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Recent policy statements have stressed the need for fundamental changes to the NHS, especially to the hospital care of older people. Person-centred care underpins such changes. If practitioners are to deliver person-centred care, then they need to learn more about the patient as an individual. One way that this might be achieved is through biographical approaches. This paper describes the findings of a developmental study undertaken over a 6-month period to investigate the introduction of a biographical approach to care on a unit in a NHS hospital. It concentrates on the views of the practitioners who used the approach. The study aimed to explore whether a biographical approach - in the form of storytelling - might be used to encourage person-centred practice. Using a practice development approach, the study explored the views of older people, their family carers and practitioners regarding their participation in life story work. Initial data were collected by focus groups with staff from a nursing home who regularly used life stories as a basis for care planning. Further data were collected through focus groups, semistructured interviews and observation - undertaken before and after the introduction of life story work - with older people, family carers and practitioners. Findings revealed that life stories helped practitioners to see patients as people, to understand individuals more fully and to form closer relationships with their families. Support workers also said how much they enjoyed using the approach to inform their care. Further longitudinal research is required to investigate biographical approaches more fully and to work more closely with practitioners to explore how biographical approaches can be undertaken as part of standard practice and be integrated into the culture and management of care. [ABSTRACT FROM AUTHOR]

This paper provides a concept analysis of respite care for frail older people and their family carers. The authors re-examine the broader conceptualization of respite care delineated by Nolan & Grant, namely, users' needs for information, education and support about respite care, based on a review of recent literature and on a user focus group study. This work was undertaken by the Sheffield arm of the ACTION Project research team. ACTION is a 36-month project (1997-1999), involving Northern Ireland, The Republic of Ireland, Portugal, Sweden and England and is the largest nurse-led project to have received funding from the European Union TIDE sector (DGXIII Telematics Applications Programme, Disabled and Elderly). The authors discuss the key elements of respite and, more specifically, how they can be successfully used so that the potential of respite may be realized fully by family carers. Recommendations within the context of the ACTION research project are put forward to enable family carers and the persons they care for to make informed choices about respite care. [ABSTRACT FROM AUTHOR]

This paper focuses upon an exploration into the world of the cancer nurse regarding stress and persons with cancer. It is proposed that the cancer nurse's world often is not emphasized or even acknowledged within clinical practice and, for the most part, remains ignored. It is argued that the cancer nurse's world is rich with meaning, and the knowledge, skills and values within this domain need to come to the fore. A phenomenological approach was adopted for the study, because of the inherent emphasis upon meaning and understanding within the cancer nurse's everyday practice. Methodological triangulation involved qualitative interviews with nursing staff on an acute oncology unit, observation of the nursing admission assessments of cancer patients and use of archival sources (nursing kardexes). Content analysis of the interview findings revealed that the common-sense understandings of the cancer nurse were present in relation to stress and the person with cancer. Although these construals have not been adequately studied, the framework of common-sense knowledge involves the informal views and the wealth of knowledge individuals have. Common-sense construals are linked to the nurses' experience, both past and present, and derived from both professional practice and educational experiences. In practice, however, the nurses often failed to rely on this knowledge, apparently because of the mainstream influence of the medical model. The study led to the recommendation reported on in this paper that nurses must bring their common-sense knowledge and values to the fore in order to provide holistic care of persons with cancer. [ABSTRACT FROM AUTHOR]

A key rule in qualitative research suggests that researchers should not carry out their research in a setting with which they are familiar, in that they work in or have previously worked in the setting. Experts in qualitative research warn of the pitfalls related to the researcher's lack of objectivity and to role confusion. The issue is not as clear cut as it may first appear. There are merits to a researcher having subjective knowledge of the setting and, at a macro level, the cultural norms and values of the health care professionals involved. [ABSTRACT FROM AUTHOR]

Dietary restriction (DR) increases lifespan in many organisms, but its underlying mechanisms are not fully understood. Mitochondria play a central role in metabolic regulation and are known to undergo changes in structure and function in response to DR. Mitochondrial membrane potential (Δψ m ) is the driving force for ATP production and mitochondrial outputs that integrate many cellular signals. One such signal regulated by Δψ m is nutrient-status sensing. Here, we tested the hypothesis that DR promotes longevity through preserved Δψ m during adulthood. Using the nematode Caenorhabditis elegans, we find that Δψ m declines with age relatively early in the lifespan, and this decline is attenuated by DR. Pharmacologic depletion of Δψ m blocked the longevity and health benefits of DR. Genetic perturbation of Δψ m and mitochondrial ATP availability similarly prevented lifespan extension from DR. Taken together, this study provides further evidence that appropriate regulation of Δψ m is a critical factor for health and longevity in response to DR., (© 2023. The Author(s), under exclusive licence to American Aging Association.)

