Feasibility of a randomized controlled trial of functional strength training for people between six months and five years after stroke: FeSTivaLS trial

Background: Functional Strength Training (FST) could enhance recovery late after stroke. The aim of this study was to evaluate the feasibility of a subsequent fully powered, randomized controlled trial. Methods: The study was designed as a randomized, observer-blind trial. Both interventions were provided for up to one hour a day, four days a week, for six weeks. Evaluation points were before randomization (baseline), after six weeks intervention (outcome), and six weeks thereafter (follow-up). The study took place in participants’ own homes. Participants (n = 52) were a mean of 24.4 months after stroke with a mean age of 68.3 years with 67.3% male. All had difficulty using their paretic upper (UL) and lower limb (LL). Participants were allocated to FST-UL or FST-LL by an independent randomization service. The outcome measures were recruitment rate, attrition rate, practicality of recruitment strategies, occurrence of adverse reactions, acceptability of FST, and estimation of sample size for a subsequent trial. Primary clinical efficacy outcomes were the Action Research Arm Test (ARAT) and the Functional Ambulation Categories (FAC). Analysis was conducted using descriptive statistics and thematic analysis of participants’ views of FST. A power calculation used estimates of clinical efficacy variance to estimate sample size for a subsequent trial. Results: The screening process identified 1,127 stroke survivors of whom 52 (4.6%) were recruited. The recruitment rate was higher for referral from community therapists than for systematic identification of people discharged from an acute stroke unit. The attrition rate was 15.5% at the outcome and follow-up time-points. None of the participants experienced an adverse reaction. The participants who remained in the study at outcome had received 68% of the total possible amount of therapy. Participants reported that their experience of FST provided a sense of purpose and involvement and increased their confidence in performing activities. The power calculation provides estimation that 150 participants in each group will be required for a subsequent clinical trial. Conclusions: This study found that a subsequent clinical trial was feasible with modifications to the recruitment strategy to be used

Providing Feedback Following Leadership Walkrounds is Associated with Better Patient Safety Culture, Higher Employee Engagement and Lower Burnout

Background There is a poorly understood relationship between Leadership WalkRounds (WR) and domains such as safety culture, employee engagement, burnout and work-life balance. Methods This cross-sectional survey study evaluated associations between receiving feedback about actions taken as a result of WR and healthcare worker assessments of patient safety culture, employee engagement, burnout and work-life balance, across 829 work settings. Results 16 797 of 23 853 administered surveys were returned (70.4%). 5497 (32.7% of total) reported that they had participated in WR, and 4074 (24.3%) reported that they participated in WR with feedback. Work settings reporting more WR with feedback had substantially higher safety culture domain scores (first vs fourth quartile Cohen’s d range: 0.34–0.84; % increase range: 15–27) and significantly higher engagement scores for four of its six domains (first vs fourth quartile Cohen’s d range: 0.02–0.76; % increase range: 0.48–0.70). Conclusion This WR study of patient safety and organisational outcomes tested relationships with a comprehensive set of safety culture and engagement metrics in the largest sample of hospitals and respondents to date. Beyond measuring simply whether WRs occur, we examine WR with feedback, as WR being done well. We suggest that when WRs are conducted, acted on, and the results are fed back to those involved, the work setting is a better place to deliver and receive care as assessed across a broad range of metrics, including teamwork, safety, leadership, growth opportunities, participation in decision-making and the emotional exhaustion component of burnout. Whether WR with feedback is a manifestation of better norms, or a cause of these norms, is unknown, but the link is demonstrably potent

Effect of distillers grains moisture and inclusion level in livestock diets on greenhouse gas emissions in the corn-ethanol-livestock life cycle

