Physical activity promotion and adults with intellectual disabilities: A neglected area.

BACKGROUND: The objective was to review physical activity (PA) promotion interventions among individuals with intellectual disability and provide recommendations for increasing PA. METHODS: A systematic mapping review was conducted in which physical activity intervention studies for adults with a disability were identified, selected, and appraised. Data were extracted regarding the study design, results, and authors' recommendations. Data were analyzed using a social-ecological framework. RESULTS: A comprehensive search of the peer reviewed literature yielded 5 studies (3 quantitative, 1 mixed methods, and 1 pre-post delayed). Studies used physical activity promotion strategies at the intrapersonal, interpersonal, organizational, community, and policy levels have been used to date. CONCLUSIONS: Recommendations are presented for researchers and practitioners seeking to increase the level of PA of adults with intellectual disability.

Main Pulmonary Artery-to-Ascending Aorta Diameter Ratio in Healthy Children on MDCT.

OBJECTIVE: This study was performed to ascertain whether the adult ratio of 1:1 of the diameter of the main pulmonary artery (MPA) to the diameter of the ascending aorta (AA) (referred to hereafter as the MPA-to-AA ratio) on MDCT is applicable to children. MATERIALS AND METHODS: Our hypothesis, which is based on experiential observation, is that the MPA-to-AA ratio would be higher than 1 in healthy children. A retrospective analysis of vessel calibers in a population of children without pulmonary hypertension who had undergone MDCT was performed. RESULTS: The MPA-to-AA ratio was statistically significantly higher in children of all ages than in adults. We would, therefore, submit that the normal MPA-to-AA ratio in children on MDCT is greater than 1 and closer to 1.09. CONCLUSION: The demonstration of an MPA segment that is slightly larger than the AA in children undergoing MDCT should not suggest a diagnosis of pulmonary arterial hypertension.

Discovery and evolution of phenoxypiperidine hydroxyamide dual CCR3/H1 antagonists. Part I.

The discovery of potent small molecule dual antagonists of the human CCR3 and H(1) receptors is described for the treatment of allergic diseases, for example, asthma and allergic rhinitis. Optimizing in vitro potency and metabolic stability, starting from a CCR1 lead compound, led to compound 20 with potent dual CCR3/H(1) activity and in vitro metabolic stability.

Discovery and evolution of phenoxypiperidine hydroxyamide dual CCR3/H1 antagonists. Part II: optimising in vivo clearance.

The second part of this communication focuses on the resolution of issues surrounding the series of hydroxyamide phenoxypiperidine CCR3/H(1) dual antagonists described in Part I. This involved further structural exploration directed at reducing metabolism and leading to the identification of compound 60 with a greatly improved in vivo pharmacokinetic profile.

Identification and quantification of glutathione adducts of clozapine using ultra-high-performance liquid chromatography with orthogonal acceleration time-of-flight mass spectrometry and inductively coupled plasma mass spectrometry.

The application of sulphur-specific detection via ultra-performance liquid chromatography coupled to inductively coupled plasma mass spectrometry (UPLC/ICPMS) to detect and quantify the glutathione (GSH)-adducts produced via the in vitro formation of reactive metabolites is demonstrated. The adducts were formed in human liver microsomes supplemented with unlabelled GSH for clozapine. The calculation of adduct concentration was performed via comparison of the peak areas to calibration curves constructed from omeprazole, a sulphur-containing compound over the range of 0.156 to 15.62 µM of sulphur with a detection limit of 1.02 ng of sulphur on-column. Identification of the adducts was performed using conventional UPLC/time-of-flight (TOF)-MS with the calculation of clozapine intrinsic clearance carried out by high-performance liquid chromatography/tandem mass spectrometry (HPLC/MS/MS). The use of ICPMS in this way appears to offer a novel, rapid and sensitive means of determining the quantity of GSH conjugates with the combined adducts producing 0.9 µM of reactive metabolite out of a total of 3.5 µM of metabolites. The GSH adduct therefore represents 26% of this total produced as a result of the metabolism of drug to reactive species.