The purpose of this project was to develop and evaluate a collaborative nursing/therapist protocol for early mobility in a medical-surgical intensive care unit (MICU) in a regional level II trauma center. Data for patients in the MICU were compared for the periods August 3, 2015-August 2, 2016, and August 3, 2014-August 2, 2015. Semistructured interviews were conducted with 10 nurses and 1 therapist. Average MICU length of stay decreased from 3.81 to 3.50 days (P = .057). Mean time in mobility chairs did not change (0.12 days vs 0.11 days, P = .389). Mean number of days to first documented level 2-5 activity decreased significantly, from 1.81 to 1.51 days (P = .036). The percentage of hospitalizations with any documented level 3 or 4 activity increased significantly (from 3.8% to 7.4% and from 61.5% to 66.7%, P = .003 and P = .031, respectively). Barriers/challenges to implementation included having enough people to assist, space, documentation, having to coax the physician to place order for upright mobility, availability of therapists for later stages of protocol, patient variability, fear of patient falls, availability of therapy chairs, staff changes, time, and patient refusal. A multidisciplinary approach to protocol development for early mobility in an intensive care unit was successfully implemented at a regional level II trauma center., Competing Interests: All authors declare that they have no known potential conflicts of interest in relation to this article., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Rationale: Histone post-translational modifications (PTMs) play key roles in regulating eukaryotic gene expression. Mass spectrometry (MS) has emerged as a powerful method to characterize and quantify histone PTMs as it allows unbiased identification and quantification of multiple histone PTMs including combinations of the modifications present., Methods: In this study we compared a range of data-acquisition methods for the identification and quantification of the histone PTMs using a Q Exactive HF Orbitrap. We compared three different data-dependent analysis (DDA) methods with MS2 resolutions of 120K, 60K, 30K. We also compared a range of data-independent analysis (DIA) methods using MS2 isolation windows of 20 m/z and DIAvw to identify and quantify histone PTMs in Chinese hamster ovary (CHO) cells., Results: The increased number of MS2 scans afforded by the lower resolution methods resulted in a higher number of queries, peptide sequence matches (PSMs) and a higher number of peptide proteoforms identified with a Mascot Ion score greater than 46. No difference in the proportion of peptide proteoforms with Delta scores >17 was observed. Lower coefficients of variation (CVs) were obtained in the DIA MS1 60 K MS2 30 K 20 m/z isolation windows compared with the other data-acquisition methods., Conclusions: We observed that DIA which offers advantages in flexibility and identification of isobaric peptide proteoforms performs as well as DDA in the analysis of histone PTMs. We were able to identify 71 modified histone peptides for histone H3 and H4 and quantified 64 across each of the different acquisition methods., (© 2019 The Authors Rapid Communications in Mass Spectrometry Published by John Wiley & Sons Ltd.)

In response to increasingly stringent microbial specifications being imposed by purchasers of frozen blueberries, chlorine dioxide (ClO2) gas generated by a dry chemical sachet was assessed for inactivation of Listeria monocytogenes, Salmonella spp., and Escherichia coli O157:H7 as well as five yeasts and molds known for blueberry spoilage. Fresh blueberry samples (100 g) were separately inoculated with cocktails of L. monocytogenes, Salmonella, E. coli O157:H7 (three strains each), or yeasts and molds (five strains each) to contain approximately 10(6) CFU/g and exposed to ClO2 (4 mg/liter, 0.16 mg/g) for 12 h in a sealed 20-liter container (99.9% relative humidity) at approximately 22 degrees C. After gassing, 25 g of blueberries was added to 225 ml of neutralizing buffer, pulsified for 1 min, and plated using standard procedures to quantify survivors. This treatment yielded reductions of 3.94, 3.62, 4.25, 3.10, and 3.17 log CFU/g for L. monocytogenes, Salmonella, E. coli O157:H7, yeasts, and molds, respectively. Thereafter, 30 lugs of uninoculated blueberries (approximately 9.1 kg per lug) were stacked on 1.2 by 1.2-m pallets (5 lugs per level x six levels), tarped, and exposed to ClO2 (18 mg/liter, 0.13 mg/g) for 12 h. After gassing, significant (P < 0.05) reductions of 2.33, 1.47, 0.52, 1.63, and 0.48 log CFU/g were seen for mesophilic aerobic bacteria, coliforms, E. coli, yeasts, and molds, respectively, compared with non-gassed controls. No significant differences (P > 0.05) in microbial inactivation were seen between lug levels and, with one exception (mesophilic aerobic bacteria), between the bottom and top surface of individual lugs. Based on these findings, ClO2 sachets may provide a simple, economical, and effective means of enhancing the microbial shelf life and safety of blueberries.

