Litter pollution is a global environmental problem that occurs in virtually all ecosystems. Scientific research on anthropogenic litter and its environmental impacts focusses predominantly on ...plastics and the marine environment. Little empirical knowledge exists about the distribution and ecological impacts of litter in terrestrial environments, where most litter is produced. To start closing that knowledge gap, we investigated the distribution of litter in a cultural landscape in central Norway and in relation to land cover types. We registered and collected litter in 110 survey plots that were randomly stratified across various land cover types. Our results show that land cover type modulates the occurrence, abundance, fragments size, and that litter is most present and abundant in or near land cover types associated with high human activities. Plastic was by far the most common litter material type, although the litter community (in terms of materials type) was not independent from land cover type. This knowledge can help to inform and optimize litter management and clean-up activities in terrestrial landscapes. How and to what extent the spatial structure of the litter community mediates ecological effects across various land cover types remains unknown to a large extent and warrants further study.
Objective To determine whether a systematic approach to the treatment of pain can reduce agitation in people with moderate to severe dementia living in nursing homes.Design Cluster randomised ...controlled trial.Setting 60 clusters (single independent nursing home units) in 18 nursing homes within five municipalities of western Norway.Participants 352 residents with moderate to severe dementia and clinically significant behavioural disturbances randomised to a stepwise protocol for the treatment of pain for eight weeks with additional follow-up four weeks after the end of treatment (33 clusters; n=175) or to usual treatment (control, 27 clusters; n=177).Intervention Participants in the intervention group received individual daily treatment of pain for eight weeks according to the stepwise protocol, with paracetamol (acetaminophen), morphine, buprenorphine transdermal patch, or pregabaline. The control group received usual treatment and care.Main outcome measures Primary outcome measure was agitation (scores on Cohen-Mansfield agitation inventory). Secondary outcome measures were aggression (scores on neuropsychiatric inventory-nursing home version), pain (scores on mobilisation-observation-behaviour-intensity-dementia-2), activities of daily living, and cognition (mini-mental state examination).Results Agitation was significantly reduced in the intervention group compared with control group after eight weeks (repeated measures analysis of covariance adjusting for baseline score, P<0.001): the average reduction in scores for agitation was 17% (treatment effect estimate −7.0, 95% confidence interval −3.7 to −10.3). Treatment of pain was also significantly beneficial for the overall severity of neuropsychiatric symptoms (−9.0, −5.5 to −12.6) and pain (−1.3, −0.8 to −1.7), but the groups did not differ significantly for activities of daily living or cognition.Conclusion A systematic approach to the management of pain significantly reduced agitation in residents of nursing homes with moderate to severe dementia. Effective management of pain can play an important part in the treatment of agitation and could reduce the number of unnecessary prescriptions for psychotropic drugs in this population.Trial registration ClinicalTrials.gov NCT01021696 and Norwegian Medicines Agency EudraCTnr 2008-007490-20.
Abstract
Context
Graves disease (GD) is one of the most common autoimmune disorders. Recent literature has shown an immune response involving several different inflammatory related proteins in these ...patients.
Objective
This work aimed to characterize the kynurenine pathway, activated during interferon-γ (IFN-γ)–mediated inflammation and cellular (T-helper type 1 Th1 type) immunity, in GD patients with and without thyroid eye disease (TED).
Methods
We analyzed 34 biomarkers by mass spectrometry in serum samples from 100 patients with GD (36 with TED) and 100 matched healthy controls. The analytes included 10 metabolites and 3 indices from the kynurenine pathway, 6 microbiota-derived metabolites, 10 B-vitamers, and 5 serum proteins reflecting inflammation and kidney function.
Results
GD patients showed significantly elevated levels of 7 biomarkers compared with healthy controls (omega squared ω2 > 0.06; P < .01). Of these 7, the 6 biomarkers with the strongest effect size were all components of the kynurenine pathway. Factor analysis showed that biomarkers related to cellular immunity and the Th1 responses (3-hydroxykynurenine, kynurenine, and quinolinic acid with the highest loading) were most strongly associated with GD. Further, a factor mainly reflecting acute phase response (C-reactive protein and serum amyloid A) showed weaker association with GD by factor analysis. There were no differences in biomarker levels between GD patients with and without TED.
Conclusion
This study supports activation of IFN-γ inflammation and Th1 cellular immunity in GD, but also a contribution of acute-phase reactants. Our finding of no difference in systemic activation of the kynurenine pathway in GD patients with and without TED implies that the local Th1 immune response in the orbit is not reflected systemically.
Background: Post‐operative urinary retention (POUR) is most accurately determined by using ultrasound to measure bladder volume. The aim of this study was to define the risk factors of POUR in the ...recovery room in hospitalised patients.
