Using illness perceptions and coping to understand distress and quality of life in carers of stroke survivors

The role of illness perceptions and coping in distress and quality of life in carers of stroke survivors is investigated. The first part is a review of the literature concerning the impact of stroke on carers and the research investigating determinants of poor outcomes in these individuals. Theoretical frameworks are examined with emphasis on the potential contribution of Leventhal's self-regulation model, which provides a useful framework for investigating illness perceptions and coping in stroke carer outcomes. The empirical paper investigated the role of illness perceptions and coping in distress and quality of life in carers of stroke survivors. Seventy-two carers completed postal questionnaires. Findings indicated an important role of illness perceptions and coping in carer outcomes. Illness perceptions accounted for variance in carer distress, psychological quality of life and social relationships, over and above carer, stroke survivor and illness characteristics. Emotional representations and belief in a psychosocial cause both independently predicted greater distress. Perceptions of greater treatment control independently predicted better psychological well-being and better social relationships. Coping added significant variance in psychological and social quality of life with less use of passive coping independently predicting better psychological well-being and better social relationships. Interpretation of the findings, implications and suggestions for further research are discussed. The critical appraisal examines further the strengths and weaknesses of the study. Theoretical and clinical implications and suggestions for further research are elaborated

Machine Learning in Falls Prediction; A cognition-based predictor of falls for the acute neurological in-patient population

Background Information: Falls are associated with high direct and indirect costs, and significant morbidity and mortality for patients. Pathological falls are usually a result of a compromised motor system, and/or cognition. Very little research has been conducted on predicting falls based on this premise. Aims: To demonstrate that cognitive and motor tests can be used to create a robust predictive tool for falls. Methods: Three tests of attention and executive function (Stroop, Trail Making, and Semantic Fluency), a measure of physical function (Walk-12), a series of questions (concerning recent falls, surgery and physical function) and demographic information were collected from a cohort of 323 patients at a tertiary neurological center. The principal outcome was a fall during the in-patient stay (n = 54). Data-driven, predictive modelling was employed to identify the statistical modelling strategies which are most accurate in predicting falls, and which yield the most parsimonious models of clinical relevance. Results: The Trail test was identified as the best predictor of falls. Moreover, addition of any others variables, to the results of the Trail test did not improve the prediction (Wilcoxon signed-rank p < .001). The best statistical strategy for predicting falls was the random forest (Wilcoxon signed-rank p < .001), based solely on results of the Trail test. Tuning of the model results in the following optimized values: 68% (+- 7.7) sensitivity, 90% (+- 2.3) specificity, with a positive predictive value of 60%, when the relevant data is available. Conclusion: Predictive modelling has identified a simple yet powerful machine learning prediction strategy based on a single clinical test, the Trail test. Predictive evaluation shows this strategy to be robust, suggesting predictive modelling and machine learning as the standard for future predictive tools

The Trail Making test : a study of its ability to predict falls in the acute neurological in-patient population

Objective: To determine whether tests of cognitive function and patient-reported outcome measures of motor function can be used to create a machine learning-based predictive tool for falls. Design: Prospective cohort study. Setting: Tertiary neurological and neurosurgical center. Subjects: In all, 337 in-patients receiving neurosurgical, neurological, or neurorehabilitation-based care. Main Measures: Binary (Y/N) for falling during the in-patient episode, the Trail Making Test (a measure of attention and executive function) and the Walk-12 (a patient-reported measure of physical function). Results: The principal outcome was a fall during the in-patient stay (n = 54). The Trail test was identified as the best predictor of falls. Moreover, addition of other variables, did not improve the prediction (Wilcoxon signed-rank P < 0.001). Classical linear statistical modeling methods were then compared with more recent machine learning based strategies, for example, random forests, neural networks, support vector machines. The random forest was the best modeling strategy when utilizing just the Trail Making Test data (Wilcoxon signed-rank P < 0.001) with 68% (± 7.7) sensitivity, and 90% (± 2.3) specificity. Conclusion: This study identifies a simple yet powerful machine learning (Random Forest) based predictive model for an in-patient neurological population, utilizing a single neuropsychological test of cognitive function, the Trail Making test