Discovery of pyrazoles as novel FPR1 antagonists.

A series of pyrazole inhibitors of the human FPR1 receptor have been identified from high throughput screening. The compounds demonstrate potent inhibition in human neutrophils and attractive physicochemical and in vitro DMPK profiles to be of further interest.

Discovery of small molecule human FPR1 receptor antagonists.

The identification of two novel series of formyl peptide receptor 1 (FPR1) antagonists are reported, represented by methionine benzimidazole 6 and diamide 7. Both series specifically inhibited the binding of labelled fMLF to hrFPR1 and selectively antagonized FPR1 function in human neutrophils, making them useful in vitro validation tools for the target.

The functional intraoperative pulmonary blood flow study is a more sensitive predictor than preoperative anatomy for right ventricular pressure and physiologic tolerance of ventricular septal defect closure after complete unifocalization in patients with pulmonary atresia, ventricular septal defect, and major aortopulmonary collaterals.

BACKGROUND: The objective was to determine if intraoperative pulmonary artery (PA) flow studies after complete unifocalization correlate with postrepair hemodynamics for pulmonary atresia (PA), ventricular septal defects (VSD), and major aortopulmonary collaterals. METHODS AND RESULTS: Twenty patients (median age, 8 months; weight, 7.9 kg) underwent unifocalization between 2003 and 2008. A functional PA flow study was achieved by cannulating the unifocalized central PA before intracardiac repair and increasing flow incrementally to 2.5 L/min per m(2). Mean PA pressure (mPAP) was measured. The intent was to close the VSD for a mPAP of <30 mm Hg. Right ventricular systolic pressure (RVSP) and systemic systolic pressure were recorded. Total incorporated pulmonary segments, pulmonary segment artery ratio (ratio of incorporated segments to 18), and total neopulmonary artery index (the sum of major aortopulmonary collaterals and native PA index) were calculated. The VSD was successfully closed in 18 patients (90%). One attempted closure required an intraoperative fenestration. The study mPAP correlated with RVSP (rho=0.72; P=0.0027) and RVSP/systemic systolic pressure (rho=0.67; P=0.0063). Total neopulmonary artery index had a nonsignificant negative correlation with RVSP (rho=-0.42; P=0.079). Total incorporated pulmonary segments and pulmonary segment artery ratio were not correlated. Flow study mPAP had the highest accuracy in predicting successful VSD closure: area under the receiver-operator curve (0.83) versus total neopulmonary artery index (0.42), pulmonary segments (0.35), and pulmonary segment artery ratio (0.33). CONCLUSIONS: The intraoperative pulmonary flow study predicted postoperative physiology significantly better than did standard anatomic measures. Conventional measures should be used with caution when determining the possibility for complete repair.

Characteristics of Indigenous healing strategies in Canada: a scoping review.

