Search

Calcium ions (Ca2+) play a fundamental role in membrane-associated physiological processes. Ca2+ can also significantly modulate the physicochemical properties of phospholipid bilayers, but whether this occurs at physiologically relevant concentrations is difficult to determine because of the uncertainty in the reported affinity of Ca2+ for phospholipid bilayers. In this article, we determine the apparent affinity of Ca2+ for zwitterionic phospholipid bilayers using tethered bilayer lipid membranes (tBLMs) used in conjunction with swept-frequency electrical impedance spectroscopy (EIS). We report that Ca2+ binds to phospholipid bilayers at physiologically relevant concentrations and modulates membrane permeability. We present direct experimental evidence that this effect is governed by specific interactions with select lipid headgroup moieties, which is supported by data from molecular dynamics (MD) simulations. This is the first reported use of tBLM/EIS to estimate cation-membrane affinity. Combined with MD simulations, this technique provides a novel methodology to elucidate the molecular details of cation-membrane interactions at the water-phospholipid interface.

“Couch hopping” is generally considered a form of housing instability. Prior research has highlighted the discomfort and, sometimes, dangers associated with couch hopping in late adolescence or young adulthood. However, we postulated that in some cases youth may develop positive longer-term housing arrangements with adults drawn from their existing network. Through in-depth interviews with a diverse group of nine youth (17–23 years) dealing with housing instability and ten adult hosts in rural, suburban and urban areas of a Midwestern state, we sought to explore how youth found adults to stay with, what kind of support they received, as well as the character of the hosting relationships. To our knowledge, this is the first study to interview hosts. Findings suggest that informal hosting arrangements can include support beyond provision of basic housing needs, that hosts sometimes play a social service role, and that youth and hosts often develop family-like ties. Also, youth do not typically initiate: more often peers or other third parties facilitate the arrangement, or the host issues an invitation. These findings challenge the existing narrative of couch hopping as uniformly negative, and suggest that expanding services for youth facing homelessness to support informal hosting arrangements may be warranted.

Couch hopping is a significant feature of youth homelessness in the United States. Every year, half of youth ages 18 to 25 who experience housing instability report couch hopping—also known as couch surfing or doubling up. Emerging work suggests that in some intergenerational informal hosting arrangements, youth and their adult hosts can form meaningful and supportive relationships. However, hosts also navigate material challenges that could threaten the stability of these arrangements. Based on in-depth interviews with nine youth ages 17 to 23 in informal hosting arrangements and 10 informal hosts, we describe how increased household costs and lease and benefits restrictions can impact stability, and the strategies hosts and youth mobilized to address them. We place hosts’ instability in the context of intergenerational poverty and structural racism, reframing material challenges as opportunities to strengthen the village of support youth need to make sustained exits from homelessness.

IntroductionDesign of an integrated diabetes service based on needs of service users (persons living with diabetes) and community clinicians in a semirural low-income health district of the UK.Research design and methodsOne hundred and eighty-five service users engaged through public meetings, questionnaires and focus groups. General practice staff contributed views through workshops and questionnaires. Analysis of feedback indicated service user needs for better access to education, dietary advice and foot care. General practice staff endorsed these views and requested regular access to secondary care in the community. Seven hundred persons registered with diabetes attended eight well-being events in the community. From 2017 virtual practice multidisciplinary patient reviews, virtual referral of foot cases and non-face-to-face helplines were developed. A National Health Service (NHS) approved ‘App’ and web-based personalized education support for those recently diagnosed with diabetes was introduced.ResultsEngagement in education for those recently diagnosed with diabetes increased from 5% to 71%. Weight and hemoglobin A1c (HbA1c) levels before and 6 months after starting the program were 99.4±25 and 95.5±24.2 kg and 59.3±16 and 54.8±12.9 mmol/mol, respectively, p=0.00003 and 0.003. Of those engaging at well-being events, 44 had missed regular follow-up. One hundred and seventy-five cases were reviewed virtually with practice staff by the secondary care team avoiding referral to the hospital diabetic clinic. One hundred and seventy-six referrals were made to the virtual multidisciplinary diabetic foot team clinic. Major amputation incidence declined from 13 to 3 major procedures/10 000 per annum and minor amputation from 26 to 18/10 000. Percentage bed day occupancy by persons with diabetes fell significantly in the district general hospital.ConclusionsIntegrated community-based diabetes care delivery has been achieved with partially virtual reviews. Patient education, secondary care in the community, access to dietetic advice and foot care outcomes have all improved.

