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Bed rest and limb immobilization are models of muscle disuse associated with skeletal muscle atrophy and reduced strength. The purpose of this systematic review was to examine the impact of protein or amino acid provision before and/or during a period of muscle disuse on muscle atrophy (primary outcome), strength and muscle protein synthesis (secondary outcomes) following a disuse period. We performed a systematic review of Embase, MEDLINE, Web of Science, PubMed and Clinical Trials in December 2022. Eligible studies were randomized controlled trials that combined a dietary protein or amino acid intervention versus control during an experimental model of disuse (bed rest or unilateral limb immobilization) in healthy individuals aged ≥18 years. Nine articles from eight independent trials were identified and rated for risk of bias by two authors. A meta-analysis of muscle mass data revealed no effect (standardized mean difference: 0.2; 95% confidence interval: -0.18 to 0.57, P = 0.31) of protein/amino acid intervention in preventing disuse-induced muscle atrophy. Although the meta-analysis was not conducted on strength or muscle protein synthesis data, there was insufficient evidence in the reviewed articles to support the use of protein/amino acid provision in mitigating the disuse-induced decline in either outcome measurement. Additional high-quality studies, including the reporting of randomization procedures and blinding procedures and the provision of statistical analysis plans, might be required to determine whether protein or amino acid provision serves as an effective strategy to attenuate muscle atrophy during periods of disuse., (© 2024 The Authors. Experimental Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society.)

This study reports on outcomes for 169 caregivers enrolled in the Michigan Stroke Transitions Trial (MISTT), an RCT of social work case management for stroke patients returning home. A mixed-model approach examined the mean change from 7- to 90-days post-discharge with group-by-time interactions for differences between treatment groups. Caregivers reported few life changes or depressive symptoms from caregiving. There was no significant change over time or treatment effects. Negative aspects of stroke caregiving may take longer to develop. Focused caregiver assessment at discharge and a better understanding of how caregiving develops over time may improve the type and timing of support.

A core collapse supernova occurs when exothermic fusion ceases in the core of a massive star, which is typically caused by exhaustion of nuclear fuel. Theory predicts that fusion could be interrupted earlier by merging of the star with a compact binary companion. We report a luminous radio transient, VT J121001+495647, found in the Very Large Array Sky Survey. The radio emission is consistent with supernova ejecta colliding with a dense shell of material, potentially ejected by binary interaction in the centuries before explosion. We associate the supernova with an archival x-ray transient, which implies that a relativistic jet was launched during the explosion. The combination of an early relativistic jet and late-time dense interaction is consistent with expectations for a merger-driven explosion.

Abstract: Direct-to-consumer genetic and genomic testing (DTCGT) has paved the way for consumers to gain information about their genetic makeup. Consumers may seek DTCGT to estimate ethnic background, identify genetic relations, or obtain raw DNA information that can be used for other purposes, such as testing for paternity and identifying genetically linked illnesses. Despite robust progress in genetic and genomic testing, most people have a low exposure threshold to DTCGT. Patient consumers may unnecessarily experience anxiety if they do not have a health care provider (HCP) to consult and review their results. Presently, there is a knowledge gap in how accurately HCPs can interpret and communicate genetic test results to patients compared with genetic specialists who may be inaccessible to underserved populations. Genetic and genomic information is rapidly progressing in health care and can identify patients at increased risk for certain diseases and improve patient care and outcomes. Appropriate use of genetic and genomic testing and knowing the limitations and difficulties of current testing available are integral to the success of HCPs in using these results in health promotion and improving quality of life. Health care providers should be aware of DTCGT recommendations and implications for patients, be prepared to counsel patients who present with testing results in hand, seeking advisement, and be competent in determining the need for further diagnostic testing or referral to a specialist genetic counselor., Competing Interests: Competing interests: The authors report no conflicts of interest., (Copyright © 2021 American Association of Nurse Practitioners.)

Purpose: Oncologic efficacy of focal therapies in prostate cancer depends heavily on accurate tumor size estimation. We aim to evaluate the agreement between radiologic tumor size and pathological tumor size, and identify predictors of pathological tumor size., Materials and Methods: This single arm study cohort included all consecutive patients with biopsy proven prostate cancer and a corresponding PI-RADS®v2 3 or greater index tumor on multiparametric magnetic resonance imaging who subsequently underwent radical prostatectomy. Radiologic tumor size was defined as maximum tumor diameter on multiparametric magnetic resonance imaging and compared to whole mount histopathology tumor correlates. The difference between radiologic tumor size and pathological tumor size was assessed, and clinical, pathological and radiographic predictors of pathological tumor size were examined., Results: A total of 461 consecutive lesions in 441 men were included for statistical analysis. Mean radiologic tumor size and pathological tumor size was 1.57 and 2.37 cm, respectively (p <0.001). Radiologic tumor size consistently underestimated pathological tumor size regardless of the preoperative covariates, and the degree of underestimation increased with smaller radiologic tumor size and lower PI-RADSv2 scores. Pathological tumor size was significantly larger for biopsy Gleason Grade Group (GG) 5 compared to GG1 (mean change 0.37 cm, p=0.014), PI-RADSv2 5 lesions compared to PI-RADSv2 4 (mean change 0.26, p=0.006) and higher prostate specific antigen density. The correlations between radiologic tumor size vs pathological tumor size according to biopsy GG and radiologic covariates were generally low with correlation coefficients ranging between 0.1 and 0.65., Conclusions: Multiparametric magnetic resonance imaging frequently underestimates pathological tumor size and the degree of underestimation increases with smaller radiologic tumor size and lower PI-RADSv2 scores. Therefore, a larger ablation margin may be required for smaller tumors and lesions with lower PI-RADSv2 scores. These variables must be considered when estimating treatment margins in focal therapy.