Methods: An ultrasound‐determined bladder volume ≥400 ml at arrival in the recovery room was used to define POUR. Multivariate regression analysis was used to identify patient and system factors linked to POUR in 773 consecutive hospitalised patients who had undergone orthopaedic, abdominal, gynaecological or plastic surgery without an indwelling urinary catheter.
Results:
We found the incidence of POUR to be 13%. The lack of pre‐operative voiding, use of regional anaesthesia, anaesthesia time >2 h and emergency surgery were all independent risk factors for POUR.
Conclusions: The detected incidence of POUR at arrival in the recovery room was rather high but had easily identifiable risk factors. We recommend pre‐operative voiding whenever possible. Routine bladder scanning at arrival in the recovery room should be considered, especially after spinal anaesthesia, emergency surgery or when the anaesthesia time exceeds 2 h.
A novel full-length cDNA that encodes for the Atlantic cod (Gadus morhua L.) PepT1-type oligopeptide transporter has been cloned. This cDNA (named codPepT1) was 2,838 bp long, with an open reading ...frame of 2,190 bp encoding a putative protein of 729 amino acids. Comparison of the predicted Atlantic cod PepT1 protein with zebrafish, bird and mammalian orthologs allowed detection of many structural features that are highly conserved among all the vertebrate proteins analysed, including (1) a larger than expected area of hydrophobic amino acids in close proximity to the N terminus; (2) a single highly conserved cAMP/cGMP-dependent protein kinase phosphorylation motif; (3) a large N-glycosylation-rich region within the large extracellular loop; and (4) a conserved and previously undescribed stretch of 8-12 amino acid residues within the large extracellular loop. Expression analysis at the mRNA level indicated that Atlantic cod PepT1 is mainly expressed at intestinal level, but that it is also present in kidney and spleen. Analysis of its regional distribution along the intestinal tract of the fish revealed that PepT1 is ubiquitously expressed in all segments beyond the stomach, including the pyloric caeca, and through the whole midgut. Only in the last segment, which included the hindgut, was there a lower expression. Atlantic cod PepT1, the second teleost fish PepT1-type transporter documented to date, will contribute to the elucidation of the evolutionary and functional relationships among vertebrate peptide transporters. Moreover, it can represent a useful tool for the study of gut functional regionalization, as well as a marker for the analysis of temporal and spatial expression during ontogeny.
Abstract
Background
Earlier observations in the era of femoral procedures using warfarin as the anticoagulant agent have shown safety following same day discharge after elective percutaneous coronary ...intervention (PCI) for stable coronary artery disease (CAD). Procedures have evolved with most European centres adopting radial procedures with corresponding improvement in technique and equipment. Adoption of “radial lounges” has improved and simplified the observation routines with early ambulation. Antiplatelet therapy has also become more efficacious. The safety of same day discharge has been demonstrated. The economic benefit of such a strategy is significant with reported cost reductions of approximately 50%. Patient reported satisfaction is also shown to be comparable to standard care.
The current bed availability in health care facilities has made it a necessity to explore measures to reduce bed occupancy rates. Reduction in bed occupancy can further permit health personell to focus on other duties and obligations in wards with patients requiring hospitalization. Early discharge may cause anxiety and dissatisfaction among patients.
Purpose
The aim of our study was to evaluate safety and patient satisfaction of same discharge following uncomplicated elective radial access PCI.
Methods
Randomized controlled single center study. Eligible patients scheduled for elective PCI with radial access were prescreened following predefined inclusion and exclusion criteria. Health related quality of life instruments (HRQOL), Seattle Angina Questionnaire (SAQ), Short form 36 (SF-36) and Hospital Anxiety and Depression Scale (HADS) were completed by the patients and received at base line and at 30 days post-procedure. All same day discharged patients were contacted by phone by a specialized study nurse the day after the procedure.
Results
517 patients were screened between November 2015 and November 2018 and 82 patients with mean age of 65 years were block randomized post-procedure. 38 patients were randomized to same day discharge after 6 hours of observation and 44 patients to standard care group which necessitated an overnight hospitalization. 11 female patients and 71 male patients were included.
No adverse events were registered in either group. No significant difference between groups were observed in the SAQ (treatment satisfaction score p=0.48, angina frequency scale p=0.58), SF-36 (SF vitality p=0.93) or HADS (HADS anxiety + depression p=0.15).
Changes of HADS score
Conclusions
Discharge on the same day following uncomplicated PCI for stable angina is safe and patient health related quality of life instruments confirm that patients are equally satisfied with this new care strategy when compared to usual care.
Acknowledgement/Funding
Stavanger University Hospital
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