Ultrasensitive enantiomeric barbiturate analysis in body fluids through capillary electrophoresis with large volume sample stacking and ultrasound assisted dispersive liquid liquid microextraction.

A rapid, straightforward, and sensitive approach to quantifying enantiomeric barbiturates in serum was developed by integrating ultrasound-assisted dispersive liquid-liquid microextraction (UA-DLLME) with large-volume sample stacking (LVSS) in capillary electrophoresis (CE). UA-DLLME was employed for sample preparation, and on-column preconcentration by using LVSS with polarity switching was implemented to enhance sensitivity. We thoroughly investigated and optimized various parameters influencing extraction and stacking to achieve optimal detection performance with the highest enrichment efficiencies. Under optimal extraction conditions (injection of a mixed solution containing 40 µL of CHCl3 and 200 µL of tetrahydrofuran into 1 mL of a sample solution at pH 10.0), LVSS was performed using 600 mM Tris-boric acid (pH 9.5) containing 35 mM hydroxypropyl-ß-cyclodextrin and sodium taurodeoxycholate hydrate. A voltage of 20 kV was applied and a preinjection water plug was loaded at a height of 25 cm for 10 s. Subsequently, the sample solution was injected at a height of 25 cm for 480 s, after which a voltage of -20 kV was applied and the sample stacking was initiated. The stacking process was completed when 95 % of the separation current was attained. Under optimized conditions, the contraction folds of the four barbiturate analytes (R, S-Secobarbital, R, S-pentobarbital) were improved by approximately 6400-fold, achieving detection limits of 0.1 ng/mL. The limits of quantification for all analyte enantiomers were 0.5-50 ng/mL, demonstrating good linearity (r > 0.997). Migration times exhibited a relative standard deviation of less than 1.7 %, whereas peak areas for the four analytes exhibited a deviation of 8.7 %. Finally, the established method was effectively applied to the analysis of human serum samples.

Inequality in Older Volunteering: Association Between Volunteer Competency and Demographic Profiles.

The present survey research investigated older people's volunteering competency relating to social inequality by exploring the latent ability profile and demographic correlates of 1,000 older volunteers in 73 community care centersin southern Taiwan. Older volunteers were classified into advanced (n = 509), basic (n = 214), and novice (n = 277) groups. Demographics examined included: individualistic characteristics (religious beliefs), resources (education; number of chronic diseases), andsocial factors (serving area and spoken language, volunteering duration, marital status, and gender). Apparent inequality issues were revealed. The advanced group was better educated, Mandarin-speaking, and in urban areas. while the novice group featured the opposite (lower education Taiwanese-speaking suburban areas).

Establishing psychometric properties of the older volunteer competency scale in the community.

AIM(S): To investigate the factorial structure, test-retest reliability, and internal consistency of the Older Volunteer Competency Scale and establish its psychometric properties. DESIGN: Cross-sectional survey. METHODS: A total of 1,000 older volunteers were recruited through random sampling and asked to complete the Older Volunteer Competency Scale. Subsequently, 100 participants were selected to participate in a second test to determine the scale's test-retest reliability. Factorial structure was assessed through exploratory factor analysis and confirmatory factor analysis, and internal consistency was assessed using Cronbach's α. RESULTS: Favorable exploratory and confirmatory factor analysis results were obtained. In addition, the three dimensions of the Older Volunteer Competency Scale, namely service awareness, service skills, and interpersonal interaction, had high internal consistency and test-retest reliability. CONCLUSION: The Older Volunteer Competency Scale is an effective and reliable research instrument for evaluating competency and needs among older volunteers.

Isolation of GLP-1 enhancing indolizidine alkaloids from Boehmeria formosana.

Boehmeria formosana, with its related species, demonstrates anti-glycemic effect, inhibition of HBV production, anti-cancer activities, etc. Some indolizidine alkaloids from the same genus are bioactive but sensitive to light. To overcome this problem and obtain more phenanthroindolizidine alkaloids, isolation was performed in darkness, yielding 10 new indolizidine alkaloids and 17 known compounds. Among them, seven enhanced glucagon-like receptor 1 (GLP-1) activity at 50 mM, especially 14 and 6 (3.5- and 2.3-fold than the negative control). This procedure yielded bioactive indolizidine alkaloids with novel structures.

Ultrasensitive analysis of mirtazapine and its metabolites enantiomers in body fluids using ultrasound-enhanced and surfactant-assisted dispersive liquid-liquid microextraction followed by polymer-mediated stacking in capillary electrophoresis.