Despite a focus on physical and cognitive outcomes, stroke survivors are also impacted by emotional and mental health challenges. Additionally, their caregivers may experience decreased well-being due to increased burden and role adjustment. A small body of literature characterizes this experience as a form of grief and loss. This study seeks to explore experiences of grief and loss reported by stroke survivors and caregivers, using Holbrook's 4-stage bereavement model. This cross-sectional, qualitative study was conducted among adult stroke survivors (n = 9) and their spousal caregivers (n = 5). Focus groups on experiences of recent hospitalizations and transitions home were transcribed, coded, and thematic analysis was conducted, identifying a major theme of loss. Data were reanalyzed guided by Holbrook's model. Common themes were losses and changes experienced by patients/caregivers, disbelief, and lack of understanding. Subthemes of denial and confusion were present. Less prevalent themes were loss of existing support systems and silver lining. Stroke survivors and caregivers experienced a range of negative emotions, impacting behaviors, self-perception, roles, and social support. Awareness of these issues can improve practice with those affected by stroke., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Background: Needs of patients that go unmet after a stroke can compromise the speed and extent of recovery. While unmet needs in long-term survivors has been studied, less is known about the unmet needs of acute stroke survivors. We examine unmet needs in the immediate postdischarge period among 160 participants in the (blinded for review) a transitional care intervention conducted in (blinded for review [1 US state]) during 2016 and 2017., Methods: Bivariate and multivariate analyses using Poisson models were used to examine the relationship between total number of unmet needs and demographics, stroke type and severity, stroke effects, and stroke risk factors., Results: The mean number of unmet needs was 4.55; number of unmet needs ranged from 2 to9; all participants had some unmet need. The most common unmet needs were stroke education (73.8%), financial (33.8%), and health-related (29.4%). In the final multivariate model income and education were inversely associated with number of unmet needs. As total number of stroke effects increased, so did number of unmet needs. Demographic variables (age, gender, and race), stroke risk factors, stroke type, and stroke severity were not statistically significantly associated with the number of unmet needs., Conclusions: These results identify that in the acute post discharge period stroke survivors have many unmet needs that range from physical to psychosocial. Targeting interventions to those with the potential for greater numbers of unmet needs might be a salient clinical approach to improving stroke recovery and rehabilitation., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To evaluate the effect of dynamic ultrasound (US) on the need for surgical intervention to achieve successful arterial cannulation in the pediatric cardiac surgery population., Design: Retrospective, observational study., Setting: Single, academic, pediatric hospital in the United States., Participants: The study comprised 3,569 consecutive patients who had an arterial catheter placed in the operating room before undergoing congenital heart surgery between January 2004 and September 2016., Interventions: Dynamic US was used in 2,064 cases (57.83%) to obtain arterial access. Arterial cannulation by palpation was performed in the remaining 37.8% of cases. Surgical cutdown for arterial access was required in 192 cases after failed cannulation attempts by the anesthesia team., Measurements and Main Results: Use of US was associated with an overall decrease in the need for surgical access from 10.43% to 1.70% (p < 0.0001). In patients younger than 30 days, US decreased the rate of surgical access, from 19.62% to 2.65% (p < 0.0001). This significant decrease also was observed in patients 1 to 6 months old (13.93% v 3.73%; p < 0.0001), 7 to 12 months old (7.34% v 0.00%, p < 0.0001), and older than 2 years (1.12% v 0%; p = 0.0083). For children between 13 and 24 months old, there was no statistically significant benefit to using US for avoiding surgical access (3.33% v 0.79%; p = 0.1411). Throughout all age groups, use of US was associated with a significant improvement in optimal arterial line location, defined as placement in an upper extremity (73.75% v 91.13%; p < 0.0001)., Conclusions: Dynamic US resulted in a significant reduction in surgical intervention to achieve arterial cannulation in children presenting for cardiac surgery., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Librarians gather data on multiple aspects of their work. Much of the data collection revolves around the library's resources, but what may be passed over during this data collection is information on how librarians are expending their time and effort. A group of librarians from a community hospital system designed a Microsoft Access database to collect such data and has been recording librarians' efforts for more than three years. The librarians use the data in annual reports and can track trends to evaluate service priorities and maximize effective use of the librarians' time.

