Unconventional life history in a migratory shorebird: desegregating reproduction and migration.

Conventional life-history theory predicts that energy-demanding events such as reproduction and migration must be temporally segregated to avoid resource limitation. Here, we provide, to our knowledge, the first direct evidence of 'itinerant breeding' in a migratory bird, an incredibly rare breeding strategy (less than 0.1% of extant bird species) that involves the temporal overlap of migratory and reproductive periods of the annual cycle. Based on GPS-tracking of over 200 female American woodcock, most female woodcock (greater than 80%) nested more than once (some up to six times) with short re-nest intervals, and females moved northwards on average 800 km between first and second nests, and then smaller distances (ca 200+ km) between subsequent nesting attempts. Reliance on ephemeral habitat for breeding, ground-nesting and key aspects of life history that reduce both the costs of reproduction and migration probably explain the prevalence of this rare phenotype in woodcock and why itinerant breeding so rarely occurs in other bird species.

Human Plasmacytoid Dendritic Cells Express C-Type Lectin Receptors and Attach and Respond to Aspergillus fumigatus.

Plasmacytoid dendritic cells (pDCs) have been implicated as having a role in antifungal immunity, but mechanisms of their interaction with fungi and the resulting cellular responses are not well understood. In this study, we identify the direct and indirect biological response of human pDCs to the fungal pathogen Aspergillus fumigatus and characterize the expression and regulation of antifungal receptors on the pDC surface. Results indicate pDCs do not phagocytose Aspergillus conidia, but instead bind hyphal surfaces and undergo activation and maturation via the upregulation of costimulatory and maturation markers. Measuring the expression of C-type lectin receptors dectin-1, dectin-2, dectin-3, and mannose receptor on human pDCs revealed intermediate expression of each receptor compared with monocytes. The specific dectin-1 agonist curdlan induced pDC activation and maturation in a cell-intrinsic and cell-extrinsic manner. The indirect activation of pDCs by curdlan was much stronger than direct stimulation and was mediated through cytokine production by other PBMCs. Overall, our data indicate pDCs express various C-type lectin receptors, recognize and respond to Aspergillus hyphal Ag, and serve as immune enhancers or modulators in the overarching fungal immune response.

Older people's views on loneliness during COVID-19 lockdowns.

BACKGROUND AND OBJECTIVES: There have been growing concerns that social distancing and stay-at-home mandates have exacerbated loneliness for older people. Empirical evidence about older people's experiences of loneliness and COVID-19 have quantified this phenomena without considering how older people themselves define and understand loneliness. This paper explores how older New Zealanders conceptualized and experienced loneliness under 'lockdown' stay-at-home measures. METHODS: This multi-methods qualitative study combines data from letters (n = 870) and interviews (n = 44) collected from 914 people aged over 60 and living in Aotearoa, New Zealand during the COVID-19 pandemic. We conducted a reflexive thematic analysis to conceptualise this data. FINDINGS: We identify three interconnected ways in which older people conceptualised and experienced loneliness: (1) feeling disconnected relating to lack of emotional closeness to another often resulting from being physically separated from others and not being able to touch; (2) feeling imprisoned relating to separation from preferred identities and activities and was frequently associated with boredom and frustration; and (3) feeling neglected which often related to feeling let down by generalised and idealised forms of support, such as one's neighbourhood and health care system. DISCUSSION: Older New Zealanders experienced lockdown loneliness in three interconnected ways rather than as a stable and homogenous experience. Maori, Pacific, Asian and New Zealand European older people often discussed loneliness in different ways; attesting to loneliness being a culturally-mediated concept shaped by expectations around desirable social interaction. We conclude the paper with implications for research and policy.

Whole genome assessment of a declining game bird reveals cryptic genetic structure and insights for population management.