A model was previously developed (Biofuel Energy Systems Simulator; www. bess.unl.edu) to predict greenhouse gas (GHG) emissions and net energy yield when ethanol is produced from corn. The model also predicts feedlot cattle, dairy cattle, and swine performance and feed replacement value of ethanol coproducts. Updated equations that predict performance of feedlot cattle fed 0 to 40% of dietary DM as corn wet (WDGS), modified (MDGS), or dry (DDGS) distillers grains plus solubles replacing dry-rolled and high-moisture corn were developed and incorporated into the model. Equations were derived from pen-level performance for 20 finishing studies evaluating WDGS, 4 evaluating MDGS, and 4 evaluating DDGS conducted at the University of Nebraska. Feeding value of WDGS was 145 to 131% of corn replaced when included at 20 to 40% of diet DM due to a quadratic (P \u3c 0.01) increase in G:F. The feeding value of MDGS was 124 to 117% with a quadratic (P \u3c 0.01) increase in G:F and 112 to 110% for DDGS with a linear (P \u3c 0.01) increase in G:F. Midwest corn-ethanol-livestock life cycle GHG reduction relative to gasoline (97.7 g CO2 equivalent/MJ of ethanol) was 61 to 57% when WDGS was fed to feedlot cattle for 20 to 40% diet inclusion. Feeding MDGS and DDGS to feedlot cattle reduced GHG emissions from the corn-ethanol-cattle system by 53 to 50% and 46 to 41%, respectively. Feeding WDGS to feedlot cattle was the optimum feed use of distillers grains plus solubles based on feeding performance and GHG reduction

Stress in nurses : stress-related affect and its determinants examined over the nursing day

Peer reviewedPostprin

Core-shell magnetic morphology of structurally uniform magnetite nanoparticles

A new development in small-angle neutron scattering with polarization analysis allows us to directly extract the average spatial distributions of magnetic moments and their correlations with three-dimensional directional sensitivity in any magnetic field. Applied to a collection of spherical magnetite nanoparticles 9.0 nm in diameter, this enhanced method reveals uniformly canted, magnetically active shells in a nominally saturating field of 1.2 T. The shell thickness depends on temperature, and it disappears altogether when the external field is removed, confirming that these canted nanoparticle shells are magnetic, rather than structural, in origin

Internal magnetic structure of magnetite nanoparticles at low temperature

Small-angle neutron scattering with polarization analysis reveals that Fe3O4 nanoparticles with 90 Å diameters have ferrimagnetic moments significantly reduced from that of bulk Fe3O4 at 10 K, nominal saturation. Combined with previous results for an equivalent applied field at 200 K, a core-disordered shell picture of a spatially reduced ferrimagnetic core emerges, even well below the bulk blocking temperature. Zero-field cooling suggests that this magnetic morphology may be intrinsic to the nanoparticle, rather than field induced, at 10 K

The role of the RACK1 ortholog Cpc2p in modulating pheromone-induced cell cycle arrest in fission yeast

The detection and amplification of extracellular signals requires the involvement of multiple protein components. In mammalian cells the receptor of activated C kinase (RACK1) is an important scaffolding protein for signal transduction networks. Further, it also performs a critical function in regulating the cell cycle by modulating the G1/S transition. Many eukaryotic cells express RACK1 orthologs, with one example being Cpc2p in the fission yeast Schizosaccharomyces pombe. In contrast to RACK1, Cpc2p has been described to positively regulate, at the ribosomal level, cells entry into M phase. In addition, Cpc2p controls the stress response pathways through an interaction with Msa2p, and sexual development by modulating Ran1p/Pat1p. Here we describe investigations into the role, which Cpc2p performs in controlling the G protein-mediated mating response pathway. Despite structural similarity to Gβ-like subunits, Cpc2p appears not to function at the G protein level. However, upon pheromone stimulation, cells overexpressing Cpc2p display substantial cell morphology defects, disorientation of septum formation and a significantly protracted G1 arrest. Cpc2p has the potential to function at multiple positions within the pheromone response pathway. We provide a mechanistic interpretation of this novel data by linking Cpc2p function, during the mating response, with its previous described interactions with Ran1p/Pat1p. We suggest that overexpressing Cpc2p prolongs the stimulated state of pheromone-induced cells by increasing ste11 gene expression. These data indicate that Cpc2p regulates the pheromone-induced cell cycle arrest in fission yeast by delaying cells entry into S phase