Background: To test whether access to home-based social worker-led case management (SWCM) program or SWCM program combined with a website providing stroke-related information improves patient-reported outcomes in patients with stroke, relative to usual care., Methods and Results: The MISTT (Michigan Stroke Transitions Trial), an open (unblinded) 3-group parallel-design clinical trial, randomized 265 acute patients with stroke to 3 treatment groups: Usual Care (group-1), SWCM (group-2), and SWCM+MISTT website (group-3). Patients were discharged directly home or returned home within 4 weeks of discharge to a rehabilitation facility. The SWCM program provided in-home and phone-based case management services. The website provided patient-orientated information covering stroke education, prevention, recovery, and community resources. Both interventions were provided for up to 90 days. Outcomes data were collected by telephone at 7 and 90 days. Primary patient-reported outcomes included Patient-Reported Outcomes Measurement Information System Global-10 Quality-of-Life (Physical and Mental Health subscales) and the Patient Activation Measure. Treatment efficacy was determined by comparing the change in mean response (90 days minus 7 days) between the 3 treatment groups using a group-by-time interaction. Subjects were aged 66 years on average, 49% were female, 21% nonwhite, and 86% had ischemic stroke. There were statistically significant changes in Patient-Reported Outcomes Measurement Information System Physical Health ( P=0.003) and Patient Activation Measure ( P=0.042), but not Patient-Reported Outcomes Measurement Information System Mental Health ( P=0.56). The mean change in Patient-Reported Outcomes Measurement Information System Physical Health scores for group-3 (SWCM+MISTT Website) was significantly higher than both group-2 (SWCM; difference, +2.4; 95% CI, 0.46-4.34; P=0.02) and group-1 (usual care; difference, +3.4; 95% CI, 1.41-5.33; P<0.001). The mean change in Patient Activation Measure scores for group-3 was significantly higher than group-2 (+6.7; 95% CI, 1.26-12.08; P=0.02) and marginally higher than group-1 (+5.0; 95% CI, -0.47 to 10.52; P=0.07)., Conclusions: An intervention that combined SWCM with access to online stroke-related information produced greater gains in patient-reported physical health and activation compared with usual care or case management alone. There was no intervention effect on mental health., Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02653170.

Foster care alumni lag behind the general population in post-secondary academic achievement. This cross-sectional study uses a random sample of forty-six foster care alumni from a Midwestern public university to explore the relationship between exposure to trauma and post-secondary academic achievement (14.5% response rate; age range 17-24). While no significant relationship was found between trauma exposure and GPA or failing classes, participants who experienced increased exposure to trauma were more likely to have withdrawn from a class because it was too difficult or the semester was too overwhelming. More research is needed to further understand these findings., Competing Interests: Conflict of InterestThe authors declare they have no conflict of interest., (© Springer Nature Switzerland AG 2018.)

Background: While previous studies have shown that regular physical activity can delay the onset of certain chronic diseases; less is known about the changes in physical activity practices following chronic disease diagnoses. China is experiencing a rapid aging transition, with physical activity an important routine in many older people's lives. This study utilizes the Health Belief Model to better understand the bidirectional relationships and bipolar effects between physical activity and chronic disease burden in Huainan City, a mid-sized city in China., Methods: Longitudinal health survey data (2010-2015) from annual clinic visits for 3198 older people were obtained from a local hospital, representing 97% of the older population in three contiguous neighborhoods in Huainan City. The chronic diseases studied included obesity, hypertension, diabetes, hyperlipidemia, cardiovascular diseases, liver and biliary system diseases, and poor kidney function. Multilevel logistic regression was used to examine differences in physical activity levels across socio-demographic groups. Cox proportional hazards models were used to examine the impacts of physical activity practice levels on chronic disease onsets. Logistic regression was used to estimate the effects of chronic disease diagnosis on physical activity practice levels., Results: The prevalence of chronic diseases increased with increasing age, among men, and those with a lower education. Older people who were physically active experienced a later onset of chronic disease compared to their sedentary counterparts, particularly for obesity and diabetes. Following diagnosis of a chronic disease, physically active older people were more likely to increase their physical activity levels, while sedentary older people were less likely to initiate physical activity, demonstrating bipolar health trajectory effects., Conclusions: Health disparities among older people may widen as the sedentary experience earlier onsets of chronic diseases and worse health trajectories, compared to physically active people. Future health education communication and programmatic interventions should focus on sedentary and less healthy older populations to encourage healthy aging. These lessons from China may be applied to other countries also experiencing an increasing aging population.

Strokes impact over 800,000 people every year. Stroke care typically begins with inpatient care and then continues across an array of healthcare settings. These transitions are difficult for patients and caregivers, with psychosocial needs going unmet. Our team developed a case management intervention for acute stroke patients and their caregivers aimed at improving stroke transitions. The intervention focusses on four aspects of a successful care transition: support, preparedness, identifying and addressing unmet needs, and stroke education. This paper describes the development and implementation of this program, and is an example of the synergy created between neuroscience and clinical practice.