Population genomics applied to game species conservation can help delineate management units, ensure appropriate harvest levels and identify populations needing genetic rescue to safeguard their adaptive potential. The ruffed grouse (Bonasa umbellus) is rapidly declining in much of the eastern USA due to a combination of forest maturation and habitat fragmentation. More recently, mortality from West Nile Virus may have affected connectivity of local populations; however, genetic approaches have never explicitly investigated this issue. In this study, we sequenced 54 individual low-coverage (~5X) grouse genomes to characterize population structure, assess migration rates across the landscape to detect potential barriers to gene flow and identify genomic regions with high differentiation. We identified two genomic clusters with no clear geographic correlation, with large blocks of genomic differentiation associated with chromosomes 4 and 20, likely due to chromosomal inversions. After excluding these putative inversions from the data set, we found weak but nonsignificant signals of population subdivision. Estimated gene flow revealed reduced rates of migration in areas with extensive habitat fragmentation and increased genetic connectivity in areas with less habitat fragmentation. Our findings provide a benchmark for wildlife managers to compare and scale the genetic diversity and structure of ruffed grouse populations in Pennsylvania and across the eastern USA, and we also reveal structural variation in the grouse genome that requires further study to understand its possible effects on individual fitness and population distribution.

Beyond fear: A longitudinal investigation of emotions and risk of a vasovagal reaction in first-time whole-blood donors.

BACKGROUND: Fear is a recognized predictor of vasovagal reactions (VVRs) in blood donors. However, less is known about the role of other emotions, including positive emotions, that donors might experience. The aim of this study was to identify the emotions experienced in center that predict onsite VVRs, and to determine at what point during the donation appointment, the experience of these emotions is most influential. STUDY DESIGN AND METHODS: A sample of 442 first-time whole-blood donors (57.7% female; mean ± SD age 30.7 ± 11.7 years) completed a survey in the waiting area and before venepuncture in the donation chair to assess their current emotional experience. The survey data were matched with routinely-collected demographic, donation, and donor adverse event information. A generalized estimating equations model was used to identify emotions associated with the occurrence of a VVR. RESULTS: A total of 56 (12.7%) participants experienced a VVR. The occurrence of a VVR was significantly associated with lower love/closeness/trust (OR: 0.53, 95%CI: 0.34-0.82) and higher scared/fearful/afraid (OR: 1.96, 95%CI: 1.18-3.25) states. Significant interaction effects suggested that the effect of scared/fearful/afraid decreased while stressed/nervous/overwhelmed increased from the waiting area to before venepuncture on the likelihood of a VVR. DISCUSSION: To effectively reduce donor VVR risk, blood collection agencies need to address a broader range of emotions at different points during the donation process.

Evaluation of independent risk factors associated with surgical site infections from caesarean section.

BACKGROUND: The present study assessed factors associated with the risk of surgical site infections (SSI) after a caesarean section (C-section). METHODS: Data were collected in 1682 women undergoing elective (53.9%) and emergency (46.1%) C-sections between 1st August 2020, and 30th December 2021, at a National Health Service hospital (Surrey, UK). RESULTS: At the time of C-section, the mean age was 33.1 yr (SD ± 5.2). Compared to women with BMI < 30 kg/m2, those with a BMI ≥ 35 kg/m2 had a greater risk of SSI, OR 4.07 (95%CI 2.48-6.69). Women with a history of smoking had a greater risk of SSI than those who had never smoked, OR 1.69 (95%CI 1.05-2.27). Women with a BMI ≥ 30 kg/m2 and had a smoking history or emergency C-section had 3- to tenfold increases for these adverse outcomes. Ethnic minority, diabetes or previous C-section did not associate with any of the outcomes. CONCLUSIONS: High BMI, smoking, and emergency C-section are independent risk factors for SSI from C-section. Women planning conception should avoid excess body weight and smoking. Women with diabetes and from ethnic minority backgrounds did not have increased risks of SSI, indicating a consistent standard of care for all patients.

The work of palliative care from the perspectives of district nurses: A qualitative study.

