Homesharing matchup agencies for seniors : a literature review

The purpose of this paper is to review the literature on homesharing for elderly people with emphasis on non-profit matching agencies. After presenting a general definition and describing the most common types of homesharing, two relevant social trends are examined. The major proponents of this practice are then considered. An overview of the clients of homesharing agencies, the types of homesharing arrangements and of the agencies themselves will follow. The paper concludes with a discussion of questions raised by the literature review

Studies on the development of assay methods for the measurement of proinsulin

The recent availability of synthetic human promsulin through recombinant DNA technology has permitted detailed studies of its actions on metabolism to be undertaken, as well as giving researchers the opportunity to develop methods for measurement of proinsulin in various metabolic conditions. Imtally, this project focussed on the use of rat hepatocytes as a model system for investigating the effect of proinsulin on 3-hydroxy-3-methylglutaryl coenzyme. A reductase, the rate limiting enzyme controlling endogenous cholesterol synthesis An ‘in vitro’ bioassay technique, based on the effect of proinsulin on enzyme activity, was developed to compare the level of proinsulin in serum from nondiabetic subjects with that from a group of diabetic patients. Higher levels of serum proinsulin were observed in the latter group Subsequent work investigated the contribution of biologically active proinsulin to total immunoreactive proinsulin in these patients. A two-site enzyme linked immunosorbent assay was developed using commercial anti-insulin and anti C-peptide immunoglobulins to determine serum proinsulin. The level of immunoreactive proinsulin in diabetic patients was shown to be approximately three-fold higher than the level of bioactive proinsulin as obtained by the bioassay technique. The advantages and disadvantages of both these methods will be discussed

A nine-year longitudinal case study of a 27-year-old male with neurocysticercosis presenting with new onset seizures

Background: Taenia solium is a cestode endemic to regions of Latin America, Asia, sub-Saharan Africa and Oceania, and serves as the most common cause of acquired epilepsy in the world. T. solium eggs are transmitted fecal-orally when a human or pig host ingests contaminated food or water. Larvae hatch from the intestines and invade into muscle, tissue, or organs, forming cysts called cysticerci. Cysticerci involving the central nervous system is termed neurocysticercosis (NCC). Patients with NCC typically remain asymptomatic for 3-5 years in the viable stage until the host’s immune response is activated in the degenerating stage. Immune-mediated degradation of cysticerci and subsequent inflammation and edema in the nonviable stage may manifest as new onset seizures, headache, and other neurological deficits caused by increasing intracranial pressure. The diagnosis of NCC in non-endemic areas is based on clinical symptoms, history of travel to an endemic region, and presence of classic ring-enhancing lesions on neuroimaging. Case Description: A healthy 27-year-old male presents with new onset seizures. The first episode was witnessed by his wife who stated he was washing dishes before he fell to the ground convulsing. The seizure spontaneously resolved upon arrival of the ambulance. The patient denies symptoms of fever, fatigue, unexplained weight change, headaches, focal neurologic deficit, visual changes, cough, rash, recent illness, or head trauma. Further history is noncontributory except for note of travel to China four years ago to visit his in-laws. Vital signs are within normal range. In the Emergency Department, he suffers another witnessed seizure and is treated with lorazepam. He is disoriented and combative in his postictal state necessitating sedation with intubation. A CBC, CMP, troponin, HIV, toxicology, and tuberculosis screen are largely normal. Lumbar puncture reveals elevated leukocytes with normal glucose and protein levels. Parasitology report and blood cultures remain negative throughout the visit. Computerized tomography (CT) scan and contrasted magnetic resonance imaging (MRI) of the brain show a 3-4 millimeter calcified, ring-enhancing lesion in the right frontal lobe with surrounding edema. He is diagnosed with NCC based on symptoms, travel history, and neuroimaging findings. Conclusion/Discussion: This is an uncomplicated nine-year longitudinal case study of a patient with NCC presenting with new onset seizures four years after traveling to China. Symptomatic management at the time of diagnosis included dexamethasone for brain edema and levetiracetam for prevention of further seizures. Antiparasitics, which can be used in viable or degenerating stages, were not utilized in our patient due to the evidence of a nonviable calcified cysticercus on imaging. The patient ultimately opted for surgical removal of the lesion to definitively treat his seizures. A six-month postoperative MRI confirmed resolution of abnormal findings, at which point the patient was weaned off levetiracetam. Nine years later, the patient remains seizure-free and without complications

Survey of Canadian homesharing agencies serving the elderly

Homesharing is a living arrangement in which two or more unrelated persons occupy a single dwelling, each having some private space but sharing common areas such as kitchen, bathroom and living room. This report describes findings from a study which examined the objectives, services, operational characteristics and clientele of 18 Canadian agencies which help older persons to make suitable homesharing arrangements

Crafting Medical Education Differently: An Innovative Pedagogical Approach to Enhance Deep Learning in Obstetrics and Gynaecology

In this article we explore an innovative pedagogical approach initiated during the COVID-19 lockdown period to support student learning in Obstetrics and Gynaecology in the Faculty of Health Sciences at the University of Cape Town. Student isolation and the lack of exposure to clinical cases during this period brought many challenges to the teaching platform. However, the global disruption enabled an ontological opening for imaginative and creative experimentation, an aspect of teaching rarely brought into medical training. We take up the unusual work of a clinician educator and others to describe the process of developing novel video recordings for undergraduate medical students. These videos, used as pedagogical tools, enabled new ways of engaging with core curricular needs in this discipline: for the teacher, new ways of producing teaching materials, and for the students, new ways of learning medical content. The videos drew on a range of creative modes including drawing and acting, to augment student learning. As authors, we suggest that the collision of the clinical content and the performative delivery in the videos fostered deep learning and made the curricular material alive and engaging. The existence of the videos enables a sustainable blended learning approach moving forward. The uploading of the videos as Open Educational Resources onto a YouTube channel and a public website now also contribute to teaching resources extending beyond institutional boundaries