Background: For some stroke patients and caregivers, navigating the transition between hospital discharge and returning home is associated with substantial psychosocial and health-related challenges. Currently, no evidence-based standard of care exists that addresses the concerns of stroke patients and caregivers during the transition period. Objectives of the Michigan Stroke Transitions Trial (MISTT) are to test the impact of a social worker home-based case management program, as well as an online information and support resource, on patient and caregiver outcomes after returning home., Methods: The Michigan Stroke Transitions Trial is a randomized, pragmatic, open (un-blinded), 3-group parallel designed superiority trial conducted in 3 Michigan hospitals. Eligible participants are adult acute stroke patients discharged home directly or within 4 weeks of being discharged to a rehabilitation facility. The patient's primary caregiver is also invited to participate. Patients are randomized on the day they return home using a randomized block design. Consented patients discharged to a rehabilitation facility who do not go home within 4 weeks are dropped from the study. The 2 study interventions begin within a week of returning home and conclude 3 months later. The 3-group design compares usual care to either a home-based social worker stroke case management (SWSCM) program, or a combination of the SWSCM program plus access to an online information and support resource (MISTT website). Outcomes data are collected at 7-days and 90-days by trained telephone interviewers. Primary patient outcomes include the PROMIS global 10 score (a generic Quality of Life scale), and the Patient Activation Measure (PAM). Caregiver outcomes include the Bakas Caregiving Outcomes Scale. Final analysis will be based on 214 randomized acute stroke patients. To accommodate subjects excluded due to prolonged rehabilitation stays, as well as those lost-to-follow-up, up to 315 patients will be consented., Discussion: The MISTT study will determine if a home-based case management program designed around the needs and preferences of stroke patients and caregivers, alone or in combination with a patient-centered online information and support resource can improve stroke survivor and caregiver outcomes 3 months after returning home., Trial Registration: ClinicalTrials.gov: NCT02653170 (Protocol ID: 135457). Registered April 9, 2015.

HIV infection among older adults is increasing. Previous research suggests that many older adults do not see themselves as at risk for HIV and that many subscribe to myths related to HIV transmission. In this focus group study (N = 48) we solicited the beliefs that older adults held about HIV. The older adults in this study were knowledgeable about how HIV is typically transmitted. However, we also identified that they subscribed to misconceptions regarding casual contact transmission and were fearful of transmission from the medical system. Educational efforts aimed at older adults must be tailored to address these persistent misconceptions.

Lesbian, gay, bisexual, or transgender (LGBT) older adults are often unaware or fearful of aging services that contribute to greater vulnerability, isolation, and risk when services are needed. In addition, they may perceive or experience bias in health care encounters. Providers may not recognize their own biases or their impact on such encounters. In response, a group of LGBT community activists, aging professionals, researchers, and a theatre ensemble developed an interactive theatre experience, described herein, that portrays challenges faced by LGBT older adults needing services. Goals included raising awareness among LGBT older adults and providers about issues such as the limited legal rights of partners, limited family support, and fear of being mistreated as a result of homophobia. Evaluations and feedback reflected the potential of interactive theatre to engage people in sensitive discussions that can lead to increased awareness, reduced bias, practice change, and ultimately improved care for LGBT older adults.

There is a large body of research demonstrating that macronutrient balancing is a primary driver of foraging in herbivores and omnivores, and more recently, it has been shown to occur in carnivores. However, the extent to which macronutrient selection in carnivores may be influenced by organoleptic properties (e.g. flavour/aroma) remains unknown. Here, we explore the roles of nutritional and hedonic factors in food choice and macronutrient balancing in a mammalian carnivore, the domestic cat. Using the geometric framework, we determined the amounts and ratio of protein and fat intake in cats allowed to select from combinations of three foods that varied in protein : fat (P : F) composition (approx. 10 : 90, 40 : 60 and 70 : 30 on a per cent energy basis) to which flavours of different 'attractiveness' (fish, rabbit and orange) were added. In two studies, in which animal and plant protein sources were used, respectively, the ratio and amounts of protein and fat intake were very consistent across all groups regardless of flavour combination, indicating regulation of both protein and fat intake. Our results suggest that macronutrient balancing rather than hedonistic rewards based on organoleptic properties of food is a primary driver of longer-term food selection and intake in domestic cats.