AIM: To explore the work of palliative care from the perspectives of district nurses with a focus on the strategies they use to achieve positive outcomes for patients. DESIGN: An exploratory descriptive qualitative study. METHODS: A combination of group and individual interviews using semi-structured interviewing were used to explore district nurses' views of providing palliative care across two large urban community nursing services. RESULTS: Sixteen district nurse participants were interviewed. Three key themes were identified: "Getting what was needed" involved finding solutions, selling a story and establishing relationships. District nurses sought ways to "Stay involved" recognizing the benefit of delaying discharge for some patients. "Completing a nursing task" was a way of managing time constraints and a form of self-protection from having difficult conversations. CONCLUSION: This study highlights the importance of understanding the contextual nature of the practice setting in relation to the provision of palliative care. In doing so, it has revealed the strategies district nurses use to overcome the challenges associated with providing palliative care within a generalist workload. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: District nurses experience a tension between managing high patient workloads and remaining patient centred in palliative care. Being task focused is a way of remaining safe while managing a high volume of work and is not always a negative factor in the care they provide. However, focusing on a task while at the same time addressing other unmet needs requires a set of skills that less experienced nurses may not have. IMPACT: Palliative care education alone will not improve the quality of palliative care provided by generalist community district nurses. The practice context is an important factor to take into consideration when supporting the integration of palliative care in district nursing. NO PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was made to this study. REPORTING METHOD: We have adhered to the relevant EQUATOR guidelines and used the COREQ reporting method.

Descriptive Comparison of Two Models of Tele-Critical Care Delivery in a Large Multi-Hospital Health Care System.

Introduction: The Society of Critical Care Medicine Tele-Critical Care (TCC) Committee has identified the need for rigorous comparative research of different TCC delivery models to support the development of best practices for staffing, application, and approaches to workflow. Our objective was to describe and compare outcomes between two TCC delivery models, TCC with 24/7 Bedside Intensivist (BI) compared with TCC with Private Daytime Attending Intensivist (PI) in relation to intensive care unit (ICU) and hospital mortality, ICU and hospital length of stay (LOS), cost, and complications across the spectrum of routine ICU standards of care. Methods: Observational cohort study at large health care system in 12 ICUs and included patients, ≥18, with Acute Physiology and Chronic Health Evaluation (APACHE) IVa scores and predictions (October 2016-June 2019). Results: Of the 19,519 ICU patients, 71.7% (n = 13,993) received TCC with 24/7 BI while 28.3% (n = 5,526) received TCC with PI. ICU and Hospital mortality (4.8% vs. 3.1%, p < 0.0001; 12.6% vs. 8.1%, p < 0.001); and ICU and Hospital LOS (3.2 vs. 2.4 days, p < 0.001; 9.8 vs. 7.2 days, p < 0.001) were significantly higher among 24/7 BI compared with PI. The APACHE observed/expected ratios (odds ratio [OR]; 95% confidence interval [CI]) for ICU mortality (0.62; 0.58-0.67) vs. (0.53; 0.46-0.61) and Hospital mortality (0.95; 0.57-1.48) vs. (0.77; 0.70-0.84) were significantly different for 24/7 BI compared with PI. Multivariate mixed models that adjusted for confounders demonstrated significantly greater odds of (OR; 95% CI) ICU mortality (1.58; 1.28-1.93), Hospital mortality (1.52; 1.33-1.73), complications (1.55; 1.18-2.04), ICU LOS [3.14 vs. 2.59 (1.25; 1.19-1.51)], and Hospital LOS [9.05 vs. 7.31 (1.23; 1.21-1.25)] among 24/7 BI when compared with PI. Sensitivity analyses adjusting for ICU admission within 24 h of hospital admission, receiving active ICU treatments, nighttime admission, sepsis, and highest third acute physiology score indicated significantly higher odds for 24/7 BI compared with PI. Conclusion: Our comparison demonstrated that TCC delivery model with PI provided high-quality care with significant positive effects on outcomes. This suggests that TCC delivery models have broad-ranging applicability and benefits in routine critical care, thus necessitating progressive research in this direction.

