Feasibility of a novel eHealth intervention for Parkinson's disease targeting motor-cognitive function in the home

BACKGROUND

Parkinson's disease (PD) drastically affects motor and cognitive function, but evidence shows that motor-cognitive training improves disease symptoms. Motor-cognitive training in the home is scarcely investigated and eHealth methods can provide continual support for PD self-management. Feasibility testing is however required.

OBJECTIVE

To assess the feasibility (i) Recruitment capability (ii) Acceptability and Suitability (iii) Demand and Safety of a home-based motor-cognitive eHealth exercise intervention in PD.

METHODS

The 10-week intervention was delivered using the ExorLive® application and exercises were individually adapted and systematically progressed and targeted functional strength, cardiovascular fitness, flexibility, and motor-cognitive function. People with mild-to moderate PD were assessed before and after the intervention regarding; gait performance in single and dual-task conditions; functional mobility; dual-task performance; balance performance; physical activity level; health related quality of life and perceived balance confidence and walking ability; global cognition and executive function. Feasibility outcomes were continuously measured using a home-exercise diary and contact with a physiotherapist. Changes from pre- and post-intervention are reported descriptively.

RESULTS

Fifteen participants (mean age 68.5 years) commenced and 14 completed the 10-week intervention. In relation to intervention Acceptability, 64% of the motor sessions and 52% of motor-cognitive sessions were rated as "enjoyable". Concerning Suitability, the average level of exertion (Borg RPE scale) was light (11-12). Adherence was high, with 86% of all (420) sessions reported as completed. No falls or other adverse events occurred in conjunction with the intervention.

CONCLUSIONS

This motor-cognitive eHealth home exercise intervention for PD was safe and feasible in terms of Recruitment capability, Acceptability, Safety and Demand. The intensity of physical challenge needs to be increased before testing in an efficacy trial.

TRIAL REGISTRATION

This trial is registered at Clinicaltrials.gov (NCT05027620).

Childhood atopic dermatitis is associated with cardiovascular risk factors in young adulthood-A population-based cohort study

BACKGROUND

Studies have indicated that atopic dermatitis (AD) is associated with an increased risk of cardiovascular disease (CVD). However, data are conflicting. Furthermore, the longitudinal effect of childhood AD on cardiovascular risk factors in young adulthood is less investigated.

OBJECTIVES

To assess associations between AD in childhood and CVD risk factors in young adulthood.

METHODS

The study encompasses longitudinal data from a population-based birth cohort. Participants with data up to age 24 years were included (n = 2270). The primary outcomes were body mass index (BMI), waist circumference (WC), body fat per cent (BF%) and blood pressure (BP) at 24 years. The secondary outcome was blood lipids. Severe AD was defined as AD in combination with sleep disturbance due to itching.

RESULTS

In total, 18.6% (n = 420) had AD at 24 years. Males with AD had higher BMI (βAdj. 0.81, 95% CI 0.15-1.47), BF% (βAdj. 1.19, 95% CI 0.09-2.29), systolic BP (βAdj. 1.92, 95% CI 0.02-3.82), total cholesterol (βAdj. 0.14, 95% CI 0.00-0.28) and LDL cholesterol (βAdj. 0.15, 95% CI 0.02-0.27) compared with males without AD. No associations were seen in females. Current AD with prepubertal onset was associated with increased BMI in both males (βAdj. 0.89, 95% CI 0.11-1.67) and females (βAdj. 0.72, 95% CI 0.11-1.33). At 24 years, 23.1% (n = 97) of all with AD, had severe disease, which was significantly associated with overweight in both sexes, with BMI (βAdj. 1.83, 95% CI 0.72-2.94), WC (βAdj. 4.03, 95% CI 1.54-6.52) and BF% (βAdj. 2.49, 95% CI 0.60-4.39) in females and with BF% (βAdj. 2.96, 95% CI 0.23-5.69) in males, compared with peers with mild to moderate AD.

CONCLUSION

AD in males appears to be associated with CVD risk factors in young adulthood. The duration and severity of AD seem to be of importance in both sexes.

Direct costs of blood drawings with pre-analytical errors in tertiary paediatric hospital care

BACKGROUND

Blood drawings is a common hospital procedure involving laboratory and clinical disciplines that is important for the diagnosis and management of illnesses in children. Blood drawings with pre-analytical error (PAE) can lead to increased costs for hospitals and healthcare organisations. The direct cost of blood drawings after a PAE is not fully understood in paediatric hospital care.

AIM

The aim of this study was to estimate the average direct cost of PAE per year and per 10,000 blood drawings in tertiary paediatric care.

METHODS

A cost analysis using a bottom-up approach was conducted on the basis of combined information from the hospital's laboratory register for the period 2013-2014 and clinical in-ward observations at a tertiary children's referral hospital in Sweden, the Astrid Lindgren Children's Hospital. For the analysis, we hypothesised the re-collection of all blood drawings with PAE and included the average costs of the sampling materials, the time of the healthcare personnel, the laboratory analyses, and in-ward premises based on the time spent on the blood sampling procedure.

RESULTS

The annual cost of PAE was estimated to be 74,267 euros per 54,040 blood drawings, which corresponds to 13,756 euros per 10,000 blood drawings or 1.5 euros per draw. The personnel cost represented 60.1% (45,261 euros per year) of the cost due to PAE, followed by costs for hospitalisation (25.2%), laboratory analyses (8.1%), and materials (5.7%).