Background: The purpose of our study was to examine the prevalence of sexual problems by age and race among older women in the United States and to examine quality of life correlates to sexual dysfunction among non-Hispanic white and African American older women., Methods: A cross-sectional study using self-report surveys was conducted among community-dwelling U.S. women, aged 60 years and over. A total of 807 women aged 61-89 years were included. Self-administered questionnaires assessed sexual dysfunction, satisfaction with life, depressive symptomatology, and self-rated health. Analyses included multivariate logistic regression., Results: The mean age of the sample was 66 years. Two-thirds of the sample had at least one sexual dysfunction; the most common for both African American and non-Hispanic white women were lack of interest in sex and vaginal dryness. Prevalence varied by age for each of the sexual dysfunctions. The odds of experiencing sexual dysfunction varied with age and race. Compared with non-Hispanic white women, African American women had lower odds of reporting lack of interest in sex or vaginal dryness. Poor self-rated health, depressive symptomatology, and lower satisfaction with life were associated with higher odds of having some sexual dysfunction., Conclusions: Improved understanding of how sexual dysfunction affects women across multiple age ranges and racial/ethnic groups can assist providers in making recommendations for care that are patient centered. The associations that we identified with quality of life factors highlight the need to assess sexual health care in the aging female population.

Many women experience changes in sexual health as they age, and discussing these changes with health care providers is an essential component of optimal health management. The purpose of this study was to understand aging women's perspectives about communicating with providers about sexual health. We used the integrative model of behavioral prediction as a theoretical lens to explore women's attitudes, perceived norms, and perceived self-efficacy that promote or inhibit the likelihood of communicating about sexual health. In this theory-based qualitative study, we interviewed 28 community-dwelling older women in the Midwestern United States. Through thematic analysis, we identified both positive and negative attitudes about communicating with providers. Women seemed most inclined to discuss sexual health if they perceived that important patient-provider conditions, such as trust and rapport, were in place. Despite situational obstacles and perceived norms, these women held strong beliefs about their abilities to discuss sexual health topics with providers., (© The Author(s) 2014.)

Primary care providers are expected to address the sexual health concerns of older adults. This study aimed to assess knowledge of aging sexuality and adequacy of formal sexual health education in a sample of U.S. physicians and nurse practitioners in primary care. Response rate was 24.9% (N = 278). Knowledge scores reflected good knowledge; however, only 3% of the sample felt that they had adequate knowledge of older adult sexuality. Training was found to be adequate for 11% of the sample. U.S. providers in primary care are interested in learning more about aging sexuality but feel ill-prepared for it.

While bereavement support groups have been shown to be helpful in assisting older adults with spousal loss, many lesbian and gay older adults would not be comfortable in these groups. Lack of recognition of same sex relationships and fear of judgment are barriers that some older lesbian and gay people face when considering these services. In this report we discuss a community-university collaboration to develop a support group for the older lesbian and gay community in our area. We share lessons we learned in developing and conducting a group for older lesbian and gay adults experiencing partner loss.

Purpose of the Study: Little is known about the effects of chronic illness on social role participation among racially and ethnically diverse older adults. This study was undertaken to better understand disruptions in role among African American, black Caribbean, white, Latino, and Asian older adults with arthritis, heart disease, or diabetes., Design and Methods: This study consisted of a cross-sectional secondary data analysis of the Collaborative Psychiatric Epidemiology Surveys. Role disruption was operationalized using time out of role and role impairment in the past 30 days. Data from participants aged 65 and older were used in negative binomial regression analyses., Results: Overall, prevalence of role impairment occurred more often than time out of role. Race and ethnicity were not associated with time out of role, but they were for role impairment. Whites experienced more role impairment than any other racial or ethnic group. Within-group analyses identified that chronic illness, role participation, and socioeconomic factors are related in different ways depending on race or ethnicity. It appears that for some racially and ethnically diverse older adults, higher income and education are protective against role disruption., Implications: Race and ethnicity are factors in how the social roles of older adults are affected by chronic illness, and it appears that role disruption varies with type of illness. Interventions to support older adults with chronic illness should take into account the cultural factors related to role disruption., (© The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Talking about sexual health can be a challenge for some older women. This project was initiated to identify key factors that improve communication between aging women and their primary care providers. A sample of women (aged 60+) completed an online survey regarding their intent to communicate with a provider about sexual health. Using the integrative model of behavioral prediction as a guide, the survey instrument captured data on attitudes, perceived norms, self-efficacy, and intent to communicate with a provider about sexual health. Data were analyzed using structural equation modeling. Self-efficacy and perceived norms were the most important factors predicting intent to communicate for this sample of women. Intent did not vary with race, but mean scores of the predictors of intent varied for African American and White women. Results can guide practice and intervention with ethnically diverse older women who may be struggling to communicate about their sexual health concerns., (© The Author(s) 2013.)

We investigated the ability of domestic cats to regulate the macronutrient composition of their diet when provided with foods that differed not only in macronutrient content but also in texture and moisture content, as typically found in the main forms of commercially manufactured cat foods. Cats were provided with foods in different combinations (1 wet + 3 dry; 1 dry + 3 wet; 3 wet + 3 dry) in three separate experiments. Within each experiment cats were offered the wet and dry food combinations in two (naïve and experienced) diet selection phases where all the foods were offered simultaneously, separated by a phase in which the foods were offered sequentially in 3-day cycles in pairs (1 wet with 1 dry). Using nutritional geometry we demonstrate convergence upon the same dietary macronutrient composition in the naïve and experienced self-selection phases of each experiment as well as over the course of the 3-day cycles in the pair-wise choice phase of each experiment. Furthermore, even though the dietary options were very different in each of these experiments the macronutrient composition of the diets achieved across all experiments were remarkably similar. These results indicate that a mammalian obligate carnivore, the domestic cat, is able to regulate food selection and intake to balance macronutrient intake despite differences in moisture content and textural properties of the foods provided.