Care and education have deep historical divisions in the Canadian policy landscape: care is traditionally situated as a private, gendered, and a welfare problem, whereas education is seen as a universal public good. Since the early 2000s, the entrenched divide between private care and public education has been challenged by academic, applied and political settings mainly through human capital investment arguments. This perspective allocates scarce public funds to early childhood education and care through a lens narrowly focused on child development outcomes. From the investment perspective, care remains a prerequisite to education rather than a public good in its own right. This chapter seeks to disrupt this neoliberal, human capital discourse that has justified and continues to position care as subordinate to education. Drawing upon the feminist ethics of care scholarship of philosopher Virginia Held, political scientist Joan Tronto, and sociologist Marian Barnes, this chapter reconceptualizes the care in early childhood education and care rooted through four key ideas: (1) Care is a universal and fundamental aspect of all human life. In early childhood settings, young children’s dependency on care is negatively regarded as a limitation, deficit and a burden. In contrast, in educational settings, older children’s growing abilities to engage in self-care and self-regulate is viewed positively. We challenge this dependence/independence dichotomy. (2) Care is more than basic custodial activities. The premise that care is focused on activities concerned with the child’s body and emotions, while education involves activities concerned with the mind, permeates early childhood education and care policy. Drawing on Held’s definition of care as value and practice, we discuss why this mind-body dualism is false. (3) Care in early childhood settings can be evaluated as promoting well-being or, in contradiction to the meaning of care, as delivering poor services that result in harm to young children. We will explore the relevancy of Barnes’s contention that parallel to theorizing about good care in social policy, “we need to be able to recognize care and its absence” through the cultivation of “ethics sensibilities and skills applied in different practices in different contexts.” (4) Care must be central to early childhood education and care policy deliberation. Using Tronto’s concept of a “caring democracy,” we discuss how such deliberation can promote care and the caring responsibilities of educators in early childhood settings, thereby redressing long standing gendered injustices. We argue that these four ideas can be framed in advocacy messages, in ways that bridge the silos of care and education as separate domains and which open up the vision of an integrated early childhood education and care system. A feminist ethics of care perspective offers new possibilities for practitioners, advocates, researchers, and decision-makers to reposition and reclaim care as integral to the politics and policies of early childhood education and care.

© 2019, International Union for Pure and Applied Biophysics (IUPAB) and Springer-Verlag GmbH Germany, part of Springer Nature. Maintaining gradients of solvated protons and alkali metal ions such as Na+ and K+ across membranes is critical for cellular function. Over the last few decades, both the interactions of protons and alkali metal ions with phospholipid membranes have been studied extensively and the reported interactions of these ions with phospholipid headgroups are very similar, yet few studies have investigated the potential interdependence between proton and alkali metal ion binding at the water–lipid interface. In this short review, we discuss the similarities between the proton–membrane and alkali ion–membrane interactions. Such interactions include cation attraction to the phosphate and carbonyl oxygens of the phospholipid headgroups that form strong lipid–ion and lipid–ion–water complexes. We also propose potential mechanisms that may modulate the affinities of these cationic species to the water–phospholipid interfacial oxygen moieties. This review aims to highlight the potential interdependence between protons and alkali metal ions at the membrane surface and encourage a more nuanced understanding of the complex nature of these biologically relevant processes.