OBJECTIVE: The objective of this review was to identify the characteristics of Indigenous healing strategies in Canada and culturally relevant approaches within Indigenous contexts. INTRODUCTION: In responding to the Canadian Truth and Reconciliation Commission's Calls to Action, there is increasing interest in Indigenous healing strategies across clinical, policy, and community sectors. The high relevance of Indigenous healing has also encouraged exploration of new approaches to research that are responsive to, and inclusive of, Indigenous contexts. To date, there is no clear understanding of what characterizes Indigenous healing strategies in Canada. INCLUSION CRITERIA: This review considered healing strategies for First Nations, Inuit, and Métis in Canada. Strategies examined included those related to health services and programs, policies and guidelines, models and frameworks, and Indigenous narratives and expert opinion in any service setting. METHODS: This review employed the JBI approach to scoping reviews. Searches were performed in CINAHL Full Text, Sociological Abstracts, PsycINFO, MEDLINE, and Academic Search Premier in December 2018. Searches for gray literature were conducted in iPortal, Canadian Electronic Library, and a list of Canadian government and Indigenous organization websites in February 2019. This review was limited to publications from 2008 onward. Non-English articles and theses and dissertations were excluded. RESULTS: Among the 59 articles included in this review, 41 were journal articles and 28 were published within the previous five years (i.e., 2014 and onward). The healing strategies were most frequently implemented in Ontario (n = 13), British Columbia (n = 8), and Manitoba (n = 5). The majority of strategies were utilized in the health settings (n = 37), which included mainstream treatment modalities as well as community-based healing initiatives. Services and programs (n = 24) were the predominant type of healing strategies, followed by models and frameworks (n = 9), policies and guidelines (n = 8), Indigenous narratives and expert opinion (n = 7), and others (n = 11). The most frequent guiding principles were identified as Honoring Cultures and Traditions (n = 14), Medicine Wheel (n = 12), and Strength-Based/Empowerment (n = 12). The most widely used main components were Artistic Expression (n = 16), Ceremonies (n = 15), and Games and Exercises (n = 12). As for human resources, Community Members (n = 19) were most frequently engaged, followed by Local Agencies (n = 12) and Knowledge Keepers (n = 12). Eight culturally relevant approaches were identified from 29 primary research studies, with the most popular being Consultation/Participatory Research (n = 20) and Indigenous Protocols (n = 5). CONCLUSIONS: The findings of this review collectively support a decolonizing approach that upholds Indigenous knowledge, respects Indigenous rights to self-determination, and recognizes Indigenous resilience and agency. More research is needed with a focus on Inuit or Métis healing, and innovative knowledge synthesis methods inclusive of diverse Indigenous ways of knowing.

Potential greenhouse gas reductions from Natural Climate Solutions in Oregon, USA.

Increasing concentrations of greenhouse gases (GHGs) are causing global climate change and decreasing the stability of the climate system. Long-term solutions to climate change will require reduction in GHG emissions as well as the removal of large quantities of GHGs from the atmosphere. Natural climate solutions (NCS), i.e., changes in land management, ecosystem restoration, and avoided conversion of habitats, have substantial potential to meet global and national greenhouse gas (GHG) reduction targets and contribute to the global drawdown of GHGs. However, the relative role of NCS to contribute to GHG reduction at subnational scales is not well known. We examined the potential for 12 NCS activities on natural and working lands in Oregon, USA to reduce GHG emissions in the context of the state's climate mitigation goals. We evaluated three alternative scenarios wherein NCS implementation increased across the applicable private or public land base, depending on the activity, and estimated the annual GHG reduction in carbon dioxide equivalents (CO2e) attributable to NCS from 2020 to 2050. We found that NCS within Oregon could contribute annual GHG emission reductions of 2.7 to 8.3 MMT CO2e by 2035 and 2.9 to 9.8 MMT CO2e by 2050. Changes in forest-based activities including deferred timber harvest, riparian reforestation, and replanting after wildfires contributed most to potential GHG reductions (76 to 94% of the overall annual reductions), followed by changes to agricultural management through no-till, cover crops, and nitrogen management (3 to 15% of overall annual reductions). GHG reduction benefits are relatively high per unit area for avoided conversion of forests (125-400 MT CO2e ha-1). However, the existing land use policy in Oregon limits the current geographic extent of active conversion of natural lands and thus, avoided conversions results in modest overall potential GHG reduction benefits (i.e., less than 5% of the overall annual reductions). Tidal wetland restoration, which has high per unit area carbon sequestration benefits (8.8 MT CO2e ha-1 yr-1), also has limited possible geographic extent resulting in low potential (< 1%) of state-level GHG reduction contributions. However, co-benefits such as improved habitat and water quality delivered by restoration NCS pathways are substantial. Ultimately, reducing GHG emissions and increasing carbon sequestration to combat climate change will require actions across multiple sectors. We demonstrate that the adoption of alternative land management practices on working lands and avoided conversion and restoration of native habitats can achieve meaningful state-level GHG reductions.