An Ultraviolet and Near-Infrared View of NGC 4214: A Starbursting Core Embedded in a Low Surface Brightness Disk

During the Astro-2 Spacelab mission in 1995 March, the Ultraviolet Imaging Telescope (UIT) obtained far-UV (λ = 1500 A) imagery of the nearby Sm/Im galaxy NGC 4214. The UIT images have a spatial resolution of ~3'' and a limiting surface brightness, μ1500 > 25 mag arcsec-2, permitting detailed investigation of the intensity and spatial distribution of the young, high-mass stellar component. These data provide the first far-UV imagery covering the full spatial extent of NGC 4214. Comparison with a corresponding I-band image reveals the presence of a starbursting core embedded in an extensive low surface brightness disk. In the far-UV (FUV), NGC 4214 is resolved into several components: a luminous, central knot; an inner region (r 2.5 kpc) with ~15 resolved sources embedded in bright, diffuse emission; and a population of fainter knots extending to the edge of the optically defined disk (r ≈ 5 kpc). The FUV light, which traces recent massive star formation, is observed to be more centrally concentrated than the I-band light, which traces the global stellar population. The FUV radial light profile is remarkably well represented by an R1/4 law, providing evidence that the centrally concentrated massive star formation in NGC 4214 is the result of an interaction, possibly a tidal encounter, with a dwarf companion(s). The brightest FUV source produces ~8% of the global FUV luminosity. This unresolved source, corresponding to the Wolf-Rayet knot described by Sargent & Filippenko, is located at the center of the FUV light distribution, giving NGC 4214 an active galactic nucleus-like morphology. Another strong source is present in the I band, located 19'' west, 10'' north of the central starburst knot, with no FUV counterpart. The I-band source may be the previously unrecognized nucleus of NGC 4214 or an evolved star cluster with an age greater than ~200 Myr. The global star formation rate derived from the total FUV flux is consistent with rates derived using data at other wavelengths and lends support to the scenario of roughly constant star formation during the last few hundred million years at a level significantly enhanced relative to the lifetime averaged star formation rate. The hybrid disk/starburst-irregular morphology evident in NGC 4214 emphasizes the danger of classifying galaxies based on their high surface brightness components at any particular wavelength

A Potent and Selective Inhibitor of Cdc42 GTPase

Cdc42, a member of the Rho family of GTPases, has been shown to play a role in cell adhesion, cytoskeletal arrangement, phagocytosis and cell motility and migration, in addition to a host of other diverse biological processes. The function of Rho-family GTPases in disease pathogenesis has been well established and identification of small, cell permeable molecules that selectively and reversibly regulate Rho GTPases is of high scientific and potentially therapeutic interest. There has been limited success in identifying inhibitors that specifically interact with small Rho family GTPases. The identified probe, ML141 (CID-2950007), is demonstrated to be a potent, selective and reversible non-competitive inhibitor of Cdc42 GTPase suitable for in vitro assays, with low micromolar potency and selectivity against other members of the Rho family of GTPases (Rac1, Rab2, Rab7). Given the highly complementary nature of the function of the Rho family GTPases, Cdc42 selective inhibitors such as those reported here should help untangle the roles of the proteins in this family

