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Advance care planning and palliative care are gaining recognition as critical care components for adults with CHD, yet these often do not occur. Study objectives were to evaluate ACHD providers’ 1) comfort managing patients’ physical symptoms and psychosocial needs and 2) perspectives on the decision/timing of advance care planning initiation and palliative care referral.
Cross-sectional study of ACHD providers. Six hypothetical patients were described in case format, followed by questions regarding provider comfort managing symptoms, initiating advance care planning, and palliative care referral.
Fifty providers (72% physicians) completed surveys. Participants reported low levels of personal palliative care knowledge, without variation by gender, years in practice, or prior palliative care training. Providers appeared more comfortable managing physical symptoms and discussing prognosis than addressing psychosocial needs. Providers recognised advance directives as important, although the percentage who would initiate advance care planning ranged from 18 to 67% and referral to palliative care from 14 to 32%. Barriers and facilitators to discussing advance care planning with patients were identified. Over 20% indicated that advance care planning and end-of-life discussions are best initiated with the development of at least one life-threatening complication/hospitalisation.
Providers noted high value in advance directives yet were themselves less likely to initiate advance care planning or refer to palliative care. This raises the critical questions of when, how, and by whom discussion of these important matters should be initiated and how best to support ACHD providers in these endeavours.
Phosphate belongs to the major mineral nutrient category in plants and is a non-renewable resource. Many natural soils are phosphate deficient, and phosphate fixation into insoluble mineral complexes limits plant growth by decreasing root uptake. Different strategies have appeared during the evolution of land plants to cope with this situation, one of which is to interact with various microbes (bacteria and fungi) located in the plant rhizosphere. This chapter will focus on three major groups of fungi that colonise the roots of most land plants: arbuscular mycorrhizal fungi (Glomeromycotina), fungi from the order Sebacinales (Basidiomycota) and the diverse form-group of dark septate endophytes (Ascomycota). Three major mechanisms of fungal contribution to plant nutrition will be discussed. First, fungi are able to solubilise phosphate from inorganic sources that are not available to plants. Second, fungi can set free mineral nutrients from organic compounds/sources. Third, fungi are able to transport phosphate along their hyphae towards the plant, thereby bridging phosphate depletion zones around the roots. In this chapter, we summarise published knowledge on this topic and present some new non-published data to complete our current model.
Adults with congenital heart disease face psychological challenges although an understanding of depression vs. anxiety symptoms is unclear. We analyzed the prevalence of elevated symptoms of anxiety and depression and explored associations with demographic and medical factors as well as quality of life.
Adults with congenital heart disease enrolled from an outpatient clinic completed the Hospital Anxiety and Depression Scale and two measures of quality of life: the Linear Analogue Scale and the Satisfaction with Life Scale. Medical data were obtained by chart review.
Of 130 patients (median age = 32 years; 55% female), 55 (42%) had elevated anxiety symptoms and 16 (12%) had elevated depression symptoms on subscales of the Hospital Anxiety and Depression Scale. Most patients with elevated depression symptoms also had elevated anxiety symptoms (15/16; 94%). Of 56 patients with at least one elevated subscale, 37 (66%) were not receiving mental health treatment. Compared to patients with 0 or 1 elevated subscales, patients with elevations in both (n=15) were less likely to be studying or working (47% vs. 81%; p=0.016) and reported lower scores on the Linear Analogue Scale (60 vs. 81, p<0.001) and the Satisfaction with Life Scale (14 vs. 28, p<0.001).
Among adults with congenital heart disease, elevated anxiety symptoms are common and typically accompany elevated depressive symptoms. The combination is associated with unemployment and lower quality of life. Improved strategies to provide psychosocial care and support appropriate engagement in employment are required.
This paper investigates how we infer the status of others from their social relationships. In a series of experimental studies, we test the effects of a social relationship's type and direction on the status judgments of others. We demonstrate empirically, possibly for the first time, a widely-assumed connection between network structure and perceptions of status; that is, that observers do infer the status positions of group members from their relationships. Moreover, we find that observers' status judgments vary with the direction and type of social relationship. We theorize that underlying this variance in status judgments are two relational schemas which differentially influence the processing of the observed social ties. Our finding that only the linear-ordering schema leads to status inferences provides an important scope condition to prior research on network cognition, and specifically on the perceptions of social status.
To provide an overview on the magnitude of the impact of schizophrenia on the healthcare system in Europe and to gain a better understanding on the most important factors influencing the variation of costs.