Working with children in end-of-life decision making.

Traditionally, physicians and parents made decisions about children's health care based on western practices. More recently, with legal and ethical development of informed consent and recognition for decision making, children are becoming active participants in their care. The extent to which this is happening is however blurred by lack of clarity about what children - of diverse levels of cognitive development - are capable of understanding. Moreover, when there are multiple surrogate decision makers, parental and professional conflict can arise concerning children's 'best interest'. Giving children a voice and offering choice promotes their dignity and quality of life. Nevertheless, it also presents with many challenges. Case studies using pseudonyms and changed situational identities are used in this article to illuminate the complexity of ethical challenges facing nurses in end-of-life care with children and families.

Understanding Mi'kmaq Women's Experiences Accessing Prenatal Care in Rural Nova Scotia.

Indigenous women experience a higher incidence of maternal complications compared with non-Indigenous women. Despite this, little is known about access to prenatal care for Mi'kmaq women in Nova Scotia. The intent of this study was to gain a more comprehensive understanding of Mi'kmaq women's experiences accessing prenatal care. The findings from this study highlight key implications for nursing practice such as promoting the nurse's role in supporting and advocating for Mi'kmaq women's health and for providing culturally safe care. This research will highlight that access to prenatal care is a complex issue for some women.

Characteristics of Indigenous healing strategies in Canada: a scoping review protocol.

OBJECTIVE: The objective of this review is to identify the characteristics of Indigenous healing strategies in Canada and approaches to improving cultural relevance to local Indigenous contexts. INTRODUCTION: In the previous 150 years, Indigenous peoples of Canada have experienced colonization, forced assimilation, cultural oppression and violence, and these are associated with high rates of social distress and health disparities. Today, legacies of colonization continue to marginalize Indigenous peoples, creating healthcare institutions devoid of Indigenous worldviews. Despite the growing number of Indigenous healing strategies currently in existence, literature describing these strategies has not been systematically scoped. To address this gap, this scoping review will identify characteristics of Indigenous healing strategies in Canada, and explore culturally relevant approaches used in research process. INCLUSION CRITERIA: This review will consider literature that describes Indigenous healing strategies in Canada and will include First Nations, Inuit and Métis as the population of interest. Strategies may include, but are not limited to, health services and programs, policies and guidelines, models and frameworks, and Indigenous narratives and expert opinions. Healing strategies delivered in all service settings are eligible for inclusion. METHODS: The databases/sources to be searched will include: CINAHL, Sociological Abstracts, PsycINFO, MEDLINE and Academic Search Premier. Searches for gray literature will be conducted in iPortal, Canadian Electronic Library, and a list of Canadian government and Indigenous organization websites. Retrieval of full-text studies and data extraction will be performed independently by two reviewers. Findings will be summarized in tabular forms accompanied by narrative text.

Silent no more: elderly women's stories of living with urinary incontinence in long-term care.

Urinary incontinence (UI) is a prevalent health issue affecting the quality of life of many elderly women living in long-term care. Minimal consideration has been given to understanding the lived experience from women's perspectives. Using one-to-one interviews, this study explored elderly women's experiences with UI while living in long-term care facilities. Data were analyzed using thematic analysis that revealed three themes related to the meaning of UI to the women, physical implications of UI, and institutional culture of UI in long-term care. Within these three themes, the women expressed common concerns. The results of this study provided information that could influence changes in nursing practice related to individualized UI care, empowering women experiencing UI, and dispelling ageism in long-term care. The study also suggests opportunities for improving health care education related to the quality of life of women who experience UI, and the need to make the experience more visible and openly discussed as a health issue rather than the traditional condition of aging.

Blending Simulation-Based Learning and Interpretative Pedagogy for Undergraduate Leadership Competency Development.

