Defining a vitamin A5/X specific deficiency - vitamin A5/X as a critical dietary factor for mental health.

A healthy and balanced diet is an important factor to assure a good functioning of the central and peripheral nervous system. Retinoid X receptor (RXR)-mediated signaling was identified as an important mechanism of transmitting major diet-dependent physiological and nutritional signaling such as the control of myelination and dopamine signalling. Recently, vitamin A5/X, mainly present in vegetables as provitamin A5/X, was identified as a new concept of a vitamin which functions as the nutritional precursor for enabling RXR-mediated signaling. The active form of vitamin A5/X, 9-cis-13,14-dehydroretinoic acid (9CDHRA), induces RXR-activation, thereby acting as the central switch for enabling various heterodimer-RXR-signaling cascades involving various partner heterodimers like the fatty acid and eicosanoid receptors/peroxisome proliferator-activated receptors (PPARs), the cholesterol receptors/liver X receptors (LXRs), the vitamin D receptor (VDR), and the vitamin A(1) receptors/retinoic acid receptors (RARs). Thus, nutritional supply of vitamin A5/X might be a general nutritional-dependent switch for enabling this large cascade of hormonal signaling pathways and thus appears important to guarantee an overall organism homeostasis. RXR-mediated signaling was shown to be dependent on vitamin A5/X with direct effects for beneficial physiological and neuro-protective functions mediated systemically or directly in the brain. In summary, through control of dopamine signaling, amyloid ß-clearance, neuro-protection and neuro-inflammation, the vitamin A5/X - RXR - RAR - vitamin A(1)-signaling might be "one of" or even "the" critical factor(s) necessary for good mental health, healthy brain aging, as well as for preventing drug addiction and prevention of a large array of nervous system diseases. Likewise, vitamin A5/X - RXR - non-RAR-dependent signaling relevant for myelination/re-myelination and phagocytosis/brain cleanup will contribute to such regulations too. In this review we discuss the basic scientific background, logical connections and nutritional/pharmacological expert recommendations for the nervous system especially considering the ageing brain.

Single-wavelength polarization- and mode-division multiplexing free-space optical communication at 689 Gbit/s in strong turbulent channels.

We experimentally demonstrated, for, it is believed, the first time, high-capacity polarization- and mode-division multiplexing free-space optical transmission with adequate strong turbulence resiliency. A compact spatial light modulator-based polarization multiplexing multi-plane light conversion module was employed to emulate strong turbulent links. By employing advanced successive interference cancellation multiple-input multiple-output decoder and redundant receive channels, the strong turbulence resiliency was significantly improved in a mode-division multiplexing system. As a result, we achieved a record-high line rate of 689.2 Gbit/s, channel number of 10, and net spectral efficiency of 13.9 bit/(s Hz) in a single-wavelength mode-division multiplexing system with strong turbulence.

Health practitioner regulation and national health goals.

The role of health practitioner regulation in ensuring patient safety is well recognized. Less recognized is the role of regulation in addressing broader health system priorities. These goals include managing the costs, capacities and distribution of health professional education institutions; ensuring the competence and equitable distribution of health workers; informing workforce planning and mobilization; enabling the use of digital technologies; and addressing challenges related to the international mobility of health workers. Even where health practitioner regulation is designed to advance these goals, important gaps exist between the potential of regulatory systems and their performance. The response to the coronavirus disease 2019 (COVID-19) pandemic led many countries to introduce regulatory changes to allow more flexibility and innovations in the mobilization of health practitioners. Building on this experience, we need to critically re-examine health practitioner regulatory systems to ensure that these systems support rather than impede progress towards national health goals. We discuss the role of health practitioner regulation in contemporary health systems, highlighting recent regulatory reforms in selected countries, including during the COVID-19 pandemic. We identify the importance of dynamic, effective and flexible health practitioner regulatory systems in progress towards universal health coverage and health security.

