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Reports on interviews and written testimony from 350 mothers and fathers that suggest several challenges and themes common to many bereaved families in the aftermath of a stillborn baby. Shock, blame, guilt, and hardship; Carrying, seeing, and remembering the baby; The autopsy and the funeral; Is it `normal' to be `crazy'; Support systems; Different responses; Surviving siblings; Subsequent pregnancies; The long process of healing; More.

Adult intermolt Gammarus pulex were exposed to a range of cadmium concentrations in an artificial stream water containing 20 mg calcium l. 96 hr and 48 hr LC-50 values obtained were 0.12 and 0.68 mg Cd l, respectively. The influence of external calcium level on cadmium toxicity was investigated at a cadmium concentration of 0.5 mg l. Calcium had an antagonistic effect on cadmium toxicity, and at a calcium concentration of 200 mg l experimental animals failed to reach 50% mortality after a period of 120 hr. Over a 48 hr period of Cd uptake a solution containing 5 mg Cd l, animals in 200 mg calcium l accumulated only half as much cadmium as animals in 20 mg calcium l. Post-molt animals were very much more sensitive to cadmium than intermolt specimens. Exposure to 0.1 mg Cd l resulted in death in approximately 24 hr and the mean mortality time for animals in 0.01 mg Cd l was 45 hr. These data are likely to be explained in terms of competition between cadmium and calcium for binding sites associated with key physiological processes. The results place these animals among the most sensitive organisms yet studied with regard to cadmium toxicity, and emphasize the importance of the molt in assessing toxic effects on crustaceans. [ABSTRACT FROM AUTHOR]

Objective: Presenteeism is an expensive and challenging problem in the healthcare industry. In anticipation of the staffing challenges expected with the COVID-19 pandemic, we examined a decade of payroll data for a healthcare workforce. We aimed to determine the effect of seasonal influenza-like illness (ILI) on absences to support COVID-19 staffing plans., Design: Retrospective cohort study., Setting: Large academic medical center in the United States., Participants: Employees of the academic medical center who were on payroll between the years of 2009 and 2019., Methods: Biweekly institutional payroll data was evaluated for unscheduled absences as a marker for acute illness-related work absences. Linear regression models, stratified by payroll status (salaried vs hourly employees) were developed for unscheduled absences as a function of local ILI., Results: Both hours worked and unscheduled absences were significantly related to the community prevalence of influenza-like illness in our cohort. These effects were stronger in hourly employees., Conclusions: Organizations should target their messaging at encouraging salaried staff to stay home when ill.

Studies analyzing depressive symptoms across chronic disease populations are limited. Our descriptive comparison investigation included two studies on life-limiting conditions: Human Immunodeficiency Virus (HIV) and breast cancer. In both, depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CES-D). We found a mean depression score of 18.1 (± 11.8) overall ( N = 243). Over half (54%) reported clinically significant depressive symptoms (CES-D ≥ 16); 26% reported severe depressive symptoms (CES-D > 24). Disease and years of education were predictors of depressive symptoms. Persons living with breast cancer showed significantly worse depressive symptoms than persons living with HIV (p < 0.0001). After adjusting for disease, fewer years of education predicted worse depressive symptoms (p < 0.0001). This study demonstrated common determinants of depressive symptoms in both disease populations, suggesting that underlying conditions known to be predictors of depression could be assessed to identify those at higher risk for depression.

The current study investigates how age impacts factors associated with successfully managing HIV. One hundred thirty adults with HIV were recruited for the study. Participants were divided into two groups, those age ≥50 and those age <50. Cognitive impairment and depressive symptoms were seen at higher rates in older adults, and the severity of depressive symptoms was also higher in older adults. Depressive symptoms impacted cognitive function to a higher degree in older adults compared to younger adults (r = -0.293, p = 0.018 vs. r = -0.109, p = 0.387). Polypharmacy was a greater concern in older adults, with 88% having polypharmacy compared with 60% of younger adults. Similarly, the prevalence of comorbidities was more than double in older adults compared to younger adults. Factors associated with aging complicate management of HIV. Gaining insight into the challenges of caring for this population will furnish nurses with information necessary to provide the best possible care for this growing population. [Journal of Gerontological Nursing, 46(4), 31-40.]., (Copyright 2020, SLACK Incorporated.)

