Caregiver Thrive, Learn, & Connect: Testing the Efficacy of an Online Psychoeducational Program for Family Caregivers.

OBJECTIVES: Research reports that providing care to a relative or friend with a chronic health condition or significant neurocognitive disorders, such as dementia is a demanding job. Caregiving often leads to higher risk for adverse mental health outcomes. In this study, we examine the short-term efficacy of the CaregiverTLC online psychoeducational program to caregivers of adults with chronic health or significant memory troubles. METHOD: Using pre-post data from the CaregiverTLC randomized controlled trial (n = 81) we examined differences between the intervention and control conditions on caregivers' psychosocial outcomes for depressive symptoms, self-efficacy, burden, anxiety, and caregiver gains. RESULTS: Data analyses indicated significant decrease in self-reported depressive symptoms, burden, anxiety, and significant increases in self-efficacy and caregiver gains for caregivers in the active intervention compared to those in the control condition. CONCLUSIONS: These results suggest that regardless of whether caregivers care for a person with a chronic illness or significant neurocognitive disorder, they can benefit from participation in this online psychoeducational program. CLINICAL IMPLICATIONS: The CaregiverTLC program may be an effective method to teach skills to reduce depression, burden, and anxiety, and improve self-efficacy and personal gains among caregivers of older adults with chronic illnesses.

Exploring the potential of eco-friendly silver nanoparticles to inhibit azole-resistant clinical isolates of Candida spp.

The antimicrobial activity and biological efficiency of silver nanoparticles (AgNps) have been widely described and can be modeled through stabilizing and reducing agents, especially if they exhibit biocidal properties, which can enhance bioactivity against pathogens. The selective action of AgNps remains a major concern. In this regard, the use of plant extracts for the green synthesis of nanoparticles offers advantages because it improves the toxicity of Nps for microorganisms and is harmless to normal cells. However, biological evaluations of the activity of AgNps synthesized using different reducing agents are determined independently, and comparisons are frequently overlooked. Thus, we investigated and compared the antifungal and cytotoxic effects of two ecological AgNps synthesized from Moringa oleifera aqueous leaf extract (AgNp-M) and glucose (AgNp-G) against azole-resistant clinical isolates of Candida spp. and nontumor mammalian cells. Synthesized AgNps exhibited an antifungal effect on planktonic cells of drug-resistant C. albicans and C. tropicalis (MIC 0.21-52.6 µg/mL). The toxicity was influenced by size. However, the use of M. oleifera extracts allows us to obtain AgNps that are highly selective and nongenotoxic to Vero cells due to modifications of the shape and surface. Therefore, these results suggest that AgNp-M has antimicrobial potential and deserves further investigation for biomedical applications.

Process-Outcome Relationships and Solution-Based Goal-Setting Interventions With Grandparent Caregivers.

The present study examines the impact of change processes on outcomes in a solution-based thinking and goal-setting intervention for grandparents raising their grandchildren. We found that across the 6 program sessions there was stability and/or increases in the salience of hypothesized change processes, i.e., hopefulness about the future, solution-based thinking, positive thoughts about one's grandchild, multiple indicators of decisional personal goal-setting regarding one's own well-being and grandchild relationship quality. Indicators of change processes were for the most part, related to both post-program outcomes as well as to pre-post program outcome difference scores. Regression analyses suggested that change processes in many cases partially mediated pre-post primary program outcome scores. These data suggest that how grandmother caregivers think about themselves and their grandchildren and their approach to setting personal goals are key change processes explaining the impact of a solution-based, goal-setting intervention on them.

A Multiplex TaqMan qPCR Assay for Detection and Quantification of Clade 1 and Clade 2 Isolates of Pseudoperonospora cubensis and Pseudoperonospora humuli.

The ability to detect and quantify aerially dispersed plant pathogens is essential for developing effective disease control measures and epidemiological models that optimize the timing for control. There is an acute need for managing the downy mildew pathogens infecting cucurbits and hop incited by members of the genus Pseudoperonospora (Pseudoperonospora cubensis clade 1 and 2 isolates and Pseudoperonospora humuli, respectively). A highly specific multiplex TaqMan quantitative polymerase chain reaction (PCR) assay targeting unique sequences in the pathogens' mitochondrial genomes was developed that enables detection of all three taxa in a single multiplexed amplification. An internal control included in the reaction evaluated whether results were influenced by PCR inhibitors that can make it through the DNA extraction process. Reliable quantification of inoculum as low as three sporangia in a sample was observed. The multiplexed assay was tested with DNA extracted from purified sporangia, infected plant tissue, and environmental samples collected on impaction spore traps samplers. The ability to accurately detect and simultaneously quantify all three pathogens in a single multiplexed amplification should improve management options for controlling the diseases they cause.