Le rôle qu'exerce la réglementation relative aux professionnels de la santé pour la sécurité du patient est bien connu. En revanche, celui qu'elle joue dans la définition des grandes priorités du système de santé l'est moins. Elle comporte ainsi plusieurs objectifs, notamment: assurer la gestion des coûts, des capacités et de la distribution des établissements de formation des professionnels de la santé; garantir une répartition équitable d'agents de santé compétents; guider la planification et la mobilisation de la main-d'œuvre; permettre l'intégration des technologies numériques; et enfin, relever les défis liés à la mobilité internationale des acteurs du secteur. Même dans les endroits où une telle réglementation est conçue pour atteindre ces objectifs, des écarts considérables subsistent entre le potentiel des systèmes de réglementation et leurs performances réelles. La lutte contre la pandémie de maladie à coronavirus 2019 (COVID-19) a encouragé de nombreux pays à modifier les règles en vigueur en vue d'offrir une plus grande flexibilité et davantage d'innovations en matière de mobilisation des agents de santé. En nous fondant sur cette expérience, nous devons impérativement réexaminer les systèmes de réglementation propres aux praticiens afin qu'ils constituent un moteur, et non un frein, à la poursuite des objectifs nationaux en matière de santé. Dans le présent document, nous évoquons le rôle de la réglementation relative aux professionnels de la santé dans les systèmes de santé actuels, en mentionnant les récentes réformes entreprises par une série de pays dans ce domaine, y compris durant la pandémie de COVID-19. Nous soulignons également l'importance d'instaurer des systèmes de réglementation dynamiques, efficaces et flexibles pour les praticiens sur la voie menant à la sécurité sanitaire et à une couverture sanitaire universelle.

La función de la reglamentación de los profesionales sanitarios para garantizar la seguridad de los pacientes es bien conocida. Sin embargo, se reconoce menos la función de la reglamentación para atender prioridades más amplias del sistema sanitario. Estos objetivos incluyen: gestionar los costes, las capacidades y la distribución de las instituciones de formación de profesionales sanitarios; asegurar la competencia y la distribución equitativa de los trabajadores sanitarios; informar la planificación y movilización del personal; permitir el uso de tecnologías digitales; y abordar los retos relacionados con la movilidad internacional de los trabajadores sanitarios. Incluso en los casos en que la reglamentación de los profesionales sanitarios está concebida para promover estos objetivos, existen diferencias considerables entre el potencial de los sistemas de reglamentación y sus resultados. La respuesta a la pandemia de enfermedad por coronavirus de 2019 (COVID-19) llevó a muchos países a introducir cambios en la reglamentación para permitir una mayor flexibilidad e innovaciones en la movilización de los profesionales sanitarios. A partir de esta experiencia, es necesario volver a examinar de forma crítica los sistemas de reglamentación de los profesionales sanitarios para garantizar que estos sistemas apoyen y no impidan el progreso hacia los objetivos sanitarios nacionales. En este artículo se analiza la función de la reglamentación de los profesionales de la salud en los sistemas sanitarios contemporáneos y se destacan las recientes reformas reglamentarias introducidas en algunos países, en particular durante la pandemia de COVID-19. Asimismo, se destaca la importancia de que los sistemas de reglamentación de los profesionales sanitarios sean dinámicos, eficaces y flexibles para avanzar hacia la cobertura sanitaria universal y la seguridad sanitaria.

Multi-nutrient interventions and cognitive ageing: are we barking up the right tree?

As we continue to elucidate the mechanisms underlying age-related brain diseases, the reductionist strategy in nutrition­brain function research has focused on establishing the impact of individual foods. However, the biological processes connecting diet and cognition are complex. Therefore, consideration of a combination of nutritional compounds may be most efficacious. One barrier to establishing the efficacy of multi-nutrient interventions is that the area lacks an established set of evidence-based guidelines for studying their effect on brain health. This review is an output of the International Life Sciences Institute (ILSI) Europe. A multi-disciplinary expert group was assembled with the aim of developing a set of considerations to guide research into the effects of multi-nutrient combinations on brain functions. Consensus recommendations converged on six key issues that should be considered to advance research in this area: (1) establish working mechanisms of the combination and contributions of each individual compound; (2) validate the relevance of the mechanisms for the targeted human condition; (3) include current nutrient status, intake or dietary pattern as inclusion/exclusion criteria in the study design; (4) select a participant population that is clinically and biologically appropriate for all nutritional components of the combination; (5) consider a range of cognitive outcomes; (6) consider the limits of reductionism and the 'gold standard' randomised controlled trial. These guiding principles will enhance our understanding of the interactive/complementary activities of dietary components, thereby strengthening the evidence base for recommendations aimed at delaying cognitive decline.

The role of interoception in age-related obesity: A structural equation modelling study.

