A qualitative study on promoting reablement among older people living at home in Norway: opportunities and constraints.

BACKGROUND: Healthcare services that traditionally have been provided in long-term care institutions in Norway are increasingly being delivered at home to a growing population of older people with chronic conditions and functional limitations. Fostering reablement among older people is therefore important if they are to live safety at home for as long as possible. This study examines how healthcare professionals and managers (staff) in Norwegian municipalities promote reablement among community-dwelling older people. METHODS: Face-to-face, semi-structured interviews lasting between 21 and 89 min were conducted between November 2018 and March 2019 with healthcare managers (N = 8) and professionals (N = 8 focus groups with 2-5 participants) in six municipalities in Norway. All interviews were audio-recorded, transcribed, and thematically coded inductively and analyzed with the aid of NVivo 12 software. RESULTS: Overall, healthcare staff in this study used several strategies to promote reablement, including: carrying out assessments to evaluate older people's functional status and needs (including for safe home environments), and to identify older people's wishes and priorities with regard to reablement training. Staff designed care plans informed by the needs assessments, and worked with older people on reablement training at a suitable pace. They promoted among older people and staff (within and across care-units) the principle of 'showing/doing with' versus 'doing for' the older person so as to not enable disablement. Additionally, they supported older people in the safe and responsible use of welfare technology and equipment. Even so, staff also reported constraints to their efforts to foster reablement, such as: heavy workload, high turnover, insufficient training in reablement care, and poor collaboration across care-units. CONCLUSION: Older people may be supported to live safely at home by meeting them as individuals with agency, identifying and tailoring services to their needs and wishes, and encouraging their functional abilities by 'showing/doing with' versus 'doing for them' when possible. The healthcare professionals and managers in this study were positive towards reablement care. However, meeting the resource demands of reablement care is a key challenge.

Comorbidities of Chronic Complete Right Bundle Branch Block and Correlations With Coronary Angiographic Findings.

BACKGROUND: This is a prospective, observational review of medical records to investigate the associated comorbidities and angiographic anatomy in patients with chronic right bundle branch block (RBBB). METHODS: The analyses of 32,345 consecutive electrocardiograms (EKGs) between October 2010 and January 2012 revealed 583 patients with RBBB. The common comorbidities associated with RBBB were hypertension (82%), diabetes (42%), coronary artery disease (CAD) (44%), valvular heart disease (aortic--16% and mitral--17%) and pulmonary disease (33%). Demographic data including age, sex, EKG and associated comorbidities were analyzed from the medical records. Coronary angiograms within 6 months of EKG in patients with RBBB were available for 184 patients and were accordingly analyzed for significant obstructive CAD. RESULTS: In all, 33 patients had single-vessel disease, 52 patients had 2-vessel disease, and 87 patients had multivessel disease whereas 12 patients had no significant disease. Left anterior descending artery was the most frequent vessel involved (72%) followed by left circumflex (58%) and right coronary artery (53%). CONCLUSIONS: In conclusion, in chronic RBBB, wherever the angiograms were available, CAD predominantly involved left anterior descending artery. Most common associated comorbidities in chronic RBBB were systemic hypertension and CAD.

Left atrial volume by echocardiography in patients with false positive myocardial perfusion scans.

A stress-induced myocardial perfusion abnormality (MPS), in the absence of angiographically significant epicardial coronary artery disease, is considered a "false-positive" test result. We hypothesized that echocardiography would provide complementary prognostic and pathophysiologic data relevant to the management of patients with MPS and normal coronary angiograms. Accordingly, left atrial volume index (LAVi) was assessed by echocardiography in 38 patients with false positive MPS as defined by normal coronary angiograms and 26 patients with true negative MPS from a total of 1,356 patients stressed from July 2006-May 2008. Pathologically abnormal elevation of LAVi (≥ 32 mL/m(2)) was observed in 16 of 19 women (84%) and 11 of 19 men (58%) in the false positive MPS (FPMPS) group while none of the patients in the true negative MPS (TNMPS) group had elevated LAVi. In the FPMPS group mean LAVi was significantly higher in women than men (40.64 ± 11.4 mL/m(2) versus 32.6 ± 10.5 mL/m(2), P = 0.01). The mean LAVi in the FPMPS group was significantly different from the TNMPS group (36.6 ± 11.6 versus 21 ± 7 mL/m(2), P = 0.000). A stepwise logistic regression determined BSA, LAV and LAVi as useful in predicting false positive and true negative MPS. All three were significant predictors (P < 0.01) and the area under the ROC curve was 0.91. Our findings in this relatively small cohort suggest that patients with false positive MPS have a greater increased LAVi.