Background and Objectives: Sexual health communication can be difficult for aging women as well as their health care providers. The current exploratory study was undertaken to learn more about how mid-to-late-life women approached communication about sexual health with their health care providers and what factors impacted their perceptions of their abilities to do so., Methods: In this descriptive qualitative study, 27 community-dwelling women, ages 50--80, were interviewed about their perceptions of their abilities to communicate with their health care providers about their sexual health. Interview data was coded for major themes., Results: All of the women in the study had self efficacy to communicate about their sexual health, especially if there was a physical problem present. For a majority of women, provider-related behaviors impacted their communication self efficacy. Provider-related behaviors that both encouraged and hindered communication were identified. Relationship quality and provider-initiated communication were among the behaviors that encourage communication about sexual health. Women in this sample valued active listening by the provider as well as a nonjudgmental stance. Perceptions of provider discomfort, lack of time or interest, as well as confidentiality concerns were identified as barriers to communication about sexual health., Conclusions: Sexual health is important to the quality of life of aging and older women. Providers can incorporate some of the behaviors identified as enhancing of communication self efficacy so that this important health topic is covered in the clinical encounter.

Although many herbivores and omnivores have been shown to balance their intake of macronutrients when faced with nutritionally variable foods, study of this ability has been relatively neglected in carnivores, largely on the assumption that prey are less variable in nutrient composition than the foods of herbivores and omnivores and such mechanisms therefore unnecessary. We performed diet selection studies in 5 breeds of adult dog (Canis lupus familiaris) to determine whether these domesticated carnivores regulate macronutrient intake. Using nutritional geometry, we show that the macronutrient content of the diet was regulated to a protein:fat:carbohydrate ratio of approximately 30%:63%:7% by energy, a value that was remarkably similar across breeds. These values, which the analysis suggests are dietary target values, are based on intakes of dogs with prior experience of the respective experimental food combinations. On initial exposure to the diets (i.e., when naive), the same dogs self-selected a diet that was marginally but significantly lower in fat, suggesting that learning played a role in macronutrient regulation. In contrast with the tight regulation of macronutrient ratios, the total amount of food and energy eaten was far higher than expected based on calculated maintenance energy requirements. We interpret these results in relation to the evolutionary history of domestic dogs and compare them to equivalent studies on domestic cats.

The objective of this literature review is to gain insight into the efficacy of nonpharmacological interventions in chronic pain management in community-dwelling older adults. An extensive search of pertinent databases was performed to identify reports of studies of nonpharmacological (physical and psychosocial) pain interventions. The review identifies intervention studies that used randomized controlled trials (RCTs) and summarizes existing evidence of effectiveness of nonpharmacological interventions. A literature search yielded 28 RCT intervention studies (18 for physical interventions and 10 for psychosocial interventions) that met inclusion criteria and are included in this review. Twenty-one studies (75%) identified in this review demonstrated statistically significant differences (P < .05) in pain scores between nonpharmacological interventions and no intervention or sham interventions; the intervention groups showed lower pain intensity. More research is needed to determine the best format, intensity, duration, and content of such treatments, as well as their efficacy in the older adult population. Methodological limitations are identified in many of the studies, such as low statistical power due to sample size and imprecise measurement, lack of reliable sham controls, and inadequate blinding. Future intervention studies of nonpharmacological pain therapies may require larger sample sizes, control for comorbidities, and long-term follow-up., (© 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.)

Immunosignaturing shows promise as a general approach to diagnosis. It has been shown to detect immunological signs of infection early during the course of disease and to distinguish Alzheimer's disease from healthy controls. Here we test whether immunosignatures correspond to clinical classifications of disease using samples from people with brain tumors. Blood samples from patients undergoing craniotomies for therapeutically naïve brain tumors with diagnoses of astrocytoma (23 samples), Glioblastoma multiforme (22 samples), mixed oligodendroglioma/astrocytoma (16 samples), oligodendroglioma (18 samples), and 34 otherwise healthy controls were tested by immunosignature. Because samples were taken prior to adjuvant therapy, they are unlikely to be perturbed by non-cancer related affects. The immunosignaturing platform distinguished not only brain cancer from controls, but also pathologically important features about the tumor including type, grade, and the presence or absence of O(6)-methyl-guanine-DNA methyltransferase methylation promoter (MGMT), an important biomarker that predicts response to temozolomide in Glioblastoma multiformae patients.

