Situational awareness in the outpatient encounter between patients with breast cancer or malignant melanoma and healthcare professionals: Patients' perceptions.

AIMS AND OBJECTIVES: To explore patients' experiences of situational awareness in the outpatient encounter when they are informed about the diagnosis of breast cancer or malignant melanoma. BACKGROUND: Patients enter a stressful situation when receiving a diagnosis of breast cancer or malignant melanoma, and research indicates that needs are most prominent at this time. However, healthcare professionals often fail to address these needs adequately. It is unclear how patients experience situational awareness practised to meet their fundamental needs in the encounter when they are informed about the diagnosis of cancer. DESIGN: This study used a phenomenological hermeneutical approach. METHODS: Nine semi-structured interviews with patients being diagnosed with breast cancer or malignant melanoma were performed. The interpretation theory of Paul Ricoeur guided the analysis. The study is presented in line with the COREQ checklist. RESULTS: The analysis resulted in three themes: 1) "Being accompanied" refers to how patients need information to be targeted to them as individuals. 2) "Being seen" points to HCPs' exploration of the patients' perspectives to get an understanding of their preferences. 3) "Being taken care of" indicates that patients feel supported if situational awareness is practised by the healthcare professionals. CONCLUSION: Practicing situational awareness in the outpatient encounter is essential to patients' experience of feeling accommodated or rejected. Patients feel rejected when their fundamental needs are not met while experiencing situational awareness seems to accommodate fundamental needs and pre-empt an inappropriate patient outcome. RELEVANCE TO CLINICAL PRACTICE: HCPs need to acknowledge the importance of using a structured approach to meeting patients' fundamental needs in a stressful situation. Each patient is different and may experience different needs in encounters where they are receiving the diagnosis of breast cancer or malignant melanoma. Therefore, treatment and care must be tailored to the individual patient based on a caring relationship.

Electromyographic Comparison of Squats Using Constant or Variable Resistance.

Andersen, V, Fimland, MS, Kolnes, MK, Jensen, S, Laume, M and Saeterbakken, AH. Electromyographic comparison of squats using constant or variable resistance. J Strength Cond Res 30(12): 3456-3463, 2016-The aim of the study was to compare the electromyographic (EMG) activity of vastus lateralis, vastus medialis, rectus femoris, and biceps femoris when performing the squat with constant resistance or variable resistance with 2 or 4 elastic bands, respectively, contributing with a mean of 39 and 73% of the total loads. Nineteen resistance-trained women performed 6 repetition maximum using 3 different experimental conditions: free weights (FW), free weights + 2 elastic bands (FW + 2EB), and free weights + 4 elastic bands (FW + 4EB). During analyses, each repetition was divided into 6 phases: upper (more extended knee), middle, and lower phase of the descending and ascending movements. Increased activation in the upper parts of the movement was observed for both variable resistance conditions compared with constant resistance (9-51%, p < 0.001-0.050). Further, a dose-response effect of variable resistance was observed in the upper ascending movement, with 4 elastic bands increasing muscle activation more than 2 elastic bands (7-28%, p = 0.003-0.007). For the whole movement, a 12% higher activation of the biceps femoris was observed for FW + 4EB compared with FW (p = 0.005). There were no differences between the other conditions in any of the muscles (p = 0.077-1.000). In conclusion, performing the squat using free weights in combination with elastic bands seems to be preferable compared with free weights alone and more so with a high contribution from variable resistance to the total load.

Adolescents' Lived Experiences While Hospitalized After Surgery for Ulcerative Colitis.

Adolescents are in a transitional phase of life characterized by major physical, emotional, and psychological challenges. Living with ulcerative colitis is experienced as a reduction of their life quality. Initial treatment of ulcerative colitis is medical, but surgery may be necessary when medical treatment ceases to have an effect. No research-based studies of adolescents' experience of the hospital period after surgery for ulcerative colitis exist. The objective of the study was to identify and describe adolescents' lived experiences while hospitalized after surgery for ulcerative colitis. This qualitative study was based on interviews with eight adolescents. Analysis and interpretation were based on a hermeneutic interpretation of meaning. Three themes were identified: Body: Out of order; Seen and understood; and Where are all the others? The adolescents experience a postoperative period characterized by physical and mental impairment. Being mentally unprepared for such challenges, they shun communication and interaction. The findings demonstrate the importance of individualized nursing care on the basis of the adolescent's age, maturity, and individual needs. Further study of adolescent patients' hospital stay, focusing on the implications of being young and ill at the same time, is needed.