Studies reporting costs and healthcare utilization among patients with schizophrenia were searched in MEDLINE (via Scopus), EMBASE (via Scopus) and Cochrane Database of Systematic Reviews on 19th January 2017.
Twenty-three studies, from the 1075 references initially identified, were included in this review. The annual cost per patient ranged from €533 in Ukraine to €13,704 in the Netherlands. Notably drug costs contributed to less than 25% of the direct healthcare cost per patient in every country, which might be explained by similar pharmaceutical prices among countries due to the reference pricing system applied in Europe. Inpatient costs were the largest component of health service costs in the majority of the countries. Despite methodological heterogeneity across studies, four major themes could be identified (age, severity of symptoms, continuation of treatment/persistence, hospitalization) that have substantial impact on the costs of schizophrenia.
Schizophrenia represents a substantial cost for the healthcare system in Europe driven by the high cost per patient. Substantial savings could potentially be achieved by increasing investment in the following areas: (1) reducing the number of hospitalizations e.g. by increasing the efficiency of outpatient care; (2) working out interventions targeted at specific symptoms; (3) improving patient persistence and adherence in antipsychotic therapy.
The adult CHD population is increasing and ageing and remains at high risk for morbidity and mortality. In a retrospective single-centre study, we conducted a comprehensive review of non-elective hospitalisations of adults with CHD and explored factors associated with length of stay.
We identified adults (⩾18 years) with CHD admitted during a 12-month period and managed by the adult CHD service. Data regarding demographics, cardiac history, hospital admission, resource utilisation, and length of stay were extracted.
There were 103 admissions of 91 patients (age 37±10 years; 52% female). Of 91 patients, 96% had moderate or complex defects. Of 103 admissions, 45% were through the emergency department. The most common reasons for admission were arrhythmia (37%) and heart failure (28%); 29% of admissions included a stay in the ICU. The mean number of consultations by other services was 2.0. Electrophysiology and anaesthesiology departments were most frequently consulted. After removing outliers, the mean length of stay was 7.9±7.4 days (median=5 days). The length of stay was longer for patients admitted for heart failure (12.2±10.3 days; p=0.001) and admitted directly to the ward (9.6±8.9 days; p=0.009).
Among non-electively hospitalised adults with CHD in a tertiary-care centre, management often entails an interdisciplinary approach, and the length of stay is longest for patients admitted with heart failure. The healthcare system must ensure optimal resources to maintain high-quality care for this expanding patient population.
Studies have shown that nutrient requirement of suckling kits is not satisfied, but they can be fed a double quantity of milk (double nursing) resulting in improved BW and weight gain. The aim of our trials was to give additional solid feed during the early suckling period (3 to 15 days of age) when rabbit kits drink exclusively milk. Two experiments were conducted with animals from Pannon Rabbit Breeding Program. In experiment 1 (n=77 does, 734 kits) the does received commercial feed (C) or C pellet supplemented with 0.2 g powdered thyme/kg (CT). Within both dietary groups of the does three groups of litters were formed: no additional solid creep feeding (N); soya bean-based pellet (S); S pellet with 1% added powdered thyme (ST). In group S and ST, cylinder-shaped solid pellets were made. At the beginning (3 days of age) two pieces of pellets were placed daily into the nestbox after nursing. Later on it was increased to six pellets till 15 days of age. The kits consumed the additional solid feed (S and ST), however, it did not affect the BW, weight gain or survival. In experiment 2 (n=30 does, 240 kits) all does consumed commercial feed. The additional feed for kits was based on commercial piglet feed. Three groups were formed: the litters in control group were fed no additional solid feed (K), kits were fed additionally with pellets (8 mm of diameter) based on piglet feed powder, pellet adhesive and water (PI), and extra glycerin powder was added to the mixture of piglet feed powder and water (PG). The experiment lasted from the age of 3 days till 21 days. At the beginning six pellets were placed on the nest material. Later on the amount was gradually increased to 24 pellets till age of 15 days. The kits consumed the pellets. The BW of PI group differed from group PG at age of 5, 9, 12 and 21 days by +7.3%, +6.5%, +5.9%, +4.8%, respectively (P<0.05) and from group K at age of 12 days by +5.9% (P< 0.05). The differences were more expressed at age of 16 and 19 days in favour of group PI (from K by +7.1%, +6.9% and from PG by +5.9%, +5 8%, respectively, P<0.01) and at 21 days of age (from K by +6.2%, P<0.01). To find appropriate composition of creep feed for kits further studies are needed.
Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections (HAIs). Reducing CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications.
To implement and describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture.
