Conversation Goals, Communication Satisfaction, and Relational Dynamics While Navigating Alzheimer’s Disease: A Pre- and Post-Diagnosis Dyadic Examination of Family Communication

Currently there are more than 16 million unpaid Alzheimer’s disease and dementia caregivers in the United States. These caregivers are often family members of the person living with dementia, and as they navigate the process of giving care to the patient, they must also maintain relationships with each other. Families enter the dementia experience with a history of their relational experiences, and their relational experiences potentially change as they navigate family experiences after the dementia diagnosis. Much existing scholarship examining family communication in the context of progressive Alzheimer’s disease and other related dementias has focused on the perspectives of one individual within a family, single communication encounters, and has operationalized communication in terms of frequency. This dissertation applied the multiple goals theory of interpersonal relationships (Caughlin, 2010) to address some of the gaps in extant scholarship by focusing on family dyads, collective past communication experiences, and measured the quality of family communication. Seven research questions were presented, which inquired about the associations between pre-diagnosis relational dynamics, post-diagnosis communication satisfaction, post-diagnosis interaction goals, and post-diagnosis relational dynamics. Perspectives of adult family members of U.S. dementia patients were elicited through self-guided online questionnaires. Participants were recruited in dyadic pairs, and the total sample included 53 family dyads (n = 106 individuals). Data were analyzed using path analyses in actor-partner interdependence models to examine the relationships between variables. Statistically significant actor effects were observed between pre-diagnosis relational dynamics and post-diagnosis communication satisfaction, post-diagnosis interaction goals and communication satisfaction, and post-diagnosis communication satisfaction and relational dynamics. Statistically significant actor and partner effects were observed between pre-diagnosis relational dynamics and post-diagnosis interaction goals, pre- and post-diagnosis relational dynamics, and post-diagnosis interaction goals and relational dynamics. The results of this dissertation provide compelling evidence that actual communication experiences are important to how family members evaluate their ability to attend to interaction goals in the context of dementia, and those perceptions in turn affect family relational dynamics after the dementia diagnosis. Findings of this research demonstrate that pre-diagnosis relational dynamics aggregate and influence post-diagnosis perceptions and evaluations of own and other’s interaction goals and satisfaction with enacted communication. Additionally, results of this dissertation show family members’ ratings of relational closeness increased and functioning decreased from pre- to post-diagnosis. Results of this dissertation have several theoretical and practical implications. Theoretically speaking, these findings provide evidence supporting previous multiple goals research and extending this work into the family dementia context. Actual communication experiences are important to how family members evaluate their ability to attend to interaction goals in this context, and those perceptions in turn affect family relational dynamics after the patient’s dementia diagnosis. The current research also provides some initial evidence that more global perceptions of interaction goals are related to more global relational concepts. Additionally, the findings from this dissertation can be used to inform the evidence-based evaluation of dementia caregiver interventions, education programs, and online social support resources. The interwoven experience of family members navigating the experience of dementia is complex. The practical insight gained from these results can be used to assist caregivers and families with their relational needs and to mitigate the negative implications associated with caregiving. These findings can be utilized to ultimately improve health outcomes for family members of dementia patients and patients themselves

Prognostication in inflammatory bowel disease

Personalized care in inflammatory bowel diseases (IBD) hinges on parsing the heterogeneity of IBD patients through prognostication of their disease course and therapeutic response to allow for tailor-made treatment and monitoring strategies to optimize care. Herein we review the currently available predictors of outcomes in IBD and those on the both near and far horizons. We additionally discuss the importance of worldwide collaborative efforts and tools to support clinical use of these prognostication tools

Genome sequence of Acetomicrobium hydrogeniformans OS1

Acetomicrobium hydrogeniformans, an obligate anaerobe of the phylum Synergistetes, was isolated from oil production water. It has the unusual ability to produce almost 4 molecules H2/molecule glucose. The draft genome of A. hydrogeniformans OS1 (DSM 22491T) is 2,123,925 bp, with 2,068 coding sequences and 60 RNA genes