Clinical experience and recent research challenge the current standards of exercise duration and intensity for pregnant women. By carefully assessing a patient's exercise history and teaching self-monitoring techniques, the physician can work with an active woman to create a safe exercise program during her pregnancy.

Physicians versed in sports medicine may want to look to industry, where primary care skills are increasingly in demand. Aggressive rehab methods honed on athletes can also return workers to the job more quickly. The result? Physicians can expand their practices while helping employers save on worker's compensation costs.

Social work education in England is currently undergoing a process of review and change reflecting broader reforms in the profession as a whole. It is therefore timely to identify the achievements of the Centre for the Development of Social Care Practice at the University of Bedfordshire which since 2006 has offered a range of practice learning opportunities to social work students in partnership with the local authority and with the participation of service users and carers. This article places this initiative in the context of other broadly similar non-traditional practice learning provision and reviews recent feedback to identify its particular characteristics. Strengths in the provision of student-centred and empowering practice learning are explored and the need for further evaluation acknowledged.

Purpose The aim of this project was to develop, deliver, and evaluate a brief evidenced-based education package to enhance physical health literacy in mental health nurses. Design and Methods Pre- and post-test survey of knowledge of physical health in serious mental illness, satisfaction with the workshop, and applicability to practice. Findings Participants were motivated to attend and complete the questions. There was statistically significant knowledge gain immediately post workshop and participants described satisfaction with the content and a willingness to apply learning from the session to their practice. Practice Implications If such workshops are provided as a collaborative and relatively inexpensive way of education, they can contribute to building the capacity of mental health nurses to be literate in physical health interventions.

Medicine administration is a high risk activity that most nurses undertake frequently. In this paper, the views of registered mental health nurses and final year student nurses are evaluated about the usefulness of the Medicines with Respect Assessment of the Administration of Medicines Competency Framework. A questionnaire using 22 items with closed and open response questions was distributed to 827 practising mental health nurses and 44 final year mental health nursing students. This article presents a content analysis of written replies to the open response questions. Four overlapping themes were identified in response to the open questions posed in the survey: (1) reasons for undertaking the Medicines with Respect Framework; (2) positive aspects; (3) negative aspects; and (4) service user benefits.

IntroductionAnnual monitoring of physical health of people with severe mental illness (SMI) in primary or secondary care is recommended in England.ObjectiveThe SMI Health Improvement Profile (HIP) was developed to target physical well-being in SMI through the role of the mental health nurse.AimThe primary aim was to investigate if health checks performed by community mental health nurses (CMHNs) trained to use the HIP improved the physical well-being of patients with SMI at 12 months.MethodsA single blind, parallel group randomised controlled trial of training to use the HIP (clustered at the level of the nurse). Physical well-being was measured in study patients using the physical component score of the SF36v2 at baseline and at 12 months.ResultsSixty CMHNs (working with 173 patients) were assigned to the HIP programme (training to use the HIP) or treatment as usual. The HIP was completed with 38 (42%) patients at baseline and 22 (24%) at follow-up in the HIP programme group. No effect of the HIP programme on physical health-related quality of life of study patients was identified, a finding supported by per protocol analyses.ConclusionsThis study found no evidence that CMHN delivered health checks following training to use the HIP are effective at improving the physical well-being of SMI patients at one year. More attention to methods that aim to enable the delivery, receipt and enactment of evidence-based interventions to improve physical health outcomes in this population is urgently required.ISRCTN: 41137900.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Dementia is a debilitating condition characterised by global loss of cognitive and intellectual functioning, which gradually interferes with social and occupational performance. It is a common worldwide condition with a significant impact on society. There are currently 36 million people worldwide with Alzheimer's disease (AD) and other dementias [1]. This is expected to more than double by 2030 (65 million) and reach ∼115 million in 2050, unless a major breakthrough is made. The worldwide societal costs were estimated at USD 604 billion in 2010 and rising [2]. To date research on the specific physical healthcare needs of people with dementia has been neglected. Yet, physical comorbidities are reported as common in people with dementia [3] and have been shown to lead to increased disability and reduced quality of life for the affected person and their carer [4]. Dementia is most frequently associated with older people who often present with other medical conditions, known as co-morbidities. Such co-morbidities include diabetes, chronic obstructive pulmonary disorder, musculoskeletal disorders and chronic cardiac failure and are common, 61% of people with …