Joy, Jobs, and Sweat: Older Adults' Physical Activity During COVID-19 Lockdowns in New Zealand.

This qualitative narrative correspondence study investigates older adults' experiences of physical activity (PA) during the 2020 COVID-19 pandemic lockdowns in Aotearoa, New Zealand. This paper presents a reflexive thematic analysis of 501 letters received from 568 participants that discussed PA. Participants described PA as bringing joy and rhythm to daily life under stay-at-home measures. The most frequently discussed forms of PA included exercising, gardening, and housework. Four interconnected conceptual themes identified were as follows: (a) renegotiating environmental relationships, (b) social connection, (c) pleasure and PA, and (d) navigating active aging discourses. This paper emphasizes the important environmental and social motivations for becoming and remaining physically active despite restrictions on movement. Older adults' understandings and performance of PA were heavily shaped by active aging discourses. As such, we suggest that initiatives seeking to promote PA should foreground older adults' feelings of connection, productivity, and pleasure and recognize their diversity. This is contrary to current recommendations focused on duration or intensity of older adults' PA.

Results from Aotearoa New Zealand's 2022 Report Card on Physical Activity for Children and Youth: A call to address inequities in health-promoting activities.

Background: This article reports the methods and findings for Aotearoa New Zealand's 2022 Report Card on Physical Activity for Children and Youth indicators, and on inequities within these indicators. Methods: Grades were assigned to indicators using the Active Healthy Kids Global Alliance criteria depending on data availability, and inequities reported based on gender, ethnicity, disability status, area-level socioeconomic deprivation, urbanicity, and school year. Two additional indicators were included in this report card: Sleep, and Physical literacy. Results: Grades were assigned to indicators as follows: Overall physical activity: C+, Organised sport and physical activity: B-, Physical literacy: B, Active transportation: D, Sedentary behaviours: C-, Sleep: B+, Whanau (family) and peers: D, School: C+, Government: A. Inequities across all socio-demographic variables were observed. An 'inconclusive' grade was assigned to the Active play, Physical fitness, and Community and Environment indicators due to insufficient data. Conclusion: It is imperative that targeted, comprehensive, and population-specific approaches are implemented to support health-promoting physical activity behaviours and reduce inequities among children and youth in Aotearoa. There is a need to promote all dimensions of physical activity (overall activity, active play, recreation, organised sport, active transportation) and the reduction of screen time through policy, research, evidence-based social marketing campaigns, and urban design. Regular, nationally representative surveys that enable the consistent and regular measurement of key Report Card indicators are needed.

A task service and a talking service: A qualitative exploration of bereaved family perceptions of community nursing care at the end of life.

BACKGROUND: Greater emphasis on community-based care at the end of life is supported by the premise that most people want to be cared for and die at home. As such, it is important to understand the current state of palliative care nursing within an integrated generalist-specialist model of care in the community. AIM: To explore bereaved family perceptions and experiences of community nursing at the end of life, with a particular focus on service integration. DESIGN: A qualitative study design using semi-structured telephone interviews with bereaved family. A critical realist framework was used to inform the analysis of interview data and thematic analysis of data was used to identify key themes. SETTING/PARTICIPANTS: Participants were the family carers of patients who had died within the catchment area of two large District Health Boards in Auckland, New Zealand. RESULTS: Twenty-three participants were interviewed. Participants described their experiences of community nursing in terms of the service they provided. Hospice nursing roles were described in terms of a "talking service" and District Nursing as a "task service." There was minimal expectation of the general practice nurse in terms of palliative care support and little evidence of service integration. CONCLUSION: Findings from this study support the need for a new integrated model of palliative care nursing which utilizes the unique skill set of nurses working across all community care settings including general practice, hospice and district nursing services. Accommodating different models of nursing care which can be responsive to patient need rather than limited to a defined service delivery model.

