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BackgroundInitially developed in the intensive care unit (ICU) at St. Joseph's Healthcare Hamilton (SJHH) the 3 Wishes Project (3WP) provides personalized, compassionate care to dying patients and their families. The objective of this study was to develop and evaluate 3WP expansion strategies for patients cared for on General Internal Medicine (GIM) wards in our hospital.MethodsFrom January 2020-November 2021, we developed a phased, multicomponent approach for program expansion. We enrolled patients on the GIM wards who had a high probability of dying in hospital, then elicited, implemented, and documented wishes for them or their families. Data were analyzed descriptively.ResultsFrom March 2020 to November 2020, we implemented staff education and engagement activities, created an Expansion Coordinator position, held strategic consultations, and offered enabling resources. From March 2020 to November 2021, we enrolled 62 patients and elicited 281 wishes (median [1st, 3rd quartiles] 4 [4, 5] wishes/patient). The most common wish categories were personalizing the environment (67 wishes, 24%), rituals and spiritual support (42 wishes, 15%), and facilitating connections (39 wishes, 14%). The median [1st, 3rd] cost/patient was $0 [0, $10.00] (range $0 to $86); 91% of wishes incurred no cost to the program.ConclusionsThe formal expansion of the 3WP on GIM wards has been successful despite COVID-19 pandemic disruptions. While there is still work ahead, these data suggest that implementing the 3WP on the GIM wards is feasible and affordable. Increased engagement of the clinical team during the pandemic suggests that it is positively received.

The purpose of this quasi-experimental pretest-posttest control group study was to examine the effect of group synchronous action observation/mental practice intervention compared to usual rehabilitation care on upper extremity motor recovery after stroke. The intervention group (n = 25) received usual care, consisting of a minimum of 3 hours of rehabilitation services per day, 5 days a week, plus group synchronous action observation/mental practice sessions 3 times per week and the control group (n = 26) received usual care. Outcome measures included the Kinesthetic and Visual Imagery Questionnaire Short Version (KVIQ-10), the Fugl-Meyer Assessment (FMA-UE) of affected upper extremity motor function only and The Box and Block Test (BBT). Although there were no statistically significant differences in upper extremity motor function between the two groups, a subgroup analysis of the intervention group identified statistically significant (FMA-UE: p <.001; BBT: p =.04) and Minimally Important Clinical Differences on upper extremity motor recovery between patients with behaviors demonstrating more versus less commitment to the intervention. Group synchronous action observation/mental practice is a promising intervention for patients demonstrating commitment to actively participating in the intervention to improve outcomes on upper extremity motor recovery after stroke. [ABSTRACT FROM AUTHOR]

Rationale: Posttraumatic stress disorder (PTSD) is highly prevalent among veterans. Many veterans with PTSD respond well to serotonin reuptake inhibitors (SRIs). Nonresponders may be prescribed augmenting medications, which are not as well‐studied in PTSD. Aims and Objectives: We used Veterans Health Administration electronic records to compare mental health outcomes (PTSD symptoms and rates of mental health hospitalizations and psychiatric emergency room visits) in patients with PTSD who were prescribed four different groups of augmenting medications (atypical antipsychotics, mirtazapine, prazosin or tricyclic antidepressants) in addition to SRIs—from the year before to the year after the start of the augmenting medication. Method: We included data from 169,982 patients with a diagnosis of PTSD (excluding patients with comorbid bipolar or psychotic disorders) seen in Veterans Affairs care from 2007 to 2015 who were taking an SRI and filled a new prescription for one of the four augmenting medications for at least 60 days. Results: Patients evidenced minimal (<2%) reduction in PTSD symptoms and a larger reduction in psychiatric hospitalizations and psychiatric emergency room visits after receiving augmenting medications; this effect was largely similar across the four medication groups. Initiating augmenting medications was preceded by increases in PTSD symptoms, psychiatric hospitalizations and psychiatric emergency room visits. After initiating an augmenting medication, PTSD symptoms/hospitalizations/emergency room visits returned to baseline levels (before the start of the augmenting medication), but generally did not improve beyond baseline. Conclusion: Importantly, these effects could be explained by regression to the mean, additional interventions or confounding. These findings should be further explored with placebo controlled randomized clinical trials. [ABSTRACT FROM AUTHOR]