ST6GalNAc-I controls expression of sialyl-Tn antigen in gastrointestinal tissues.

Sialyl-Tn is a simple mucin-type carbohydrate antigen aberrantly expressed in gastrointestinal adenocarcinomas and in the precursor lesion intestinal metaplasia. Sialyl-Tn tumour expression is an independent indicator of poor prognosis. We have previously shown in vitro that ST6GalNAc-I and ST6GalNAc-II sialyltransferases can synthesize sialyl-Tn. The aim of the present study was to establish whether ST6GalNAc-I is the major enzyme responsible for the expression of sialyl-Tn. We used a model of CHO-ldlD cells producing only MUC1-Tn glycoform and showed that ST6GalNAc-I is the key-enzyme leading to sialyl-Tn biosynthesis. We developed novel monoclonal antibodies specific for ST6GalNAc-I and evaluated its expression in gastrointestinal tissues. ST6GalNAc-I was detected in normal colon mucosa co-localized with O-acetylated sialyl-Tn. Expression was largely unaltered in colorectal adenocarcinomas. In contrast, we found that ST6GalNAc-I is weakly expressed in normal gastric mucosa, but over-expressed in intestinal metaplasia, co-localized with sialyl-Tn. In gastric carcinomas ST6GalNAc-I was also associated with sialyl-Tn, but with heterogeneous staining and partial co-localization. Our results showed ST6GalNAc-I as the major enzyme controlling the expression of cancer-associated sialyl-Tn antigen in gastrointestinal tissues.

Seromic profiling of colorectal cancer patients with novel glycopeptide microarray.

Cancer-associated autoantibodies hold promise as sensitive biomarkers for early detection of cancer. Aberrant post-translational variants of proteins are likely to induce autoantibodies, and changes in O-linked glycosylation represent one of the most important cancer-associated post-translational modifications (PTMs). Short aberrant O-glycans on proteins may introduce novel glycopeptide epitopes that can elicit autoantibodies because of lack of tolerance. Technical barriers, however, have hampered detection of such glycopeptide-specific autoantibodies. Here, we have constructed an expanded glycopeptide array displaying a comprehensive library of glycopeptides and glycoproteins derived from a panel of human mucins (MUC1, MUC2, MUC4, MUC5AC, MUC6 and MUC7) known to have altered glycosylation and expression in cancer. Seromic profiling of patients with colorectal cancer identified cancer-associated autoantibodies to a set of aberrant glycopeptides derived from MUC1 and MUC4. The cumulative sensitivity of the array analysis was 79% with a specificity of 92%. The most prevalent of the identified autoantibody targets were validated as authentic cancer immunogens by showing expression of the epitopes in cancer using novel monoclonal antibodies. Our study provides evidence for the value of glycopeptides and other PTM-peptide arrays in diagnostic measures.

Investigation of groundwater quality in hardrock terrain using Geoinformation System.

Two hundred sample sites were selected systematically and samples were taken for a baseline study to understand the geochemistry of the groundwater and to assess the overall physicochemical characteristics. Sampling was carried out using pre-cleaned polyethylene containers. The physical and chemical parameters of the analytical results of groundwater were compared with the standard guideline values recommended by the World Health Organization for drinking and public health standards. Thematic maps pertaining to TDS, EC, Cl, NO(3), SO(4), and Na were generated using Arc View 3.1 platform. Results showed that most of the locations are contaminated by higher concentration of EC, TDS, K( + ), and NO3(-). Major hydro-chemical facies were identified using Piper trilinear diagram. Based on US salinity diagram, most of the samples fall in the field of C3-S1 indicating high salinity and low sodium water, which can be used for almost all types of soil with little danger of exchangeable sodium. Majority of the samples are not suitable for domestic purposes and far from drinking water standards. However, PI values indicate that groundwater is suitable for irrigation.

