Partner bereavement when parenting dependent children: What factors influence adjustment?

Little is known about those who are widowed while raising dependent children. This study aimed to explore the factors which influence adjustment to partner death. Seven fathers and five mothers were interviewed, and constructivist grounded theory was used. Three interrelated themes were identified: Interpersonal influences, Intrapersonal influences, and Contextual influences. Dependent children meant sole responsibility and increased demands, yet ultimately provided widowed parents a purpose. Participants highlighted the need for increased awareness of young widowhood at a systemic and cultural level, to improve communication around death and young widowhood. Implications included social, financial and therapeutic interventions.

New imaging tools to measure nephron number in vivo: opportunities for developmental nephrology.

The mammalian kidney is a complex organ, requiring the concerted function of up to millions of nephrons. The number of nephrons is constant after nephrogenesis during development, and nephron loss over a life span can lead to susceptibility to acute or chronic kidney disease. New technologies are under development to count individual nephrons in the kidney in vivo. This review outlines these technologies and highlights their relevance to studies of human renal development and disease.

Time-sensitive predictors of embolism in patients with left-sided endocarditis: Cohort study.

INTRODUCTION: Accurate prediction of embolic events in infective endocarditis could inform critical clinical decisions, such as the timing of cardiac surgical intervention. However, many embolic events occur before hospital admission and echocardiography and are thus non-modifiable. We aimed to identify time-sensitive variables that predict embolic events in infective endocarditis, focusing on those that occur after diagnosis. METHODS: Clinical, microbiological, and echocardiographic characteristics were collected from 116 patients with definite or probable left-sided infective endocarditis admitted to Sunnybrook Health Sciences Centre (Toronto, Canada) between October 2013 and July 2016; associations between these characteristics and embolic events were identified using simple logistic regression. RESULTS: The mean (SD) age was 66 (17) years; 82 patients (71%) were men. The most frequent microorganisms were Staphylococcus aureus (23%) and viridans group streptococci (21%). Seventy-nine (68%) patients had left-sided vegetations, with involvement of the aortic valve in 34 (43%) patients, mitral valve in 37 (47%) patients, and both in 8 (10%) patients. The mean (SD) vegetation size was 10 (7) mm. Forty-three unique patients (37%) had 50 embolic events, with most (34/43; 79%) having a first embolic event (38/50; 76%) before or on the day of echocardiography. There were no significant predictors of the 11 patients with an embolic event after echocardiography; significant predictors of an embolic event at any time were single valve vegetation vs. no vegetation (OR, 4.75; 95% confidence interval [CI], 1.76-12.78) and, among patients with a vegetation, mitral vs. aortic valve location (OR, 4.43; 95%CI, 1.63-12.04). CONCLUSIONS: Associations between patient and echocardiographic characteristics and embolism in patients with infective endocarditis may be time-sensitive, as few embolic events occurred after clinical and echocardiographic assessment.

Safety and acceptability of an organic light-emitting diode sleep mask as a potential therapy for retinal disease.

PurposeThe purpose of the study was to study the effect of an organic light-emitting diode sleep mask on daytime alertness, wellbeing, and retinal structure/function in healthy volunteers and in diabetic macular oedema (DMO).Patients and methodsHealthy volunteers in two groups, 18-30 yrs (A), 50-70 yrs (B) and people with DMO (C) wore masks (504 nm wavelength; 80 cd/m2 luminance; ≤8 h) nightly for 3 months followed by a 1-month recovery period. Changes from baseline were measured for (means): psychomotor vigilance task (PVT) (number of lapses (NL), response time (RT)), sleep, depression, psychological wellbeing (PW), visual acuity, contrast sensitivity, colour, electrophysiology, microperimetry, and retinal thickness on OCT.ResultsOf 60 participants, 16 (27%) withdrew, 8 (13%) before month 1, due to sleep disturbances and mask intolerance. About 36/55 (65%) who continued beyond month 1 reported ≥1 adverse event. At month 3 mean PVT worsened in Group A (RT (7.65%, P<0.001), NL (43.3%, P=0.005)) and mean PW worsened in all groups (A 28.0%, P=0.01, B 21.2%, P=0.03, C 12.8%, P<0.05). No other clinically significant safety signal was detected. Cysts reduced/resolved in the OCT subfield of maximal pathology in 67% Group C eyes. Thinning was greater at 3 and 4 months for greater baseline thickness (central subfield P<0.001, maximal P<0.05).ConclusionSleep masks showed no major safety signal apart from a small impairment of daytime alertness and a moderate effect on wellbeing. Masks were acceptable apart from in some healthy participants. Preliminary data suggest a beneficial effect on retinal thickness in DMO. This novel therapeutic approach is ready for large clinical trials.

The emerging role of MRI in quantitative renal glomerular morphology.

