Effect of Variable Activities on the Engagement of Memory Care Patients

Background and Objectives: Studies demonstrate that social activities (e.g., church attendance, recreation, and group activities), productive activities (e.g., gardening, preparing meals, and shopping), and fitness activities (e.g., sports, walking, and exercise) are independently associated with survival of elderly persons even after functional disability. The Heritage Community of Kalamazoo focuses on activities such as bible study, music, pet therapy, and modified volleyball exercises to provide and maintain residents’ spiritual appreciation, cognitive abilities, and quality of life. The purpose of the project is to identify any strengths and weaknesses in activity programming for memory care residents at Heritage Community through observation and reflection of resident engagement. Furthermore, ongoing student interaction with the residents provides the organization with the opportunity to reflect upon their experiences on how to better communicate with geriatric and dementia populations. Methods: Five medical students investigated the engagement of Heritage Community memory care residents in various activities from July 2016 to December 2016. Students attended organized activities at Amber Place twice per month for two hours per session. Activities include devotions, dog visits, and modified volleyball games involving hitting a balloon. During each session, students observed residents as they participated in the day’s activities and recorded their observations. Student reflections were compiled to identify common themes between activities and attitudes. Results: Analysis of reflection notes demonstrate that most activities were effective in engaging residents with varying success. Activity effectiveness tended to vary by activity and day. It was not uncommon for residents to join and subsequently leave activities. Sometimes residents were not eager to engage initially, but with some persuasion and discussion, sat quietly and eventually participated. Activities involving music, singing, and devotions evoked general engagement. Residents enjoyed repetitive activities, such as dog visits and balloon games. However, residents most commonly lost interest in the balloon games during the activity. Conclusions: Overall, Heritage Community utilizes effective activities to maintain a stimulating environment for memory care residents. Residents appreciated activity consistency and commonly recognized when activities would occur. Study limitations included the inability to measure activity effectiveness across differing days of the week, as well as limited sample size. There are numerous opportunities for further research into resident engagement and activity programming at Heritage Community. Activity impact on resident engagement and emotional health is a particularly important area to direct further research with quantitative measures

Relationship between medical examination methods and actual conditions of life for preserving visual acuity in primary and junior high school: Verification of the current vision test

The deterioration of children’s eyesight is on the rise. Children's lives have changed in a short period of time, such as an increase in blue light due to the use of electronic devices. It is necessary to consider non-traditional content of health guidance for prevention. The accurate visual acuity test is important to examine the effects of visual acuity and environmental or living factors. We examined the accuracy of the visual acuity test with the three stage Landolt ring for children from the relationship with the eye axial length. After performing a normal detailed visual acuity test of the children and the correlation analysis with the eye axial length, we examined the distribution of the eye axis according to the results of the three-stage visual acuity test by the Landolt ring. The number of children measured eye axial length was 13. The correlation coefficient between detailed visual acuity test and eye axial length was negative. According to the results of the three-stage visual acuity test, the distribution of the eye axis is good for the right eye: the average eye axis of “A” was 23.44 mm, moderate: the average of “B” was 22.58 mm. The average of the left eye axis for “A” children is 23.34 mm, for “B” is 23.08 mm, and for “C” is 23.7 mm. The correlation coefficient between the detailed visual acuity test and the eye axial length was negative on both sides, namely a negative correlation between the visual acuity and the eye axial length. There was a possibility of not correspondence between the three-stage visual test and the eye axial length. In the case of children, it was considered that their visual performance and answers were different because of their mood and physical condition on the day

Left atrial metastasis of renal cell carcinoma: a case report and review of the literature