Testing a Proactive Model of Successful Aging Among Older Adults in Costa Rica and Spain.

The purpose of this study is to examine successful aging among Spanish-speaking older adults in Costa Rica and in Spain using the proactive framework proposed by Kahana et al. (2014). More specifically, we hypothesized that older adults' life satisfaction would be positively associated with the frequency and perceived level of social support, spirituality/having purpose in life, and the use of proactive physical, cognitive, and social self-care behaviors. Our results confirmed these hypotheses, not only for the overall group of participants, but also separately for older adults in Costa Rica and in Spain. The present study contributes to the literature of successful aging among older adults, by examining the protective factors associated with life satisfaction among Spanish speaking older adults in Costa Rica and in Spain. It identifies specific protective factors (spirituality/purpose in life, social support, and self-care) associated with the values and preferences held by participants in the study.

Primary distal renal tubular acidosis: novel findings in patients studied by next-generation sequencing.

This corrects the article DOI: 10.1038/pr.2015.243.

Restoration of pyrethroid susceptibility in a highly resistant Aedes aegypti population.

Insecticide resistance has evolved in disease vectors worldwide, creating the urgent need to either develop new control methods or restore insecticide susceptibility to regain use of existing tools. Here we show that phenotypic susceptibility can be restored in a highly resistant field-derived strain of Aedes aegypti in only 10 generations through rearing them in the absence of insecticide.

Distal renal tubular acidosis. Clinical manifestations in patients with different underlying gene mutations.

BACKGROUND: To evaluate whether there are differences in the phenotype of primary distal renal tubular acidosis (dRTA) patients according to the causal defective gene. METHODS: Twenty-seven non-oriental patients with genetically confirmed dRTA were grouped according to the identified underlying mutations in either ATP6V1B1 (n = 10), ATP6V0A4 (n = 12), or SLC4A1 (n = 5) gene. Demographic features, growth impairment, biochemical variables and presence of deafness, nephrocalcinosis, and urolithiasis at diagnosis were compared among the three groups. RESULTS: Patients with SLC4A1 mutations presented later than those with ATP6V1B1 or ATP6V0A4 defects (120 vs. 7 and 3 months, respectively). Hearing loss at diagnosis was present in the majority of patients with ATP6V1B1 mutations, in two patients with ATP6V0A4 mutations, and in none of cases harboring SLC4A1 mutations. Serum potassium concentration (X ± SD) was higher in SLC4A1 group (3.66 ± 0.44 mEq/L) than in ATP6V0A4 group (2.96 ± 0.63 mEq/L) (p = 0.046). There were no differences in the other clinical or biochemical variables analyzed in the three groups. CONCLUSIONS: This study indicates that non-oriental patients with dRTA caused by mutations in the SLC4A1 gene present later and have normokalemia or milder hypokalemia. Hypoacusia at diagnosis is characteristically associated with ATP6V1B1 gene mutations although it may also be present in infants with ATP6V0A4 defects. Other phenotypical manifestations do not allow predicting the involved gene.

Effect of continuous positive airway pressure on blood pressure and metabolic profile in women with sleep apnoea.

Continuous positive airway pressure (CPAP) reduces blood pressure levels in hypertensive patients with obstructive sleep apnoea (OSA). However, the role of CPAP in blood pressure and the metabolic profile in women has not yet been assessed. In this study we investigated the effect of CPAP on blood pressure levels and the glucose and lipid profile in women with moderate-to-severe OSA.A multicentre, open-label, randomised controlled trial was conducted in 307 women diagnosed with moderate-to-severe OSA (apnoea-hypopnoea index ≥15 events·h-1) in 19 Spanish Sleep Units. Women were randomised to CPAP (n=151) or conservative treatment (n=156) for 12 weeks. Changes in office blood pressure measures as well as in the glucose and lipid profile were assessed in both groups.Compared with the control group, the CPAP group achieved a significantly greater decrease in diastolic blood pressure (-2.04 mmHg, 95% CI -4.02- -0.05; p=0.045), and a nonsignificantly greater decrease in systolic blood pressure (-1.54 mmHg, 95% CI -4.58-1.51; p=0.32) and mean blood pressure (-1.90 mmHg, 95% CI -4.0-0.31; p=0.084). CPAP therapy did not change any of the metabolic variables assessed.In women with moderate-to-severe OSA, 12 weeks of CPAP therapy improved blood pressure, especially diastolic blood pressure, but did not change the metabolic profile, compared with conservative treatment.