The obesity pandemic and its adverse effect on health and quality of life are well established. In younger populations, interoception and aberrant eating behaviour contribute to overconsumption and being overweight. Although the incidence of obesity is higher in older individuals, they remain under-researched in the obesity literature. Therefore, the present study considered the role of general (interoceptive sensibility) and appetite-specific (hunger drive and satiety responsiveness) interoception and obesogenic eating behaviour (food responsivity, emotional eating, enjoyment of eating) in the association between age and BMI. A total of 1006 female adults (aged 18 to 80) completed the Adult Eating Behaviour Questionnaire and the Interoceptive Attention and Accuracy scales. Structural Equation Modelling (SEM) in AMOS was used to explore the data for multiple serial mediation effects. Despite being more overweight, older adults reported lower interoceptive attention, hunger drive, emotional overeating, food responsivity, and enjoyment of food. In contrast, compared to younger adults, older adults reported a higher interoceptive accuracy, and a similar responsivity to satiety. Importantly, two indirect pathways positively mediated the link between age and BMI: (1) age ➤(-)➤ interoceptive attention ➤(+)➤ satiety responsivity ➤(-)➤ emotional eating ➤(+)➤ BMI and (2) age ➤(-)➤ interoceptive attention ➤(+)➤ satiety responsivity ➤(-)➤ food responsivity ➤(+)➤ BMI. However, a stronger antagonistic indirect pathway was also present: age ➤(-)➤ interoceptive attention ➤(+)➤ hunger drive ➤(+)➤ emotional eating ➤(+)➤ BMI. The present findings suggested that overall reduced interoceptive attention in older adults may protect against weight gain by lowering hunger and the propensity towards obesogenic eating behaviours. These findings have implications for the design of appetite interventions in older populations.

Weaker connectivity in resting state networks is associated with disinhibited eating in older adults.

BACKGROUND/OBJECTIVES: Obesity affects more than forty percent of adults over the age of sixty. Aberrant eating styles such as disinhibition have been associated with the engagement of brain networks underlying executive functioning, attentional control, and interoception. However, these effects have been exclusively studied in young samples overlooking those most at risk of obesity related harm. METHODS: Here we assessed associations between resting-state functional connectivity and disinhibited eating (using the Three Factor Eating Questionnaire) in twenty-one younger (aged 19-34 years, BMI range: 18-31) and twenty older (aged 60-73 years, BMI range: 19-32) adults matched for BMI. The Alternative Healthy Eating Index was used to quantify diet quality. RESULTS: Older, compared to younger, individuals reported lower levels of disinhibited eating, consumed a healthier diet, and had weaker connectivity in the frontoparietal (FPN) and default mode (DMN) networks. In addition, associations between functional connectivity and eating behaviour differed between the two age groups. In older adults, disinhibited eating was associated with weaker connectivity in the FPN and DMN--effects that were absent in the younger sample. Importantly, these effects could not be explained by differences in habitual diet. CONCLUSIONS: These findings point to a change in interoceptive signalling as part of the ageing process, which may contribute to behavioural changes in energy intake, and highlight the importance of studying this under researched population.

Demonstration of 10-channel mode- and polarization-division multiplexed free-space optical transmission with successive interference cancellation DSP.

We experimentally demonstrate 10-channel mode-division multiplexed free-space optical transmission with five spatial modes, each carrying 19.6925-Gbaud dual-polarization quadrature phase shift keying signals. Strong inter-mode cross talk is observed in our commercially available photonic lantern based system when using a complete orthogonal mode set as independent channels. A successive interference cancellation based multiple-input multiple-output digital signal processing (DSP) algorithm is first applied to mitigate the inter-mode cross talk in mode-division multiplexed systems. The DSP also supports unequal transmit and receive channel numbers to further improve the cross talk resiliency. Compared to the conventional minimum mean square error DSP, the required optical signal-to-noise ratio of the successive interference cancellation DSP is decreased by approximately 5 dB at the hard-decision forward error correction limit. As a result, this system demonstrates a record-high independent channel number of 10 and spectral efficiency of 13.7 b/s/Hz in mode-division multiplexed free-space optical systems.

Single-wavelength transmission at 1.1-Tbit/s net data rate over a multi-modal free-space optical link using commercial devices.

We employ commercial mode-selective photonic lanterns to implement mode multiplexing and demultiplexing for high-capacity free-space optical communications. Moreover, we design a time-division-multiplexed frame structure to efficiently emulate multiple independent transmitters with channelized precoding using only one transmitter. To maximize the throughput of the system, we optimize the modes selected for carrying data, and apply adaptive loading to different channels. By leveraging mode- and polarization-division multiplexing, the free-space optical data link comprising multiple independent channels provides an aggregate net data rate of 1.1 Tbit/s and net spectral efficiency of 28.35 bit/s/Hz. Different from many previous demonstrations based on delayed or partially delayed copies of identical data streams, to the best of our knowledge, ours is a record-high net data rate and net spectral efficiency achieved by a single-wavelength mode-division multiplexed free-space optical communication system with fully independent channels. Moreover, all key devices used in this work, including optical transponder, multiplexer, and demultiplexer are commercially available.

Interoceptive accuracy moderates the response to a glucose load: a test of the predictive coding framework.