Characterization of a Cdc42 Protein Inhibitor and Its Use as a Molecular Probe

Cdc42 plays important roles in cytoskeleton organization, cell cycle progression, signal transduction, and vesicle trafficking. Overactive Cdc42 has been implicated in the pathology of cancers, immune diseases, and neuronal disorders. Therefore, Cdc42 inhibitors would be useful in probing molecular pathways and could have therapeutic potential. Previous inhibitors have lacked selectivity and trended toward toxicity. We report here the characterization of a Cdc42-selective guanine nucleotide binding lead inhibitor that was identified by high throughput screening. A second active analog was identified via structure-activity relationship studies. The compounds demonstrated excellent selectivity with no inhibition toward Rho and Rac in the same GTPase family. Biochemical characterization showed that the compounds act as noncompetitive allosteric inhibitors. When tested in cellular assays, the lead compound inhibited Cdc42-related filopodia formation and cell migration. The lead compound was also used to clarify the involvement of Cdc42 in the Sin Nombre virus internalization and the signaling pathway of integrin VLA-4. Together, these data present the characterization of a novel Cdc42-selective allosteric inhibitor and a related analog, the use of which will facilitate drug development targeting Cdc42-related diseases and molecular pathway studies that involve GTPases.This work was supported by National Science Foundation (NSF) Grant MCB0956027 and National Institutes of Health Grant R03 MH081231-01 from the Molecular Libraries Program (to A. W. N.); University of New Mexico Center for Molecular Discovery Molecular Libraries Probe Production Centers (UNMCMD MLPCN) National Institutes of Health Grants U54MH084690 and R01HL081062 (to L. A. S.); UNM National Center for Research Resources (NCRR) Grant 5P20RR016480 (to L. G. H.); National Institutes of Health Grant R21 CA170375-01 through the NCI (to A. W. N., L. G. H., and J. E. G.); National Institutes of Health Grants NS066429 and AI092130 (to T. B.); and University of Kansas Specialized Chemistry Center (KUSCC) MLPCN National Institutes of Health Grant U54HG005031 (to J. A.)

Far Ultraviolet Imagery of the Edge-On Spiral Galaxy NGC 4631

Far ultraviolet FUV imagery of the edge-on, Sc/SBd galaxy, NGC 4631 reveals very strong FUV emission, resulting from active star formation, uniformly distributed along the galactic mid- plane. Multi-band imagery, HI and HII position-velocity curves and extinction considerations all imply that the emission is from the outer edges of the visible galaxy. The overall FUV morphology of this edge-on disk system is remarkably similar to those of the so-called "chain galaxies" evident at high redshift, thus suggesting a similar interpretation for at least some of those distant objects. FUV, U, B and V magnitudes, measured for 48 star forming regions, along with corresponding H-alpha and H-beta measurements are used to construct diagnostic color-color diagrams. Although there are significant exceptions, most of the star forming regions are less massive and older than 30 Doradus. Comparison with the expectations from two star formation models yields ages of 2.7 to 10 Myr for the instantaneous burst (IB) model and star formation cut-off ages of 0 to 9 Myr for the continuous star formation (CSF) model. Interpreted in terms of the IB model the photometry implies a total created mass in the 48 star forming regions of 25 million solar-masses. When viewed as resulting from constant star formation the photometry implies a star formation rate of 0.33 solar-masses/yr. These results are compared to those derived from FIR and radio observations. Corrections for FUV emission reprocessed by interstellar grains are estimated.Comment: 29 pages including 6 encapsulated Postscript figures; accepted for publication in ApJ; changed table forma

Randomised controlled trial of thermostatic mixer valves in reducing bath hot tap water temperature in families with young children in social housing: A protocol