Continuous Positive Airway Pressure Improves Quality of Life in Women with Obstructive Sleep Apnea. A Randomized Controlled Trial.

RATIONALE: Continuous positive airway pressure (CPAP) is the treatment of choice in patients with symptomatic obstructive sleep apnea (OSA). CPAP treatment improves quality of life (QoL) in men with OSA, but its role in women has not yet been assessed. OBJECTIVES: To investigate the effect of CPAP on QoL in women with moderate to severe OSA. METHODS: We conducted a multicenter, open-label randomized controlled trial in 307 consecutive women diagnosed with moderate to severe OSA (apnea-hypopnea index, ≥15) in 19 Spanish sleep units. Women were randomized to receive effective CPAP therapy (n = 151) or conservative treatment (n = 156) for 3 months. The primary endpoint was the change in QoL based on the Quebec Sleep Questionnaire. Secondary endpoints included changes in daytime sleepiness, mood state, anxiety, and depression. Data were analyzed on an intention-to-treat basis with adjustment for baseline values and other relevant clinical variables. MEASUREMENTS AND MAIN RESULTS: The women in the study had a mean (SD) age of 57.1 (10.1) years and a mean (SD) Epworth Sleepiness Scale score of 9.8 (4.4), and 77.5% were postmenopausal. Compared with the control group, the CPAP group achieved a significantly greater improvement in all QoL domains of the Quebec Sleep Questionnaire (adjusted treatment effect between 0.53 and 1.33; P < 0.001 for all domains), daytime sleepiness (-2.92; P < 0.001), mood state (-4.24; P = 0.012), anxiety (-0.89; P = 0.014), depression (-0.85; P = 0.016), and the physical component summary of the 12-item Short Form Health Survey (2.78; P = 0.003). CONCLUSIONS: In women with moderate or severe OSA, 3 months of CPAP therapy improved QoL, mood state, anxiety and depressive symptoms, and daytime sleepiness compared with conservative treatment. Clinical trial registered with www.clinicaltrials.gov (NCT02047071).

Primary distal renal tubular acidosis: novel findings in patients studied by next-generation sequencing.

BACKGROUND: Primary distal renal tubular acidosis (DRTA) is a rare disease caused by loss-of-function mutations in at least three genes (ATP6V0A4, ATP6V1B1, and SLC4A1) involved in urinary distal acidification. The next-generation sequencing (NGS) technique facilitates the search for mutations in DRTA patients and helps to characterize the genetic and clinical spectrum of the disease. METHODS: Ten DRTA patients were studied. They had normal serum anion gap (AG), metabolic acidosis with simultaneous positive urinary AG, and inability to maximally acidify the urine. The exons of the three genes were sequenced in two pools by ultrasequencing. Putative mutations were confirmed by corresponding Sanger sequencing of each exon. RESULTS: We found 13 mutations in nine patients. ATP6V0A4: Intron16+2insA; p.R807Q; p.Q276fs; p.P395fs; Intron7-2T>C. ATP6V1B1: p.I386fs; p.R394Q. SLC4A1: p.V245M; p.R589C; p.R589H; p.G609A. One case was a compound heterozygous with a known mutation in ATP6V1B1 (p.G609R) and a pathogenic variation at SLC4A1 (p.E508K). One patient was negative for mutations. CONCLUSION: This study evidences that NGS is labor and cost effective for the analysis of DRTA genes. Our results show for the first time SLC4A1 gene mutations in Spanish patients and disclose that compound heterozygosity at two different genes can be responsible for DRTA.

Can vitamin D status be assessed by serum 25OHD in children?