The present paper provides an overview of the application of the key ethical issues which arose in an EU-funded research, technology and development project, Assisting Carers using Telematics Interventions to meet Older Persons' Needs (ACTION). The primary aim of the ACTION project was to support frail older people and their family carers in their own homes across England, Northern Ireland, the Republic of Ireland, Sweden and Portugal via the use of user-friendly information and communication technology. Ethical guidelines were developed in the project and used as a tool to enable the multidisciplinary project team to increase their awareness of ethical issues in their everyday work, and to act as a useful ethical framework for regular team discussions at international and local meetings across the partner countries. A range of ethical issues arose during the field-study phases of the project when the ACTION services were introduced into a number of families' own homes. It can be argued that these ethical issues reflect factors relating both to the application of research into practice, as well as those relating more directly to the use of new technology by families and care professionals. Key issues centre upon the ethical concepts of autonomy, independence, quality of life, beneficence, non-maleficence and justice, and more specifically, on ethical issues of security, privacy and confidentiality, increased expectations, and withdrawal of the service. This paper is intended to facilitate dialogue and debate in the area of enabling (assistive) technology in home care for older people and their families.

Samples of ripe fruit were taken at harvest from all eight commercial cranberry farms in Michigan over a 3-year period to determine the distribution and incidence of fruit rot diseases and the fungal pathogens associated with rotted fruit. Totals of 23, 33, and 28 beds were sampled in 1999, 2000, and 2001, respectively. Fruit rot incidence varied widely among beds and farms and ranged from 5 to 97% (mean 33.4%) in 1999, 1 to 91% (mean 26.3%) in 2000, and 1 to 67% (mean 12.8%) in 2001. Differences in fruit rot incidence were observed among cultivars, but rankings differed among farms. In general, cultivars Ben Lear, Bergman, and Pilgrim tended to have lower and Beckwith and WSU61 higher fruit rot incidence than other cultivars grown in the same location. Colletotrichum acutatum, Pestalotia vaccinii, and Phyllosticta vaccinii were the fungi most frequently recovered from rotted fruit. Fusicoccum putrefaciens, Phomopsis vaccinii, Physalospora vaccinii, Allantophomopsis lycopodina, Coleophoma empetri, and Botrytis cinerea were isolated occasionally in 1999. The isolation frequency of Physalospora vaccinii, Phomopsis vaccinii, and C. empetri increased markedly in 2000. Glomerella cingulata was first detected in 2001. Fusicoccum putrefaciens was most common in the northern and Glomerella cingulata in the southern growing areas. A comparison of sound and rotted fruit from selected beds showed that Phyllosticta elongata predominated in sound fruit, whereas G. cingulata predominated in rotted fruit.