A charge made against feeding dry foods to cats is that the high carbohydrate (i.e. starch) content results in high blood glucose levels which over time may have detrimental health effects. The present study determined the post-meal concentrations of plasma glucose and insulin in adult cats (seven males and four females) and dogs (Labrador retrievers; four males and five females) fed dry diets with low-starch (LS), moderate-starch (MS) or high-starch (HS) levels. In a cross-over design with at least 7 d between the test meals, plasma glucose and insulin concentrations were measured following a single meal of a LS, MS and HS diet (209 kJ/kg bodyweight). Only the HS diet resulted in significant post-meal increases in plasma glucose concentration in cats and dogs although the time-course profiles were different between the species. In cats, plasma glucose concentration was significantly increased above the pre-meal concentration from 11 h until 19 h after the meal, while in dogs, a significant increase above baseline was seen only at the 7 h time point. Plasma insulin was significantly elevated in dogs 4-8 h following the MS diet and 2-8 h after the HS diet. In cats, plasma insulin was significantly greater than baseline from 3-7 and 11-17 h after the HS diet. The time lag (approximately 11 h) between eating the HS diet and the subsequent prolonged elevation of plasma glucose concentration seen in cats may reflect metabolic adaptations that result in a slower digestive and absorptive capacity for complex carbohydrate.

Data from intravenous (i.v.) glucose tolerance tests suggest that glucose clearance from the blood is slower in cats than in dogs. Since different physiological pathways are activated following oral administration compared with i.v. administration, we investigated the profiles of plasma glucose and insulin in cats and dogs following ingestion of a test meal with or without glucose. Adult male and female cats and dogs were fed either a high-protein (HP) test meal (15 g/kg body weight; ten cats and eleven dogs) or a HP + glucose test meal (13 g/kg body-weight HP diet + 2 g/kg body-weight D-glucose; seven cats and thirteen dogs) following a 24 h fast. Marked differences in plasma glucose and insulin profiles were observed in cats and dogs following ingestion of the glucose-loaded meal. In cats, mean plasma glucose concentration reached a peak at 120 min (10.2, 95 % CI 9.7, 10.8 mmol/l) and returned to baseline by 240 min, but no statistically significant change in plasma insulin concentration was observed. In dogs, mean plasma glucose concentration reached a peak at 60 min (6.3, 95 % CI 5.9, 6.7 mmol/l) and returned to baseline by 90 min, while plasma insulin concentration was significantly higher than pre-meal values from 30 to 120 min following the glucose-loaded meal. These results indicate that cats are not as efficient as dogs at rapidly decreasing high blood glucose levels and are consistent with a known metabolic adaptation of cats, namely a lack of glucokinase, which is important for both insulin secretion and glucose uptake from the blood.

Very little research exists examining the interactions between community-based aging service providers and lesbian, gay, bisexual, and transgender (LGBT) older adults. It is unclear whether mainstream aging services acknowledge the needs of this community. We asked direct care providers and administrators in the Michigan aging services network to describe their work with LGBT older adults. We found there are very few services specific to the needs of older LGBT adults and very little outreach to this community. At the agency level, resistance to providing services was found.

Within 5 years, half the U.S. HIV-infected population will be over age 50, and providers caring for older adults must deal with this reality. This study assessed attitudes toward people with HIV/AIDS and knowledge of HIV/AIDS among physicians with a geriatrics specialty, and nurses and social workers who specialize in gerontology. A survey mailed in 2008 to a random sample of U.S. providers yielded a 60% response rate. Main outcome measures included: Knowledge of HIV/AIDS, attitudes toward people with HIV/AIDS, and knowledge of issues related to HIV in older adults. General knowledge of HIV/AIDS was good with scores of 89%, 84%, and 81% for physicians, nurses, and social workers, respectively; groups differed significantly (F(2, 483)=18.626, p<0.0005). Attitudes were positive, with a significant main effect of profession on the attitude subscales (F(4, 952)=6.84, p<0.0005). Eighty-three percent of the sample were unaware that dementia due to HIV may be reversible; no significant differences by profession (χ(2)=4.50, p=0.105). The sample had difficulty ranking the four most common risk factors for HIV infection in older adults, with no significant differences among the professions (F(2, 483)=1.22, p=0.296). Only 6% of the sample correctly ranked all four risk factors. Estimates of the percent of U.S. AIDS cases in people over age 50 varied widely; few answered correctly, with no significant differences by professional group (F(2,319)=2.82, p=0.06). These findings highlight the need for further education among providers who specialize in aging.

We report feeding studies on adult domestic cats designed to disentangle the complex interactions among dietary protein, fat and carbohydrate in the control of intake. Using geometric techniques that combine mixture triangles and intake plots from the geometric framework, we: (1) demonstrate that cats balance their macronutrient intake, (2) estimate the composition of the target balance and (3) reveal the priorities given to different macronutrients under dietary conditions where the target is unachievable. Our analysis indicates that cats have a ceiling for carbohydrate intake, which limits ingestion and constrains them to deficits in protein and fat intake (relative to their target) on high-carbohydrate foods. Finally, we reanalyse data from a previous experiment that claimed that kittens failed to regulate protein intake, and show that, in fact, they did. These results not only add to the growing appreciation that carnivores, like herbivores and omnivores, regulate macronutrient intake, they also have important implications for designing feeding regimens for companion animals.