Will nature work with us? Erosion and flooding impacts on a UK barrier

‘Barrier island’ refers to a diverse collection of coastal landforms that often support substantial human populations, critical infrastructures, and ecosystems. Globally, many coastal barriers are experiencing climatically altered environmental forcing coupled with increasing anthropogenic pressures. This paper undertakes high resolution shoreline change analysis to reveal how Blakeney Point, a mixed sandy-gravel barrier located on the UK’s East Coast, has evolved over centennial, decadal and event timescales. We seek to establish the implications of barrier evolution, under contrasting management regimes, for present erosion and flooding hazards. Interrogating a series of alternative shoreline proxies reveals a series of interdependent behaviors. Over the 130-year period of study, Blakeney Point is shown to be rolling landward at a mean rate of 0.60 m a-1. Assuming continued landward retreat over the coming decades, future flood-generating storm events will encounter more landward shoreline positions than today. Superimposed on this trend, we observe the presence of alongshore migrating erosional hotspots which give rise to unpredictable morphologies at any given location on the spit. Finally, we find that instances of barrier setback are driven by individual storm events, which makes barrier retreat both highly variable and discontinuous in time and space. This is illustrated by the presence of overwash, particularly along stretches of the barrier that have experienced a recent shift in management regime towards a non-interventionist approach.This work was funded by the NERC/ESRC Data, Risk and Environmental Analytical Methods (DREAM) Centre, Grant/Award Number: NE/M009009/1. It is also a contribution to the NERC-funded project “Physical and Biological dynamic coastal processes and their role in coastal recovery” (BLUEcoast), Grant Award Number: NE/N015924/1

Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children

BACKGROUND: Neuraminidase inhibitors (NIs) are stockpiled and recommended by public health agencies for treating and preventing seasonal and pandemic influenza. They are used clinically worldwide. OBJECTIVES: To describe the potential benefits and harms of NIs for influenza in all age groups by reviewing all clinical study reports of published and unpublished randomised, placebo-controlled trials and regulatory comments. SEARCH METHODS: We searched trial registries, electronic databases (to 22 July 2013) and regulatory archives, and corresponded with manufacturers to identify all trials. We also requested clinical study reports. We focused on the primary data sources of manufacturers but we checked that there were no published randomised controlled trials (RCTs) from non-manufacturer sources by running electronic searches in the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE (Ovid), EMBASE, Embase.com, PubMed (not MEDLINE), the Database of Reviews of Effects, the NHS Economic Evaluation Database and the Health Economic Evaluations Database. SELECTION CRITERIA: Randomised, placebo-controlled trials on adults and children with confirmed or suspected exposure to naturally occurring influenza. DATA COLLECTION AND ANALYSIS: We extracted clinical study reports and assessed risk of bias using purpose-built instruments. We analysed the effects of zanamivir and oseltamivir on time to first alleviation of symptoms, influenza outcomes, complications, hospitalisations and adverse events in the intention-to-treat (ITT) population. All trials were sponsored by the manufacturers. MAIN RESULTS: We obtained 107 clinical study reports from the European Medicines Agency (EMA), GlaxoSmithKline and Roche. We accessed comments by the US Food and Drug Administration (FDA), EMA and Japanese regulator. We included 53 trials in Stage 1 (a judgement of appropriate study design) and 46 in Stage 2 (formal analysis), including 20 oseltamivir (9623 participants) and 26 zanamivir trials (14,628 participants). Inadequate reporting put most of the zanamivir studies and half of the oseltamivir studies at a high risk of selection bias. There were inadequate measures in place to protect 11 studies of oseltamivir from performance bias due to non-identical presentation of placebo. Attrition bias was high across the oseltamivir studies and there was also evidence of selective reporting for both the zanamivir and oseltamivir studies. The placebo interventions in both sets of trials may have contained active substances. Time to first symptom alleviation. For the treatment of adults, oseltamivir reduced the time to first alleviation of symptoms by 16.8 hours (95% confidence interval (CI) 8.4 to 25.1 hours, P 1000) and nausea whilst on treatment (RD 4.15%, 95% CI 0.86 to 9.51); NNTH = 25 (95% CI 11 to 116). AUTHORS' CONCLUSIONS: Oseltamivir and zanamivir have small, non-specific effects on reducing the time to alleviation of influenza symptoms in adults, but not in asthmatic children. Using either drug as prophylaxis reduces the risk of developing symptomatic influenza. Treatment trials with oseltamivir or zanamivir do not settle the question of whether the complications of influenza (such as pneumonia) are reduced, because of a lack of diagnostic definitions. The use of oseltamivir increases the risk of adverse effects, such as nausea, vomiting, psychiatric effects and renal events in adults and vomiting in children. The lower bioavailability may explain the lower toxicity of zanamivir compared to oseltamivir. The balance between benefits and harms should be considered when making decisions about use of both NIs for either the prophylaxis or treatment of influenza. The influenza virus-specific mechanism of action proposed by the producers does not fit the clinical evidence

Surveilling the web, mobile, and language accessibility of Communication’s digital presence within institutions of higher education globally

This study aims to understand the general web accessibility of digital information networks which may serve as barriers for access to the global discipline of Communication through institutional and departmental websites, specifically for persons with disabilities and those with limited English proficiency (LEP). Our exploratory content analysis relies on computer-aided software to systematically analyze the departmental home pages of websites of institutional members of the International Communication Association (ICA), N = 77, representing 26 countries, globally. Findings from this study help us to: (1) better understand the general web, language, and mobile accessibility of discipline-related online information; (2) identify strengths and opportunities for improvement; and, (3) to reflect upon the anticipated barriers impacting persons with disabilities when accessing higher education information online