The deposition and characterization of starch in Brachypodium distachyon.

Brachypodium distachyon is a non-domesticated cereal. Nonetheless, Brachypodium was recently introduced as a model plant for temperate cereals. This study compares grain starch metabolism in Brachypodium and barley (Hordeum vulgare). In Brachypodium, we identified and annotated 28 genes involved in starch metabolism and identified important motifs including transit peptides and putative carbohydrate-binding modules (CBMs) of the families CBM20, CBM45, CBM48, and CBM53. Starch content was markedly lower in Brachypodium grains (12%) compared to barley grains (47%). Brachypodium starch granules were doughnut shaped and bimodally distributed into distinct small B-type (2.5-10 µm) and very small C-type (0.5-2.5 µm) granules. Large A-type granules, typical of cereals, were absent. Starch-bound phosphate, important for starch degradation, was 2-fold lower in Brachypodium compared with barley indicating different requirements for starch mobilization. The amylopectin branch profiles were similar and the amylose content was only slightly higher compared with barley cv. Golden Promise. The crystallinity of Brachypodium starch granules was low (10%) compared to barley (20%) as determined by wide-angle X-ray scattering (WAXS) and molecular disorder was confirmed by differential scanning calorimetry (DSC). The expression profiles in grain for most genes were distinctly different for Brachypodium compared to barley, typically showing earlier decline during the course of development, which can explain the low starch content and differences in starch molecular structure and granule characteristics. High transitory starch levels were observed in leaves of Brachypodium (2.8% after 14h of light) compared to barley (1.9% after 14h of light). The data suggest important pre-domesticated features of cereals.

Concerted suppression of all starch branching enzyme genes in barley produces amylose-only starch granules.

BACKGROUND: Starch is stored in higher plants as granules composed of semi-crystalline amylopectin and amorphous amylose. Starch granules provide energy for the plant during dark periods and for germination of seeds and tubers. Dietary starch is also a highly glycemic carbohydrate being degraded to glucose and rapidly absorbed in the small intestine. But a portion of dietary starch, termed "resistant starch" (RS) escapes digestion and reaches the large intestine, where it is fermented by colonic bacteria producing short chain fatty acids (SCFA) which are linked to several health benefits. The RS is preferentially derived from amylose, which can be increased by suppressing amylopectin synthesis by silencing of starch branching enzymes (SBEs). However all the previous works attempting the production of high RS crops resulted in only partly increased amylose-content and/or significant yield loss. RESULTS: In this study we invented a new method for silencing of multiple genes. Using a chimeric RNAi hairpin we simultaneously suppressed all genes coding for starch branching enzymes (SBE I, SBE IIa, SBE IIb) in barley (Hordeum vulgare L.), resulting in production of amylose-only starch granules in the endosperm. This trait was segregating 3:1. Amylose-only starch granules were irregularly shaped and showed peculiar thermal properties and crystallinity. Transgenic lines retained high-yield possibly due to a pleiotropic upregualtion of other starch biosynthetic genes compensating the SBEs loss. For gelatinized starch, a very high content of RS (65 %) was observed, which is 2.2-fold higher than control (29%). The amylose-only grains germinated with same frequency as control grains. However, initial growth was delayed in young plants. CONCLUSIONS: This is the first time that pure amylose has been generated with high yield in a living organism. This was achieved by a new method of simultaneous suppression of the entire complement of genes encoding starch branching enzymes. We demonstrate that amylopectin is not essential for starch granule crystallinity and integrity. However the slower initial growth of shoots from amylose-only grains may be due to an important physiological role played by amylopectin ordered crystallinity for rapid starch remobilization explaining the broad conservation in the plant kingdom of the amylopectin structure.

A randomized trial on the efficacy of split-body versus full-body resistance training in non-resistance trained women.