A shadowing program for PAs and APRNs to promote collaborative care.

ABSTRACT: This article describes a shadowing program aimed at promoting collaborative care among PAs and NPs at an academic medical center. The program fostered interprofessional and interdisciplinary experiences to improve collaborative skills. Clinicians who completed the program had a significant improvement in collaborative competencies, as measured by the Interprofessional Collaboration Competency Attainment Survey.

Probing the correlation between ligand efficacy and conformational diversity at the α1A-adrenoreceptor reveals allosteric coupling of its microswitches.

G protein-coupled receptors (GPCRs) use a series of conserved microswitches to transmit signals across the cell membrane via an allosteric network encompassing the ligand-binding site and the G protein-binding site. Crystal structures of GPCRs provide snapshots of their inactive and active states, but poorly describe the conformational dynamics of the allosteric network that underlies GPCR activation. Here, we analyzed the correlation between ligand binding and receptor conformation of the α1A-adrenoreceptor, a GPCR that stimulates smooth muscle contraction in response to binding noradrenaline. NMR of [13CϵH3]methionine-labeled α1A-adrenoreceptor variants, each exhibiting differing signaling capacities, revealed how different classes of ligands modulate the conformational equilibria of this receptor. [13CϵH3]Methionine residues near the microswitches exhibited distinct states that correlated with ligand efficacies, supporting a conformational selection mechanism. We propose that allosteric coupling among the microswitches controls the conformation of the α1A-adrenoreceptor and underlies the mechanism of ligand modulation of GPCR signaling in cells.

The Impact of Temporal Trajectories of Emotional Experience on Blood Donor Return.

BACKGROUND: Despite recognition that blood donation is an affectively poignant process, many aspects of donors' emotional experiences and their consequences remain unexamined. PURPOSE: This study tracked the donor's experience of several positive and negative emotions live as they arose during the donation process and tracked the impact of that experience on donor return. METHODS: New whole blood donors (N = 414) reported their experience of 10 positive and 10 negative discrete emotions before, during, and after donation. Return behavior of these donors and a business-as-usual control group was tracked over the next 6 months. RESULTS: In total, 46.4% of participants and 43.2% of the control group returned to donate within 6 months. On the basis of established relevance to blood donation and statistical considerations, group-based latent trajectories of three emotions (joy, calm, and stress) were modeled over time, revealing five classes of emotion trajectories. A trajectory of low/increasing joy and calm and high/decreasing stress was associated with significantly lower probability of return (preturn = .28, 95% confidence interval [CI] = 0.20, 0.38) relative to all but one other trajectory group and the control group. A trajectory of medium-high/increasing joy, high calm, and low/decreasing stress was associated with a significantly greater probability of return (preturn = .59, 95% CI = 0.49, 0.69) relative to two other trajectory classes and the control group. CONCLUSIONS: By identifying blood donors' emotion trajectories over time and the impact of those trajectories on return behavior, this research paves the way for the development of effective emotion-focused interventions to boost retention.

UK general practice: Continuing to fail in the care of people with epilepsy?