CONCLUSION

PAEs lead to substantial increases in the costs in tertiary paediatric hospital care. If these PAEs can be avoided, costs related to the re-collection of blood drawings with PAE may be re-allocated to other health-promoting activities for children visiting hospital institutions.

Ghanaian Female Adolescents Perceived Changes in Nutritional Behaviors and Social Environment After Creating Participatory Videos: A Most Significant Change Evaluation

Background

Understanding the influence of participatory video-making on the nutrition-related behavior of video creators may help shape nutrition education interventions.

Objectives

This study assessed the perceived value and influence of a participatory video intervention among participants and stakeholders.

Methods

A 2018-2019 cluster randomized controlled trial (registered at clinicaltrials.gov as NCT03704649) selected 20 schools (10 intervention, n = 181; 10 control, n = 170) in 1 Ghanaian rural district, enrolled adolescent girls aged 13-16 y, and provided a nutrition curriculum. Each intervention school also participated in 2 series of activities designed to help adolescents plan, film, and screen 2 nutrition-related videos. The Most Significant Change method involved intervention participants and local stakeholders to assess the value and influence of the intervention - a secondary outcome of the trial. Project staff collected 116 stories of change from the adolescents. Stories described shifts in 4 domains: participant, peer, and family behavior, and structural changes in the school. The project team used a selection rubric to identify 14 stories that reflected heightened nutrition literacy. Staff conducted interviews with the 14 adolescents whose stories were selected to elaborate on details and perceived resonance. Finally, local stakeholders assessed the stories to identify the 4 most significant changes of the intervention - 1 per domain. A separate thematic analysis identified emerging patterns of motivation and action across the 14 interviews.

Results

The chosen Most Significant Change stories revealed how adolescents found creative solutions to acquire iron-rich foods, encouraged neighbors to eat iron-rich foods, taught their family new agricultural practices, and promoted change in their school canteen. Local stakeholders valued stories that addressed common community nutrition issues in a creative and sustainable way, whereas adolescents prioritized stories that showed a change in health outcomes.

Conclusion

Stories of change revealed that the intervention promoted a transformative influence; participants modified their eating habits, lifestyle, and their environment.

Angular Analysis of D^{0}→π^{+}π^{-}μ^{+}μ^{-} and D^{0}→K^{+}K^{-}μ^{+}μ^{-} Decays and Search for CP Violation

The first full angular analysis and an updated measurement of the decay-rate CP asymmetry of the D^{0}→π^{+}π^{-}μ^{+}μ^{-} and D^{0}→K^{+}K^{-}μ^{+}μ^{-} decays are reported. The analysis uses proton-proton collision data collected with the LHCb detector at center-of-mass energies of 7, 8, and 13 TeV. The dataset corresponds to an integrated luminosity of 9  fb^{-1}. The full set of CP -averaged angular observables and their CP asymmetries are measured as a function of the dimuon invariant mass. The results are consistent with expectations from the standard model and with CP symmetry.

Tests of Lepton Universality Using B^{0}→K_{S}^{0}ℓ^{+}ℓ^{-} and B^{+}→K^{*+}ℓ^{+}ℓ^{-} Decays

Tests of lepton universality in B^{0}→K_{S}^{0}ℓ^{+}ℓ^{-} and B^{+}→K^{*+}ℓ^{+}ℓ^{-} decays where ℓ is either an electron or a muon are presented. The differential branching fractions of B^{0}→K_{S}^{0}e^{+}e^{-} and B^{+}→K^{*+}e^{+}e^{-} decays are measured in intervals of the dilepton invariant mass squared. The measurements are performed using proton-proton collision data recorded by the LHCb experiment, corresponding to an integrated luminosity of 9  fb^{-1} . The results are consistent with the standard model and previous tests of lepton universality in related decay modes. The first observation of B^{0}→K_{S}^{0}e^{+}e^{-} and B^{+}→K^{*+}e^{+}e^{-} decays is reported.

Nurses' experiences of blood sample collection from children: a qualitative study from Swedish paediatric hospital care

Background

Nurses play an active role in supporting the children with the blood sampling experience. Unfortunately, the blood sampling collection procedure is often affected by pre-analytical errors, leading to consequences such as delayed diagnosis as well as repeated sampling. Moreover, children state that needle procedures are the worst experience of their hospital stay. The nurses’ experiences of errors occurring during blood sample collection is unknown. Therefore, the aim of this study therefore was to describe paediatric nurses’ experiences of blood sampling collections from children.

Method

We used a qualitative study design with a (reflexive) thematic analysis (TA) method described by Braun and Clarke. Three focus group interviews were conducted, with 19 nurses collected by purposeful sampling from Sweden working at two different paediatric hospitals, focusing on their experiences of the blood sample collection procedure.

Results

From the three focus group interviews we analysed patterns and meanings of the following main theme Paediatric blood sampling is a challenge for the nurses and the four subthemes Nurses’ feelings of frustration with unsuccessful samplings, Nurses believe in team work, Venous blood sampling was experienced as the best option, and Nurses’ thoughts and needs regarding skills development in paediatric blood sampling.