WHITE J., GRAY R.JONES M. (2009) Journal of Psychiatric and Mental Health Nursing16, 493-498 The development of the serious mental illness physical Health Improvement ProfilePeople with serious mental illness (SMI), such as schizophrenia and bipolar disorder, are more likely to suffer from a range of long-term physical conditions including diabetes and cardiovascular disease. Consequently they will die 10-15 years earlier than the general population. Health services have failed to address this major health inequality because of a lack of consensus about the type and frequency of monitoring people with SMI require and a lack of knowledge and skills in the mental health workforce. We developed the SMI physical Health Improvement Profile to help mental health nurses profile the physical health of the SMI patients they work with and direct them towards the evidence base interventions available to address identified health problems.

The Olympia oyster of Washington State, USA (Ostrea lurida†) was heavily exploited (1850 to 1940), declined dramatically, and has subsequently failed to recover, although it still supports small aquaculture operations. This paper documents the distribution and abundance of O. lurida in one of the last remaining locations where it forms extensive beds: the North Bay Oyster Reserve in south Puget Sound. We monitored recruitment every 2 wk between May and September 2004 and found a small recruitment peak in late July, which was much later than reported for these oysters when they were abundant throughout Puget Sound. We also experimentally tested two factors that could influence recovery: tidal elevation and substrate type. We established 1 m2 plots at three tidal elevations (-0.3, 0, +0.3 m MLLW) with six substrates: bare, gravel, crushed shell of Crassostrea gigas (Pacific oyster), whole C. gigas shell, whole shell of O. lurida, and live O. lurida. The plots were set up May 21, 2004 and measured f...

Overexploited fisheries are a worldwide problem. Restoration efforts aimed at these fisheries often involve a combination of reduced catch, hatcheries, and habitat improvement. The native oyster of western North America, Ostrea lurida,† was commercially extinct in most locations more than a century ago. In this paper, we track the history of its management for insight into its demise and failed recovery in Washington State. We document six phases of management: open access, aquaculture, control of water pollution sources, substitution by nonindigenous oysters, harvest regulations and marine reserves, and restoration. Three general lessons emerge from this historical analysis, which may apply generally to exploited fisheries that fail to recover. First, the introduction of substitute species led to neglect of the native species for many decades. Second, reserves were not fully protected and instead were designed for commercial removal of newly settled oysters, thus they largely failed. Finally, cu...