Background: Cardiac metastasis of renal cell carcinoma is an exceptional event, particularly when there is lack of inferior vena cava involvement. Indeed, only a few cases have been reported worldwide thus far. Moreover, discussion of treatment and follow-up strategies for cardiac metastasis of renal cell carcinoma is important because of the high risk of sudden death. Case presentation. We report the case of a 75-year-old Japanese man with metastatic tumor in the left atrium from renal cell carcinoma. He had a history of right renal cell carcinoma, for which he had undergone hand-assisted laparoscopic nephrectomy. Lung and bone metastases were detected after nephrectomy, and treatment with interferon-alpha was initiated. After disease progression, he was treated concurrently with targeted molecular therapy and radiotherapy for bone metastasis. After these therapies, a 42 × 24 mm mass was found on transthoracic echocardiography in left atrium without involvement of the right atrium or inferior vena cava. The provisional diagnosis was metastatic mass or myxoma, and surgical resection was performed. Histopathological examination led to a final diagnosis of metastatic tumor from clear cell renal cell carcinoma. Conclusion: Cardiac metastasis, metastasis to the left atrium in particular, is rare in patients with renal cell carcinoma. In our study, surgery of the cardiac mass was effective to avoid sudden death and quality of life decline resulting from heart failure. We describe this case and review cardiac metastasis of renal cell carcinoma

Kinetic frustration and the nature of the magnetic and paramagnetic states in iron pnictides and iron chalcogenides

The iron pnictide and chalcogenide compounds are a subject of intensive investigations due to their high temperature superconductivity.\cite{a-LaFeAsO} They all share the same structure, but there is significant variation in their physical properties, such as magnetic ordered moments, effective masses, superconducting gaps and T$_c$. Many theoretical techniques have been applied to individual compounds but no consistent description of the trends is available \cite{np-review}. We carry out a comparative theoretical study of a large number of iron-based compounds in both their magnetic and paramagnetic states. We show that the nature of both states is well described by our method and the trends in all the calculated physical properties such as the ordered moments, effective masses and Fermi surfaces are in good agreement with experiments across the compounds. The variation of these properties can be traced to variations in the key structural parameters, rather than changes in the screening of the Coulomb interactions. Our results provide a natural explanation of the strongly Fermi surface dependent superconducting gaps observed in experiments\cite{Ding}. We propose a specific optimization of the crystal structure to look for higher T$_c$ superconductors.Comment: 5 pages, 3 figures with a 5-page supplementary materia

Multifaceted Analyses of Epidermal Serine Protease Activity in Patients with Atopic Dermatitis

The serine proteases kallikrein-related peptidase (KLK) 5 and KLK7 cleave cell adhesion molecules in the epidermis. Aberrant epidermal serine protease activity is thought to play an important role in the pathogenesis of atopic dermatitis (AD). We collected the stratum corneum (SC) from healthy individuals (n = 46) and AD patients (n = 63) by tape stripping and then measuring the trypsin- and chymotrypsin-like serine protease activity. We also analyzed the p.D386N and p.E420K of SPINK5 variants and loss-of-function mutations of FLG in the AD patients. The serine protease activity in the SC was increased not only in AD lesions but also in non-lesions of AD patients. We found, generally, that there was a positive correlation between the serine protease activity in the SC and the total serum immunoglobulin E (IgE) levels, serum thymus and activation-regulated chemokine (TARC) levels, and peripheral blood eosinophil counts. Moreover, the p.D386N or p.E420K in SPINK5 and FLG mutations were not significantly associated with the SC's serine protease activity. Epidermal serine protease activity was increased even in non-lesions of AD patients. Such activity was found to correlate with a number of biomarkers of AD. Further investigations of serine proteases might provide new treatments and prophylaxis for AD

A case of compressive optic neuropathy putatively caused by IgG4-related idiopathic orbital inflammation.

We report the case of a 58-year-old male presenting with an impairment of the left-sided visual acuity caused by compressiveoptic neuropathy, and marked bilateral proptosis. Blood test showed markedly elevated IgG4 (1830 mg/dl) and positiveTSH receptor-stimulating antibodies (200%), but the thyroid function test were normal. Orbital MRI revealed abnormal soft tissueproliferation around the optic nerve and fusiform enlargement of the extraocular muscles. Systemic CT analysis detectedmultiple lymph node swelling, pseudotumor in the lung, retroperitoneal fibrosis, and kidney lesions. We considered that the eyemanifestation was most likely caused by IgG4-related idiopathic orbital inflammation. Systemic administration of a moderatedose of prednisolone dramatically improved the compression of the optic nerve, as shown by the improvement of the visualacuity and the MRI findings. The clinical course made thyroid-associated ophthalmopathy unlikely. In conclusion, an overallconsideration of the clinical picture and extensive work-up of any possible differential diagnosis including measurement of theserum levels of IgG4 was highly useful in making the diagnosis of the patient