BACKGROUND: To examine the relationship of serum 25-hydroxyvitamin D (25OHD) concentrations with serum parathyroid hormone (PTH) levels, body mass index (BMI), and environmental factors in a population of Caucasian children living at latitude 43°N. METHODS: Cross-sectional study on 288 children aged 1 month to 13 years who presented to a pediatric emergency unit during a 21-month period. RESULTS: Mean (SD) serum 25OHD concentrations were 40.6 (17.6), 30.9 (12.0), and 26.4 (9.9) ng/ml (1 ng/ml = 2.5 nmol/l), in children aged 0-1, 2-5, and ≥ 6 years, respectively. Serum PTH levels were 26.6 (13.6), 24.3 (11.9), and 32.7 (12.1) pg/ml in the same groups. Infants had 25OHD concentrations significantly higher. PTH levels were significantly higher in children aged ≥ 6 years. There was no significant correlation between serum 25OHD and PTH concentrations. Totals of 15.6 % and 2.1 % of children had 25OHD values less than 20 and 10 ng/ml, respectively, but none had elevated serum PTH or clinical manifestations related with vitamin D deficiency. Age (inverse correlation) and season (higher values in summer), but not BMI, sex, and time spent outdoors, influenced serum 25OHD concentrations. CONCLUSIONS: Our results raise doubt on the assumption of only a serum 25OHD threshold as indicative of vitamin D deficiency in children.

Cranial nerve assessment: a concise guide to clinical examination.

Examination of the cranial nerves is an integral and important part of a complete neurological examination. Historically, these skills were crucial for diagnosing specific lesions. With the development of modern imaging modalities, the significance of clinical examination techniques has perhaps been undermined. The authors present an overview of each cranial nerve with a concise summary of examination techniques.

[Impact of eradication of Pseudomonas aeruginosa on survival in Mexican patients with cystic fibrosis]. / Impacto de la erradicación de Pseudomonas aeruginosa sobre la sobrevida en pacientes con fibrosis quística del noreste de México.

INTRODUCTION: Patients with cystic fibrosis (CF) present lower airway infection with Pseudomonas aeruginosa. Treatment of initial infection is fundamental to reduce subsequent damage. MATERIAL AND METHODS: We evaluated the efficacy of eradication treatment of P. aeruginosa in patients with CF from northeast Mexico using two protocols: inhaled colistin/oral ciprofloxacin and nebulized tobramycin 300 mg/oral ciprofloxacin. The intervention group included 17 patients with CF and recent infection with P. aeruginosa. The control group consisted of 23 chronically colonized patients of comparable age. RESULTS: Patients received 27 courses of eradication treatment. P. aeruginosa was eradicated in 21/27 (77.77%). The infection free period was 16.9, 11.7 months (colistin) and 17 ± 9.7 months (tobramycin) with no statistically significant difference (P = 0.97). CONCLUSIONS: Treated patients maintained normal lung function, better nutritional status, and a better chest X-ray score. In the control group 17/23 (73.9%) patients died with no deaths in the study group.

LGBTQ Incorporated: YouTube and the Management of Diversity.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) people use the video-sharing service YouTube to educate and entertain audiences. However, YouTube, a subsidiary of Google, has a fraught history with LGBTQ users. Informed by digital ethnography and content analysis, this paper illustrates the company's strategic incorporation of LGBTQ creators and their video content. On the one hand, I show how YouTube publicly presents LGBTQ people's diversity in terms of race, ethnicity, nationality, gender, sexuality, and mental health status. On the other hand, the platform privately discriminates against LGBTQ users creating content about queer sex education, lesbian sexuality, and transgender identity-topics in conflict with advertising and community guidelines. YouTube's discriminatory practices (closely tied to automated algorithms) include demonetization, age restriction, video deletion, account termination, and harassment facilitation. Ultimately, this paper cautions against uncritical celebrations of social media industries' recognition of the LGBTQ community.

Effects of simulated climate change conditions of increased temperature and [CO2] on the early growth and physiology of the tropical tree crop, Theobroma cacao L.