BACKGROUND: The aim of this study was to assess the efficacy of a 12-week upper/lower split- versus a full-body resistance training program on maximal strength, muscle mass and explosive characteristics. Fifty resistance untrained women were pair-matched according to baseline strength and randomized to either a full-body (FB) routine that trained all of the major muscle groups in one session twice per week, or a split-body program (SPLIT) that performed 4 weekly sessions (2 upper body and 2 lower body). Both groups performed the same exercises and weekly number of sets and repetitions. Each exercise was performed with three sets and 8-12 repetition maximum (RM) loading. Study outcomes included maximal strength, muscle mass, jump height and maximal power output. RESULTS: No between-group differences were found in any of the variables. However, both FB and SPLIT increased mean 1-RM from pre- to post-test in the bench press by 25.5% versus 30.0%, lat pulldown by 27.2% versus 26.0% and leg press by 29.2% versus 28.3%, respectively. Moreover, both FB and SPLIT increased jump height by 12.5% versus 12.5%, upper-body power by 20.3% versus 16.7% and muscle mass by 1.9% versus 1.7%, p < 0.01, respectively. CONCLUSIONS: This study did not show any benefits for split-body resistance-training program compared to full-body resistance training program on measures of maximal- and explosive muscle strength, and muscle mass. TRIAL REGISTRATION: ISRCTN81548172, registered 15. February 2022.

Training induces scapular dyskinesis in pain-free competitive swimmers: a reliability and observational study.

OBJECTIVE: Scapular dyskinesis is a major etiological factor in overhead athletes' shoulder problems. Our hypotheses were to evaluate if (1) visual observation of scapular dyskinesis during scaption has substantial interobserver reliability, and (2) scapular dyskinesis may be induced by swim training in pain-free swimmers. DESIGN: A reliability and observational study. SETTING: Bachelor project at a college institution and at a private sports orthopedic hospital. PARTICIPANTS: Seventy-eight competitive swimmers with no history of shoulder pain were included in the study. Fourteen swimmers were evaluated regarding reliability. Inclusion criteria were competitive swimmers with high training volume who previously had no shoulder pain. INTERVENTIONS: Observations of scapular dyskinesis (yes/no) during simple scaption. The interobserver reliability of scaption and wall push-up was evaluated in 14 swimmers using kappa analysis. MAIN OUTCOME MEASURES: Prevalence of scapular dyskinesis at 4 time intervals during a swim training session. RESULTS: The scaption test resulted in a weighted kappa value of 0.75. Scapular dyskinesis was seen in 29 shoulders (37%) after the first time interval, in another 24 (cumulated prevalence 68%) after one-half of the training session, and in an additional 4 swimmers (cumulated prevalence 73%) after three-quarters of the training session. During the last quarter of the training session, another 7 swimmers had dyskinesis, resulting in a cumulated prevalence of 82%. CONCLUSIONS: The prevalence of abnormal scapular kinesis during a normal training session is high in previously pain-free swimmers. The prevalence increases with more training and occurs early during the training session.

Consensus multivariate methods in gas chromatography mass spectrometry and denaturing gradient gel electrophoresis: MHC-congenic and other strains of mice can be classified according to the profiles of volatiles and microflora in their scent-marks.

House mice (Mus domesticus) communicate using scent-marks, and the chemical and microbial composition of these 'extended phenotypes' are both influenced by genetics. This study examined how the genes of the major histocompatibility complex (MHC) and background genes influence the volatile compounds (analysed with Gas Chromatography Mass Spectrometry or GC/MS) and microbial communities (analysed using Denaturating Gradient Gel Electrophoresis or DGGE) in scent-marks produced by congenic strains of mice. The use of Consensus Principal Components Analysis is described and shows relationships between the two types of fingerprints (GC/MS and DGGE profiles). Classification methods including Support Vector Machines and Discriminant Partial Least Squares suggest that mice can be classified according to both background strain and MHC-haplotype. As expected, the differences among the mice were much greater between strains that vary at both MHC and background loci than the congenics, which differ only at the MHC. These results indicate that the volatiles in scent-marks provide information about genetic similarity of the mice, and support the idea that the production of these genetically determined volatiles is influenced by commensal microflora. This paper describes the application of consensus methods to relate two blocks of analytical data.