Objective: We compared the outcome of drug eluting stent (DES) implantation (Sirolimus or Paclitaxel) in patients with ischemic cardiomyopathy and severe left ventricular (LV) dysfunction with the outcome of a similar group of patients undergoing coronary artery by-pass grafting (CABG). Background: Revascularization provides long-term benefits in patients with severe LV dysfunction. However the modality to achieve it is still unsettled in this high risk group of patients. Methods: Two-hundred-twenty patients (20% women) with severe LV dysfunction (LV Ejection Fraction ≤35%) underwent revascularization with either coronary stent implantation or CABG between May 2002 and May 2005. One-hundred-twenty-eight patients received DES (Sirolimus in 72 and Paclitaxel in 54) and 92 patients underwent surgery. Patients with acute STEMI were excluded. The primary endpoint was all cause mortality. A composite endpoint of major cardiac adverse events (MACCE), including all cause mortality, stroke, myocardial infarction (STEMI), and TVR was the secondary endpoint. Results: Mean follow-up was 15 ± 9 months. No differences were noted in age (69 ± 10 years vs. 68 ± 10 years, P = NS), LVEF (28 ± 6 vs. 27 ± 8, P = NS) history of diabetes (48% vs. 45%, P = NS), congestive heart failure (47% vs. 37%, P = NS) or MI (60% vs. 50%, P = NS) between the DES and CABG groups. The NYHA class was also similar between the two groups (2.6 ± 0.9 vs. 2.7 ± 0.8). More patients in DES group had previous CABG (24% vs. 7%. P = 0.001). Patients undergoing CABG had a greater number of vessel disease (2.8 ± 0.5 vs. 2.3 ± 0.7, P = 0.001) and received a mean of 3.0 ± 0.8 graft per patient. Most of the CABG patients had a left internal mammary artery (83%) graft and 24% had off-pump surgery. The DES group had 1.3 artery/patient treated and 1.3 stents were implanted per artery. During the follow-up there were a total of 20 deaths of which three were cancer related (two in DES group and one in the CABG group). Ten deaths (8%) occurred in the DES group and 10 (11%) in the CABG group (P = NS by log-rank test). The 30-day mortality was significantly greater in patients undergoing CABG than DES (five patients in the CABG vs. only one patient in DES group, P = 0.04). At 6 months there was only a trend toward better survival in DES group (97% vs. 93%, P = 0.2). At 2 years follow-up however both groups had the same survival probability from death (83% in both groups). The 2 years MACCE free survival rate was 76% in DES group and 79% in the CABG cohort (P = NS by log rank test). Eight (6%) DES patients needed additional PCI in nontarget vessel during follow-up. The magnitude of NYHA class improvement was greater for the CABG than DES patients (0.9 vs. 1.5, P = 0.01). Conclusion: In selected high risk patients with severe LV dysfunction revascularization with DES implantation offers comparable long term mortality and MACCE rate to CABG patients. © 2007 Wiley-Liss, Inc.

Cohort review has been used internationally to support tuberculosis (TB) control. We describe its first use in the UK by a London TB service. Improvements were noted in case management and contact tracing, weaknesses identified and important service changes put in place. Key areas of impact were directly observed therapy (DOT) provision (a greater proportion of cases offered DOT, and in response to low uptake resources diverted to create posts responsible for patient-centred DOT delivery), and contact tracing (more contacts per case screened and assessed). Cohort review enables whole system review and improvement. It has subsequently been adopted across the UK.

Objectives: dementia is a debilitating condition characterised by global loss of cognitive and intellectual functioning, which reduces social and occupational performance. This population frequently presents with medical co-morbidities such as hypertension, cardiovascular disease and diabetes. The CONSORT statement outlines recommended guidance on reporting of participant characteristics in clinical trials. It is, however, unclear how much these are adhered to in trials assessing people with dementia. This paper assesses the reporting of medical co-morbidities and prescribed medications for people with dementia within randomised controlled trial (RCT) reports. Design: a systematic review of the published literature from the databases AMED, CINAHL, MEDLINE, EMBASE and the Cochrane Clinical Trial Registry from 1 January 1997 to 9 January 2014 was undertaken in order to identify RCTs detailing baseline medical co-morbidities and prescribed medications . Eligible studies were appraised using the Critical Appraisal Skills Programme (CASP) RCT appraisal tool, and descriptive statistical analyses were calculated to determine point prevalence. Results: nine trials, including 1474 people with dementia, were identified presenting medical co-morbidity data. These indicated neurological disorders (prevalence 91%), vascular disorders (prevalence 91%), cardiac disorders (prevalence 74%) and ischaemic cerebrovascular disease (prevalence 53%) were most frequently seen. Conclusions: published RCTs poorly report medical co-morbidities and medications for people with dementia. Future trials should include the report of these items to allow interpretation of whether the results are generalisable to frailer older populations. PROSPERO Registration: CRD42013006735.