Despite multiple studies of the impact of climate change on temperate tree species, experiments on tropical and economically important tree crops, such as cacao (Theobroma cacao L.), are still limited. Here, we investigated the combined effects of increased temperature and atmospheric carbon dioxide concentration ([CO2]) on the growth, photosynthesis and development of juvenile plants of two contrasting cacao genotypes: SCA 6 and PA 107. The factorial growth chamber experiment combined two [CO2] treatments (410 and 700 p.p.m.) and three day/night temperature regimes (control: 31/22 °C, control + 2.5 °C: 33.5/24.5 °C and control + 5.0 °C: 36/27 °C) at a constant vapour pressure deficit (VPD) of 0.9 kPa. At elevated [CO2], the final dry weight and the total and individual leaf areas increased in both genotypes, while the duration for individual leaf expansion declined in PA 107. For both genotypes, elevated [CO2] also improved light-saturated net photosynthesis (Pn) and intrinsic water-use efficiency (iWUE), whereas leaf transpiration (E) and stomatal conductance (gs) decreased. Under a constant low VPD, increasing temperatures above 31/22 °C enhanced the rates of Pn, E and gs in both genotypes, suggesting that photosynthesis responds positively to higher temperatures than previously reported for cacao. However, dry weight and the total and individual leaf areas declined with increases in temperature, which was more evident in SCA 6 than PA 107, suggesting the latter genotype was more tolerant to elevated temperature. Our results suggest that the combined effect of elevated [CO2] and temperature is likely to improve the early growth of high temperature-tolerant genotypes, while elevated [CO2] appeared to ameliorate the negative effects of increased temperatures on growth parameters of more sensitive material. The evident genotypic variation observed in this study demonstrates the scope to select and breed cacao varieties capable of adapting to future climate change scenarios.

Association of VO2 and VCO2 rate variability with serum glucose, insulin, and glucose intolerance.

Changes in the cellular metabolism assessed by the variability of oxygen consumption (VO(2) ) and carbon dioxide production (VCO(2) ) as well as the association of serum glucose and insulin to energy spectral density (ESD) of VO(2) and VCO(2) were evaluated. Ten nonglucose intolerant and 10 glucose intolerant subjects, aged 21-70 years, were included. Glucose and insulin concentrations and VO(2) and VCO(2) records were collected every 10 min during 3 h. ESD of VO(2) and VCO(2) was estimated and associated with glucose and insulin concentrations. Statistical significance in glucose levels, insulin, and ESD of VO(2) and VCO(2) among nonglucose intolerant subjects and glucose and insulin among glucose intolerance subjects at postload glucose (PLG) state compared with basal state was found. Moreover, glucose was significantly higher in glucose intolerance subjects than nonglucose intolerant subjects for basal and PLG states. These results show an increment in ESD of VO(2) and VCO(2) at PLG state among nonglucose intolerant subjects and suggest that their measurement may be a key indicator of the variability of cellular metabolic activity and contribute to confirm disturbances in glucose metabolism.

A Proactive Behavioral Activities Program (EWA) and the Influence of COVID-19 among Seniors in Congregate Living Communities.

Older adults in affordable housing are at risk for mental health problems, physical vulnerability, and isolation. We examine the role of an activities program in buffering the influence of life stressors on the mental health of seniors in congregate housing, using a non-experimental pretest-posttest study design. Results based upon repeated measures analyses (N = 29), found statistically significant (p < .05) program by time effects for depression, coping strategies, positive affect, isolation, and resident satisfaction. Analyses based upon independent samples of pretest and posttest measures (N = 60) were considerably less strong, but consistent in yielding similar patterns to those of the longitudinally gathered data. Our longitudinal findings substantiate the positive impact of the Engage with Age program in supporting older adults living in congregate housing. Researchers need to develop strategies to assess and support the mental health of older persons in low-income urban congregate living in the larger context of COVID-19.

The changing fate of a secretory glycoprotein in developing maize endosperm.

Zeins are the major storage proteins in maize (Zea mays) endosperm, and their accumulation in zein bodies derived from the endoplasmic reticulum is well characterized. In contrast, relatively little is known about post-Golgi compartments or the trafficking of vacuolar proteins in maize endosperm, specifically the presence of globulins in structures resembling protein storage vacuoles that appear in early to mid-stage seed development. We investigated this pathway by expressing and analyzing a recombinant reporter glycoprotein during endosperm maturation, using a combination of microscopy and sensitive glycopeptide analysis. Specific N-glycan acceptor sites on the protein were followed through the stages of grain development, revealing a shift from predominantly paucimannosidic vacuolar glycoforms to predominantly trimmed glycan structures lacking fucose. This was accompanied by a change in the main subcellular localization of the protein from large protein storage vacuole-like post-Golgi organelles to the endoplasmic reticulum and zein bodies. The endogenous storage proteins corn alpha-globulin and corn legumin-1 showed a similar spatiotemporal profile both in transgenic plants expressing the reporter glycoprotein and in wild-type plants. This indicates that the shift of the intracellular trafficking route, as observed with our reporter glycoprotein, may be a common strategy in maize seed development.