A simple, rapid, and sensitive technique for measuring mirtazapine and its metabolites enantiomers in human fluids, such as urine and serum, was developed by applying ultrasound-enhanced and surfactant-assisted dispersive liquid-liquid microextraction (USA-DLLME) integrated with poly(diallyldimethylammonium chloride) (PDDAC)-mediated stacking in capillary electrophoresis (CE). The parameters that affect extraction and stacking performance, such as the extraction volume, surfactant types, surfactant concentrations, salt additives, extraction time, solution pH, and background electrolytes, were comprehensively studied and optimized to achieve optimal detection performance. Under optimal extraction conditions (injection of 120 µL of C2H2Cl4 into 1 mL of a sample solution containing 0.05 mM Brij-35 at pH 10.0) and separation conditions (0.9% PDDAC, 10 mM phosphate, pH 3.0, and 20 mM dimethyl-ß-cyclodextrin), on-line CE stacking of mirtazapine-related chiral drugs was achieved by the two strategies: (i) neutral DM-ß-CD sweep low concentrations of DL-NaSSA and (ii) DL-NASSA is stacked by the difference in the viscosity between the PDDAC and sample zone. An approximately 2,800-4000-fold improvement in detection sensitivity was revealed for mirtazapine, N-demethylmirtazapine, and 8-hydroxymirtazapine enantiomers. The linear ranges for the quantification of all analyte enantiomers were 1.2-150 nM, with a coefficient of determination higher than 0.99; the relative standard deviations in the migration time and peak areas for six analytes were less than 1.8% and 5.8%, respectively. The proposed system provided the limits of detection (signal-to-noise ratio of 3) of the six analytes as 0.3-0.5 nM. The recovery of the six separated analytes spiked in urine and serum samples was revealed to be 82.7%-109.5% and 91%-112.8%, respectively. This advanced technique with high sensitivity enhancement factors was successfully employed to analyze mirtazapine and its metabolites enantiomers in urine and serum samples with reliability.

Psychometric Properties of the High-Need Community-Dwelling Older Adults Screening Scale.

This study aimed to verify the factorial structure, internal consistency, test-retest reliability, and discriminant validity of the High-need Community-dwelling Older Adults Screening Scale (HCOASS). A 20-item HCOASS covering five domains was used with a systematic random sample of 818 community-dwelling older adults. After the analyses, the Exploratory Factor Analysis suggested a removal of two items, resulting in 5 domains with 18 items, and the Confirmatory Factor Analysis yielded satisfactory results with Goodness of Fit Index of .98. The HCOASS demonstrated acceptable internal consistency (Kuder-Richardson Formula 20 α = .75) and excellent test-retest reliability (0.94; 95% CI [0.91, 0.97]). The area under the Receiver Operating Characteristic (ROC) curve was 0.90 (95% CI [0.84, 0.95]) and the optimal cut-off score was 4/5. The HCOASS is a valid and reliable screening tool. It has the potential for consistent and efficient administration to be used by non-healthcare professionals in the community.

The individualized supervision strategy and effectiveness under the strength perspective: a pilot study for the case management model of the high-care elderly in communities.

BACKGROUND: This study tried to improve the operational efficiency and service quality of the community case management model for the High-Care Elderly in Communities in Taiwan. This study tried to assistant social workers in community care sites to establish individualized treatment planning, to empower them with flexibility to discover and utilize their own unique strengths, to reach the goal of developing community care capacity. METHODS: A case consulting model was employed in this study by providing case by case supervision service. We collected all supervision meeting records and related data as our qualitative research materials, analyzed these materials and tried to define intervention effectiveness of the individualized supervision strategy under the strength perspective applied to the case management model of the high-care elderly in communities. To find out what helps these social workers the most, and how these social workers realize and recognize their process and key to improve their service quality and work efficiency, in the way of qualitative interpretation. RESULTS: A supervision model under the perspective of strength was developed in this study, and was applied to clinical community care sites to help their social workers. The results proved that our supervision model provided an opportunity to empower and re-know themselves, re-establish their professional confidence and meaning of existence for their organization, and eventually produced positive effect to quality of service and service receiver's satisfaction improvement. The key feature that made this supervision model of the strength perspective work was to let social workers have the autonomy to interpret the challenges they face and to think possible alternative solutions creatively. CONCLUSIONS: This study showed that create a supervisee-friendly psycho-socio environment empowered these workers by increasing their resource network and taking advantage of what they still have and what they were good at, this could help these workers upgrade their level on ladders of empowerment, become an active and independent professional worker that have power and confidence to make treatment and intervention.