BACKGROUND: Effective leadership is an essential component guiding nursing activity and influencing health systems, health workers, and patient outcomes. Despite this evidence, undergraduate nursing programs may not be adequately preparing graduates to effectively engage in leadership practice. METHOD: This article describes an educational innovation designed to support prelicensure leadership competency development. The authors blended simulation-based learning (SBL) with an interpretative pedagogical frame in a senior nursing leadership course at a primarily undergraduate university. RESULTS: The innovation involves a break from traditional nursing educational pedagogy by bringing SBL into the leadership classroom. Using interpretative pedagogy to purposefully create different relationships in the learning space supported deeper personal and professional transformation for the students. CONCLUSION: Nurse educators must purposefully design leadership curricula using active educational strategies that adequately prepare nurses for complex health systems. Integrating SBL within an interpretative pedagogy for leadership development moves students from merely knowing theory to informed and effective action. [J Nurs Educ. 2017;56(1):49-54.].

The advantage of early plication in children diagnosed with diaphragm paresis.

BACKGROUND: In this single-center study, we sought to determine the frequency of phrenic nerve injury leading to diaphragm paresis (DP) in children following open cardiac surgery over the last 10 years, and to identify possible variables that predict the need for plication and associated clinical outcomes. METHODS: Patients diagnosed with DP were identified from departmental databases and a review of clinical diaphragm ultrasound images. A cohort was analyzed for predictors of diaphragm plication and associations with clinical outcomes. Cumulative proportion graphs modeled the association between plication and length of stay. RESULTS: DP was diagnosed in 161 of 6448 patients (2.5%) seen between January 2002 and December 2012. All diagnoses but 1 were confirmed by ultrasound. Plication of the diaphragm was performed in 30 patients (19%); compared with patients who did not undergo plication, these patients were younger (median age, 10 days vs 138 days; P < .001), more likely to have undergone deep hypothermic circulatory arrest (47% vs 18%; P = .005), had a longer duration of positive pressure ventilation (median, 15 days vs 7 days; P < .001), and had longer lengths of stay in both the intensive care unit (median, 23 days vs 8 days; P < .0001) and the hospital (median, 37 days vs 15 days; P < .0001). Early plication was associated with reduction in all intervals of care. CONCLUSIONS: Early plication should be considered for patients with diaphragm paresis requiring prolonged respiratory support after cardiac bypass surgery. Longer follow-up evaluation is required to better define the long-term implications of plication.

Defining guilt in depression: a comparison of subjects with major depression, chronic medical illness and healthy controls.

BACKGROUND: Although guilt is a widely accepted feature of depression, there is limited and inconsistent data defining the nature of this symptom. The purpose of the current study was to examine the specificity and nature of guilt in subjects with major depression as compared to patients with another chronic medical illness and healthy controls. METHODS: Outpatients with current major depressive episode (MDE; n=34), past-MDE (n=22), chronic cardiac illness (n=20) and healthy controls (n=59) were administered the following measures: The Guilt Inventory (GI), State Shame and Guilt Scale (SSGS), 17-item Hamilton Rating Scale for Depression (Ham-D) and the Structured Clinical Interview for DSM-IV. RESULTS: Overall multivariate analysis of covariance comparing mean scores for the six guilt subscales [state-guilt, trait-guilt, moral standards (from the GI); state-guilt, -pride, and -shame (from the SSGS)] across the four groups was significant (F=9.1, df=6:121, p<0.0001). Post-hoc analysis revealed the following differences (each at least p<0.01): for state-guilt (GI), current-MDE>past-MDE>cardiac=healthy controls; for trait-guilt (GI), current-MDE=past-MDE>cardiac=healthy controls; for state-shame, -guilt and -pride (SSGS), current-MDE>past-MDE, past-MDE=cardiac, past-MDE>healthy, cardiac=healthy controls. Among depressed patients, there was significant correlation between Ham-D score and all guilt sub-scales (p<0.01), except moral standards. LIMITATIONS: The cardiac group may have less illness burden than currently depressed. CONCLUSIONS: State expression of guilt, shame and low pride distinguish acutely depressed from all other groups, and are highly influenced by severity of depression. Trait-guilt does not differentiate acute from past depressed. Data suggests guilt may represent both an enduring and fluctuating feature of depressive illness over its longitudinal course.