Identification and characterization of Dekkera bruxellensis, Candida pararugosa, and Pichia guilliermondii isolated from commercial red wines.

Yeast isolates from commercial red wines were characterized with regards to tolerances to molecular SO(2), ethanol, and temperature as well as synthesis of 4-ethyl-phenol/4-ethyl-guaiacol in grape juice or wine. Based on rDNA sequencing, nine of the 11 isolates belonged to Dekkera bruxellensis (B1a, B1b, B2a, E1, F1a, F3, I1a, N2, and P2) while the other two were Candida pararugosa (Q2) and Pichia guilliermondii (Q3). Strains B1b, Q2, and Q3 were much more resistant to molecular SO(2) in comparison to the other strains of Dekkera. These strains were inoculated (10(3)-10(4)cfu/ml) along with lower populations of Saccharomyces (<500 cfu/ml) into red grape juice and red wine incubated at two temperatures, 15 degrees C and 21 degrees C. Although Saccharomyces quickly dominated fermentations in grape juice, B1b and Q2 grew and eventually reached populations >10(5)cfu/ml. In wine, Q3 never entered logarithmic growth and quickly died in contrast to Q2 which survived >40 days after inoculation. B1b grew well in wine incubated at 21 degrees C while slower growth was observed at 15 degrees C. Neither Q2 nor Q3 produced 4-ethyl-phenol or 4-ethyl-guaiacol, unlike B1b. However, lower concentrations of volatile phenols were present in wine incubated at 15 degrees C compared to 21 degrees C.

Completeness and data validity in the Danish Achilles tendon Database.

INTRODUCTION: Acute Achilles tendon rupture is a severe injury causing functional deficits and sick leave. Data from the Danish Achilles tendon Database (DADB) can help us monitor and optimise treatment. The aim of this study was to investigate the completeness and data validity in the DADB. METHODS: The study was performed as a registry study comparing data in the DADB with data from patient records. Data were collected from three of 11 hospitals registered in the DADB. The study was conducted from 1 January to 31 December 2016. A completeness of 80% was considered satisfactory, and a parameter was valid if there was agreement between the DADB and the patient record in 80% of the cases. RESULTS: Overall, completeness was 77% (155/201); for the non-operated patients 81% (150/185) and the operated patients 31% (5/16). The seven investigated parameters all showed a validity of 83-100%. CONCLUSIONS: This study documented a satisfactory completeness of data on the non-operated patients registered in the DADB and an unsatisfactory completeness of data on operated patients. All investigated parameters were valid. These results suggest that data in the DADB on non-operated patients can contribute to research within the field. Due to a limited sample on operated patients, conclusions should be made with caution. The logistics concerning data collection among operated patients warrants optimisation. FUNDING: not relevant. TRIAL REGISTRATION: The study was approved by the Danish Data Protection Agency and the Danish Patient Safety Authority.

Murine scent mark microbial communities are genetically determined.

Scent marking in mice allows males to communicate information such as territory ownership, male competitive ability and current reproductive, nutritional, social and health status. It has been suggested that female mice eavesdrop on these olfactory cues, using them as a means of selecting mates with dissimilar major histocompatibility complex (MHC) genes, known as H2 in mice. The mechanisms underpinning MHC-dependent olfactory communication remain unresolved. Using congenic mouse strains and molecular methods we explore the involvement of the microbial communities, a known source of odourants, in scent marks to test the hypothesis that the microbial communities and hence the olfactory signals are genetically determined. Here we show that the indigenous microbial community of murine scent marks is genetically determined. Both background genotype and H2 haplotype influence the community structure of the scent mark flora, removing the possibility that community composition is solely orchestrated by the MHC. Qualitative and quantitative components of the bacterial community associated with MHC haplotype and background genotype were identified. The analyses confirm that the four groups of congenic mice tested are distinguishable on basis of the microbiology of their scent marks alone, strengthening the role of microorganisms in the development of MHC-dependent odours.

Cost-effectiveness of case-based training for primary care physicians in evidence-based medicine of patients with coronary heart disease.

BACKGROUND: We have shown that a case-based training programme for general practitioners, aimed to implement evidence-based care of patients at very high risk of coronary death, was associated with decreased mortality. In the present study we assessed long-term cost-effectiveness of this programme. DESIGN: Registry-based long-term cost-effectiveness analysis on a clinical trial. METHODS: Costs of the programme, health care, drugs and added years of life were included. Costs were adjusted to 2012 level and discounted by 3%. Life-years gained were estimated as the difference between the survival curves of the trial. The effectiveness measure, quality adjusted life-years (QALYs), was constructed by multiplying each life-year with a quality of life weight corresponding to the health status of that year. QALYs were also discounted by 3%. Incremental cost-effectiveness ratio (ICER) was estimated as the incremental cost per QALY gained. RESULTS: The number of undiscounted life-years gained was 365 days in the intervention group as compared to control (p = 0.02). The number of discounted QALYs gained was 0.66. The net increase in total costs was estimated as 17,862 € when costs of added years of life were included and 4621 € exclusive of these costs. This implied an ICER of 27,063 € per gained QALY. This ICER is well below commonly used threshold values of the societal willingness to pay for a QALY. CONCLUSIONS: The results show that a case-based training programme of general practitioners is a cost-effective way to save years of life in patients with very high risk of coronary death.

Levanase from Bacillus subtilis hydrolyses ß-2,6 fructosyl bonds in bacterial levans and in grass fructans.

A Levanase, LevB, from Bacillus subtilis 168, was expressed as a His6-tagged protein in Escherichia coli. The enzyme was purified and characterised for its activity and substrate specificity. LevB has a pH optimum of 6.0-6.5 and a maximum observed specific activity of 3 U mg(-1) using levan from Erwinia herbicola as substrate. Hydrolysis products were analysed by HPAEC, TLC, and NMR using chicory root inulin, mixed linkage fructans purified from ryegrass (Lolium perenne) and levan from E. herbicola as substrates. This revealed that LevB is an endolevanase that selectively cleaves the (ß-2,6) fructosyl bonds and does not hydrolyse inulin. Ryegrass fructans and bacterial levan was hydrolysed partially releasing oligosaccharides, but together with exoinulinase, LevB hydrolysed both ryegrass fructans and bacterial levan to near completion. We suggest that LevB can be used as a tool to achieve more structural information on complex fructans and to achieve complete degradation and quantification of mixed linkage fructans.

Structural and physical properties of granule stabilized starch obtained by branching enzyme treatment.

Chemical cross-linking of starch is an important modification used in the industry for granule stabilization. It has been demonstrated that treatment with branching enzyme (BE) can stabilize the granular structure of starch and such treatment thereby provides a potential clean alternative for chemical modification. This study demonstrates that such BE-assisted stabilization of starch granules led to partial protection from BE catalysis of both amylose (AM) and amylopectin (AP) in their native state as assessed by triiodide complexation, X-ray diffractometry (XRD) and differential scanning calorimetry (DSC). The granule stabilizing effects were inversely linked to hydration of the starch granules, which was increased by the presence of starch-phosphate esters and suppressed by extreme substrate concentration. The data support that the granule stabilization is due to the intermolecular transglycosylation occurring in the initial stages of the reaction prior to AM-AP phase separation. The enzyme activity needed to obtain granule stabilization was therefore dependent on the hydration capability of the starch used.

[Severe diarrhea after the original well-functioning percutaneous endoscopic gastrostomy tube was replaced by a Mic-Key button]. / Svaer diaré efter skift fra velfungerende perkutan endoskopisk gastrostomisonde til Mic-key-knap.

We report two cases of colocutaneous fistula as a complication of percutaneous endoscopic gastrostomy (PEG) in small children. Both children developed severe osmotic diarrhoea immediately after the original PEG tube was replaced by a Mic-Key button which subsequently migrated to the colon.

Characterization of the Sulfolobus host-SSV2 virus interaction.

