Jessica Schomberg and Wendy Highby begin with a very broad and thought-provoking discussion of the demographics of disability. Diagnosed “behavioral disorders and mental illness are on the rise while ...diagnosed physical impairments are decreasing” (15). Disablement is defined very broadly, as occurring where there is a mismatch between the environment and ability. Their review of the evolution of disability theory is effective.
IntroductionCerebral small vessel disease (SVD) is a major cause of stroke anddementia. Neuroinflam- mation and blood-brain barrier (BBB) leakage have been suggested as important pathogenic ...processes. Focal areas of microglial signal measured using 11C-PK11195 positron emission tomography (PET) and of BBB leakage using dynamic contrast-enhanced MRI (DCE-MRI) have been identified, but it is unclear whether these processes are causal (and potential therapeutic targets), or merely secondary to tissue damage. We assessed whether measurements of microglial signal and BBB permeability predict disease progression.Methods20 participants with confluent white matter hyperintensities underwent DCE-MRI and 11C-PK11195 PET and neuropsychometric testing at least three months after lacunar stroke. We repeated conventional MRI and neuropsychometric testing one year later.ResultsMean age was 70.9±9.0 years and 50% were male. 90% had a history of hypertension, 55% of hypercholesterolaemia and 20% diabetes. Neither BBB permeability nor 11C-PK11195 binding were asso- ciated with white matter lesions growth (standardised β=-0.004, p=0.53 and β=-.033, p=0.45 respectively). Change in cognition was not associated with BBB permeability (β=0.0006, p=0.15), but was associated with 11C-PK11195 binding (β=0.002, p=0.013).DiscussionWe found no evidence that neuroinflammation or BBB permeability are causally related to SVD progression. Baseline microglial signal was associated with better cognitive performance at follow- up; this may be related to resolution of post-stroke inflammation.
Purpose
The purpose of this study was to examine relationships between change fatigue, resilience, and job satisfaction among novice and seasoned hospital staff nurses.
Background
Health care is ...typified by change. Frequent and vast changes in acute care hospitals can take a toll on nurses and cause change fatigue, which has been largely overlooked and under‐researched.
Design and Method
A descriptive correlational design was employed with 521 hospital staff nurses in one midwestern state. Participants completed three online surveys: (a) Change Fatigue Scale, (b) Connor‐Davidson Resilience Scale, and (c) McCloskey/Mueller Satisfaction Scale.
Findings
In a multiple regression model, job satisfaction had a statistically significant negative association with change fatigue (p < .001) and significant positive association with resilience (p < .001). A linear trend was found with hospital size (number of beds) and change fatigue (p = .001) and education level and resilience (p = .03).
Conclusions
The results are consistent with job satisfaction among hospital nursing staff being negatively influenced by change fatigue and positively influenced by resilience, although reverse causal connections are also possible. Change fatigue may be increased by larger hospital size (number of beds), and resilience may be increased by higher educational level of hospital staff nurses.
Clinical Relevance
The study advanced the nursing knowledge on change fatigue, resilience, and job satisfaction of staff nurses working in acute care hospitals. Engaging in strategies aimed at preventing change fatigue in nursing staff can enhance workplace environments, job satisfaction, and retention of nurses.
Background and aim
Whether cerebral microbleeds cause cognitive impairment remains uncertain. We analyzed whether cerebral microbleeds are associated with cognitive dysfunction in patients with ...symptomatic cerebral small vessel disease, and whether this association is independent of other neuroimaging markers of cerebral small vessel disease.
Methods
We analyzed consecutive patients with MRI-confirmed lacunar stroke included in DNA-Lacunar-2 multicenter study. Cerebral microbleeds were graded using the Brain Observer Microbleed Rating Scale (BOMBS). Neuropsychological assessment was performed using the Brief Memory and Executive Test (BMET). We analyzed the association between cerebral microbleeds, BMET, and the following subdomains: executive function/processing speed and orientation/memory. We also searched for an independent association between cerebral microbleeds and vascular cognitive impairment, defined as BMET ≤ 13.