Recently, interoception and homeostasis have been described in terms of predictive coding and active inference. Afferent signals update prior predictions about the state of the body, and stimulate the autonomic mediation of homeostasis. Performance on tests of interoceptive accuracy (IAc) may indicate an individual's ability to assign precision to interoceptive signals, thus determining the relative influence of ascending signals and the descending prior predictions. Accordingly, individuals with high IAc should be better able to regulate during the postprandial period. One hundred females were allocated to consume glucose, an artificially sweetened drink, water or no drink. Before, and 30 min after a drink, IAc, heart rate (HR) and blood glucose (BG) were measured, and participants rated their hunger, thirst and mood. A higher IAc was related to lower BG levels, a decline in anxiety and a higher HR, after consuming glucose. A higher IAc also resulted in a larger decline in hunger if they consumed either glucose or sucralose. These data support the role of active inference in interoception and homeostasis, and suggest that the ability to attend to interoceptive signals may be critical to the maintenance of physical and emotional health.

Beyond a Single Country's Borders: Trade in Services Uncovered Through Bibliometrics.

We live and work in an increasingly connected global environment where actions in one part of the world can have consequences for all of us. This article examines, through the use of bibliometric analysis, the extent to which nursing scholars are engaged in the policy debate surrounding trade in services. Results demonstrate that, in comparison to medical colleagues, the nursing profession is more regionally orientated, focused on more operational-based themes and orientated to Mode 4: Mobility of the Profession. However, with the impetus of initiatives such as Nursing Now, opportunities exist to increase nurses' contribution to policy in today's ever more connected supranational environment. To be effective, and if quantum rather than incremental progress is to be made, more scholarship on policy-oriented topics is needed. An increased output of PhD-prepared nurses is essential. Collaborative working in multidisciplinary policy teams must become the norm, so nurses can demonstrate their unique and essential contribution to addressing the many and complex challenges that health systems now face. This is what is required if nurses are to be equipped to make robust evidence-based arguments at national and supranational levels.

Heart-rate variability: a biomarker to study the influence of nutrition on physiological and psychological health?

As the influence of diet on health may take place over a period of decades, there is a need for biomarkers that help to identify those aspects of nutrition that have either a positive or a negative influence. The evidence is considered that heart-rate variability (HRV) (the time differences between one beat and the next) can be used to indicate the potential health benefits of food items. Reduced HRV is associated with the development of numerous conditions for example, diabetes, cardiovascular disease, inflammation, obesity and psychiatric disorders. Although more systematic research is required, various aspects of diet have been shown to benefit HRV acutely and in the longer term. Examples include a Mediterranean diet, omega-3 fatty acids, B-vitamins, probiotics, polyphenols and weight loss. Aspects of diet that are viewed as undesirable, for example high intakes of saturated or trans-fat and high glycaemic carbohydrates, have been found to reduce HRV. It is argued that the consistent relationship between HRV, health and morbidity supports the view that HRV has the potential to become a widely used biomarker when considering the influence of diet on mental and physical health.

Acute and repetitive fronto-cerebellar tDCS stimulation improves mood in non-depressed participants.

Transcranial direct current stimulation (tDCS) is a non-invasive form of brain stimulation, which allows for selective inhibition or excitation of neural structures. It has demonstrated some efficacy in the treatment of mood disorders. However, these studies have predominately focused on stimulation of the prefrontal cortex (PFC). The cerebellum has an increasingly recognized role in emotional control, affective state, and some psychopathologies. As such, tDCS research into mood modulation needs to expand beyond conventional PFC-focused paradigms. Using a contralateral stimulation electrode placement [anodal left dorsolateral(dl)PFC, cathodal right cerebellum], and a single-blind, repeated-measures design, we initially assessed changes in the mood of healthy participants in response to acute stimulation (n = 44) and three repeated stimulations delivered second-daily (n = 21). In a second experiment, we separately investigated the influence of reversed polarity upon these same measures, in response to acute stimulation (n = 23) and repeated stimulation (n = 11). We observed a systematic elevation of mood in both active conditions following single and repeated tDCS, the latter of which displayed a progressive elevation of mood from baseline. No mood change was noted in response to either single or repeated stimulation in the sham condition. Frontocerebellar tDCS stimulation advantageously influences mood in healthy participants, with an accumulative and potentiated effect following successive stimulations. The possibility that frontocerebellar stimulation may provide a novel therapeutic adjunctive or pre-emptive intervention in stress-related disorders and mood-related psychopathologies should be considered.

A Spiral of Transitions Leading to Broader Influence and Action.