High-resolution genetic analysis reveals extensive gene flow within the jellyfish Pelagia noctiluca (Scyphozoa) in the North Atlantic and Mediterranean Sea

12 pages, 5 figures, 3 tables, supporting Information http://onlinelibrary.wiley.com/doi/10.1111/bij.12654/suppinfoDespite the importance of gelatinous zooplankton as components of marine ecosystems, both ecologically and socio-economically, relatively little information is known about population persistence or connectivity in jellyfish. In the present study, we employed a combination of nuclear microsatellite markers and sequence data from the mitochondrial cytochrome oxidase I (COI) gene to determine levels and patterns of population genetic structuring in the holoplanktonic jellyfish Pelagia noctiluca across the northeast Atlantic Ocean and Mediterranean Sea. Our results indicate a high degree of connectivity in P. noctiluca, with little evidence of geographical structuring of genetic variation. A small but significant differentiation of Atlantic Ocean and Mediterranean stocks was detected based on the microsatellite data, but no evidence of differentiation was observed with the mtDNA, probably due to the higher power of the microsatellites to detect low levels of genetic structuring. Two clearly distinct groups of genotypes were observed within the mtDNA COI, which probably diverged in the early Pleistocene, but with no evidence of geographical structuring. Palaeodistribution modelling of P. noctiluca at the Last Glacial Maximum (LGM; c. 21 Kya) indicated large areas of suitable habitat south of the species’ current-day distribution, with little reduction in area. The congruent evidence for minimal genetic differentiation from the nuclear microsatellites and the mtDNA, coupled with the results of the palaeodistribution modelling, supports the idea of long-term population stability and connectivity, thus providing key insights into the population dynamics and demography of this important speciesFergal Glynn’s PhD was funded by the Department of Agriculture and Rural Development, Northern Ireland (DARDNI). Martin Lilley was funded by l’Agence Nationale de la Recherche projects ‘Ecogely’ ANR-10-PDOC-005-01 and ‘NanoDeconGels’ ANR-12-EMMA-0008Peer Reviewe

Confidence in the face of risk: the Risk Assessment and Management Self-Efficacy Study (RAMSES).

Aims and method To evaluate a comprehensive risk management programme. A Risk Assessment and Management Self-Efficacy Scale (RAMSES) was used to evaluate the impact of a clinical guideline and training course. Fifty-three psychological therapists were randomly allocated to training v. waiting list in a controlled, delayed-intervention design. Differences in mean self-efficacy scores between groups were examined using analysis of covariance (ANCOVA). Results The RAMSES measure had adequate factor structure, internal consistency and construct validity. When adjusting for baseline scores and cluster design, the group exposed to training had a higher mean self-efficacy score than controls. Mean differences between groups were not significant after the control group received training, nor at 6 months' follow-up. Clinical implications Exposure to training and clinical guidelines can improve self-efficacy in risk assessment and management. An important advance put forward by this study is the specification of areas of competence in risk assessment and management, which can be measured using a psychometrically sound tool

A novel protamine variant reversal of heparin anticoagulation in human blood in vitro

AbstractPurpose: Protamine reversal of heparin anticoagulation during cardiovascular surgery may cause severe hypotension and pulmonary hypertension. A novel protamine variant, [+18RGD], has been developed that effectively reverses heparin anticoagulation without toxicity in canine experiments. Heretofore, human studies have not been undertaken. This investigation hypothesized that [+18RGD] would effectively reverse heparin anticoagulation of human blood in vitro. Methods: Fifty patients who underwent anticoagulation therapy during vascular surgery had blood sampled at baseline and 30 minutes after receiving heparin (150 IU/kg). Activated clotting times were used to define specific quantities of [+18RGD] or protamine necessary to completely reverse heparin anticoagulation in the blood sample of each patient. These defined amounts of [+18RGD] or protamine were then administered to the heparinized blood samples, and percent reversals of activated partial thromboplastin time, thrombin clotting time, and antifactor Xa/IIa levels were determined. In addition, platelet aggregation assays, as well as platelet and white blood cell counts were performed. Results: [+18RGD] and protamine were equivalent in reversing heparin as assessed by thrombin clotting time, antifactor Xa, antifactor IIa levels, and white blood cell changes. [+18RGD], when compared with protamine, was superior in this regard, as assessed by activated partial thromboplastin time (94.5 ± 1.0 vs 86.5 ± 1.3%δ, respectively; p < 0.001) and platelet declines (–3.9 ± 2.9 vs –12.8 ± 3.4 per mm3, respectively; p = 0.048). Platelet aggregation was also decreased for [+18RGD] compared with protamine (23.6 ± 1.5 vs 28.5 ± 1.9%, respectively; p = 0.048). Conclusions: [+18RGD] was as effective as protamine for in vitro reversal of heparin anticoagulation by most coagulation assays, was statistically more effective at reversal than protamine by aPTT assay, and was associated with lesser platelet reductions than protamine. [+18RGD], if less toxic than protamine in human beings, would allow for effective clinical reversal of heparin anticoagulation. (J Vasc Surg 1997;26:1043-8.