Results
Out of 688 included patients, cerebral microbleeds were detected in 192 (27.9%). After adjusting for white matter hyperintensities severity, lacune count, and other confounders, both the presence and the number of cerebral microbleeds were significantly associated with impaired cognitive performance β = −13.0; 95% CI = (−25.3, −0.6) and β = −13.1; 95% CI = (−19.8, −6.4), respectively. On analysis of specific cognitive domains, associations were present for executive function/processing speed β = −5.8; 95% CI = (−9.3, −2.2) and β = −4.3; 95% CI = (−6.2, −2.4), respectively but not for orientation/memory β = −0.4; 95% CI = (−4.0, 3.2) and β = −2.1; 95% CI = (−4.0, 0.1), respectively. We also found an independent association between the presence and the number of cerebral microbleeds and vascular cognitive impairment adjusted OR = 1.48; 95% CI = (1.01, 2.18) and OR = 1.43; 95% CI = (1.15, 1.79), respectively.
Conclusion
In a large cohort of symptomatic cerebral small vessel disease patients, after controlling for other neuroimaging markers of cerebral small vessel disease severity, cerebral microbleeds were associated with cognitive dysfunction. Executive function and processing speed were predominantly impaired. This might suggest a causal role of cerebral microbleeds in determining vascular cognitive impairment.
The large discharge of radioactivity into the northwest Pacific Ocean from the 2011 Fukushima Dai-ichi nuclear reactor accident has generated considerable concern about the spread of this material ...across the ocean to North America. We report here the first systematic study to our knowledge of the transport of the Fukushima marine radioactivity signal to the eastern North Pacific. Time series measurements of ¹³⁴Cs and ¹³⁷Cs in seawater revealed the initial arrival of the Fukushima signal by ocean current transport at a location 1,500 km west of British Columbia, Canada, in June 2012, about 1.3 y after the accident. By June 2013, the Fukushima signal had spread onto the Canadian continental shelf, and by February 2014, it had increased to a value of 2 Bq/m ³ throughout the upper 150 m of the water column, resulting in an overall doubling of the fallout background from atmospheric nuclear weapons tests. Ocean circulation model estimates that are in reasonable agreement with our measured values indicate that future total levels of ¹³⁷Cs (Fukushima-derived plus fallout ¹³⁷Cs) off the North American coast will likely attain maximum values in the 3–5 Bq/m ³ range by 2015–2016 before declining to levels closer to the fallout background of about 1 Bq/m ³ by 2021. The increase in ¹³⁷Cs levels in the eastern North Pacific from Fukushima inputs will probably return eastern North Pacific concentrations to the fallout levels that prevailed during the 1980s but does not represent a threat to human health or the environment.
Significance The radionuclide results in this report represent the first systematic study, to our knowledge, of the arrival of the Fukushima radioactivity signal in continental waters off North America. The present time series results are critical to an understanding of the circulation of Fukushima tracers in the eastern North Pacific and to the tuning and validation of ocean circulation models that are being used to predict the future evolution of this signal. They are also important for informing the public of the magnitude of the Fukushima radioactivity signal in North American continental waters and enabling a science-based assessment of the significance of its potential effects on human health and the environment.
BACKGROUND AND PURPOSE—The role of inflammation in ischemic white matter disease is increasingly recognized, and further understanding of the pathophysiology might inform future treatment strategies. ...Multiple sclerosis (MS) is a chronic autoimmune condition in which inflammation plays a central role that also affects the white matter. We hypothesized that white matter injury might share common mechanisms and used statistical genetics techniques to assess whether having genetically elevated white matter hyperintensity (WMH) volume was associated with increased MS risk.