Changes at multiple levels of the hypothalamo-pituitary adrenal axis following repeated electrically induced seizures

Seizures, including electrically induced seizures (ECS), activate the hypothalamo-pituitary-adrenal (HPA) axis in rats. The present studies were undertaken to characterize the effects of repeated ECS on hormone release and brain adrenal steroid receptors. Repeated ECS led to an increase in adrenal weight, an increase in the corticosterone response to the eighth seizure compared to the first seizure, and an increase in basal plasma corticosterone levels at the trough of the circadian rhythm. Despite increased plasma corticosterone levels at the time of sacrifice, there were no decreases in adrenal steroid receptor numbers in hypothalamus, cortex or hippocampus. In chronic ECS-treated rats which were adrenalectomized overnight to remove glucocorticoids, an increase in Type I (mineralocorticoid) steroid receptors occurred in both hippocampus and cortex. These data suggest that chronic ECS has a trophic effect on Type I receptors and that the higher levels of corticosterone resulting from chronic ECS do not induce adrenal steroid receptor down-regulation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/28829/1/0000663.pd

Overview of systematic reviews assessing the evidence for shorter versus longer duration antibiotic treatment for bacterial infections in secondary care

<div><p>Our objective was to assess the clinical effectiveness of shorter versus longer duration antibiotics for treatment of bacterial infections in adults and children in secondary care settings, using the evidence from published systematic reviews. We conducted electronic searches in MEDLINE, Embase, Cochrane, and Cinahl. Our primary outcome was clinical resolution. The quality of included reviews was assessed using the AMSTAR criteria, and the quality of the evidence was rated using the GRADE criteria. We included 6 systematic reviews (n = 3,162). Four reviews were rated high quality, and two of moderate quality. In adults, there was no difference between shorter versus longer duration in clinical resolution rates for peritonitis (RR 1.03, 95% CI 0.98 to 1.09, I² = 0%), ventilator-associated pneumonia (RR 0.93; 95% CI 0.81 to 1.08, I² = 24%), or acute pyelonephritis and septic UTI (clinical failure: RR 1.00, 95% CI 0.46 to 2.18). The quality of the evidence was very low to moderate. In children, there was no difference in clinical resolution rates for pneumonia (RR 0.98, 95% CI 0.91 to 1.04, I² = 48%), pyelonephritis (RR 0.95, 95% CI 0.88 to 1.04) and confirmed bacterial meningitis (RR 1.02, 95% CI 0.93 to 1.11, I² = 0%). The quality of the evidence was low to moderate. In conclusion, there is currently a limited body of evidence to clearly assess the clinical benefits of shorter versus longer duration antibiotics in secondary care. High quality trials assessing strategies to shorten antibiotic treatment duration for bacterial infections in secondary care settings should now be a priority.</p></div

The effects of elevated CO2 and eutrophication on surface elevation gain in a European salt marsh.

Salt marshes can play a vital role in mitigating the effects of global environmental change by dissipating incident storm wave energy and, through accretion, tracking increasing water depths consequent upon sea level rise. Atmospheric CO2 concentrations and nutrient availability are two key variables that can affect the biological processes that contribute to marsh surface elevation gain. We measured the effects of CO2 concentrations and nutrient availability on surface elevation change in intact mixed-species blocks of UK salt marsh using six open-top chambers receiving CO2 -enriched (800 ppm) or ambient (400 ppm) air. We found more rapid surface elevation gain in elevated CO2 conditions: an average increase of 3.4 mm over the growing season relative to ambient CO2 . Boosted regression analysis to determine the relative influence of different parameters on elevation change identified that a 10% reduction in microbial activity in elevated CO2 -grown blocks had a positive influence on elevation. The biomass of Puccinellia maritima also had a positive influence on elevation, while other salt marsh species (e.g. Suaeda maritima) had no influence or a negative impact on elevation. Reduced rates of water use by the vegetation in the high CO2 treatment could be contributing to elevation gain, either directly through reduced soil shrinkage or indirectly by decreasing microbial respiration rates due to lower redox levels in the soil. Eutrophication did not influence elevation change in either CO2 treatment despite doubling aboveground biomass. The role of belowground processes (transpiration, root growth and decomposition) in the vertical adjustment of European salt marshes, which are primarily minerogenic in composition, could increase as atmospheric CO2 concentrations rise and should be considered in future wetland models for the region. Elevated CO2 conditions could enhance resilience in vulnerable systems such as those with low mineral sediment supply or where migration upwards within the tidal frame is constrained.Marie Curie Incoming International Fellowship (Grant ID: FP7-PEOPLE-IIF 623720 STORM)This is the author accepted manuscript. The final version is available from Wiley via https://doi.org/10.1111/gcb.1339