Spatial assessment of groundwater quality in Mamundiyar basin, Tamil Nadu, India.

Understanding the groundwater quality is important as it is the main factor determining its suitability for drinking, domestic, agricultural, and industrial purposes. In order to assess the groundwater quality, 30 groundwater samples have been collected in year 2008. The water samples collected in the field were analyzed for electrical conductivity, pH, total dissolved solids (TDS), major cations like calcium, magnesium, sodium, potassium, and anions like bicarbonate, carbonate, chloride, nitrate, and sulfate, in the laboratory using the standard methods given by the American Public Health Association. The groundwater locations were selected to cover the entire study area and attention was been given to the area where contamination is expected. The expected groundwater contaminants were chloride, nitrate, TDS, etc. The results were evaluated in accordance with the drinking water quality standards given by the World Health Organization (WHO 1993). To know the distribution pattern of the concentration of different elements and to demarcate the higher concentration zones, the contour maps for various elements were also generated, discussed, and presented.

Fluorine contamination in groundwater: a major challenge.

Fluoride in high concentration in groundwater has been reported from many parts of India. However, a systematic study is required to understand the behavior of fluoride in natural water in terms of local hydrogeological setting, climatic conditions, and agricultural practices. The present study is an attempt to assess hydrogeochemistry of groundwater in parts of Palar river basin pertaining to Kancheepuram district Tamil Nadu to understand the fluoride abundance in groundwater and to deduce the chemical parameters responsible for the dissolution activity of fluoride. The study area is geologically occupied by partly sedimentary and partly crystalline formations. A total of 50 dug cum borewell-water samples, representing an area of 2,628.92 km2. The results of the chemical analyses in September 2009 show fluoride abundance in the range of 1 to 3.24 mg/l with 86% of the samples in excess of the permissible limit of 1.5 mg/l. Presence of fluoride-bearing minerals in the host rock, chemical properties like decomposition, dissociation, and dissolution, and their interaction with water are considered to be the main causes for fluoride in groundwater. Chemical weathering with relatively high alkalinity favors high concentration of fluoride in groundwater. Villagers who consume nonpotable high fluoride water may suffer from yellow, cracked teeth; joint pains; and crippled limbs and also age rapidly.

Deciphering groundwater potential zones in hard rock terrain using geospatial technology.

Remote sensing and geographical information system (GIS) has become one of the leading tools in the field of groundwater research, which helps in assessing, monitoring, and conserving groundwater resources. This paper mainly deals with the integrated approach of remote sensing and GIS to delineate groundwater potential zones in hard rock terrain. Digitized vector maps pertaining to chosen parameters, viz. geomorphology, geology, land use/land cover, lineament, relief, and drainage, were converted to raster data using 23 m×23 m grid cell size. Moreover, curvature of the study area was also considered while manipulating the spatial data. The raster maps of these parameters were assigned to their respective theme weight and class weights. The individual theme weight was multiplied by its respective class weight and then all the raster thematic layers were aggregated in a linear combination equation in Arc Map GIS Raster Calculator module. Moreover, the weighted layers were statistically modeled to get the areal extent of groundwater prospects with respect to each thematic layer. The final result depicts the favorable prospective zones in the study area and can be helpful in better planning and management of groundwater resources especially in hard rock terrains.

Major ion chemistry and hydrochemical studies of groundwater of parts of Palar river basin, Tamil Nadu, India.