Conclusion

The narrative results of this study illustrate that nurses working in paediatric hospital care face a big challenge in blood sampling collection from children. The nurses felt frustrated due to unsuccessful blood samplings and frequently could not understand why pre-analytical errors occurred. Nevertheless, they felt strengthened by colleagues in their team and shared feelings of responsibility to help each other with this complex procedure. The implications of this study are that paediatric hospital care needs to focus on improving guidelines for and increasing competence in blood sampling children and helping nurses to understand why samplings may be unsuccessful and how this can be avoided.

Capillary blood sampling increases the risk of preanalytical errors in pediatric hospital care: Observational clinical study

PURPOSE

The blood sampling procedure is complex and prone to failure, as reflected by preanalytical errors in pediatric hospital care. The primary aim was to evaluate if the risk of preanalytical errors was higher with capillary blood sampling than with venous blood sampling, and secondary, explore specific factors associated with preanalytical errors, both overall and stratified by capillary and venous blood sampling.

DESIGN AND METHODS

This observational pediatric hospital study collected outcomes from medical records and blood sampling surveys from year 2014 to 2016. The risk of preanalytical errors was analyzed with adjusted-odds ratio (adj-OR) by multivariable logistic regression with 95% confidence intervals (CIs).

RESULTS

Overall, 128 (13%) preanalytical errors were identified among 951 blood samples. The proportion and adj-OR of errors was significantly higher in capillary compared with venous blood samples, 72 (20%) of 354 versus 56 (9.4%) of 597, p = .001, adj-OR 2.88 (CI 1.79-4.64). Blood collection with multiple sample tubes was significantly associated with increased risk of preanalytical errors (n = 97 of 601, 16%), while log weight (kg) significantly decreased the risk of preanalytical errors adj-OR 0.66 (CI 0.50-0.86), indicating a protective effect of increasing weight. However, stratified analyses indicated a protective effect of increasing log weight for venous blood sampling adj-OR 0.52 (CI 0.38-0.72), but not capillary blood sampling, adj-OR 1.08 (CI 0.76-1.55).

CONCLUSION

This study indicates that capillary blood sampling collection increases the risk of preanalytical errors. Further, a child's increasing body weight reduced the risk of preanalytical errors, while multiple sample tube collections significantly increased the risk of preanalytical errors.

PRACTICE IMPLICATIONS

This new information may help nurses improve their knowledge concerning blood sampling collection in pediatrics. Altogether, this study also indicates that implementing more venous blood sampling and improve the cases of capillary sampling could reduce the number of preanalytical errors in pediatric hospitals.

Lymphocyte antigen 6 superfamily member D is a marker of urothelial and squamous differentiation: implications for risk stratification of bladder cancer

Background

Screening across a multitude of normal and malignant tissues revealed an enhanced expression of lymphocyte antigen 6 superfamily member D (LY6D) in squamous epithelium and urothelium, as well as in malignancies derived therefrom. The aim of this study was to further delineate the protein expression of LY6D in urothelial bladder cancer, with particular attention to its relationship with clinicopathological characteristics and patient outcome.

Methods

Immunohistochemical expression of LY6D was assessed in tissue microarrays with urothelial bladder cancer tumours from three independent patient cohorts; one with transurethral resection of the bladder (TURB) specimens of mixed tumour stages from 110 consecutive cases, one with tumours of mixed stages from 260 incident cases in a population-based cohort, and one with paired TURB specimens, resected tumours and a subset of lymph node metastases from 145 patients with muscle-invasive bladder cancer (MIBC). Chi-square and non-parametric tests were applied to examine associations of LY6D expression with clinicopathological characteristics. Kaplan-Meier and Cox regression analyses were applied to examine 5-year overall survival (OS) and recurrence free survival (RFS) in relation to LY6D expression.

Results

In the two cohorts with mixed stages, positive LY6D expression was denoted in 63 and 64% of the cases, respectively, and found to be significantly higher in low-grade and less invasive tumours. Negative LY6D expression was significantly associated with a reduced 5-year OS, although not independently of established prognostic factors. In the population-based cohort, LY6D expression was higher in tumours with squamous differentiation and lower in other variant histologies compared to pure urothelial tumours, and the association of LY6D expression with survival was somewhat enhanced after exclusion of the former. LY6D expression was generally lower in the MIBC cohort, and even more reduced in resected tumours compared to TURB specimens in patients who had not received neoadjuvant chemotherapy. There were no significant associations between LY6D expression and RFS, neither allover nor in relation to neoadjuvant chemotherapy.

Conclusion

LY6D is a marker of urothelial and squamous differentiation that may add useful diagnostic and prognostic information to better guide the clinical management of bladder cancer, given that the presence of variant histology is taken into account.

Confidence and authority through new knowledge: An evaluation of the national educational programme in paediatric oncology nursing in Sweden

BACKGROUND

There is a lack of nurse specialists in many paediatric hospitals in Sweden. This lack of competence is devastating for childhood cancer care because it is a highly specialised area that demands specialist knowledge. Continuing education of nurses is important to develop nursing practice and also to retain them.

OBJECTIVES

The aim of this study was to evaluate a Swedish national educational programme in paediatric oncology nursing.

SETTINGS AND PARTICIPANTS

The nurses who participated came from all of the six paediatric oncology centres as well as from general paediatric wards. At the time of the evaluation, three groups of registered nurses (n=66) had completed this 2year, part-time educational programme.

DESIGN AND METHODS

A study specific questionnaire, including closed and open-ended questions was sent to the 66 nurses and 54 questionnaires were returned. Answers were analysed using descriptive statistics and qualitative content analysis.