Antioxidant activity, total phenolic content, anthocyanin content, and six other fruit characters including titratable acid concentration, soluble solids, firmness, and percentage of bruised berries were determined for nine blueberry (Vaccinium L. sp.) cultivars at harvest and at various postharvest intervals after storage at 5 degrees C. Berries from MSU-58, Brigitta, and Legacy stored successfully for 7 weeks, Bluegold stored for 3-5 weeks, Bluecrop, Elliott, and Nelson stored for 3 weeks, and Jersey and Little Giant stored for fewer than 3 weeks. During the time they retained marketable quality, one cultivar (MSU-58) demonstrated a 29% increase in antioxidant activity. None of the cultivars showed a significant decrease from the harvest antioxidant activity value during storage. Antioxidant activity, total phenolic content, and anthocyanin content were strongly correlated with each other (r = 0.87-0.99, P < 0.01). All three parameters were moderately correlated with soluble solids (r = 0.47, P < or =0.05; r = 0.44, P < or = 0.05; and r = 0.64, P < or = 0.01, respectively), and antioxidant activity and total phenolic content were both moderately correlated with pH (r = 0.53 and 0.49, respectively; P < or = 0.05). However, antioxidant activity, total phenolic content, and anthocyanin content showed no correlation with firmness, percent severely bruised berries, or weight loss. Antioxidant activity and total phenolic content at harvest both correlated with titratable acidity at harvest (r = 0.68, P < or = 0.05 and r = 0.70, P < or = 0.05, respectively) on a cultivar mean basis. Berries from Elliott were also harvested from plants at two levels of bush ripeness (30-50% and 60-80% ripe berries on plants) and separated into three fruit maturity classes on the basis of percent blue color. The level of bush ripeness had no significant effect on antioxidant activity, total phenolic content, or anthocyanin content; however, fruit maturity had a significant effect on antioxidant activity, total phenolic content, and anthocyanin content, and bush ripeness x fruit maturity interactions were significant for these three traits. Berries with 50-75% blue coloration harvested from bushes with 60-80% mature fruit showed a significant increase in antioxidant activity, total phenolic content, and anthocyanin content during the first 3 weeks in storage. Our results demonstrate that increases in antioxidant activity, total phenolic content, and anthocyanin content may occur in the blueberry during cold storage and are cultivar-dependent. The increases that occur in immature fruit, such as in Elliott, may be advantageous for producers who wish to delay marketing of the fruit.

ACTION (Assisting Carers using Telematic Interventions to meet Older persons' Needs) is a nursing led Pan-European project (1997-2000). Its primary aim is to maintain the autonomy, independence and quality of life of frail older and disabled persons and their family carers by the application of telematic technology. This article describes the development of two multimedia programmes created as part of the ACTION project. Programme 1 'Planning ahead' helps family carers and frail older people to think about and plan for the future. Programme 2 'Break from caring' assists carers and older people to explore the range of respite care options available. Both programmes have been developed using a multimethod, user-centred approach. Preliminary evaluation data have indicated that frail older people and their carers have used the programmes to assist them when making difficult decisions such as selecting a nursing home, or exploring the use of respite care facilities.

The overall aim of the ACTION research project (Assisting Carers using Telematic Interventions to meet Older person's Needs) is to maintain or enhance the autonomy, independence and quality of life of frail older and disabled people and their family carers by providing information, advice and support in the home. The authors report on the first phase of evaluation conducted using a case-study approach to test the ACTION system in several family carers' homes in Sheffield, England. The results reflect the realities of conducting an applied research technology project and are discussed with reference to the government's recent national strategy for carers. The authors acknowledge the need for further evaluation studies to explore the key issues raised within this preliminary evaluation phase.

The lack of choice and predominance of crisis-oriented care in relation to respite and long-term care for family carers and frail older people provided the authors with the rationale for the development, within the European-funded Assisting Carers using Telematic Interventions to meet Older person's Needs (ACTION) project, of two innovative multimedia programs. The key aim of the programs is to provide education, information, and support about respite care and planning for the future for family carers and frail older people in their homes. In this way, it is intended that family carers and frail older people will be able to make informed choices concerning their health and social care needs. The authors describe the conceptual basis of the multimedia programs, the research and development process, the content of the multimedia programs, and the evaluation of the developed product.

Background and Purpose: When the clinical and radiologic characteristics of an unusual cervical spinal cord complication of intra-arterial (IA) chemotherapy with blood brain-barrier (BBB) disruption in the vertebral circulation are documented. Seven cases are reported and analyzed in search of a pathophysiologic explanation., Methods: We retrospectively identified 94 patients who received a total of 380 standardized regimens of IA carboplatin, IA or IV etoposide phosphate, and IV cyclophosphamide infusion in conjunction with osmotic BBB disruption of the vertebral artery. We describe seven of those patients in whom unexpected neck pain developed followed by neurologic symptoms primarily in the upper extremities., Results: The symptoms correlated with MR abnormalities (T1 hypointensity, T2 hyperintensity, and unusual contrast enhancement) in the cervical spinal cord, usually involving the gray matter. The neurologic deficits and MR changes were generally transient. One patient who received a flu vaccination 48 hours before the chemotherapy incurred progressive myelitis and expired., Conclusion: The pathophysiology of this complication is probably multifactorial but may be related to vascular streaming and an atypical inflammatory toxic reaction to carboplatin and etoposide. The complication has not recurred during a 6-month period following modification of the protocol.