A project team composed of all critical care disciplines was assembled to address an institutional goal of decreasing CAUTIs. Interventions implemented between year 1 and year 2 included protocols recommended by the Centers for Disease Control and Prevention for placement, maintenance, and removal of catheters. Leaders from all critical care disciplines agreed to align routine culturing practice with American College of Critical Care Medicine (ACCCM) and Infectious Disease Society of America (IDSA) guidelines for evaluating a fever in a critically ill patient. Surveillance data for CAUTI and hospital-acquired bloodstream infection (HABSI) were recorded prospectively according to National Healthcare Safety Network (NHSN) protocols. Device utilization ratios (DURs), rates of CAUTI, HABSI, and urine cultures were calculated and compared.
The CAUTI rate decreased from 3.0 per 1,000 catheter days in 2013 to 1.9 in 2014. The DUR was 0.7 in 2013 and 0.68 in 2014. The HABSI rates per 1,000 patient days decreased from 2.8 in 2013 to 2.4 in 2014.
Effectively reducing ICU CAUTI rates requires a multifaceted and collaborative approach; stewardship of culturing was a key and safe component of our successful reduction efforts.
Shifting prey distributions due to global warming are expected to generate dramatic ecosystem-wide changes in trophic structure within Arctic marine ecosystems. Yet a relatively poor understanding of contemporary Arctic food webs makes it difficult to predict the consequences of such changes for Arctic predators. Doing so requires quantitative approaches that can track contemporary changes in predator diets through time, using accurate, well-defined methods. Here we use fatty acids (FA) to quantify differences in consumer diet using permutational multivariate analysis of variance tests that characterize spatial and temporal changes in consumer FA signatures. Specifically we explore differences in Greenland shark (Somniosus microcephalus) FA to differentiate their potential trophic role between Svalbard, Norway and Cumberland Sound, Canada. Greenland shark FA signatures revealed significant inter-annual differences, probably driven by varying seal and Greenland halibut responses to environmental conditions such as the NAO, bottom temperature, and annual sea-ice extent. Uncommon FA were also found to play an important role in driving spatial and temporal differences in Greenland shark FA profiles. Our statistical approach should facilitate quantification of changing consumer diets across a range of marine ecosystems.
Because depressive illness is recurrent, recurrence prevention should be a mainstay for reducing its burden on society. One way to reach this goal is to identify malleable risk factors. The ability to attenuate sadness/dysphoria (mood repair) and parasympathetic nervous system functioning, indexed as respiratory sinus arrhythmia (RSA), are impaired during depression and after it has remitted. The present study therefore tested the hypothesis that these two constructs also may mirror risk factors for a recurrent major depressive episode (MDE).
At time 1 (T1), 178 adolescents, whose last MDE had remitted, and their parents, reported on depression and mood repair; youths’ RSA at rest and in response to sad mood induction also were assessed. MDE recurrence was monitored until time 2 (T2) up to 2 years later. Mood repair at T1 (modeled as a latent construct), and resting RSA and RSA response to sadness induction (RSA profile), served to predict onset of first recurrent MDE by T2.
Consistent with expectations, maladaptive mood repair predicted recurrent MDE, above and beyond T1 depression symptoms. Further, atypical RSA profiles at T1 were associated with high levels of maladaptive mood repair, which, in turn, predicted increased risk of recurrent MDE. Thus, maladaptive mood repair mediated the effects of atypical RSA on risk of MDE recurrence.
This study documented that a combination of behavioral and physiological risk factors predicted MDE recurrence in a previously clinically referred sample of adolescents with depression histories. Because mood repair and RSA are malleable, both could be targeted for modification to reduce the risk of recurrent depression in youths.
Knowledge regarding interactions between predators and their prey is fundamental for understanding underlying links between climate change and ecosystem responses, including predator demographics, in the Southern Ocean. This study reports data on reproductive performance, total population size and diet composition for macaroni and chinstrap penguins breeding at Nyrøysa on Bouvetøya during the summers of 1996–97, 1998–99, 2000–01 and 2007–08. The breeding populations of these two species at Nyrøysa decreased significantly over the study period, with an 80% decline for chinstraps and a 50% decline for macaroni penguins, despite relatively high levels of chick production. During this period macaroni penguins at this site ate a diverse diet, dominated by myctophid fish and two krill species, whereas chinstrap penguins were Antarctic krill specialists. The population changes are probably primarily due to the expanding Antarctic fur seal population, and also to landslides that are the result of increased melting on the island which have destroyed penguin breeding sites. Additional impacts from global warming of the ocean might also be playing a role and could exacerbate the decline in these penguin populations if krill and other prey are negatively impacted in the future in this region. The local chinstrap penguin population would probably be most heavily affected given its narrow feeding niche and small current population size.