RESULTS

The results show that almost all the nurses (93%) stayed in paediatric care after the programme. Furthermore, 31% had a position in management or as a consultant nurse after the programme. The vast majority of the nurses (98%) stated that the programme had made them more secure in their work. The nurses were equipped, through education, for paediatric oncology care which included: knowledge generating new knowledge; confidence and authority; national networks and resources. They felt increased confidence in their roles as paediatric oncology nurses as well as authority in their encounters with families and in discussions with co-workers. New networks and resources were appreciated and used in their daily work in paediatric oncology.

CONCLUSIONS

The programme was of importance to the career of the individual nurse and also to the quality of care given to families in paediatric oncology. The national educational programme for nurses in Paediatric Oncology Care meets the needs of the highly specialised care.

Are allergic multimorbidities and IgE polysensitization associated with the persistence or re-occurrence of foetal type 2 signalling? The MeDALL hypothesis

Allergic diseases [asthma, rhinitis and atopic dermatitis (AD)] are complex. They are associated with allergen-specific IgE and nonallergic mechanisms that may coexist in the same patient. In addition, these diseases tend to cluster and patients present concomitant or consecutive diseases (multimorbidity). IgE sensitization should be considered as a quantitative trait. Important clinical and immunological differences exist between mono- and polysensitized subjects. Multimorbidities of allergic diseases share common causal mechanisms that are only partly IgE-mediated. Persistence of allergic diseases over time is associated with multimorbidity and/or IgE polysensitization. The importance of the family history of allergy may decrease with age. This review puts forward the hypothesis that allergic multimorbidities and IgE polysensitization are associated and related to the persistence or re-occurrence of foetal type 2 signalling. Asthma, rhinitis and AD are manifestations of a common systemic immune imbalance (mesodermal origin) with specific patterns of remodelling (ectodermal or endodermal origin). This study proposes a new classification of IgE-mediated allergic diseases that allows the definition of novel phenotypes to (i) better understand genetic and epigenetic mechanisms, (ii) better stratify allergic preschool children for prognosis and (iii) propose novel strategies of treatment and prevention.

Pulsar glitches: the crust is not enough

Pulsar glitches are traditionally viewed as a manifestation of vortex dynamics associated with a neutron superfluid reservoir confined to the inner crust of the star. In this Letter we show that the nondissipative entrainment coupling between the neutron superfluid and the nuclear lattice leads to a less mobile crust superfluid, effectively reducing the moment of inertia associated with the angular momentum reservoir. Combining the latest observational data for prolific glitching pulsars with theoretical results for the crust entrainment, we find that the required superfluid reservoir exceeds that available in the crust. This challenges our understanding of the glitch phenomenon, and we discuss possible resolutions to the problem.

Thermal dynamics in general relativity

We discuss a relativistic model for heat conduction, building on a convective variational approach to multi-fluid systems where the entropy is treated as a distinct dynamical entity. We demonstrate how this approach leads to a relativistic version of the Cattaneo equation, encoding the finite thermal relaxation time that is required to satisfy causality. We also show that the model naturally includes the non-equilibrium Gibbs relation that is a key ingredient in most approaches to extended thermodynamics. Focusing on the pure heat conduction problem, we compare the variational results with the second-order model developed by Israel and Stewart. The comparison shows that, despite the very different philosophies behind the two approaches, the two models are equivalent at first-order deviations from thermal equilibrium. Finally, we complete the picture by working out the non-relativistic limit of our results, making contact with recent work in that regime.

A variant near the interleukin-6 gene is associated with fat mass in Caucasian men

Context

Regulation of fat mass appears to be associated with immune functions. Studies of knockout mice show that endogenous interleukin (IL)-6 can suppress mature-onset obesity.

Objective

To systematically investigate associations of single nucleotide polymorphisms (SNPs) near the IL-6 (IL6) and IL-6 receptor (IL6R) genes with body fat mass, in support for our hypothesis that variants of these genes can be associated with obesity.

Design and Study Subjects

The Gothenburg Osteoporosis and Obesity Determinants (GOOD) study is a population-based cross-sectional study of 18-20 years old men (n=1 049), from the Gothenburg area (Sweden). Major findings were confirmed in two additional cohorts consisting of elderly men from the Osteoporotic Fractures in Men (MrOS) Sweden (n=2 851) and MrOS US (n=5 611) multicenter population-based studies.

Main Outcome

The genotype distributions and their association with fat mass in different compartments, measured with dual-energy X-ray absorptiometry (DXA).

Results

Out of 18 evaluated tag single nucleotide polymorphisms (SNPs) near the IL6 and IL6R genes, a recently identified SNP rs10242595 G/A [minor allele frequency (MAF) = 29%] 3′ of the IL6 gene was negatively associated with the primary outcome total body fat mass (effect size -0.11 standard deviation (SD) units/A allele, P=0.02). This negative association with fat mass was also confirmed in the combined MrOS Sweden and MrOS US cohorts (effect size -0.05 SD units/A allele; P=0.002). When all three cohorts were combined (n= 8 927, Caucasian subjects), rs10242595*A showed a negative association with total body fat mass (effect size -0.05 SD units/A allele, P<0.0002). Furthermore, the rs10242595*A was associated with low body mass index [(BMI, effect size -0.03, P<0.001)] and smaller regional fat masses. None of the other SNPs investigated in the GOOD study were reproducibly associated with body fat.

Conclusions

The IL6 gene polymorphism rs10242595*A is associated with decreased fat mass in three combined cohorts of 8 927 Caucasian men.

Variational multi-fluid dynamics and causal heat conductivity

We discuss heat conductivity from the point of view of a variational multi-fluid model, treating entropy as a dynamical entity. We demonstrate that a two-fluid model with a massive fluid component and a massless entropy can reproduce a number of key results from extended irreversible thermodynamics. In particular, we show that the entropy entrainment is intimately linked to the thermal-relaxation time that is required to make heat propagation in solids causal. We also discuss non-local terms that arise naturally in a dissipative multi-fluid model, and relate these terms to those of phonon hydrodynamics. Finally, we formulate a complete heat-conducting two-component model and discuss briefly the new dissipative terms that arise.

Variants of the interleukin-1 receptor antagonist gene are associated with fat mass in men

CONTEXT

Immune functions seem to have connections to variations in body fat mass. Studies of knockout mice indicate that endogenous interleukin (IL)-1 can suppress mature-onset obesity.

OBJECTIVE

To systematically investigate our hypotheses that single-nucleotide polymorphisms (SNPs) and/or haplotypes variants in the IL-1 gene system are associated with fat mass.

SUBJECTS

The Gothenburg osteoporosis and obesity determinants (GOOD) study is a population-based cross-sectional study of 18-20 year-old men (n=1068), from Gothenburg, Sweden. Major findings were confirmed in elderly men (n=3014) from the Swedish part of the osteoporotic fractures in men (MrOS) multicenter population-based study.

MAIN OUTCOME MEASURE

The genotype distributions and their association with body fat mass in different compartments, measured with dual-energy X-ray absorptiometry (DXA).

RESULTS

Out of 15 investigated SNPs in the IL-1 receptor antagonist (IL1RN) gene, a recently identified 3' untranslated region C>T (rs4252041, minor allele frequency=4%) SNP was associated with the primary outcome total fat mass (P=0.003) and regional fat masses, but not with lean body mass or serum IL-1 receptor 1 (IL1RN) levels. This SNP was also associated with body fat when correcting the earlier reported IL1RN+2018 T>C (rs419598) SNP (in linkage disequilibrium with a well-studied variable number tandem repeat of 86 bp). The association between rs4252041 SNP and body fat was confirmed in the older MrOS population (P=0.03). The rs4252041 SNP was part of three haplotypes consisting of five adjacent SNPs that were identified by a sliding window approach. These haplotypes had a highly significant global association with total body fat (P<0.001). None of the other investigated members of the IL-1 gene family displayed any SNPs that have not been described previously to be significantly associated with body fat.

CONCLUSIONS

The IL1RN gene, shown to enhance obesity by suppressing IL-1 effects in experimental animals, have not [corrected] previously described gene polymorphisms and haplotypes that are associated with fat, but not lean mass in two populations of men.

The role of the G protein-coupled receptor GPR30 in the effects of estrogen in ovariectomized mice

In vitro studies suggest that the membrane G protein-coupled receptor GPR30 is a functional estrogen receptor (ER). The aim of the present study was to determine the possible in vivo role of GPR30 as a functional ER primarily for the regulation of skeletal parameters, including bone mass and longitudinal bone growth, but also for some other well-known estrogen-regulated parameters, including uterine weight, thymus weight, and fat mass. Three-month-old ovariectomized (OVX) GPR30-deficient mice (GPR30(-/-)) and wild-type (WT) mice were treated with either vehicle or increasing doses of estradiol (E(2); 0, 30, 70, 160, or 830 ng.mouse(-1).day(-1)). Body composition [bone mineral density (BMD), fat mass, and lean mass] was analyzed by dual-energy-X ray absorptiometry, while the cortical and trabecular bone compartments were analyzed by peripheral quantitative computerized tomography. Quantitative histological analyses were performed in the distal femur growth plate. Bone marrow cellularity and distribution were analyzed using a fluorescence-activated cell sorter. The estrogenic responses on most of the investigated parameters, including increase in bone mass (total body BMD, spine BMD, trabecular BMD, and cortical bone thickness), increase in uterine weight, thymic atrophy, fat mass reduction, and increase in bone marrow cellularity, were similar for all of the investigated E(2) doses in WT and GPR30(-/-) mice. On the other hand, E(2) treatment reduced longitudinal bone growth, reflected by decreased femur length and distal femur growth plate height, in the WT mice but not in the GPR30(-/-) mice compared with vehicle-treated mice. These in vivo findings demonstrate that GPR30 is not required for normal estrogenic responses on several major well-known estrogen-regulated parameters. In contrast, GPR30 is required for a normal estrogenic response in the growth plate.

Risk factors associated with recent transmission of tuberculosis: systematic review and meta-analysis

A systematic review of published articles was performed to identify risk factors associated with recent transmission of tuberculosis (TB). The computerized search identified studies in PubMed, Ovid, CDSR, CINAHL and EMBASE published between 1994 and 2005. Of 137 articles, 30 satisfied all the inclusion criteria for meta-analysis. A random effects model estimated the odds ratio (OR), confidence interval (CI), and heterogeneity between studies. Recent transmission of TB was associated with: ethnic minority (OR 3.03, 95%CI 2.21- 4.16), being a native of the country (OR 2.33, 95%CI 1.76-3.08), residing in an urban area (OR 1.52, 95%CI 1.35-1.72), drug use (OR 3.01, 95%CI 2.14-4.22), excessive alcohol consumption (OR 2.27, 95%CI 1.69-3.06), homelessness (OR 2.87, 95%CI 2.04-4.02), previous incarceration (OR 2.21, 95%CI 1.71-2.86), human immunodeficiency virus infection/acquired immune-deficiency syndrome (OR 1.66, 95%CI 1.36-2.05), young age (OR 2.09, 95%CI 1.69-2.59), sputum smear positivity (OR 1.39, 95%CI 1.20-1.60) and male sex (OR 1.37, 95%CI 1.19-1.58). The results should be useful for improving prevention and control strategies, thus contributing to a reduction in Mycobacterium tuberculosis transmission.

Dependency of cerebrospinal fluid outflow resistance on intracranial pressure

OBJECT

The outflow resistance (Rout) of the cerebrospinal fluid (CSF) system has generally been accepted by most investigators as independent of intracranial pressure (ICP), but there are also those claiming that it is not. The general belief is that this question has been investigated numerous times in the past, but few studies have actually been specifically aimed at looking at this relationship, and no study has been able to provide scientific evidence to elucidate fully this fundamental and important issue. The objective of this study was to investigate the relationship between ICP and CSF outflow in 30 patients investigated for idiopathic normal-pressure hydrocephalus.

METHODS

Lumbar infusion tests with constant pressure levels were performed, and ICP and corresponding flow were measured on 6 pressure levels for each patient. All data were standardized for comparison.

RESULTS

In the range of moderate increases from baseline pressure (approximately 5-12 mm Hg, mean baseline pressure 11.7 mm Hg), the assumption of a pressure-independent Rout was confirmed (p = 0.5). However, when the pressure increment from baseline pressure was larger (approximately 15-22 mm Hg), the relationship had a nonlinear tendency (p < 0.05).

CONCLUSIONS

The results of this study support the classic textbook theory of a pressure-independent Rout in the normal ICP range, where the CSF system is commonly operating. However, the theory might have to be questioned in regions where ICP exceeds baseline pressure by too much.

Stability of precessing superfluid neutron stars

We discuss a new superfluid instability occurring in the interior of mature neutron stars with implications for free precession. This instability is similar to the instability which is responsible for the formation of turbulence in superfluid helium. We demonstrate that the instability is unlikely to affect slowly precessing systems with weak superfluid coupling. In contrast, fast precession in systems with strong coupling appears to be generically unstable. This raises serious questions about our understanding of neutron star precession and complicates attempts to constrain neutron star interiors using such observations.

Nurses in paediatric care--self-reported professional self and perceived research utilization

The aim was to describe how nurses in different professional levels evaluated their professional self and perceived barriers to research utilization in paediatric care. The sample consisted of three groups of nurses: control, trainee and specialists (n = 113) employed at two Paediatric University hospitals in Sweden. The control and trainee groups were nurses with a general education and the specialists had a specialist education in paediatric care. The nurses answered the two questionnaires: the Professional Self Description Form (PSDF) and the Barriers Scale. The results showed that the highest scores in the PSDF were found in sensitivity in all the three groups and consideration (in control and specialist group) and creativity (trainee group). The control group scored significantly higher in the item persistence. In the Barriers Scale, the three groups scored the greatest barriers in; 'there is insufficient time on the job to implement new ideas' and 'the nurses do not have time to read research'. The lowest barriers were found in; 'the nurse is unwilling to change/try new ideas' and 'the nurse is unaware of research'. The specialist nurses had significantly higher barriers in; 'the nurse is isolated from knowledgeable colleagues with whom to discuss the research', 'the nurse is unwilling to try new ideas' and 'administration will not allow implementation'. No correlations were found between the PSDF and the Barriers Scale. In conclusion, the self-evaluation of professional self and perceived research utilization showed few differences between the nurses. These findings indicate that the professional self is independent of educational level and work experiences while barriers to research utililization increases with competence and experience.

Are neutron stars with crystalline color-superconducting cores relevant for the LIGO experiment?

We estimate the maximal deformation that can be sustained by a rotating neutron star with a crystalline color-superconducting quark core. Our results suggest that current gravitational-wave data from the Laser Interferometer Gravitational-Wave Observatory have already reached the level where a detection would have been possible over a wide range of the poorly constrained QCD parameters. This leads to the nontrivial conclusion that compact objects do not contain maximally strained color crystalline cores drawn from this range of parameter space. We discuss the uncertainties associated with our simple model and how it can be improved in the future.