Phosphorylation of the RSRSP stretch is critical for splicing regulation by RNA-Binding Motif Protein 20 (RBM20) through nuclear localization

RBM20 is a major regulator of heart-specific alternative pre-mRNA splicing of TTN encoding a giant sarcomeric protein titin. Mutation in RBM20 is linked to autosomal-dominant familial dilated cardiomyopathy (DCM), yet most of the RBM20 missense mutations in familial and sporadic cases were mapped to an RSRSP stretch in an arginine/serine-rich region of which function remains unknown. In the present study, we identified an R634W missense mutation within the stretch and a G1031X nonsense mutation in cohorts of DCM patients. We demonstrate that the two serine residues in the RSRSP stretch are constitutively phosphorylated and mutations in the stretch disturb nuclear localization of RBM20. Rbm20 S637A knock-in mouse mimicking an S635A mutation reported in a familial case showed a remarkable effect on titin isoform expression like in a patient carrying the mutation. These results revealed the function of the RSRSP stretch as a critical part of a nuclear localization signal and offer the Rbm20 S637A mouse as a good model for in vivo study

p53-mediated activation of the mitochondrial protease HtrA2/Omi prevents cell invasion

Oncogenic Ras induces cell transformation and promotes an invasive phenotype. The tumor suppressor p53 has a suppressive role in Rasdriven invasion. However, its mechanism remains poorly understood. Here we show that p53 induces activation of the mitochondrial protease high-temperature requirement A2 (HtrA2; also known as Omi) and prevents Ras-driven invasion by modulating the actin cytoskeleton. Oncogenic Ras increases accumulation of p53 in the cytoplasm, which promotes the translocation of p38 mitogen-activated protein kinase (MAPK) into mitochondria and induces phosphorylation of HtrA2/Omi. Concurrently, oncogenic Ras also induces mitochondrial fragmentation, irrespective of p53 expression, causing the release of HtrA2/Omi from mitochondria into the cytosol. Phosphorylated HtrA2/Omi therefore cleaves β-actin and decreases the amount of filamentous actin (F-actin) in the cytosol. This ultimately down-regulates p130 Crk-associated substrate (p130Cas)-mediated lamellipodia formation, countering the invasive phenotype initiated by oncogenic Ras. Our novel findings provide insights into the mechanism by which p53 prevents the malignant progression of transformed cells. © 2014 Yamauchi et al.published_or_final_versio

EVER Proteins, Key Elements of the Natural Anti-Human Papillomavirus Barrier, Are Regulated upon T-Cell Activation

Human papillomaviruses (HPV) cause a variety of mucosal and skin lesions ranging from benign proliferations to invasive carcinomas. The clinical manifestations of infection are determined by host-related factors that define the natural anti-HPV barrier. Key elements of this barrier are the EVER1 and EVER2 proteins, as deficiency in either one of the EVER proteins leads to Epidermodysplasia Verruciformis (EV), a genodermatosis associated with HPV-induced skin carcinoma. Although EVERs have been shown to regulate zinc homeostasis in keratinocytes, their expression and function in other cell types that may participate to the anti-HPV barrier remain to be investigated. In this work, we demonstrate that EVER genes are expressed in different tissues, and most notably in lymphocytes. Interestingly, in contrast to the skin, where EVER2 transcripts are hardly detectable, EVER genes are both abundantly expressed in murine and human T cells. Activation of CD4+ and CD8+ T cells via the TCR triggers a rapid and profound decrease in EVER expression, accompanied by an accumulation of free Zn2+ ions. Thus, EVER proteins may be involved in the regulation of cellular zinc homeostasis in lymphocytes. Consistent with this hypothesis, we show that the concentration of Zn2+ ions is elevated in lymphoblastoid cells or primary T cells from EVER2-deficient patients. Interestingly, we also show that Zn2+ excess blocks T-cell activation and proliferation. Therefore, EVER proteins appear as key components of the activation-dependent regulation of Zn2+ concentration in T cells. However, the impact of EVER-deficiency in T cells on EV pathogenesis remains to be elucidated