This article describes lessons learned through a reflective analysis of job transitions experienced by a registered nurse from the time of entry into the profession until the current point where the nurse is engaged in state, national, and international policy development work. The centrality and symbiotic nature of the link between policy and practice and the importance of evidence and leadership have emerged as key aspects of the expanding spiral of influence traversed as a result of various career moves. At every stage, lessons have been learned. Some of these are professional in nature, but on occasion, the lessons have been more personal. The importance of mentors cannot be underestimated in terms of the support and guidance they offer but also the challenges they bring to existing patterns of thought and behavior.

Opportunities for change: the United Nations Working for Health and Growth report.

The United Nations High-Level Commission on Health Employment and Economic Growth recently published a report that makes ten recommendations and four calls for immediate action. Analysis of the report, Working for Health and Growth: Investing in the Health Workforce, highlights several opportunities for nursing to contribute to a wide-based agenda while positioning the profession to gain wider influence. The report, when analysed through the lens of regulation, professional practice and socio-economic welfare, offers opportunities for nurses in different sectors to work collaboratively to further the recommendations. Importantly, the report seeks to reframe how money spent on healthcare provision is viewed. In particular, it suggests that such funding should be regarded as an investment rather than a cost, and one that delivers up to ninefold returns. The report is supported by several technical evidence-based documents, and features contributions from a range of intergovernmental agencies, such as the World Health Organization, the Organisation for Economic Cooperation and Development and the International Labour Organization. This article argues that nurses can, and should, make a significant contribution to this agenda and, in so doing, position the profession for the future.

Windows to the Future: Can the United Nations Sustainable Development Goals Provide Opportunities for Nursing?

Windows of opportunity are wide open for the nursing profession to actively participate and engage in the policy implementation, evaluation, and achievement of the United Nations Sustainable Development Goals. Nurses bring valuable perspectives as members of diverse governance structures and offer a range of solutions that can help governments pursue and achieve the Sustainable Development Goals and targets by 2030.

Social network of an internationally connected nurse leader.

Over the past decade, there has been a proliferation of social media sites offering the opportunity for colleagues to connect with each other locally, nationally and internationally. Meanwhile, nurses have been increasingly using social network analytical techniques to look at team functioning and communication pathways. This article uses the author's LinkedIn social network to illustrate how analysis can offer insights into the connections, and how the results can be used to professional advantage.

How anxiety about communication affects the role of nurse leaders in international social networks.

Social network analysis examines the way individuals are connected within groups or networks, and the role they play in these groups. In terms of its application to issues related to nurse leaders, much of the research focuses on the structure of their networks, the roles they play, and whether the networks can be changed to improve communication flows. This article reports results of a study that aimed to deepen understanding of how a particular trait - communication apprehension - can affect the roles that nurse leaders play within network structures. It also shows how the research expands understanding of the factors that influence connections between senior nurse leaders internationally, and describes the communication apprehension instrument used, which provides a practical tool to assist aspirant nurse leaders to identify areas for personal development.

How the nursing profession can contribute to sustainable development goals.

As of 1 January 2016, the UN sustainable development goals (SDGs) became the focus of global efforts on a wide range of development agenda. The SDGs have subsumed the work of the UN millennium development goals (MDGs), so it is timely to reflect on the contribution made by nurses and midwives, so that we can optimise the profession's contribution to the 17 SDGs. This article reports the results of a scientometrics analysis of the published literature related to the MDGs and SDGs indexed in CINAHL, which identified the underlying themes addressed by nurses and midwives. It shows how analysis demonstrates that although nursing was slow to engage with the MDG agenda, it has made some progress in contributing to SDG scholarship. So far this contribution has been narrowly focused, but the profession could contribute to all 17 of the SDG goals. Routine updates of the analysis described here could help monitor progress, identify gaps in nursing's contributions to the goals, and provide further impetus to its engagement in this major global policy initiative.

Portion size: what we know and what we need to know.

There is increasing evidence that the portion sizes of many foods have increased and in a laboratory at least this increases the amount eaten. The conclusions are, however, limited by the complexity of the phenomenon. There is a need to consider meals freely chosen over a prolonged period when a range of foods of different energy densities are available. A range of factors will influence the size of the portion size chosen: amongst others packaging, labeling, advertising, and the unit size rather than portion size of the food item. The way portion size interacts with the multitude of factors that determine food intake needs to be established. In particular, the role of portion size on energy intake should be examined as many confounding variables exist and we must be clear that it is portion size that is the major problem. If the approach is to make a practical contribution, then methods of changing portion sizes will need to be developed. This may prove to be a problem in a free market, as it is to be expected that customers will resist the introduction of smaller portion sizes, given that value for money is an important motivator.