Identification of target cells for the genomic effects of estrogens in bone

Estrogen has bone protective effects, but the exact mechanism behind these effects remains unclear. The aim of the present study was to identify the primary target cells in bone for the classical genomic effects of estrogens in vivo. For this purpose we have used reporter mice with a luciferase gene under the control of three estrogen-responsive elements (EREs), enabling detection of in vivo activation of gene transcription. Three-month-old ovariectomized mice were treated with a single dose (50 mug/kg) 17beta-estradiol (E2). Luciferase activity was analyzed in several tissues and in different bone marrow-derived lymphocyte enriched/depleted preparations using MacsMouse CD19 (for B lymphocytes) or CD90 (for T lymphocytes) MicroBeads (Miltenyi Biotec GmbH, Bergisch Gladbach, Germany). Histological characterization of cells with high luciferase content was performed using immunohistochemistry. Both cortical bone and bone marrow displayed a rapid (within 1 h) and pronounced E2-induced increase in luciferase activity. The luciferase activity in total bone marrow and in bone marrow depleted of lymphocytes was increased six to eight times more than in either B-lymphocyte or T-lymphocyte enriched cell fractions 4 h after the E2 injection, demonstrating that mature lymphocytes are not major direct targets for the genomic effect of estrogens in bone. Immunohistochemistry identified clear luciferase staining in hypertrophic growth plate chondrocytes, megakaryocytes, osteoblasts, and lining cells, whereas no staining was seen in proliferative chondrocyte. Although most of the osteocytes did not display any detectable luciferase staining, a subpopulation of osteocytes both in cortical and trabecular bone stained positive for luciferase. In conclusion, hypertrophic growth plate chondrocytes, megakaryocytes, osteoblasts, lining cells, and a subpopulation of osteocytes were identified to respond to estrogen via the classical ERE-mediated genomic pathway in bone. Furthermore, our findings indicate that possible direct estrogenic effects on the majority of osteocytes, not staining positive for luciferase, on proliferative chondrocytes and on mature lymphocytes are mediated by non-ERE actions.

Professional roles and research utilization in paediatric care: newly graduated nurses experiences

The aim of the study was to describe and analyse how newly graduated nurses perceive themselves as professionals and their perceptions of barriers to research utilization when starting to work within paediatric care. The nurses were employed in two paediatric university hospitals in Sweden and had been working as staff nurses for 1-3 months. They answered two questionnaires: The Professional Self-Description Form and the Barriers Scale. The results showed that in the assessment of their professional level the highest scores were found in consideration, ambition and sensitivity, and the lowest scores in grasp of ideas, leadership and discrimination. In perceptions of research utilization (Barriers Scale), the items with the most common barriers were 'there is insufficient time on the job to implement new ideas', 'the nurse does not have time to read research' and 'the facilities are inadequate for implementation'. These results indicate that newly graduated nurses seem to be prepared for the nursing profession when it concerns themselves as human individuals but not so prepared for the practice in the real day-to-day work. The most common barriers in the research utilization were connected to the work organization and not to themselves as individuals. The evaluation of professional self, barriers to research utilization and the relationship between these aspects indicates a need for further investigation into the significant meaning of professional self and how this influences the implementation and use of research in everyday work. The results so far also raise the question of how to best support and develop newly graduated nurses in their professional role, to help them to be the highly competent nurses that we need in providing the best and evidence-based care to those who need it.

Adaptive method for assessment of cerebrospinal fluid outflow conductance

Outflow conductance (C(out)) is important for predicting shunt responsiveness in patients with suspected idiopathic adult hydrocephalus syndrome (IAHS). C (out) is determined by performing an infusion test into the cerebrospinal fluid system, and the reliability of the test is dependent on the measurement time. The objective of this study was to develop an adaptive signal analysis method to reduce the investigation time, by taking the individual intracranial pressure variations of the patient into consideration. The method was evaluated on 28 patients with suspected IAHS. The results from full time investigations (60 min) were compared to the results of the new algorithm. Applying the new adaptive method resulted in a reduction of mean investigation time by 14.3 +/- 5.9 min (mean +/- SD), p<0.01. The reduction of reliability in the C(out) estimation was found clinically negligible. We thus recommend this adaptive method to be used when performing constant pressure infusion tests.

Combined emulsion and solvent evaporation (ESE) synthesis route to well-ordered mesoporous materials

Control over morphology and internal mesostructure of surfactant templated silicas remains a challenge, especially when considering scaling laboratory syntheses up to industrial volumes. Here we report a method combining emulsification with the evaporation-induced self-assembly (EISA) method for preparing spherical, mesoporous silica particles. This emulsion and solvent evaporation (ESE) method has several potential advantages over classic precipitation routes: it is easily scaled while providing superior control over stoichiometric homogeneity of templating surfactants and inorganic precursors, and particle sizes and distributions are determined by principles developed for manipulating droplet sizes within water-in-oil emulsions. To demonstrate the method, triblock copolymer P104 is used as a templating amphiphile, generating unusually well-ordered 2D hexagonal (P6mm) mesoporous silica, while particle sizes and morphologies were controlled by varying the type of emulsifier and the method for emulsification.

SHBG gene promoter polymorphisms in men are associated with serum sex hormone-binding globulin, androgen and androgen metabolite levels, and hip bone mineral density

CONTEXT

SHBG regulates free sex steroid levels, which in turn regulate skeletal homeostasis. Twin studies have demonstrated that genetic factors largely account for interindividual variation in SHBG levels. Glucuronidated androgen metabolites have been proposed as markers of androgenic activity.

OBJECTIVE

Our objective was to investigate whether polymorphisms in the SHBG gene promoter [(TAAAA)(n) microsatellite and rs1799941 single-nucleotide polymorphism] are associated with serum levels of SHBG, sex steroids, or bone mineral density (BMD) in men.

DESIGN AND STUDY SUBJECTS

We conducted a population-based study of two cohorts of Swedish men: elderly men (MrOS Sweden; n congruent with 3000; average age, 75.4 yr) and young adult men (GOOD study; n = 1068; average age, 18.9 yr).

