and dendritic cells is facilitated by increased proteasomal degradation of caspase-3. In addition S-nitrosylation of pro- and active forms of caspase-3, which can inhibit the enzymes activity, is increased in AIEC infected macrophages. This S-nitrosylated caspase-3 was seen to accumulate upon inhibition of the proteasome indicating an additional role for S-nitrosylation in inducing caspase-3 degradation in a manner independent of ubiquitination. In addition to the autophagic genetic defects that are linked to CD, this delay in apoptosis mediated in AIEC infected cells through increased degradation of caspase-3, may be an essential factor in its prolonged persistence in CD patients

Particle flux in the oceans: Challenging the steady state assumption

Atmospheric carbon dioxide levels are strongly controlled by the depth at which the organic matter that sinks out of the surface ocean is remineralized. This depth is generally estimated from particle flux profiles measured using sediment traps. Inherent in this analysis is a steady state assumption; that export from the surface does not significantly change in the time it takes material to reach the deepest trap. However, recent observations suggest that a significant fraction of material in the mesopelagic zone sinks slowly enough to bring this into doubt. We use data from a study in the North Atlantic during July/August 2009 to challenge the steady state assumption. An increase in biogenic silica flux with depth was observed which we interpret, based on vertical profiles of diatom taxonomy, as representing the remnants of the spring diatom bloom sinking slowly (<40 m d-1). We were able to reproduce this behaviour using a simple model using satellite-derived export rates and literature-derived remineralization rates. We further provide a simple equation to estimate ‘additional’ (or ‘excess’) POC supply to the dark ocean during non-steady state conditions, which is not captured by traditional sediment trap deployments. In seasonal systems, mesopelagic net organic carbon supply could be wrong by as much as 25% when assuming steady state. We conclude that the steady state assumption leads to misinterpretation of particle flux profiles when input fluxes from the upper ocean vary on the order of weeks, such as in temperate and polar regions with strong seasonal cycles in export

What causes the inverse relationship between primary production and export efficiency in the Southern Ocean?

The ocean contributes to regulating atmospheric CO2 levels, partly via variability in the fraction of primary production (PP) which is exported out of the surface layer (i.e. the e-ratio). Southern Ocean studies have found that, contrary to global scale analyses, an inverse relationship exists between e-ratio and PP. This relationship remains unexplained, with potential hypotheses being i) large export of dissolved organic carbon (DOC) in high PP areas, ii) strong surface microbial recycling in high PP regions and/ or iii) grazing mediated export varies inversely with PP. We find that the export of DOC has a limited influence in setting the negative e-ratio/PP relationship. However, we observed that at sites with low PP and high e-ratios, zooplankton mediated export is large and surface microbial abundance low suggesting that both are important drivers of the magnitude of the e-ratio in the Southern Ocean

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy