Music therapy for supporting informal carers of adults with life-threatening illness pre- and post-bereavement; a mixed-methods systematic review.

BACKGROUND: Music therapy interventions with informal carers of individuals with life-threatening illness at pre- and post-bereavement is an increasingly important clinical area. This systematic review is the first to synthesise and critically evaluate the international evidence associated with music therapy with adult informal carers pre- and post-bereavement. Specifically, the objectives were: i) to describe the characteristics and effectiveness of music therapy interventions which aim to improve health-related outcomes for adult informal carers of adults with life-threatening illness (pre- and post-bereavement), and ii) to describe the experience of music therapy for adult informal carers of adults with life-threatening illness (pre- and post-bereavement). METHODS: Eligibility: adult informal carers of adults at end of life or bereaved; music therapy interventions for improving health-related outcomes; qualitative; mixed-method; and quantitative studies including comparators of any other intervention; published in English from 1998 onwards. Six databases were searched up to July 2022. A JBI mixed-methods systematic review approach was followed throughout, including quality appraisal, data extraction and a convergent segregated approach to synthesis and integration. RESULTS: A total of 34 studies were included, published between 2003 and 2022. Most were conducted in North America (n = 13), Australia (n = 10), or Europe (n = 8). No studies were conducted in low- and middle-income countries or in the UK. The majority were qualitative (n = 17), followed by quasi-experimental (n = 8), mixed-methods (n = 7) and two RCTs. The majority focused on carers of individuals with dementia (n = 21) or advanced cancer (n = 7). Seventeen studies were purely quantitative or included a quantitative component. During meta-synthesis, findings were aligned to core outcomes for evaluating bereavement interventions in palliative care and previously identified risk factors for complicated grief. Commonly targeted outcomes in quantitative studies included quality of life and mental wellbeing, showing equivocal effectiveness of music therapy with significant and non-significant results. Twenty-two studies either purely qualitative or with a qualitative component underwent meta synthesis and suggested a diverse range of improved pre- and post-bereavement outcomes for informal carers across all core outcomes, and across all risk and protective factors, including psychological, spiritual, emotional, and social outcomes. CONCLUSIONS: Qualitative studies provide moderate to strong evidence for improved health-related outcomes for adult informal carers of adults with life-threatening illness pre-bereavement. Limited studies including those bereaved negates conclusions for the bereavement phase. Comparisons and explanations for effectiveness across quantitative and qualitative studies are equivocal, with a high risk of bias and small samples in the limited number of quantitative studies, demonstrating a need for high-quality RCTs. SYSTEMATIC REVIEW PRE-REGISTRATION: PROSPERO [CRD42021244859].

Costs of fragility hip fractures globally: a systematic review and meta-regression analysis.

Purpose This study was conducted in order to systematically review the costs of hip fractures globally and identify drivers of differences in costs. Methods A systematic review was conducted to identify studies reporting patient level fragility hip fracture costs between 1990 and 2015. We extracted data on the participants and costs from these studies. Cost data concerning the index hospitalisation were pooled, and a meta-regression was used to examine its potential drivers. We also pooled data on the first-year costs following hip fracture and considered healthcare, social care as well as other cost categories if reported by studies. Results One hundred and thirteen studies reported costs of hip fracture based on patient level data. Patients developing complications as well as patients enrolled in intervention arms of comparative studies were found to have significantly higher costs compared to the controls. The pooled estimate of the cost for the index hospitalisation was $10,075. Health and social care costs at 12 months were $43,669 with inpatient costs being their major driver. Meta-regression analysis identified age, gender and geographic region as being significantly associated with the differences in costs for the index hospitalisation. Conclusion Hip fracture poses a significant economic burden and variation exists in their costs across different regions. We found that there was a considerable variation across studies in terms of study design, methodology, follow-up period, costs considered and results reported that highlights the need for more standardisation in this area of research.

Vegetarian diet as a risk factor for symptomatic gallstone disease.

BACKGROUND/OBJECTIVES: Previous small studies have shown either no difference or a lower risk of symptomatic gallstone disease in vegetarians than in non-vegetarians. This study examined the incidence of symptomatic gallstone disease in a cohort of British vegetarians and non-vegetarians, and investigated the associations between nutrient intake and risk of symptomatic gallstone disease. SUBJECTS/METHODS: The data were analysed from 49 652 adults enroled in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Oxford study, one-third of whom were vegetarian. The linked databases of hospital records were used to identify incident cases. Risk by diet group was estimated using Cox proportional hazards models. Further analysis quantified risk by intakes of selected macronutrients. RESULTS: There were 1182 cases of symptomatic gallstone disease during 687 822 person-years of follow-up (mean=13.85 years). There was a large significant association between increasing body mass index (BMI) and risk of developing symptomatic gallstone disease (overall trend P<0.001). After adjustment for BMI and other risk factors, vegetarians had a moderately increased risk compared with non-vegetarians (HR: 1.22; 95% CI: 1.06-1.41; P=0.006). Although starch consumption was positively associated with gallstones risk (P=0.002 for trend), it did not explain the increased risk in vegetarians. CONCLUSIONS: There is a highly significant association of increased BMI with risk of symptomatic gallstone disease. After adjusting for BMI, there is a small but statistically significant positive association between vegetarian diet and symptomatic gallstone disease.

Typology of Ohio, USA, tree farmers based upon forestry outreach needs.

This study differentiated groups of Ohio tree farmers through multivariate clustering of their perceived needs for forest management outreach. Tree farmers were surveyed via a mailed questionnaire. Respondents were asked to rate, on a 1-7 scale, their informational needs for 26 outreach topics, which were reduced to six factors. Based on these factors, three clusters were identified-holistic managers, environmental stewards, and pragmatic tree farmers. Cluster assignment of individuals was dependent upon a tree farmer's age, acreage owned, and number of years enrolled in the American Tree Farm System. Holistic managers showed a greater interest in the outreach topics while pragmatic tree farmers displayed an overall lesser interest. Across clusters, print media and in-person workshops were preferred over emails and webinars for receiving forest management information. In-person workshops should be no more than 1 day events, held on a weekday, during the daytime, at a cost not exceeding $35. Programming related to environmental influences, which included managing for forest insects and diseases, was concluded to have the greater potential to impact clientele among all outreach factors due to the information being applicable across demographics and/or management objectives.

Religiosity and religious coping in patients with cardiovascular disease: change over time and associations with illness adjustment.

Little is known about the longitudinal relationship between religiosity/spirituality (R/S) and patient physical and mental health in patients with cardiovascular disease. Forty-three patients with a first-time myocardial infarction or coronary artery revascularization bypass surgery completed measures of religiosity, religious coping, quality of life (QOL), and weight prior to a cardiac rehabilitation program and 1 and 2 years later. R/S changed over time; the direction of the change varied by type of R/S. Increases in religiosity were associated with increases in weight and QOL; increases in religious coping were associated with decreases in weight and increases in QOL.

Preference of Formosan subterranean termites for blue-stained southern yellow pine sapwood.

Little research has been conducted to investigate interactions between the invasive Formosan subterranean termite, Coptotermes formosanus Shiraki, and pine bark beetles native to the southeastern United States. Facilitative interactions between these organisms could alter stand dynamics and impact wood utilization strategies. American Wood Protection Association Standard E1-09 choice tests were carried out to determine the feeding preference of Formosan subterranean termites for blue-stained versus unstained southern yellow pine sapwood. Three separate colonies of Formosan subterranean termites consumed on average twice as much air-dried blue-stained southern yellow pine sapwood over unstained air-dried controls. Additionally, Formosan subterranean termites consumed over five-times more kiln-dried blue-stained sapwood than unstained kiln-dried control wafers. The implications of these results are particularly relevant to pine forest ecology, nutrient cycling, and the utilization of blue-stained southern pine building products in the southeastern United States, where Formosan subterranean termites have become established.

Oxygen pulse is not predictive of stroke volume in heart failure.

AIM: Stroke volume (SV) is the major cardiovascular discriminator between those that are exercise trained versus untrained individuals and healthy individuals versus those with pathologic left ventricular dysfunction. Furthermore, since the increase in oxygen pulse (O(2)P) (O(2)P=VO(2)/HR?oxygen uptake/heart rate) that occurs with exercise is a function of SV and the arterial-venous oxygen difference (a-vO(2)), O(2)P has been demonstrated a reliable indicator of SV for healthy individuals. Although commonly used as a physiological and clinical marker of SV, the validity of O(2)P as an indicator of SV in patients with heart failure has not been investigated. METHODS: Thirty-one (23 men, 8 women) patients (age: 64+/-7.9; ejection fraction: 24+/-7.8) with chronic heart failure had cardiac output measured during steady-state workloads (25 watts and 75% VO(2peak)) upon entry and again at completion of 12 weeks of exercise training. Four patients were excluded due to clinical complications and 3 because of non-compliance; therefore, 24 patients completed the study. RESULTS: The relationships between SV and O2P are: 1) baseline: SV=11.1+4(O2P), SEE=11.8; r(2)=0.39 and 2) study completion: SV=25.1+2.3(O2P), SEE=12.7; r(2)=0.21. While SV did not increase after 25 watts, O2P continued to increase by 17%, respectively. In addition, there were no training effects on SV or O(2)P. As SV increased, O(2)P underpredicted measured SV. CONCLUSIONS: In patients with heart failure and poor left ventricular function, O(2)P is not recommended as a marker of the SV during exercise.

A review to develop an effective exercise training for heart failure patients.

The patient with heart failure relies on varied physiological adaptations to exercise training. Although, the cardiovascular adaptations may be limited, the patient with heart failure relies on changes in the pulmonary system as well as peripheral muscular adaptations. Therefore, the intent of this review is to outline effective exercise program design and to discuss the effects of exercise training on the patient with heart failure, including cardiovascular, pulmonary, and peripheral musculature adaptations. As a result of exercise training, patients with heart failure can improve their exercise capacity and quality of life, despite no or reduced improvement in central hemodynamics. Respiratory muscle endurance improves with exercise training which contributes to patients' increased exercise capacity, decreased breathlessness, and decreased perception of breathlessness. In addition, peripheral muscle adaptations result in an enhanced ability for oxygen extraction and utilization, a delayed onset of anaerobic metabolism during physical activity, and less fatigue as a result of physical activity and activities of daily living. Many of the physiological sequela associated with reduce functional ability in heart failure patients are correctable with exercise training. The practical implications (and maybe the most important to the patient) of these positive adaptations include less frequent rest periods, lesser overall fatigue, greater confidence to embark on physical tasks, maintenance of independence, and enhanced quality of life.

Measuring energy expenditure in cardiac patients using the Body Media Armband versus indirect calorimetry. A validation study.

AIM: The purpose of this study was to compare differences in energy expenditure using the newly developed SenseWear Armband body monitor to indirect calorimetry in cardiac rehabilitation patients. METHODS: Twenty-four (62+/-8.1 years) patients completed steady state exercise for 8 minutes on 4 modes of exercise (arm ergometry, treadmill walking, recumbent stepping and rowing ergometry). Total cumulative kilojoules were recorded simultaneously by indirect calorimetry and the SenseWear Armband. Statistical analyses assessed the degree of agreement between the 2 measurement methods and 3 different versions of the SenseWear software. RESULTS: The correlations between indirect calorimetry and version 2.2 of the SenseWear armband for arm and rowing ergometry, the treadmill and recumbent stepper were r=0.90, r=0.67, r=0 .80 and r=0.74, respectively. There were no between method differences during arm ergometry (p<1.000) and the recumbent stepper (p<0.102). Bland and Altman plots revealed the greatest spread of scores for the rower and the treadmill. Between method differences were minimal when using the preliminary cardiac software. The correlations for arm and rowing ergometry, the treadmill and recumbent stepper were r=0.90, r=0.84, r=0.78 and r=0.82, respectively. CONCLUSIONS: The accuracy of the BodyMedia SenseWear Armband appears to be exercise modality dependent in those with heart disease when using software developed for the general population. Therefore, the information should be interpreted cautiously, particularly during treadmill walking and rowing. Initial experiments with cardiac-focused software are promising, but preliminary.

Immunologic characterization of the recombinant fire ant venom allergen Sol i 3.

Individuals sensitized to fire ant stings show immunoglobulin (Ig)E antibodies against the venom protein Sol i 3. We determined the full-length complementary DNA (cDNA) sequence of this protein and expressed recombinant Sol i 3 in immunogenic form. The complete cDNA of Sol i 3 was obtained by reverse transcription polymerase chain reaction (RT-PCR) and PCR + 1 reactions using gene-specific oligonucleotides, and oligonucleotides designed from the amino acid sequence of this protein. The encoding cDNA is 705 bp in length corresponding to 235 amino acids. The first 22 amino acids are a leader sequence. The protein with an added C-terminal hexahistidine tag was expressed in insect cells using a baculovirus system. The recombinant protein was secreted into the supernatant and affinity purified with a cobalt chelating resin. The recombinant fire ant venom allergen Sol i 3 showed similar IgE binding activity to the native protein in radioallergosorbent test (RAST) and RAST inhibition assays. It was produced in both a glycosylated and an unglycosylated form. A three-dimensional reconstruction of Sol i 3 was compared with the experimentally determined structure of the related allergen Ves v 5. This model is supported by results of circular dichroism spectroscopy.

Interleukin-2 promotes antigenic reactivity of rested T cells but prolongs the postactivational refractory phase of activated T cells.

IL-2 is a principal autocrine growth factor that promotes T-cell activation and proliferation. However, IL-2 has also been implicated as a key intermediate in the induction and maintenance of self-tolerance in vivo. The purpose of this study was to assess whether the differential regulatory activity of IL-2 was related to the activation status of responder T cells. In cultures of rested myelin basic protein (MBP)-specific T cells, IL-2 not only induced IL-2R alpha but also augmented surface expression of several other activation-associated glycoproteins including OX40, LFA-1, B7.1, B7.2, TCR, and CD4. Pretreatment of T cells with IL-2 also up-regulated subsequent antigen reactivity in assays of MBP-stimulated proliferation and IL-2 production and also promoted proliferative responsiveness to IL-2. In cultures of activated T cells, however, IL-2 inhibited subsequent reactivity to antigen or IL-2 and thereby prolonged a phase of postactivational refractoriness. Exposure of preactivated T cells to IL-2 also inhibited subsequent responses to the mitogenic combination of PMA, ionomycin, and IL-2 without enhancing cell death. These data support the concept that the inhibitory activity of IL-2 is dependent upon the activation status of T cells and is manifest as impaired cell cycle progression in response to a variety of IL-2-dependent stimuli.

Marginal plafond impaction in association with supination-adduction ankle fractures: a report of eight cases.

In five years, approximately 800 ankle fractures were seen at the authors' institution, forty-four (5 percent) of which were of the supination-adduction pattern. Nineteen of these injuries had displaced vertical medial malleolus fractures, of which eight (42 percent) showed marginal impaction of the tibial plafond. All eight patients underwent open reduction and internal fixation with elevation of the impacted articular component and had good to excellent functional outcome with no arthritis on radiograph at the time of the most recent follow-up. The index of suspicion of marginal impaction of the tibial plafond should be high when treating supination-adduction pattern ankle fractures with displaced medial malleolus.

Proximity of the invariant loop of U5 snRNA to the second intron residue during pre-mRNA splicing.

A photoactivatable azidophenacyl group has been introduced into seven positions in the backbone of the 11 nucleotide invariant loop of U5 snRNA. By reconstituting depleted splicing extracts with reassembled U5 snRNP particles, molecular neighbors were assessed as a function of splicing. All cross-links to the pre-mRNA mapped to the second nucleotide downstream of the 5' splice site, and formed most readily when the reactive group was at the phosphate between U5 positions 42 and 43 or 43 and 44. Both their kinetics of appearance and sensitivity to oligonucleotide inhibition suggest that these cross-links capture a late state in spliceosome assembly occurring immediately prior to the first step. A later forming, second cross-linked species is a splicing product of the first cross-link, suggesting that the U5 loop backbone maintains this position through the first step. The proximity of the U5 loop backbone to the intron's 5' end provides sufficient restrictions to develop a three-dimensional model for the arrangement of RNA components in the spliceosome during the first step of pre-mRNA splicing.

Tibial portal placement: the radiographic correlate of the anatomic safe zone.

OBJECTIVE: To identify the radiographic correlate of the anatomic safe zone for tibial portal placement. DESIGN: Cadaveric, anatomic, and radiographic study using twenty cadaveric knees. Kirschner wires were placed in the anatomic safe zone. Anteroposterior and lateral radiographs were taken to evaluate the portal placement. SETTING: Anatomy laboratory. OUTCOME MEASUREMENTS: Radiographic measurements of Kirschner wires placed in the anatomic safe zone. RESULTS: The safe zone for tibial nail placement as seen on radiographs is just medial to the lateral tibial spine on the anteroposterior radiograph and immediately adjacent and anterior to the articular surface as visualized on the lateral radiograph. There is some variance on the anteroposterior radiograph but no variance on the lateral radiograph. CONCLUSIONS: The placement of tibial nails in the superior portion of the tibia in the documented position generates the least risk to the intraarticular structures of the knee.

Preoperative dobutamine stress echocardiography versus cardiac arteriography for risk assessment prior to renal transplantation.

Because coronary artery disease is the leading cause of death in patients with end-stage renal disease, we prospectively studied the prognostic value of dobutamine stress echocardiography (DSE) compared to coronary angiography (CA) as an evaluative tool. Thirty-three patients at high risk for coronary artery disease were selected from a cohort of 133 renal transplant candidates and underwent both DSE and CA. In this study, the value of DSE was found to exist in its strong negative predictive value (92%). A negative DSE coupled with a negative clinical cardiac evaluation was found to practicably exclude the necessity for CA. DSE can thus serve as a non-invasive, low cost screening test.

Isolated tibial shaft fracture.

A nineteen-year-old otherwise healthy woman is seen in the emergency room after being struck by a car. The patient reports left lower extremity pain and has no other injuries. Exam shows a Tscherne grade I soft tissue injury with otherwise normal motor and sensory exam. There are no signs of compartment syndrome. A closed reduction was performed.

MHC class II A genes in the channel catfish (Ictalurus punctatus).

In order to characterize the Major histocompatibility complex (MHC) class II A genes of the channel catfish (Ictalurus punctatus) a cDNA library was screened and PCR was performed. Four different full-length cDNA sequences for MHC class II A genes were obtained from a clonal B cell line derived from an outbred fish. Two different genomic sequences and corresponding cDNAs were obtained from a presumably homozygous gynogenetic catfish. The A genes have five exons and four phase one introns. The first exon encodes the 5' untranslated region (UTR) and leader peptide; the second and third exons encode the alpha1 and alpha2 domains, respectively. The connecting peptide, transmembrane and cytoplasmic domains, as well as part of the 3' UTR, are encoded by the fourth exon and the rest of the 3' UTR is encoded by the fifth exon. Southern blot analyses using an exon three probe revealed two to four hybridizing fragments with considerable restriction fragment length polymorphisms evident among randomly selected outbred channel catfish. These findings are consistent with the presence of at least two functional polymorphic MHC class II A gene loci. An unusual aspect of the channel catfish MHC class II alpha chain is its lack of N-linked glycosylation sites.