Accessing hospital packaged foods and beverages : the importance of a seated posture when eating

Background: Hospitalised and community dwelling older people (65 years and over), have difficulties opening food and beverage items such as cheese portions and tetra packs served in public hospitals. Previously, the role of hand strength on successful pack opening has been explored in a seated position. However, as many people in hospital eat in bed, this laboratory study examined the differences between participants opening a selection of products both in a hospital bed and a chair. Methods: This study used a qualitative method (satisfaction) and quantitative methods (grip and pinch strength, dexterity, time and attempts) in two conditions (bed; chair) with a sample of well older community dwelling adults (n=34). Packs tested included foil sealed thickened pudding, foil sealed thickened water, tetra pack, dessert, custard, jam, cereal, honey sachet and cheese portions. Results: Honey sachets, cheese portions, foil sealed thickened pudding and tetra packs were the most difficult packs to open, with 15% of cheese portions unable to be opened in either the bed or chair posture. While grip strength was consistent for each posture, pinch grips and dexterity were adversely affected by the bed posture. Lying in a hospital bed required greater pinch strength and dexterity to open packs. Conclusions: Eating in a seated position while in hospital has been shown to improve intake. This study demonstrates that eating in a seated posture is also advantageous for opening food and beverage packs used in NSW hospital food service and supports the notion that patients should sit to eat in hospital

Clinical characteristics of cyclodeviation

PURPOSE: To retrospectively evaluate the incidence of cyclodeviation among patients with diplopia and analyse the causative diseases and clinical manifestations of cyclodeviation. METHODS: The medical records of 266 consecutive patients of 15 years of age or older presenting with diplopia, who had undergone the Lancaster red-green test (LRGT) from January 2001 to December 2002, were retrospectively reviewed. The presence of cyclodeviation on LRGT, predisposing conditions, causative diseases, and clinical manifestations of cyclotropia were analysed. Cyclodeviation on the LRGT were compared with those from the Maddox double-rod test (MDRT) and fundus photography. RESULTS: A total of 63 (24%) out of 266 patients exhibited cyclodeviation on LRGT. Eight out of 63 patients with cyclodeviation on the LRGT complained of torsional diplopia. Superior oblique palsy (SOP) was the most common causative disease (42 patients), followed by skew deviation (six) and thyroid orbitopathy (three). Excyclodeviation was found in 57 patients and incyclodeviation in four patients on the LRGT. The spontaneous recovery rate was 83% in patients of vascular origin and 17% of traumatic origin. Cyclodeviation with the MDRT and fundus photography showed good correlation with those obtained from the LRGT. There was no association of the amount of cyclotropia with the presence of torsional diplopia as well as with its recovery. CONCLUSION: In spite of the rare complaint of torsional diplopia, 24% of the patients with diplopia showed cyclodeviation on the LRGT. SOP was the most common causative disease. Most of the patients with cyclodeviation of a vascular origin showed spontaneous improvement

Global patterns of insect herbivory in gap and understorey environments, and their implications for woody plant carbon storage

Insect herbivory is thought to favour carbon allocation to storage in juveniles of shade-tolerant trees. This argument assumes that insect herbivory in the understorey is sufficiently intense as to select for storage; however, understoreys might be less attractive to insect herbivores than canopy gaps, because of low resource availability and - at temperate latitudes - low temperatures. Although empirical studies show that shade-tolerant species in tropical forests do allocate more photosynthate to storage than their light-demanding associates, the same pattern has not been consistently observed in temperate forests. Does this reflect a latitudinal trend in the relative activity of insect herbivory in gap versus understorey environments? To date there has been no global review of the effect of light environment on insect herbivory in forests. We postulated that if temperature is the primary factor limiting insect herbivory, the effect of gaps on rates of insect herbivory should be more evident in temperate than in tropical forests; due to low growing season temperatures in the oceanic temperate forests of the Southern Hemisphere, the effect of gaps on insect herbivory rates should in turn be stronger there than in the more continental temperate climates of the Northern Hemisphere. We examined global patterns of insect herbivory in gaps versus understories through meta-analysis of 87 conspecific comparisons of leaf damage in contrasting light environments. Overall, insect herbivory in gaps was significantly higher than in the understorey; insect herbivory was 50% higher in gaps than in understoreys of tropical forests but did not differ significantly between gaps and understories in temperate forests of either hemisphere. Results are consistent with the idea that low resource availability - and not temperature - limits insect herbivore activity in forest understoreys, especially in the tropics, and suggest the selective influence of insect herbivory on late-successional tree species may have been over-estimated

Rationale and design of BISTRO: a randomized controlled trial to determine whether bioimpedance spectroscopy guided fluid management maintains residual kidney function in incident haemodialysis patients