Prevalence and demographic characteristics of high-need community-dwelling older adults in Taiwan.

By early screening, the high-need older adults who require multiple care needs and resources can be identified and the necessary assistance can then be provided. However, a precise definition of and related research on high-need older adults are limited. Identifying older adults with high needs is of practical urgency. This study aimed to investigate the prevalence of high-need community-dwelling older adults and to identify the characteristic differences between high-need older adults and those without high needs. This cross-sectional descriptive survey research was conducted between July and December 2018 and used a simple random sampling to select older adults aged 65 and older who had lived in the community for at least 3 months. The High-need Community-dwelling Older Adults Screening Scale was used to identify high-need older adults in the community. A total of 818 community-dwelling older adults were surveyed and the prevalence of high-need older adults was 24.1%. Those screened as high-need older adults (n = 197) were 78.58 (SD = 7.60) years old in average, mostly female, widowed or single but living with someone, had chronic illnesses (M = 2.11, SD = 1.41), an elementary school level of education and religious beliefs. Furthermore, differences were found between older adults with high needs (n = 197) and those without high needs (n = 621) where there is a significantly higher proportion of high-need older adults who were 85 years and older, being male, widowed or single, illiterate, living alone, had chronic illnesses and no religious belief. The high prevalence of high-need community-dwelling older adults highlighted the importance of screening. If community care centres are provided with a comprehensive screening tool for finding high-need older adults during home visits, this would lead to timely identification of older adults with potential needs and enhance the preventive nature of home visits.

Development of a Screening Scale for Community-dwelling Older Adults with Multiple Care Needs.

Objectives: To develop a screening scale for community-dwelling older adults with multiple care needs.Methods: A modified Delphi was employed; 10 experts were invited to evaluate the relevancy, clarity, and suitability of the scale. A descriptive evaluation survey was tested on the screening scale users who were community volunteers to evaluate the clarity, relevance, and usefulness of the scale using a 10-point rating system. Confirmatory factor analysis was applied to determine the suitability of the factorial structure of the HCOASS. The internal consistency was examined using Kuder-Richardson Formula 20. A suitable cutoff point was developed using receiver operating characteristic analysis.Results: In the first round of the modified Delphi, the item-level content validity index (I-CVI) on the content relevance, item clarity, and suitability of the scale were all higher than .90, .80, and .80, respectively. In the second round, the scores for content relevancy, item clarity, and suitability were all 1.0. Community volunteers rated highly on the scale. The result of the confirmatory factor analysis indicated a good fit. The internal consistency reliability was satisfactory. The area under curve (AUC), sensitivity, and specificity for cutoff score of 6/7 were .91, 88%, and 81%, respectively.Conclusions: The screening scale demonstrated adequate reliability, content validity, and discriminant validity.Clinical Implications: The screening scale would serve as a reference for community volunteers in the identification of community-dwelling older adults with multiple care needs.

Systematic Review and Meta-Analysis on Using Acupressure to Promote the Health of Older Adults.

Acupressure is noninvasive, safe, and appropriate for use among older adults. However, there remains little evidence of the common elements that contribute to the effectiveness of acupressure in promoting the health of older adults. A systematic review using meta-analysis was designed to examine the effects of acupressure on the health promotion in older adults. Studies published between 2012 and 2017 were searched for in 11 electronic databases. Acupressure was highly effective for improving sleep quality and cognitive functioning (0.85, 95% confidence interval [CI] = [0.49, 1.22]; 1.23, 95% CI = [0.88, 1.59]). A slight to moderate effect was found in alleviating constipation (0.37, 95% CI = [0.03, 0.71]), and a moderate effect was found for alleviating pain and improving quality of life (0.71, 95% CI = [0.09, 1.32]; 0.59 95% CI = [0.36, 0.82]).

Development of a Care Delivery Model for High-Need Older Adults in the Community.