The Sulfolobus spindle virus, SSV2, encodes a tyrosine integrase which furthers provirus formation in host chromosomes. Consistently with the prediction made during sequence analysis, integration was found to occur in the downstream half of the tRNA(Gly) (CCC) gene. In this paper we report the findings of a comparative study of SSV2 physiology in the natural host, Sulfolobus islandicus REY15/4, versus the foreign host, Sulfolobus solfataricus, and provide evidence of differently regulated SSV2 life cycles in the two hosts. In fact, whereas a significant induction of SSV2 replication takes place during the growth of the natural host REY15/4, the cellular content of SSV2 DNA remains fairly low throughout the incubation of the foreign host. The accumulation of episomal DNA in the former case cannot be traced to decreased packaging activity because of a simultaneous increase in the virus titre in the medium. In addition, the interaction between SSV2 and its natural host is characterized by the concurrence of host growth inhibition and the induction of viral DNA replication. When this virus-host interaction was investigated using S. islandicus REY15A, a strain which is closely related to the natural host, it was found that the SSV2 replication process was induced in the same way as in the natural host REY15/4.

Model of microtine cycles caused by lethal toxins in non-preferred food plants.

A recent model of microtine cycles has hypothesized that plant chemical defences can drive the precipitous decline phase, through periodic lethal toxin production (PLTP) by non-preferred plant foods. Here we enumerate possible mechanisms using a previously published model of optimal foraging by one consumer (microtine rodent) of two types of food plant (1 preferred and 1 non-preferred). Rate constants for each of the model parameters were sought from the extensive literature on vole cycles. For a range of likely values of input parameters, we evaluated model fit by applying five empirically derived criteria for cyclic behaviour. These were: cycles with a period length of 2-5 yr, peak densities of 100-350 voles per ha and trough densities of 0-25 ha(-1), ratio of peak to trough densities of 10-100, and the occurrence of a catastrophic collapse in the vole population followed by a prolonged low phase. In contrast to previous models of food-induced microtine cycles, the optimal foraging model successfully reproduced the first four criteria and the prolonged low phase. The criterion of population collapse was met if the non-preferred food began producing lethal toxins at a threshold grazing intensity, as predicted by PLTP. Fewer criteria could be met in variations on the model, in which the non-preferred food was equally as nutritious as the preferred food or was continuously toxic.

Novel RepA-MCM proteins encoded in plasmids pTAU4, pORA1 and pTIK4 from Sulfolobus neozealandicus.

Three plasmids isolated from the crenarchaeal thermoacidophile Sulfolobus neozealandicus were characterized. Plasmids pTAU4 (7,192 bp), pORA1 (9,689 bp) and pTIK4 (13,638 bp) show unusual properties that distinguish them from previously characterized cryptic plasmids of the genus Sulfolobus. Plasmids pORA1 and pTIK4 encode RepA proteins, only the former of which carries the novel polymerase-primase domain of other known Sulfolobus plasmids. Plasmid pTAU4 encodes a mini-chromosome maintenance protein homolog and no RepA protein; the implications for DNA replication are considered. Plasmid pORA1 is the first Sulfolobus plasmid to be characterized that does not encode the otherwise highly conserved DNA-binding PlrA protein. Another encoded protein appears to be specific for the New Zealand plasmids. The three plasmids should provide useful model systems for functional studies of these important crenarchaeal proteins.

Lateral sphincteromyotomy in patients with outlet obstruction after surgery for Hirschsprung's disease and short-segment disease.

The results of lateral sphincteromyotomy (LSM) including the external sphincter in patients with severe outlet obstruction (OO) and constipation refractory to medical treatment after surgery for Hirschsprung's disease (HD) or with short-segment disease were evaluated. The parents filled out a detailed questionnaire on the child's bowel habits prior to surgery and at follow-up 2-26 months after surgery. The postoperative questionnaire included a 10-grade visual analog scale (VAS) indicating the general effect of LSM on the child's bowel habits: grade 1 represented no change at all and 10 represented an excellent result with normal bowel habits. 15 (65%) of the 23 patients had a VAS score of 7 or more, and 7 were reported to have normal bowel habits. Patients with a previous Soave operation did better compared to patients with short-segment disease (SSD). In 2 patients (Soave's operation) with scores of 1 and 2, respectively, a sigmoidostomy was performed 4 and 6 months after the LSM. High-dose laxatives and/or enemas have been used in the 5 patients with scores of 3-5. One patient developed a perianal abscess and one experienced minor soiling. LSM including the whole sphincter complex thus gave significant symptomatic relief in two-thirds of the patients. However, the long-term results are still pending.