<p>Abstract</p> <p>Background</p> <p>Each year in the UK 2000 children attend emergency departments and 500 are admitted to hospital following a bath water scald. The long term effects can include disability, disfigurement or psychological harm and repeated skin grafts may be required as the child grows. The costs of treating a severe scald are estimated at 250,000 GBP. Children living in the most deprived wards are at greatest risk of thermal injuries; hospital admission rates are three times that for children living in the least deprived wards.</p> <p>Domestic hot water, which is usually stored at around 60 degrees Celsius, can result in a second-degree burn after 3 seconds and a third-degree burn after 5 seconds. Educational strategies to encourage testing of tap water temperature and reduction of hot water thermostat settings have largely proved unsuccessful. Legislation in the USA mandating pre-setting hot water heater thermostats at 49 degrees Celsius was effective in reducing scald injuries, suggesting passive measures may have a greater impact. Thermostatic mixer valves (TMVs), recently developed for the domestic market, fitted across the hot and cold water supply pipes of the bath, allow delivery of water set at a fixed temperature from the hot bath tap. These valves therefore offer the potential to reduce scald injuries.</p> <p>Design/Methods</p> <p>A pragmatic, randomised controlled trial to assess the effectiveness of TMVs in reducing bath hot tap water temperatures in the homes of families with young children in rented social housing. Two parallel arms include an intervention group and a control group where the intervention will be deferred.</p> <p>The intervention will consist of fitting a TMV (set at 44 degrees Celsius) by a qualified plumber and provision of educational materials. The control arm will not receive a TMV or the educational materials for the study duration but will be offered the intervention after collection of follow-up data 12 months post randomisation.</p> <p>The primary outcome measure will be the bath hot tap water temperature. Fifteen families per arm are required to detect a reduction in the mean bath hot tap water temperature from 60.4 degrees Celsius (SD 9.1) in the control group to 46 degrees Celsius in the intervention group, with 90% power and a 5% significance level (2 sided). Secondary outcome measures including acceptability will require a sample size of 120 participants.</p> <p>Discussion</p> <p>Whilst TMVs have the potential to reduce scald injuries, to date there have been no randomised controlled trials assessing their effectiveness, acceptability and cost effectiveness.</p> <p>Trial Registration</p> <p>ISRCTN21179067</p

Preventing childhood scalds within the home: overview of systematic reviews and a systematic review of primary studies

Objective: To synthesise and evaluate the evidence of the effectiveness of interventions to prevent scalds in children. Methods: An overview of systematic reviews (SR) and a SR of primary studies were performed evaluating interventions to prevent scalds in children. A comprehensive literature search was conducted covering various resources up to October 2012. Experimental and controlled observational studies reporting scald injuries, safety practices and safety equipment use were included. Results: Fourteen systematic reviews and 39 primary studies were included. There is little evidence that interventions are effective in reducing the incidence of scalds in children. More evidence was found that inventions are effective in promoting safe hot tap water temperature, especially when home safety education, home safety checks and discounted or free safety equipment including thermometers and thermostatic mixing valves were provided. No consistent evidence was found for the effectiveness of interventions on the safe handling of hot food or drinks nor improving kitchen safety practices. Conclusion: Education, home safety checks along with thermometers or thermostatic mixing valves should be promoted to reduce tap water scalds. Further research is needed to evaluate the effectiveness of interventions on scald injuries and to disentangle the effects of multifaceted interventions on scald injuries and safety practices

A Randomized Trial of a Physical Conditioning Program to Enhance the Driving Performance of Older Persons

BACKGROUND: As the number of older drivers increases, concern has been raised about the potential safety implications. Flexibility, coordination, and speed of movement have been associated with older drivers’ on road performance. OBJECTIVE: To determine whether a multicomponent physical conditioning program targeted to axial and extremity flexibility, coordination, and speed of movement could improve driving performance among older drivers. DESIGN: Randomized controlled trial with blinded assignment and end point assessment. Participants randomized to intervention underwent graduated exercises; controls received home, environment safety modules. PARTICIPANTS: Drivers, 178, age ≥ 70 years with physical, but without substantial visual (acuity 20/40 or better) or cognitive (Mini Mental State Examination score ≥24) impairments were recruited from clinics and community sources. MEASUREMENTS: On-road driving performance assessed by experienced evaluators in dual-brake equipped vehicle in urban, residential, and highway traffic. Performance rated three ways: (1) 36-item scale evaluating driving maneuvers and traffic situations; (2) evaluator’s overall rating; and (3) critical errors committed. Driving performance reassessed at 3 months by evaluator blinded to treatment group. RESULTS: Least squares mean change in road test scores at 3 months compared to baseline was 2.43 points higher in intervention than control participants (P = .03). Intervention drivers committed 37% fewer critical errors (P = .08); there were no significant differences in evaluator’s overall ratings (P = .29). No injuries were reported, and complaints of pain were rare. CONCLUSIONS: This safe, well-tolerated intervention maintained driving performance, while controls declined during the study period. Having interventions that can maintain or enhance driving performance may allow clinician–patient discussions about driving to adopt a more positive tone, rather than focusing on driving limitation or cessation