PURPOSE: To review the standard of clinical care of people with epilepsy (PWE) attending UK general practice after epilepsy was removed from the Quality and Outcomes Framework (QOF) in 2014. METHOD: The case notes of 324 people were reviewed against standards based on National Institute for Health and Care Excellence (NICE), Drug Safety Unit (DSU), and Medicines and Healthcare products Regulatory Agency (MHRA) guidelines. RESULTS: Annual face-to-face review fell significantly (p = 0.021) after the removal of epilepsy from QOF in 2014. Clinical Commissioning Group (CCG) downloaded review rates fell significantly from 95% in 2010 to only 14% in 2016. One hundred and twenty seven (39%) people had seen their GP, and108 (33%) had not seen any doctor, in the past year. One hundred and seventy three (53%) were under specialist care. Forty nine percent not under specialist care had poor control. Two hundred and fifty four (78%) people were on ASM (Anti-Seizure Medication) associated with poor bone health, of these 41 (16%) were prescribed vitamin D. Fourteen women of childbearing age were taking sodium valproate, of whom only 5 (36%) had written confirmation of being counseled of the associated risks. Fifty six (17%) people were non-complaint with prescription collection, of which 66% had documented poor control. There was a discrepancy between actual face-to-face review rates and the review rates the CCG collected. CONCLUSION: This study reveals poor annual review rates for PWE in UK primary care, which have fallen further since the removal of epilepsy from QOF. Unmet needs persist for people with poorly controlled epilepsy not under specialist care, bone health, and the care of women of child bearing age. This study, along with previous work, brings into question the concept of shared care for PWE. Clinical Commissioning Groups should consider investing in the training and employment of GPwSIe (GP with Special Interest in epilepsy) and ENS (Epilepsy Nurse Specialists) to work in the community. The Government should examine re-introducing epilepsy back into QOF with measurable clinical targets and adequate remuneration.

Metabolomic Signature as a Predictor of Liver Disease Events in Patients With HIV/HCV Coinfection.

BACKGROUND: Advanced liver disease due to hepatitis C virus (HCV) is a leading cause of human immunodeficiency virus (HIV)-related morbidity and mortality. There remains a need to develop noninvasive predictors of clinical outcomes in persons with HIV/HCV coinfection. METHODS: We conducted a nested case-control study in 126 patients with HIV/HCV and utilized multiple quantitative metabolomic assays to identify a prognostic profile that predicts end-stage liver disease (ESLD) events including ascites, hepatic encephalopathy, hepatocellular carcinoma, esophageal variceal bleed, and spontaneous bacterial peritonitis. Each analyte class was included in predictive modeling, and area under the receiver operator characteristic curves (AUC) and accuracy were determined. RESULTS: The baseline model including demographic and clinical data had an AUC of 0.79. Three models (baseline plus amino acids, lipid metabolites, or all combined metabolites) had very good accuracy (AUC, 0.84-0.89) in differentiating patients at risk of developing an ESLD complication up to 2 years in advance. The all combined metabolites model had sensitivity 0.70, specificity 0.85, positive likelihood ratio 4.78, and negative likelihood ratio 0.35. CONCLUSIONS: We report that quantification of a novel set of metabolites may allow earlier identification of patients with HIV/HCV who have the greatest risk of developing ESLD clinical events.

Skyline for Small Molecules: A Unifying Software Package for Quantitative Metabolomics.

Vendor-independent software tools for quantification of small molecules and metabolites are lacking, especially for targeted analysis workflows. Skyline is a freely available, open-source software tool for targeted quantitative mass spectrometry method development and data processing with a 10 year history supporting six major instrument vendors. Designed initially for proteomics analysis, we describe the expansion of Skyline to data for small molecule analysis, including selected reaction monitoring, high-resolution mass spectrometry, and calibrated quantification. This fundamental expansion of Skyline from a peptide-sequence-centric tool to a molecule-centric tool makes it agnostic to the source of the molecule while retaining Skyline features critical for workflows in both peptide and more general biomolecular research. The data visualization and interrogation features already available in Skyline, such as peak picking, chromatographic alignment, and transition selection, have been adapted to support small molecule data, including metabolomics. Herein, we explain the conceptual workflow for small molecule analysis using Skyline, demonstrate Skyline performance benchmarked against a comparable instrument vendor software tool, and present additional real-world applications. Further, we include step-by-step instructions on using Skyline for small molecule quantitative method development and data analysis on data acquired with a variety of mass spectrometers from multiple instrument vendors.

Emotional mechanisms and format effects of motivational questions for blood donation.