Utility scores of symptom profiles in major depression.

Utility is a measure of undesirability for a specific health state. This study determines the utility scores for the individual symptoms of depression, and examines the impact that personal experience with depression has on these scores. Seventy-five subjects (19 with current depression, 21 with past depression, and 35 healthy controls) assigned utility scores to each of 10 individual symptoms of depression, and three depression severity profiles. Utility scores were measured using the standard gamble technique. Mean utility scores were used to list the symptoms of depression from most to least undesirable. The three diagnostic groups were compared with respect to the magnitude of undesirability of the depressive symptoms. The results of this study found that individuals assigned different utility scores to different symptoms of depression. The psychological symptoms of depression such as suicidal ideation, guilt and depressed mood were ranked as more undesirable than the somatic symptoms of depression. Each diagnostic group ranked the symptoms of depression in a similar manner. Patients with a current depression were willing to accept a greater risk of death to avoid suffering from lifelong depressive symptoms as compared to patients with a past depression or healthy controls.

Evidence-based practice: a quality indicator analysis of peer-tutoring in adapted physical education.

The purpose of the research was to conduct a quality indicator analysis of studies investigating peer-tutoring for students with a disability in adapted physical education. An electronic search was conducted among English journals published from 1960 to November 2012. Databases included ERIC, PsycINFO, and SPORTDiscus. Fifteen research studies employing group-experimental (Gersten et al., 2005) or single-subject designs (Horner et al., 2005) met inclusion criteria. Each study was assessed for the presence and clarity of quality indicators. Group designs met an average of 62.5% essential and 69% desirable indicators. An average of 80% of indicators was present for single-subject designs. Results suggest claims of peer-tutoring being an evidence-based practice are premature. Recommendations for clarifying and applying the quality indicators are offered.

Preoperative total pulmonary blood flow predicts right ventricular pressure in patients early after complete repair of tetralogy of Fallot and pulmonary atresia with major aortopulmonary collateral arteries.

OBJECTIVE: The management of patients with tetralogy of Fallot (ToF) and pulmonary atresia (PA) with major aortopulmonary collateral arteries (MAPCAs) is challenging. Frequently it is difficult to predict whether complete repair with closure of the ventricular septal defect (VSD) will be tolerated. The aim of this study was to investigate whether measurements of preoperative pulmonary blood flow are associated with early postoperative outcome after VSD closure. METHODS: In this retrospective study, the data from 10 patients who had undergone a cardiac magnetic resonance imaging study with flow measurements before attempted surgical complete repair were collected. Systemic blood flow (Qs) was calculated as the sum of descending aortic blood flow distal to the MAPCA origins and superior vena cava flow. Pulmonary blood flow (Qp) was measured either from the sum of the pulmonary flow (n = 7) or calculated as the difference between ascending aortic flow and Qs. RESULTS: Preoperative Qp/Qs averaged 1.71 ± 0.68 and correlated inversely with right ventricular systolic pressure (relative to systolic blood pressure, r = -0.75, P = .03) and positively with the total neopulmonary artery index (TNPAI, r = 0.66, P = .04), as measured by fluoroscopic angiography. Two children did not tolerate VSD closure. This was likely related to bronchial compression in 1 patient while the other had the lowest TNPAI and the lowest Qp/Qs of all patients. CONCLUSIONS: CMR provides not only anatomic but also functional information for surgical decision making in patients with ToF and PA with MAPCAs. Preoperative Qp/Qs is associated with postoperative right ventricular pressure and may be a marker of readiness for VSD closure.