Groundwater is almost globally important for human consumption as well as for the support of habitat and for maintaining the quality of base flow to rivers, while its quality assessment is essential to ensure sustainable safe use of the resources for drinking, agricultural, and industrial purposes. In the current study, 50 groundwater samples were collected from parts of Palar river basin to assess water quality and investigate hydrochemical nature by analyzing the major cations (Ca, Mg, Na, K) and anions (HCO(3), Cl, F,SO(4), NO(3), PO(4),CO(3), HCO(3), and F) besides some physical and chemical parameters (pH, electrical conductivity, alkalinity, and total hardness). Also, geographic information system-based groundwater quality mapping in the form of visually communicating contour maps was developed using ArcGIS-9.2 to delineate spatial variation in physicochemical characteristics of groundwater samples. Wilcox classification and US Salinity Laboratory hazard diagram suggests that 52% of the groundwater fall in the field of C2-S1, indicating water of medium salinity and low sodium, which can be used for irrigation in almost all types of soil with little danger of exchangeable sodium. Remaining 48% is falling under C1-SI, indicating water of low salinity and low sodium.

A unique set of SH3-SH3 interactions controls IB1 homodimerization.

Islet-brain 1 (IB1 or JIP-1) is a scaffold protein that interacts with components of the c-Jun N-terminal kinase (JNK) signal-transduction pathway. IB1 is expressed at high levels in neurons and in pancreatic beta-cells, where it controls expression of several insulin-secretory components and secretion. IB1 has been shown to homodimerize, but neither the molecular mechanisms nor the function of dimerization have yet been characterized. Here, we show that IB1 homodimerizes through a novel and unique set of Src homology 3 (SH3)-SH3 interactions. X-ray crystallography studies show that the dimer interface covers a region usually engaged in PxxP-mediated ligand recognition, even though the IB1 SH3 domain lacks this motif. The highly stable IB1 homodimer can be significantly destabilized in vitro by three individual point mutations directed against key residues involved in dimerization. Each mutation reduces IB1-dependent basal JNK activity in 293T cells. Impaired dimerization also results in a reduction in glucose transporter type 2 expression and in glucose-dependent insulin secretion in pancreatic beta-cells. Taken together, these results indicate that IB1 homodimerization through its SH3 domain has pleiotropic effects including regulation of the insulin secretion process.

Crystallization and preliminary crystallographic characterization of an SH3 domain from the IB1 scaffold protein.

IB1 is a mammalian scaffold protein that interacts with components of the c-Jun N-terminal kinase (JNK) signal-transduction pathway mainly via its protein-protein interaction domains. Crystallization of the key Src homology 3 (SH3) domain of IB1 has been achieved. Crystallization experiments with unmodified protein and deliberately oxidized protein have led to different crystal forms. X-ray data have been collected to 3.0 A resolution from a crystal form with rectangular prism morphology. These crystals are orthorhombic (P2(1)2(1)2(1)), with unit-cell parameters a = 45.9, b = 57.0, c = 145.5 A. These are the first crystallographic data on a scaffold molecule such as IB1 to be reported.

Oligosaccharide and sucrose complexes of amylosucrase. Structural implications for the polymerase activity.

The glucosyltransferase amylosucrase is structurally quite similar to the hydrolase alpha-amylase. How this switch in functionality is achieved is an important and fundamental question. The inactive E328Q amylosucrase variant has been co-crystallized with maltoheptaose, and the structure was determined by x-ray crystallography to 2.2 A resolution, revealing a maltoheptaose binding site in the B'-domain somewhat distant from the active site. Additional soaking of these crystals with maltoheptaose resulted in replacement of Tris in the active site with maltoheptaose, allowing the mapping of the -1 to +5 binding subsites. Crystals of amylosucrase were soaked with sucrose at different concentrations. The structures at approximately 2.1 A resolution revealed three new binding sites of different affinity. The highest affinity binding site is close to the active site but is not in the previously identified substrate access channel. Allosteric regulation seems necessary to facilitate access from this binding site. The structures show the pivotal role of the B'-domain in the transferase reaction. Based on these observations, an extension of the hydrolase reaction mechanism valid for this enzyme can be proposed. In this mechanism, the glycogen-like polymer is bound in the widest access channel to the active site. The polymer binding introduces structural changes that allow sucrose to migrate from its binding site into the active site and displace the polymer.