Depletion of Ca from forest soils due to acidic deposition has had potentially pervasive effects on forest communities, but these impacts remain largely unknown. Because snails, salamanders, and plants play essential roles in the Ca cycle of northern hardwood forests, we hypothesized that their community diversity, abundance, and structure would vary with differences in biotic Ca availability. To test this hypothesis, we sampled 12 upland hardwood forests representing a soil Ca gradient in the Adirondack Mountains, New York (USA), where chronic deposition has resulted in acidified soils but where areas of well-buffered soils remain Ca rich due to parent materials. Along the gradient of increasing soil [[Ca.sup.2+]], we observed increasing trends in snail community richness and abundance, live biomass of redback salamanders (Plethodon cinereus (Green, 1818)), and canopy tree basal area. Salamander communities were dominated by mountain dusky salamanders (Desmognathus ochrophaeus Cope, 1859) at Ca-poor sites and changed continuously along the Ca gradient to become dominated by redback salamanders at the Ca-rich sites. Several known calciphilic species of snails and plants were found only at the highest-Ca sites. Our results indicated that Ca availability, which is shaped by geology and acidic deposition inputs, influences northern hardwood forest ecosystems at multiple trophic levels, although the underlying mechanisms require further study. Resume: L'epuisement du Ca dans les sols forestiers a cause des depots acides a eu des repercussions potentiellement generalisees sur les communautes forestieres mais ces impacts demeurent largement inconnus. Etant donne que les escargots, les salamandres et les plantes jouent un role essentiel dans le cycle du Ca des forets feuillues nordiques, nous avons emis l'hypothese que la diversite, l'abondance et la structure de leurs communautes varieraient en fonction de la disponibilite du Ca. Pour tester cette hypothese, nous avons echantillonne 12 forets feuillues en milieu sec dans les monts Adirondacks, dans l'Etat de New York aux Etats-Unis d'Amerique, ou des depots chroniques ont acidifie les sols mais ou il y a encore des en-droits ou les sols ont un pouvoir tampon eleve et demeurent riches en Ca a cause du materiau originel. A mesure que la concentration de [Ca.sup.2+] augmentait le long du gradient, nous avons observe des tendances a la hausse de l'abondance et de la richesse des communautes d'escargots, de la biomasse vivante de salamandres rayees (Plethodon cinereus (Green, 1818)) et de la surface terriere des arbres qui forment la canopee. Les communautes de salamandres etaient dominees par la salaman-dre sombre des montagnes (Desmognathus ochrophaeus Cope, 1859) dans les stations pauvres en Ca et changeaient progressivement le long du gradient de Ca pour devenir dominees par la salamandre rayee dans les stations riches en Ca. Plusieurs especes calcicoles connues d'escargots et de plantes ont ete observees seulement dans les stations les plus riches en Ca. Nos resultats indiquent que la disponibilite du Ca, qui est determinee par les conditions geologiques et les apports de depots acides, influence les ecosystemes de feuillus nordiques a de multiples niveaux trophiques bien que les mecanismes sous-jacents necessitent plus de recherche. [Traduit par la Redaction], Introduction Research on forest ecosystem processes has suggested that Ca availability plays a critical role in shaping ecosystem structure, function, and responses to change (McLaughlin and Wimmer 1999). In the [...]

Although good glycaemic control can significantly reduce the risk of developing complications, less than one-half of people with diabetes in the US achieve target Hb[A.sub.1c] levels of 7% (The Diabetes [...]

Background: Women who experience intimate partner violence (IPV) report greater stress and negative health consequences than nonabused women. Although an association between psychological stress and altered immune function has been shown, IPV studies have not investigated this relationship. Objective: This study explored the association of IPV with mental health symptoms and an immune marker to determine if posttraumatic stress disorder (PTSD) symptoms mediate the effect of IPV on pro-inflammatory (IFN-[gamma]) cytokine levels. Methods: A cross-sectional, comparative design was used to compare 62 women with IPV and 39 nonabused women. Results: Mean IFN-[gamma] values were higher in abused women and in women with current PTSD symptoms. There were no significant relationships with potential confounding variables that could provide an alternative explanation for the increase in production of proinflammatory cytokines. Conclusions: PTSD symptoms mediate the association between IPV and IFN-[gamma] levels and may partially explain the association of mental health symptoms with physical health sequelae in IPV. KEY WORDS: intimate partner violence; posttraumatic stress disorder; depression; cytokine; IFN-[gamma].

Research has been conducted on the syndecans, the transmembrane proteoglycans involved in the cytoskeleton and actin microfilaments organization. The biological role of these syndecans has been investigated via the conformation of the syndecan-4 cytoplasmic domain.