A comparison of regional cerebral blood flow measurements made with beta- and gamma-emitting isotopes revealed good correspondence in areas of normal perfusion and reactive hyperemia but poor correspondence in areas of focal ischemia. After middle cerebral artery occlusion at normocapnia, there was a 65% reduction in regional cerebral blood flow from 1.40 plus or minus 0.27 ml/g min--1 to 0.49 plus or minus 0.10 ml/g min--1 in monkeys studied with 85Kr but only a 27% reduction in regional cerebral blood flow from 0.84 plus or minus 0.09 ml/g min--1 to 0.61 plus or minus 0.08 ml/g min--1 in monkeys studied with 133Xe. The lack of correlation within areas of focal, incomplete ischemia was attributed to an impairment of isotope delivery to the area of ischemia coupled with the inherent lack of spatial resolution of determinations made with 133Xe. This finding may partly explain the numerous discrepancies in experimental and clinical studies of the effects of alterations in the arterial partial pressure of CO2 on regional cerebral blood flow in areas of ischemia; it may also explain the failure of such studies to reflect the true severity of focal ischemia.

Established respiratory infections with mucoid Pseudomonas aeruginosa in patients suffering from cystic fibrosis were treated with conventional as well as larger doses of tobramycin. The infection was eradicated in four of the 17 patients treated, but the duration of follow-up study of one patient was short. It appeared that treatment was most successful in those patients in whom the highest peak concentrations of tobramycin in sputum were obtained. No side effects were noted, even when tobramycin was given in large doses for two weeks.

Two cases of ventriculitis with Staphylococcus epidermidis that failed on therapy with an antistaphylococcal penicillin are presented. Both infections responded to a combination of intravenous and intraventricular vancomycin and rifampin. Vancomycin and rifampin represent an important antibiotic regimen for the management of resistant infections of the central nervous system, especially with those due to S. epidermidis or methicillin-resistant Staphylococcus aureus.

Regional cerebral blood flow (rCBF) measurements with krypton-85 (100 separate determinations) were compared in squirrel monkeys anesthetized with sodium pentobarbital (a cerebral vasoconstrictor) and halothane (a cerebral vasodilator) before, during, and after middle cerebral artery (MCA) occlusion. Prior to MCA occlusion, a normal physiological response to alterations in arterial carbon dioxide tensions (Paco2) was demonstrated in both groups of monkeys; the cerebral vascular resistance was significantly lower in those anesthetized with halothane. During ischemia, there was loss of autoregulation and a failure to respond to alterations in Paco2 in both groups. Flow in the ischemic region remained uniform in the barbiturate group but decreased progressively in the halothane group, suggesting a "paradoxical response" to the dilating agent. Reactive hyperemia (luxury perfusion) was demonstrated in both groups after restoration of flow. The use of a beta-emitting isotope ensured that measurements in regions of ischemia accurately reflected rCBF and were free of the artifacts ("look through" and Compton scatter) related to use of a gamma-emitting indicator.

The diagnosis of hormonally active acromegaly has been aided by the radioimmunoassay for human growth hormone (hGH). We report a case in which baseline plasma hGH levels were elevated minimally and partial suppression during the glucose tolerance test occurred. Subsequent hGH assay of the cerebrospinal fluid, however, confirmed active acromegaly and correctly predicted suprasellar extension of the tumor.

This is the report of two children who had prominent arachnoid granulations that were mistaken clinically for dermoid cysts. These lesions appeared in the midline, primarily posteriorly. During surgery, the lesions extended through the dura connected by a stalk. A pathologic examination confirmed the lesions to be arachnoid granulations.

A helpful clinical sign of ruptured cervical disc is pain relief upon arm abduction. When the disease process is spondylosis with foraminal stenosis, changing arm position does not relieve pain. Anatomical considerations are discussed.