Endothelin-1 (ET-1) inhibition of vasopressin (AVP)-stimulated cAMP accumulation in the collecting duct has been hypothesized to be mediated, at least in part, by nitric oxide (NO). To examine this, the effect of ET-1 on NO production by acutely isolated rat inner medullary collecting duct (IMCD) cell suspensions and the role of NO in mediating ET-1 effects on AVP-stimulated cAMP accumulation were studied. ET-1 dose dependently (first evident at 100 pM ET-1) increased IMCD NO production as determined by DAF-FM fluorescence. ET(B) receptor (BQ-788), but not ET(A) receptor (BQ-123), antagonism blocked this effect. Nonspecific NO synthase (NOS) inhibitors [N(G)-nitro-L-arginine methyl ester (L-NAME) or N(G)-monomethyl-L-arginine] or NOS-1 inhibitors (SMTC or VNIO) inhibited the ET-1 response, whereas NOS-2 or NOS-3 inhibitors (L-NAA or 1400W) were ineffective. ET-1 also increased cGMP accumulation. ET-1 caused a 35% reduction in AVP-stimulated cAMP levels; however, this response was not affected by L-NAME or SMTC. The addition of L-arginine, NADPH, tetrahydrobiopterin, or tempol (to reduce superoxide-dependent conversion of NO to peroxynitrate) did not affect the response. NO donors (SNAP or spermine NONOate), at concentrations that stimulated DAF-FM fluorescence and increased cGMP levels, did not alter AVP-stimulated cAMP accumulation in the IMCD cell suspensions. In conclusion, ET-1 stimulates IMCD NO production through activation of the ET(B) receptor and NOS-1. However, neither ET-1-mediated NO production nor NO donors inhibit AVP-stimulated cAMP accumulation, indicating that NO does not mediate ET-1 inhibition of cAMP production by the IMCD.

Adenosine triphosphate (ATP) and endothelin (ET)-1 inhibit vasopressin-stimulated water reabsorption in the inner medullary collecting duct (IMCD). Because both ATP and ET-1 are released by the IMCD and can act in an autocrine manner to regulate IMCD water transport, we sought to determine whether these factors can modulate the other's production. To begin such studies, the effect of ATP on IMCD ET-1 production was examined. ATP caused a dose-dependent inhibition of ET-1 release and inhibited ET-1 mRNA levels in primary cultures of rat IMCD cells. This effect was first evident after 4 hrs of exposure to ATP and persisted for at least 24 hrs. The 50% inhibitory concentration for ATP inhibition of ET-1 production was approximately 1 microM, and the maximal response was observed at 25-100 microM. ATP acted, at least in part, through the P2Y2 receptor because its effect was mimicked by UTP, but not by the P2X agonist, alpha,beta-methylene-ATP. N-methyl-L-arginine, or indomethacin, did not block the ATP inhibitory effect. In summary, these data demonstrate that ATP inhibits IMCD ET-1 protein and mRNA accumulation, that this is mediated via P2Y receptors, and that the ATP effect is independent of cyclooxygenase or nitric oxide synthase metabolites. These findings suggest that although ATP and ET-1 both antagonize vasopressin action in the IMCD, they may have a complex interaction that ultimately determines the degree to which they each participate in modulating collecting duct function.

Background/aims: Previous studies have identified a contractile function for renomedullary interstitial cells (RMIC). Such studies focused on the mechanism of endothelin-1-induced RMIC contraction; however, vasopressin (AVP) was also noted to contract RMIC. Since AVP-induced RMIC contraction may be relevant to the medullary effects of AVP on urinary concentration, these initial observations have been extended to examination of the mechanism of AVP-induced RMIC contraction., Methods: Cultured rat RMIC were exposed to AVP and other agents, and examined using video microscopy., Results: AVP caused a slowly developing and dose-dependent reduction in RMIC surface area. AVP-induced RMIC contraction was abolished by blockade of V1, but not V2, receptors. Nifedipine and nickel reduced AVP-stimulated RMIC contraction, indicating that this effect is dependent upon dihydropyridine-sensitive calcium channels. H7, a protein kinase C inhibitor, completely abrogated AVP action, while the nitric oxide synthase inhibitor, NMMA, had no effect. Indomethacin enhanced AVP-induced RMIC contraction, and addition of PGE2 together with indomethacin reduced AVP action., Conclusion: These data indicate that AVP potently contracts RMIC via V1 receptor stimulation of PKC and intracellular calcium accumulation, and that AVP-stimulated prostaglandin production downregulates the contractile effect of AVP on RMIC. AVP modulation of RMIC contraction may be involved in the regulation of urinary concentration., (Copyright 2006 S. Karger AG, Basel)