METHODS—We investigated the genetic association in 2 cohorts with magnetic resonance imaging-quantified ischemic white matter lesion volume (WMH in stroke; n=2797 and UK Biobank; n=8353) and 14 802 cases of MS and 26 703 controls from the International Multiple Sclerosis Genetics Consortium. We further performed individual-level polygenic risk score calculations for MS and measures of structural white matter disease in UK Biobank. Finally, we looked for evidence of overlapping risk across the whole genome.
RESULTS—There was no association of genetic variants influencing MS with WMH volume using summary statistics in the WMH in stroke cohort (relative risk score =1.014; 95% CI, 0.936–1.110) or in the UK Biobank cohort (relative risk score =1.030; 95% CI, 0.932–1.117). Conversely, assessing the contribution of single nucleotide polymorphisms significantly associated with WMH on the risk of MS there was no significant association (relative risk score =0.930; 95% CI, 0.736–1.191). There were no significant associations between polygenic risk scores calculations; these results were robust to the selection of single nucleotide polymorphisms at a range of significance thresholds. Whole genome analysis did not reveal any overlap of risk between the traits.
CONCLUSIONS—Our results do not provide evidence to suggest a shared mechanism of white matter damage in ischemia and MS. We propose that inflammation acts in distinct pathways because of the differing nature of the primary insult.
ObjectivesTo estimate COVID-19 infections and deaths in healthcare workers (HCWs) from a global perspective during the early phases of the pandemic.DesignSystematic review.MethodsTwo parallel ...searches of academic bibliographic databases and grey literature were undertaken until 8 May 2020. Governments were also contacted for further information where possible. There were no restrictions on language, information sources used, publication status and types of sources of evidence. The AACODS checklist or the National Institutes of Health study quality assessment tools were used to appraise each source of evidence.Outcome measuresPublication characteristics, country-specific data points, COVID-19-specific data, demographics of affected HCWs and public health measures employed.ResultsA total of 152 888 infections and 1413 deaths were reported. Infections were mainly in women (71.6%, n=14 058) and nurses (38.6%, n=10 706), but deaths were mainly in men (70.8%, n=550) and doctors (51.4%, n=525). Limited data suggested that general practitioners and mental health nurses were the highest risk specialities for deaths. There were 37.2 deaths reported per 100 infections for HCWs aged over 70 years. Europe had the highest absolute numbers of reported infections (119 628) and deaths (712), but the Eastern Mediterranean region had the highest number of reported deaths per 100 infections (5.7).ConclusionsCOVID-19 infections and deaths among HCWs follow that of the general population around the world. The reasons for gender and specialty differences require further exploration, as do the low rates reported in Africa and India. Although physicians working in certain specialities may be considered high risk due to exposure to oronasal secretions, the risk to other specialities must not be underestimated. Elderly HCWs may require assigning to less risky settings such as telemedicine or administrative positions. Our pragmatic approach provides general trends, and highlights the need for universal guidelines for testing and reporting of infections in HCWs.
Summary
Effective insect pollination requires appropriate responses to internal and external environmental cues in both the plant and the pollinator. Helianthus annuus, a highly outcrossing species, ...is marked for its uniform eastward orientation of mature pseudanthia, or capitula. Here we investigate how this orientation affects floral microclimate and the consequent effects on plant and pollinator interactions and reproductive fitness.
We artificially manipulated sunflower capitulum orientation and temperature in both field and controlled conditions and assessed flower physiology, pollinator visits, seed traits and siring success.
East‐facing capitula were found to have earlier style elongation, pollen presentation and pollinator visits compared with capitula manipulated to face west. East‐facing capitula also sired more offspring than west‐facing capitula and under some conditions produced heavier and better‐filled seeds. Local ambient temperature change on the capitulum was found to be a key factor regulating the timing of style elongation, pollen emergence and pollinator visits.
These results indicate that eastward capitulum orientation helps to control daily rhythms in floral temperature, with direct consequences on the timing of style elongation and pollen emergence, pollinator visitation, and plant fitness.
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