Some studies suggest a link between creativity and rapid eye movement sleep. Narcolepsy is characterized by falling asleep directly into rapid eye movement sleep, states of dissociated wakefulness and rapid eye movement sleep (cataplexy, hypnagogic hallucinations, sleep paralysis, rapid eye movement sleep behaviour disorder and lucid dreaming) and a high dream recall frequency. Lucid dreaming (the awareness of dreaming while dreaming) has been correlated with creativity. Given their life-long privileged access to rapid eye movement sleep and dreams, we hypothesized that subjects with narcolepsy may have developed high creative abilities. To test this assumption, 185 subjects with narcolepsy and 126 healthy controls were evaluated for their level of creativity with two questionnaires, the Test of Creative Profile and the Creativity Achievement Questionnaire. Creativity was also objectively tested in 30 controls and 30 subjects with narcolepsy using the Evaluation of Potential Creativity test battery, which measures divergent and convergent modes of creative thinking in the graphic and verbal domains, using concrete and abstract problems. Subjects with narcolepsy obtained higher scores than controls on the Test of Creative Profile (mean ± standard deviation: 58.9 ± 9.6 versus 55.1 ± 10, P = 0.001), in the three creative profiles (Innovative, Imaginative and Researcher) and on the Creative Achievement Questionnaire (10.4 ± 25.7 versus 6.4 ± 7.6, P = 0.047). They also performed better than controls on the objective test of creative performance (4.3 ± 1.5 versus 3.7 ± 1.4; P = 0.009). Most symptoms of narcolepsy (including sleepiness, hypnagogic hallucinations, sleep paralysis, lucid dreaming, and rapid eye movement sleep behaviour disorder, but not cataplexy) were associated with higher scores on the Test of Creative Profile. These results highlight a higher creative potential in subjects with narcolepsy and further support a role of rapid eye movement sleep in creativity., (© The Author(s) (2019). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

The aims of this study were to examine differences in medication management between older and younger adults living with HIV and to examine the relationship between age and cognitive ability, depressive symptoms, and self-efficacy on medication management. This research utilized a descriptive-correlational, cross-sectional design to compare medication management between older and younger adults living with HIV and to describe differences in predictive factors of cognition, depressive symptoms, and self-efficacy on medication management. Results indicated that both older and younger adults had poor medication management skills and high rates of mild cognitive impairment. While older adults performed worse on the medication management test than younger adults, the results were not statistically significant. In both older and younger adults, cognitive ability and depressive symptoms were predictors of medication management, with cognitive ability being the strongest predictor for both groups. Cognitive ability was a stronger predictor for older adults than for younger adults., (Copyright © 2014 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.)

The diagnosis of human immunodeficiency virus (HIV)-associated neurocognitive impairment is time-intensive and often omitted in busy outpatient settings. Brief screening tools are needed. The Montreal Cognitive Assessment (MoCA) and the Alzheimer's disease (AD)-8 have been used in neurodegenerative disorders. We evaluated the sensitivity and specificity of these brief screening tools in HIV-infected persons. The AD-8, MoCA, and formal neuropsychological testing were administered to 200 HIV-infected patients who were followed at a single institution. Normalized scores on formal neuropsychological testing were used to define neurocognitive impairment. The sensitivity and specificity of the MoCA and AD-8 were assessed to diagnose the impairment. Neurocognitive impairment was highly prevalent in this cohort: 127 persons (64 %) were diagnosed with neurocognitive impairment based on formal testing. Using the AD-8 and MoCA, 113 (57 %) and 101 (51 %) persons were identified with neurocognitive impairment, respectively. The sensitivity and specificity of MoCA were 63 % and 71 %, respectively. The sensitivity and specificity of AD-8 were 61 % and 51 %, respectively. Our findings highlight that brief screening tools correlate with formal neuropsychological testing. However, the sensitivities of these screening tools are lower than desired. Nevertheless, given their ease in administration, these tools could assist as a first line for identifying individuals who may subsequently require formal neuropsychological testing.

Objectives: To discuss three contextual factors related to advanced cancer: socioeconomic status, race and racism, and religion and spirituality., Data Sources: Published qualitative research, quantitative research, journal articles., Conclusion: A diagnosis of advanced cancer in marginalized individuals means that people are diagnosed much later, do not have the social, political, and economic capital available to deal with the diagnosis, have more serious complications, and their quality of life is compounded by unequal quality of care. IMPLICATIONS TO NURSING PRACTICE: Examples are provided of successful evidenced-based strategies that can be extrapolated by nurses to a cancer population.