Prior studies suggest that responding to online motivational questions increases blood donation intention. The present studies were designed to extend these findings by (a) exploring the impact of methodologic variations in the content and order of administration of specific questions on donation intention and (b) examining anticipated positive and negative emotional reactions as potential mediators. STUDY DESIGN AND METHODS: In the first study, 4709 respondents (51.2% female; mean ± SD age, 38.4 ± 12.1 years) were randomly assigned to one of four motivational questions or a no-question control. In the second study, 5291 respondents (52.7% female; mean ± SD age, 37.3 ± 11.9 years) were randomly assigned to one of six motivational questions or a no-question control. In both studies, the motivational questions were followed by measures of donation intention, anticipated warm glow, and anticipated regret. RESULTS: In Study 1, three of the four questions were associated with higher donation intentions, with anticipated warm glow being a potential partial mediator for two of the questions. In Study 2, five of the six questions were associated with higher donation intentions, with anticipated warm glow and anticipated regret being potential partial mediators for three of the questions. These effects were largely consistent among donors and nondonors. CONCLUSION: These studies expand our understanding of the association between particular motivational questions and donation intentions and provide preliminary support for the notion that specific questions may influence donation intention by increasing anticipated positive and negative emotional reactions to the thought of giving or not giving, respectively.

Dietary and lifestyle factors effect erythrocyte PIG-A mutant frequency in humans.

It is well understood that poor diet and lifestyle choices can increase the risk of cancer. It is also well documented that cancer is a disease of DNA mutations, with mutations in key genes driving carcinogenesis. Measuring these mutations in a minimally invasive way may be informative as to which exposures are harmful and thus allow us to introduce primary preventative measures, in a bid to reduce cancer incidences. Here, we have measured mutations in the phosphatidylinositol glycan class A (PIG-A) gene in erythrocytes from healthy volunteers (n = 156) and from non-cancer patients attending the local endoscopy department (n = 144). The X-linked PIG-A gene encodes an enzyme involved in glycosylphosphatidylinositol (GPI) anchor synthesis. A silencing mutation in which leads to the absence of GPI anchors on the extracellular surface which can be rapidly assessed using flow cytometry. The background level of PIG-A mutant erythrocytes was 2.95 (95% CI: 2.59-3.67) mutant cells (10-6). Older age increased mutant cell frequency (P < 0.001). There was no difference in mutant cell levels between males and females (P = 0.463) or smokers and non-smokers (P = 0.186). In the endoscopy group, aspirin users had lower mutant frequencies (P = 0.001). Further information on diet and exercise was available for the endoscopy patient group alone, where those with a higher health promotion index score had lower mutant frequencies (P = 0.011). Higher dietary intake of vegetables reduced mutant cell levels (P = 0.022). Participants who exercised for at least 1 h a week appeared to have reduced mutant frequencies than those who did not exercise, although this was not statistically significant (P = 0.099). This low background level of mutant erythrocytes in a population makes this assay an attractive tool to monitor exposures such as those associated with lifestyles and diet, as demonstrated here.

'People haven't got that close connection': meanings of loneliness and social isolation to culturally diverse older people.

Objectives: Social isolation and loneliness among older people are known to have negative effects on health and wellbeing. Few studies, however, have enabled older people to define these concepts in their own terms. This paper based on research in Aotearoa, New Zealand is the first to comparatively outline the meanings of loneliness and social isolation from the perspective of four ethnically diverse groups of older adults (Maori, Pacific, Asian, and NZ European).Method: We interviewed 44 older people and conducted three focus groups with 32 older people. We used thematic and narrative analyses.Results: Loneliness and social isolation were conceptualized as interconnected concepts described as a 'look and feel', a 'state of mind' and as a 'lack of desired companionship'. Participants conveyed sophisticated understandings of the structural underpinnings of both loneliness and social isolation as multi-dimensional, complex, and situated.Conclusions: Older people describe complex and culturally- nuanced understanding and experience of social isolation and loneliness. More culturally appropriate services, greater mental-health support and more service provision on weekends and evenings are needed.