We report an in situ measurement of the electric field attenuation length Lα at radio frequencies for the bulk ice at Summit Station, Greenland, made by broadcasting radio-frequency signals vertically through the ice and measuring the relative power in the return ground bounce signal. We find the depth-averaged field attenuation length to be at 75 MHz. While this measurement has clear radioglaciological applications, the radio clarity of the ice also has implications for the detection of ultra-high energy (UHE) astrophysical particles via their radio emission in dielectric media such as ice. Assuming a reliable extrapolation to higher frequencies, the measured attenuation length at Summit Station is comparable to previously measured radio-frequency attenuation lengths at candidate particle detector sites around the world, and strengthens the case for Summit Station as a promising northern site for UHE neutrino detection.
The aim of our experiment Phage and Uracil Response was to extend the use of bacteriophage T7 and uracil biological dosimeters for measuring the biologically effective ultraviolet (UV) dose in the harsh extraterrestrial radiation conditions. The biological detectors were exposed in vacuum-tightly cases in the European Space Agency (ESA) astrobiological exposure facility attached to the external platform of Zvezda (EXPOSE-R). EXPOSE-R took off to the International Space Station (ISS) in November 2008 and was installed on the External platform of the Russian module Zvezda of the ISS in March 2009. Our goal was to determine the dose–effect relation for the formation of photoproducts (i.e. damage to phage DNA and uracil, respectively). The extraterrestrial solar UV radiation ranges over the whole spectrum from vacuum-UV (λ<200 nm) to UVA (315 nm<λ<400 nm), which causes photolesions (photoproducts) in the nucleic acids/their components either by photoionization or excitation. However, these wavelengths cause not only photolesions but in a wavelength-dependent efficiency the reversion of some photolesions, too. Our biological detectors measured in situ conditions the resultant of both reactions induced by the extraterrestrial UV radiation. From this aspect the role of the photoreversion in the extension of the biological UV dosimetry are discussed.
The aim of the present study was to investigate if context-specific measures of parental-reported physical activity and sedentary behaviour are associated with objectively measured physical activity and sedentary time in children.
Seven European countries taking part in the IDEFICS (Identification and Prevention of Dietary- and Lifestyle-induced Health Effects in Children and Infants) study.
Data were analysed from 2–9-year-old children (n 5982) who provided both parental-reported and accelerometer-derived physical activity/sedentary behaviour measures. Parents reported their children’s daily screen-time, weekly sports participation and daily outdoor playtime by means of the Outdoor Playtime Checklist (OPC) and Outdoor Playtime Recall Questions (OPRQ).
Sports participation, OPC- and OPRQ-derived outdoor play were positively associated with accelerometer-derived physical activity. Television viewing and computer use were positively associated with accelerometer-derived sedentary time. All parental-reported measures that were significantly associated with accelerometer outcomes explained only a minor part of the variance in accelerometer-derived physical activity or sedentary time.
Parental-reported measures of physical activity and sedentary behaviour are not useful as a proxy for 2–9-year-old children’s physical activity and sedentary time. Findings do not preclude the use of context-specific measures but imply that conclusions should be limited to the context-specific behaviours that are actually measured. Depending on the aim of the study, future research should carefully consider the choice of measurements, including the use of subjective or objective measures of the behaviour of interest or a combination of both.
At-sea behaviour of central-place foraging fur seals and penguins in the Southern Ocean is understudied during the latter stages of parental care and the subsequent pre-moulting period. This biologically important period is costly to investigate due to the risk (or certainty) of losing tracking instruments when the animals moult. Early in this period, parents must meet the increasing demands of larger, more mobile offspring that are still nutritionally dependent and then the parents must recover lost body condition prior to the onset of their annual moult. This study reports late-season, at-sea movement patterns of macaroni penguins, chinstrap penguins and adult female Antarctic fur seals from the subantarctic island Bouvetøya, in relation to remotely-sensed oceanographic features. Foraging trips differing significantly in direction and distance travelled compared to those performed earlier in the breeding season, coincide with the time when offspring would be expected to become independent. On these trips, macaroni penguins moved towards the Polar Front while chinstrap penguins and Antarctic fur seals moved southward. Individuals from all three species appeared to target submesoscale ocean features once they were presumed to have been released from the constraints of feeding their young and were able to travel greater distances from the colony.