Objective: Several studies have demonstrated biologic responses of intervertebral disc (IVD) cells to loading, although the mechanotransduction pathways have not been elucidated. In articular chondrocytes, which have a phenotype similar to that of IVD cells, a number of mechanoreceptors have been identified, with alpha5beta1 integrin acting as a predominant mechanoreceptor. The purpose of this study was to investigate the role of integrin signaling in IVD cells during mechanical stimulation and to determine whether RGD integrins are involved., Methods: Human nucleus pulposus (NP) cells derived from nondegenerated and degenerated discs were subjected to dynamic compressive loading in the presence of an RGD inhibitory peptide. Expression of the alpha5beta1 heterodimer in IVD tissue was examined by immunohistochemistry and possible alternative mechanoreceptors by real-time quantitative polymerase chain reaction., Results: Aggrecan gene expression was decreased following loading of NP cells from nondegenerated and degenerated discs. This response was inhibited by treatment with an RGD peptide in cells from nondegenerated, but not degenerated, IVDs. Immunohistochemistry demonstrated that expression of the alpha5beta1 heterodimer was unaltered in degenerated IVD tissue as compared with normal IVD tissue., Conclusion: Our results indicate that the mechanotransduction pathways are altered in cells from degenerated IVDs. Mechanosensing in NP cells from nondegenerated discs occurs via RGD integrins, possibly via the alpha5beta1 integrin, while cells from degenerated discs show a different signaling pathway that does not appear to involve RGD integrins.

The intervertebral disc (IVD) is one of the body's most important load-bearing structures with the major mechanical force experienced in the nucleus pulposus (NP) being hydrostatic pressure (HP). Physiological levels of HP have an anabolic effect on IVD matrix metabolism in cells derived from non-degenerate animal and herniated IVD while excessive HP has a catabolic effect. However, no studies have investigated the response of non-degenerate and degenerate human disc cells derived from non-herniated discs to HP. Here we investigate the effect of physiological HP on such cells using a novel loading rig. Human IVD cells (both NP and AF) cultured in alginate were subjected to dynamic HP (0.8-1.7 MPa 0.5 Hz) for 2 h. Cell viability was assessed, RNA extracted and qRT-PCR for 18 s, c-fos, Sox-9, collagen type II, aggrecan and MMP-3 performed. Cell viability was unaffected by the loading regime. In non-degenerate NP cells, HP increased c-fos, aggrecan, Sox-9 and collagen type II (significantly so in the case of c-fos and aggrecan), but not MMP-3 gene expression. In contrast, application of HP to AF or degenerate NP cells had no effect on target gene expression. Our data shows that cells obtained from the healthy NP respond to dynamic HP by up-regulating genes indicative of healthy matrix homeostasis. However, responses differed in degenerate NP cells suggesting that an altered mechanotransduction pathway may be operational.

A complaint of sleep disturbance may be subjective, requiring education and reassurance, but it may also indicate underlying morbidity. Elderly people expect to sleep six to eight hours each night. Many accept fragmentation of sleep and night-time waking as a normal part of ageing.

Consultants with experience of GP intrapartum care believe it is safe for the low-risk woman. However, GPs are perceived as lacking enthusiasm and as having varying degrees of obstetric expertise. Consultants feel that women themselves are not requesting more intrapartum care from GPs.

Echocardiography is now considered to be the key investigation when heart failure is suspected, and should improve clinical management. An open-access echocardiography service was piloted to 24 general practitioners and the service was audited after 250 cases. The impact on clinical management was assessed by reviewing general practice notes 2 months after the echocardiogram. Significant impairment of left ventricular function was found in 49 patients (20%). Out of these subjects, 38 had been started on an ACE inhibitor. Twenty patients were considered to have a significant valve lesion by echocritiera, of whom 14 had been referred for a cardiological opinion. The provision of an open-access echocardiography service was popular with general practitioners and the information resulted in appropriate management decisions being made.

To assess the current training and practice of central venous cannulation and temporary transvenous pacemaker insertion, a telephone survey of senior house officers (n = 60) and registrars (n = 20) was carried out in 80 acute hospitals in England and Wales. A median of one central line and two pacings were performed under supervision before the respondents were left unsupervised. The procedures were almost invariably taught at the bedside and usually by a fellow SHO or registrar. Virtually all the doctors surveyed were familiar with subclavian puncture, but experience with other routes was limited; 39/80 doctors questioned were unhappy about the training they had received, and 47 felt that formal training, such as tutorials or videos, would have helped. Training in central vein cannulation and temporary pacing needs to be more structured. This could be done by the use of videos or mannequins, and should include the use of routes other than the subclavian.