MAIN OUTCOME MEASURES

We measured serum levels of SHBG, testosterone, estradiol, dihydrotestosterone, 5alpha-androstane-3alpha,17beta-diol glucuronides, androsterone glucuronide, and BMD determined by dual-energy x-ray absorptiometry.

RESULTS

In both cohorts, (TAAAA)(n) and rs1799941 genotypes were associated with serum levels of SHBG (P < 0.001), dihydrotestosterone (P < 0.05), and 5alpha-androstane-3alpha,17beta-diol glucuronides (P < 0.05). In the elderly men, they were also associated with testosterone and BMD at all hip bone sites. The genotype associated with high levels of SHBG was also associated with high BMD. Interestingly, male mice overexpressing human SHBG had increased cortical bone mineral content in the femur, suggesting that elevated SHBG levels may cause increased bone mass.

CONCLUSIONS

Our findings demonstrate that polymorphisms in the SHBG promoter predict serum levels of SHBG, androgens, and glucuronidated androgen metabolites, and hip BMD in men.

Liver-derived IGF-I is permissive for ovariectomy-induced trabecular bone loss

INTRODUCTION

Estrogen deficiency results in trabecular bone loss, associated with T-cell proliferation in the bone marrow. Insulin-like growth factor I (IGF-I) is involved in the regulation of both bone metabolism and lymphopoiesis. A major part of serum IGF-I is derived from the liver. The aim of the present study was to investigate the role of liver-derived IGF-I for ovariectomy (ovx)-induced trabecular bone loss.

MATERIALS AND METHODS

Mice with adult liver-specific IGF-I inactivation (LI-IGF-I-/-) and wild type mice (WT) were either ovx or sham operated. After 5 weeks, the skeletal phenotype was analyzed by pQCT and microCT. The bone marrow cellularity was analyzed using FACS technique, and mRNA levels were quantified using real-time PCR.

RESULTS

Ovx resulted in a pronounced reduction in trabecular bone mineral density (-52%, P < 0.001), number (-45%, P < 0.01) and thickness (-13%, P < 0.01) in WT mice while these bone parameters were unaffected by ovx in LI-IGF-I-/- mice. Furthermore, ovx increased the number of T-cells in the bone marrow of the femur in WT but not in LI-IGF-I-/- mice. Interleukin 7 (IL-7) has been reported to stimulate the formation and function of osteoclasts by inducing the expression of receptor activator of NF-kappaB ligand (RANKL) on T-cells. IL-7 mRNA levels and the RANKL/osteoprotegerin ratio in bone were increased by ovx in WT but not in LI-IGF-I-/- mice.

CONCLUSIONS

Liver-derived IGF-I is permissive for ovx-induced trabecular bone loss. Our studies indicate that IGF-I might exert this permissive action by modulation of the number of T-cells and the expression of IL-7, which in turn is of importance for the RANKL/OPG ratio and consequently osteoclastogenesis in the bone marrow.

Assessment of cerebrospinal fluid outflow conductance using constant-pressure infusion—a method with real time estimation of reliability

The outflow conductance (C(out)) of the cerebrospinal fluid (CSF) system is a parameter considered to be predictive in selection for hydrocephalus surgery. C(out) can be determined through an infusion test. A new apparatus for performing infusion tests in a standardized and automated way was developed. The objective was to evaluate repetitiveness as well as to propose and evaluate a method for real time estimation of the reliability of individual C(out) investigations. Repeated investigations were performed on an experimental model simulating the CSF system, and on 14 patients with hydrocephalus. DeltaC(out), calculated as the 95% confidence interval of C(out), was introduced as an estimate of the reliability of individual C(out) investigations. On the model, no significant difference was found between DeltaC(out) and the actual C(out) variation in repeated investigations (p = 0.135). The correlation between the first and the second patient investigation was high (R = 0.99, p < 0.05), although there was a significant difference between the investigations (p < 0.05). The standard deviation of difference was 2.60 microl (s kPa)(-1). The repetitiveness of C(out) with the new apparatus was high, and DeltaC(out) reflected the reliability of each investigation. This feature has to be taken into account in every individual case, before making a decision or performing research based on measurements of C(out) in the future.

Objective B wave analysis in 55 patients with non-communicating and communicating hydrocephalus

BACKGROUND

B waves, slow and rhythmic oscillations in intracranial pressure (ICP), are claimed to be one of the best predictors of outcome after surgery for normal pressure hydrocephalus (NPH).

OBJECT

To determine the relation between the percentage of B waves and outcome in patients with hydrocephalus, and also the diurnal variation of B waves.

METHODS

ICP and patient behaviour were recorded overnight (17 to 26 hours) in 29 patients with non-communicating hydrocephalus and 26 with NPH. The B wave activity, measured with an amplitude threshold of 0.5, 0.75, 1.0, 1.5, 2.0, 3.0, and 5.0 mm Hg, was estimated as the percentage of total monitoring time (% B waves) using a computer algorithm, and correlated with postoperative outcome, defined as changes in 12 standardised symptoms and signs.

RESULTS

There was no linear correlation between improvement after surgery in the 55 patients and total % B waves, but a correlation was found between improvement and % B waves during sleep (r = 0.39, p = 0.04). The percentage of B waves was the same during sleep and wakefulness, and patients with NPH had the same proportion of B waves as the non-communicating patients.

CONCLUSIONS

B waves are commonly observed in patients with both communicating and non-communicating hydrocephalus, but are only weakly related to the degree of postsurgical improvement.