The application of minimally invasive techniques to the performance of abdominal surgery by general surgeons has been perhaps the greatest advance in the history of general surgery. The safe adoption of many of these procedures, however, has been hampered by significant obstacles, mainly due to the problem of providing adequate training for surgeons. Outside of animal and cadaver labs, most training has been didactic in nature, and adoption rates after completion of these courses are discouraging. Multimedia interactive training has been used in a number of high-tech industries with great success. A60% improvement in the learning curve after multimedia interactive training, as compared to traditional didactic training, has been reported. Multimedia interactive training programs for surgeons that use content and input from multiple experts in laparoscopic procedures have now been developed.Residents from a general surgery residency program who used these programs were asked to rate their effectiveness in increasing their knowledge and comfort level prior to their participation in a real procedure as the primary surgeon or first assistant. A comparison to other traditional training techniques was also made. Eleven residents completed 41 programs designed to teach one of five different laparoscopic procedures-cholecystectomy, fundoplication, appendectomy, colon resection, or hernia repair.On a scale of 1 to 10, with 10 being the highest, the residents reported that the multimedia interactive training programs raised their knowledge level of the procedure from 6.0 to 8.7 (+2.7 point value increase after using the multimedia interactive program). The programs increased their comfort level when actually called on to perform or assist with the procedure from 5.3 to 8.1 (+2.8 point value increase after using the multimedia interactive program). In comparing the value of training methods for learning laparoscopic procedures, the residents rated text, lectures, videos, and animal labs at 4.7, 5.1, 6.0 and 7.3, respectively. By comparison, the residents rated the multimedia interactive training program at 8.8.The use of multimedia interactive training programs in addition to current laparoscopic training courses may help to increase the safe adoption of laparoscopic procedures. These programs may be a beneficial adjunct to residency training programs.

The use of minimally invasive surgery for abdominal pathology, including malignancy, has increased significantly within the past decade. Despite the advances in radiographic imaging, the use of laparoscopy for diagnosing and staging abdominal malignancy has become an important tool in the overall care of these patients. A review of published series for a variety of abdominal malignancies is presented. With the growing experience in this technique, some preliminary conclusions and ongoing issues are discussed.

Cohort review has been used internationally to support tuberculosis (TB) control. We describe its first use in the UK by a London TB service. Improvements were noted in case management and contact tracing, weaknesses identified and important service changes put in place. Key areas of impact were directly observed therapy (DOT) provision (a greater proportion of cases offered DOT, and in response to low uptake resources diverted to create posts responsible for patient-centred DOT delivery), and contact tracing (more contacts per case screened and assessed). Cohort review enables whole system review and improvement. It has subsequently been adopted across the UK.

Physicians versed in sports medicine may want to look to industry, where primary care skills are increasingly in demand. Aggressive rehab methods honed on athletes can also return workers to the job more quickly. The result? Physicians can expand their practices while helping employers save on worker's compensation costs.

In the newly reconfigured world that healthcare reform will someday create, what role will sports medicine play? The prospect of reform is prompting some physicians to reassess-and in some cases, revise-how they practice sports medicine today. But many think that their primary care sports medicine knowledge positions them well for the changes to come.

By building on the strengths of minority communities, new health programs are offering physicians practical strategies for promoting healthy life-style choices for minority patients.

Treatment of low-back pain has evolved in the past 15 years away from a reliance on x-rays for diagnosis, prolonged bed rest for pain relief, and surgery for treatment. Mechanical low-back pain is now recognized as a generally self-limiting condition, which for most patients resolves in a few weeks with conservative treatment. Early mobilization is helpful: The McKenzie technique can help identify appropriate rehabilitation exercises, which for most patients are not flexion but extension exercises.

Many active patients and athletes use alternative medical therapies when conventional medicine fails to relieve their musculoskeletal symptoms. Research is expanding, and medical organizations and schools, insurers, and physicians are exploring the efficacy of these alternatives. Profiled here are several of the alternative therapies that are popular with athletes: acupuncture, chiropractic, hyperbaric oxygen, magnet therapy, massage, and relaxation techniques. Also included are tips on how to talk with patients about alternative therapies and resources for further information.