BACKGROUND: High-need older adults have multiple needs and require different types of care services. Care coordinators in community care centers in Taiwan, however, often experience difficulties in providing sufficient care services because of the inadequate capacity of case management. OBJECTIVE: The aim of this study was to develop a realistic care delivery model for the care coordinators to manage the care of high-need, community-dwelling older adults. METHODS: Focus-group interviews concerning elements and process for establishing a care delivery model were conducted with 12 care management experts in two groups: the practical work group (three registered nurses and three social workers) and the care management group (three care managers and three care management supervisors). The interviews were video-recorded and subjected to content analysis. RESULTS: A five-stage care delivery model was formulated: case screening, case assessment, care plan, care delivery, and follow-up evaluation. Six types of high-need older adults were identified: those living with disability, solitude, dementia, depression, elder abuse, and poverty. A list of categorized care services, including care resources, social welfare resources, and caregiver resources, was then used as a guide for case management and care delivery. DISCUSSION: The developed model-consisting a classification of services for different types of high-need older adults-serves as a guide for care coordinators in community care centers to make better decisions on service linkages, resource management, and care plan monitoring.

Knowledge gap regarding dementia care among nurses in Taiwanese acute care hospitals: A cross-sectional study.

AIM: The quality of dementia care in hospitals is typically substandard. Staff members are underprepared for providing care to older people with dementia. The objective of the present study was to examine dementia care knowledge, attitude and behavior regarding self-education about dementia care among nurses working in different wards. METHODS: This was a descriptive cross-sectional study. The present study was carried out from July 2013 to December 2013. In total, 387 nurses working in different wards were recruited from two hospitals in Taiwan by using convenience sampling. The nurses completed a self-report questionnaire on demographic data, experience and learning behavior, and attitude towards dementia care, and a 16-item questionnaire on dementia care knowledge. Descriptive and inferential statistics were used to analyze the status and differences in dementia care knowledge among nurse in different wards. RESULTS: The average dementia care knowledge score was 10.46 (SD 2.13), with a 66.5% mean accuracy among all nurses. Dementia care knowledge was significantly associated with age, nursing experience, possession of a registered nurse license, holding a bachelor's degree, work unit, training courses and learning behavior towards dementia care. The dementia care knowledge of the emergency room nurses was significantly lower than that of the psychiatric and neurology ward nurses. A significantly lower percentage of emergency room nurses underwent dementia care training and actively searched for information on dementia care, compared with the psychiatric and neurology ward nurses. CONCLUSIONS: Hospital nurses show a knowledge gap regarding dementia care, especially emergency room nurses. Providing dementia care training to hospital nurses, particularly emergency room nurses, is crucial for improving the quality of care for patients with dementia. Geriatr Gerontol Int 2018; 18: 276-285.

Economic and living statuses of community-dwelling older adults and the related factors.

AIM: The health and well-being of older adults are closely related to their economic and living statuses. Socioeconomic inequality has a substantial impact on the healthcare received by these older adults. The present study aimed to understand the current economic and living statuses of community older adults, and examine the relationships among their demographics, economic status and living status. METHODS: This study used a cross-sectional correlational design. Stratified random sampling was applied to recruit 384 community-dwelling older adults. A face-to-face structured questionnaire was used to collect data. RESULTS: The economic and living statuses of older adults were significantly correlated with age, sex, and educational level. Young-old adults were more likely than the oldest-old adults to possess economic power in their households (OR 2.80, P < 0.001). Men were less likely than women to be financially supported by others (OR 0.28, P = 0.001). Participants with a high school education or above were less likely than uneducated participants to be financially supported by others (OR 0.11, P < 0.001); the probability of participants with an elementary school education living alone was 2.65-fold that of uneducated participants (OR 2.65, P = 0.028). CONCLUSIONS: We suggest that in addition to placing its concern over age, the government should focus on older women and uneducated older adults to further refine the current social welfare policies. Geriatr Gerontol Int 2017; 17: 1689-1697.

GH-releasing peptides improve cardiac dysfunction and cachexia and suppress stress-related hormones and cardiomyocyte apoptosis in rats with heart failure.