Background: Preserved residual kidney function (RKF) and normal fluid status are associated with better patient outcomes in incident haemodialysis patients. The objective of this trial is to determine whether using bioimpedance technology in prescribing the optimal post-dialysis weight can reduce the rate of decline of RKF and potentially improve patient outcomes. Methods/Design: 516 patients commencing haemodialysis, aged >18 with RKF of > 3 ml/min/1.73 m2 or a urine volume >500 ml per day or per the shorter inter-dialytic period will be consented and enrolled into a pragmatic, open label, randomized controlled trial. The intervention is incorporation of bioimpedance spectroscopy (BI) determination of normally hydrated weight to set a post-dialysis target weight that limits volume depletion, compared to current standard practice. Clinicians and participants will be blinded to BI measures in the control group and a standardized record capturing management of fluid status will be used in all participants. Primary outcome is preservation of residual kidney function assessed as time to anuria (≤100 ml/day or ≤200 ml urine volume in the short inter-dialytic period). A sample size of 516 was based upon a cumulative incidence of 30% anuria in the control group and 20% in the treatment group and 11% competing risks (death, transplantation) over 10 months, with up to 2 years follow-up. Secondary outcomes include rate of decline in small solute clearance, significant adverse events, hospitalization, loss of vascular access, cardiovascular events and interventions, dialysis efficacy and safety, dialysis-related symptoms and quality of life. Economic evaluation will be carried out to determine the cost-effectiveness of the intervention. Analyses will be adjusted for patient characteristics and dialysis unit practice patterns relevant to fluid management. Discussion: This trial will establish the added value of undertaking BI measures to support clinical management of fluid status and establish the relationship between fluid status and preservation of residual kidney function in incident haemodialysis patients. Trial registration: ISCCTN Number: 11342007, completed 26/04/2016; NIHR Portfolio number: CPMS31766; Sponsor: Keele University Keywords: Fluid status, Body composition, Residual kidney function, Haemodialysis, Bioimpedance, Fluid management, Health economic

Rationale and study design of the prospective, longitudinal, observational cohort study “rISk strAtification in end-stage renal disease” (ISAR) study

Background: The ISAR study is a prospective, longitudinal, observational cohort study to improve the cardiovascular risk stratification in endstage renal disease (ESRD). The major goal is to characterize the cardiovascular phenotype of the study subjects, namely alterations in micro-and macrocirculation and to determine autonomic function. Methods/design: We intend to recruit 500 prevalent dialysis patients in 17 centers in Munich and the surrounding area. Baseline examinations include: (1) biochemistry, (2) 24-h Holter Electrocardiography (ECG) recordings, (3) 24-h ambulatory blood pressure measurement (ABPM), (4) 24 h pulse wave analysis (PWA) and pulse wave velocity (PWV), (5) retinal vessel analysis (RVA) and (6) neurocognitive testing. After 24 months biochemistry and determination of single PWA, single PWV and neurocognitive testing are repeated. Patients will be followed up to 6 years for (1) hospitalizations, (2) cardiovascular and (3) non-cardiovascular events and (4) cardiovascular and (5) all-cause mortality. Discussion/conclusion: We aim to create a complex dataset to answer questions about the insufficiently understood pathophysiology leading to excessively high cardiovascular and non-cardiovascular mortality in dialysis patients. Finally we hope to improve cardiovascular risk stratification in comparison to the use of classical and non-classical (dialysis-associated) risk factors and other models of risk stratification in ESRD patients by building a multivariable Cox-Regression model using a combination of the parameters measured in the study

Allocation, stress tolerance and carbon transport in plants: How does phloem physiology affect plant ecology?

Despite the crucial role of carbon transport in whole plant physiology and its impact on plant-environment interactions and ecosystem function, relatively little research has tried to examine how phloem physiology impacts plant ecology. In this review, we highlight several areas of active research where inquiry into phloem physiology has increased our understanding of whole plant function and ecological processes. We consider how xylem-phloem interactions impact plant drought tolerance and reproduction, how phloem transport influences carbon allocation in trees and carbon cycling in ecosystems, and how phloem function mediates plant relations with insects, pests, microbes and symbiotes. We argue that in spite of challenges that exist in studying phloem physiology, it is critical that we consider the role of this dynamic vascular system when examining the relationship between plants and their biotic and abiotic environment

Grammaticality Judgements in L1 and L2 Sentence Reading

This study investigated the cross-language influence of a reader’s first language (L1 German) grammar knowledge on the syntactic processing of sentences in their second language (L2 English), using a grammaticality judgement task and comparing results to monolingual L1 English-speakers. In Experiment 1, unbalanced bilinguals (N = 82) read sentences in their L1 German and L2 English that were either grammatical in German but not English, grammatical in English but not German, or ungrammatical in both languages. Sentences were presented in mixed language blocks. Grammaticality judgements were less accurate and slower for ungrammatical L2 sentences that were grammatical in their literal L1 translation, compared to sentences that were ungrammatical in both languages. Experiment 2 replicated these findings with an independent German-English bilingual sample (N = 78), using monolingual language blocks. In Experiment 3, effects were absent in decision accuracy and weaker in decision latency for monolingual English readers (N = 54). A post hoc validation study with an independent sample of L1 English-speakers (N = 21) provided further evidence that the ungrammatical English sentences with German word order were indeed less natural and grammatically acceptable to L1 English-speakers than the grammatical English sentences. These findings suggest that, consistent with competition models of language comprehension, multiple languages are simultaneously active and can compete during syntactic processing. However, due to the complex nature of cross-language comparisons, the cross-language transfer effects are likely to be driven by multiple interacting factors, of which one is cross-language transfer

Cognate Facilitation in Bilingual Reading

A central finding of bilingual research is that cognates⸺words that share semantic, phonological, and orthographic characteristics across languages⸺are processed faster than non-cognate words. However, it remains unclear whether cognate facilitation effects are solely reliant on identical cognates, or whether facilitation is best described on a continuum of cross-language orthographic and phonological similarity. In two experiments, German-English bilinguals read identical cognates, close cognates, and non-cognates in a lexical decision task and a sentence-reading task while their eye movements were tracked. Participants read the stimuli in their L1 German and L2 English. Converging results found comparable facilitation effects of identical and close cognates compared to non-cognates. Cognate facilitation could be described as a continuous linear effect of cross-language orthographic similarity on lexical decision accuracy and latency, as well as eye movement measures. Cross-language phonological similarity modulated the continuous cognate facilitation effect in single word recognition, but not in sentence processing