Growth hormone (GH)-releasing peptides (GHRP), a class of synthetic peptidyl GH secretagogues, have been reported to exert a cardioprotective effect on cardiac ischemia. However, whether GHRP have a beneficial effect on chronic heart failure (CHF) is unclear, and the present work aims to clarify this issue. At 9 wk after pressure-overload CHF was created by abdominal aortic banding in rats, one of four variants of GHRP (GHRP-1, -2, and -6 and hexarelin, 100 mug/kg) or saline was injected subcutaneously twice a day for 3 wk. Echocardiography and cardiac catheterization were performed to monitor cardiac function and obtain blood samples for hormone assay. GHRP treatment significantly improved left ventricular (LV) function and remodeling in CHF rats, as indicated by increased LV ejection fraction, LV end-systolic pressure, and diastolic posterior wall thickness and decreased LV end-diastolic pressure and LV end-diastolic dimension. GHRP also significantly alleviated development of cardiac cachexia, as shown by increases in body weight and tibial length in CHF rats. Plasma CA, renin, ANG II, aldosterone, endothelin-1, and atrial natriuretic peptide were significantly elevated in CHF rats but were significantly decreased in GHRP-treated CHF rats. GHRP suppressed cardiomyocyte apoptosis and increased cardiac GH secretagogue receptor mRNA expression in CHF rats. GHRP also decreased myocardial creatine kinase release in hypophysectomized rats subjected to acute myocardial ischemia. We conclude that chronic administration of GHRP alleviates LV dysfunction, pathological remodeling, and cardiac cachexia in CHF rats, at least in part by suppressing stress-induced neurohormonal activations and cardiomyocyte apoptosis.

Hexarelin protects rat cardiomyocytes from angiotensin II-induced apoptosis in vitro.

Loss of cardiomyocytes by apoptosis is proposed to cause heart failure. Angiotensin II (ANG II), an important neurohormonal factor during heart failure, can induce cardiomyocyte apoptosis. Inasmuch as hexarelin has been reported to have protective effects in this process, we examined whether hexarelin can prevent cardiomyocytes from ANG II-induced cell death. Cultured cardiomyocytes from neonatal rats were stimulated with ANG II. Apoptosis was evaluated using fluorescence microscopy, TdT-mediated dUTP nick-end labeling (TUNEL) method, flow cytometry, DNA laddering, and analysis of cell viability by (3,4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT). It was found that incubation with 0.1 micromol/l ANG II for 48 h increased cardiomyocyte apoptosis. Administration of 0.1 micromol/l hexarelin significantly decreased this ANG II-induced apoptosis and DNA fragmentation and increased myocyte viability. To further investigate the underlying mechanisms, caspase-3 activity assay and mRNA expression of Bax, Bcl-2, and growth hormone secretagogue receptor (GHS-R; the supposed hexarelin binding site) were examined. GHS-R mRNA was abundantly expressed in cardiomyocytes and was upregulated after administration of hexarelin. These results suggest that hexarelin abates cardiomyocytes from ANG II-induced apoptosis possibly via inhibiting the increased caspase-3 activity and Bax expression induced by ANG II and by increasing the expression of Bcl-2, which is depressed by ANG II. Whether the upregulated expression of GHS-R induced by hexarelin is associated with this antiapoptotic effect deserves further investigation.

The positive inotropic and calcium-mobilizing effects of growth hormone-releasing peptides on rat heart.

GH-releasing peptides (GHRP) are synthetic peptides exerting GH-dependent or GH-independent effects via GH secretagogue receptor on many organs, including the heart. The underlying mechanisms of the cardiotropic properties of GHRP are poorly understood. This study investigates these effects of four GHRP in isolated perfused heart preparations and isolated neonatal and adult ventricular myocytes. The calcium response of cardiocytes to GHRP was visualized using confocal microscopy. All tested GHRP facilitated both ventricular contraction and relaxation in a dose-dependent manner, moderately decreasing coronary flow, but not modifying heart rate. GHRP induced a biphasic increase in intracellular free Ca2+ of the cardiocytes, consisting of a transient phase (phase 1), followed by a plateau phase (phase 2). Phase 1 was abolished by pretreatment with thapsigargin, a Ca2+-adenosine triphosphatase inhibitor of the sarcoplasmic reticulum. The phase 2 response was eliminated by removing extracellular free Ca2+, by verapamil, a voltage-gated Ca2+ channel blocker, or by 24-h pretreatment with phorbol 12-myristate 13-acetate, down-regulating protein kinase C. In isolated (denervated) heart, GHRP have a direct cardiotropic, without chronotropic, effect. GHRP elevate myocardial intracellular free Ca2+ through activating Ca2+ influx via voltage-gated Ca2+ channels and triggering Ca2+ release from thapsigargin-sensitive intracellular Ca2+ stores. Protein kinase C mediates the GHRP-induced Ca2+ influx, but not Ca2+ release. These finding support a number of roles for GHRP in the cardiovascular system.