Techniques to measure morphological parameters, such as glomerular (and thereby nephron) number, glomerular size, and kidney volume, have been vital to understanding factors contributing to chronic kidney disease (CKD). These techniques have also been important to understanding the associations between CKD and other systemic and cardiovascular diseases and have led to the identification of developmental risk factors for these pathologies. However, existing techniques in quantitative kidney morphology are resource- and time-consuming and are destructive to the organ. This review discusses the emerging generation of techniques to study kidney morphology quantitatively using magnetic resonance imaging (MRI) using the intravenous injection of the superparamagnetic nanoparticle cationic ferritin, which binds to the glomerular basement membrane. A primary advantage of MRI over previously established techniques is the ability to quantify morphology in the intact organ with minimal sample preparation. We highlight areas of research where MRI-based morphological measurements will be helpful in animal models and possibly diagnostic clinical nephrology, discuss technical challenges in light of the progress in MRI techniques to date, and identify novel measurements that may be possible using MRI, both ex vivo and in vivo.

Why do so many petals have conical epidermal cells?

BACKGROUND: The conical epidermal cells found on the petals of most Angiosperm species are so widespread that they have been used as markers of petal identity, but their function has only been analysed in recent years. This review brings together diverse data on the role of these cells in pollination biology. SCOPE: The published effects of conical cells on petal colour, petal reflexing, scent production, petal wettability and pollinator grip on the flower surface are considered. Of these factors, pollinator grip has been shown to be of most significance in the well-studied Antirrhinum majus/bumble-bee system. Published data on the relationship between epidermal cell morphology and floral temperature were limited, so an analysis of the effects of cell shape on floral temperature in Antirrhinum is presented here. Statistically significant warming by conical cells was not detected, although insignificant trends towards faster warming at dawn were found, and it was also found that flat-celled flowers could be warmer on warm days. The warming observed is less significant than that achieved by varying pigment content. However, the possibility that the effect of conical cells on temperature might be biologically significant in certain specific instances such as marginal habitats or weather conditions cannot be ruled out. CONCLUSIONS: Conical epidermal cells can influence a diverse set of petal properties. The fitness benefits they provide to plants are likely to vary with pollinator and habitat, and models are now required to understand how these different factors interact.

Coping, depressive feelings and gender differences in late life widowhood.

The study investigated the relationship between depressive feelings and coping amongst older widowed men and women. Participants were interviewed about their affective experiences of widowhood and completed two depression questionnaire assessments, the Symptoms of Anxiety and Depression Scale (SAD) and the Hospital Anxiety and Depression Scale (HADS). Participants were assessed as either coping or not coping. The results showed that both measures were effective at differentiating those who coped (Copers) from those who did not (Non-Copers) in the sample as a whole. Amongst the widows the HADS significantly differentiated the two groups. Amongst men, neither measure significantly distinguished Copers from Non-Copers. However, an examination of the interviews suggested that widowers reported depressive feelings significantly more often than widows. The results suggest that depressive feelings are associated with non-coping in older widowed people. There is also evidence to suggest that widows and widowers respond differentially to assessment measures.

A four-year experience with patient individualized heparin and protamine dosing using the Hemochron RxDx system.

Cardiac surgical case histories, collected over 4 years at Huntsville Hospital in Alabama, were reviewed for 2,293 patients. Patients were separated into two dosing groups for both heparin and protamine, hospital empirically dosed and Hemochron RxDx dosed. Review of the heparin dosing information found that incomplete data were collected for 47 patients, leaving 2,246 patients eligible to be evaluated for heparin dose comparison. Both RxDx recommended and empirically calculated doses were recorded, as well as the actual dose given. Of the 2,246 patients, 1671 were administered heparin according to the RxDx calculated dose, and the remaining 575 patients were dosed according to the hospital's empirical protocol. The average RxDx calculated heparin dose was 17% greater then the empirically calculated heparin dose (350 U/kg) (p < .001). Anticoagulation to target ACT (480 sec) was achieved in 92% of the patients dosed according to the RxDx recommended dose; whereas, in the empirically dosed patient group only 80% of the patients reached the target ACT after initial heparin bolus dose. Incomplete protamine dosing data was recorded for 336 patients, leaving a total of 1,957 patients available for protamine dose evaluation. All patients had an RxDx protamine calculation, empirical protamine calculation, and actual amount of protamine dosed recorded. Of the 1,953 patients, 1,764 were dosed according to the RxDx recommended dose, with the remaining 189 patients dosed empirically (1 mg protamine/100 U of heparin). In both the RxDx and the empirical groups, 96% of the patients returned to baseline following initial protamine infusion. The overall RxDx dose (293 mg) was 16% lower than the average empirical dose (348 mg). The RxDx system has been shown to be an effective method for determining patient-specific dosing for both heparin and protamine. This long-term clinical experience demonstrates the consistency and reliability of patient maintenance using this individualized dosing system, which has been shown, in other independent evaluations, to lead to improved patient outcomes.

Interference from distractors in reach-to-grasp movements.

Descriptions of interference effects from non-relevant stimuli are extensive in visual target detection and identification paradigms. To explore the influence of features of non-relevant objects on reach-to-grasp movements, we instructed healthy normal controls to reach for and pick up a cylinder (target) placed midsagittally 30 cm from the starting position of the hand. In Experiment 1, the target was presented alone, or accompanied by a narrower, wider, or same-size distractor positioned to the left or right of the target. In Experiment 2, the target was presented alone or accompanied by a distractor, which was slanted at a different orientation to the target. Reflective markers were placed on the wrist, thumb, and index finger of the right hand, and infra-red light-detecting cameras recorded their displacement through a calibrated 3-dimensional working space. Kinematic parameters were derived and analysed. Consistent changes in the expression of peak velocity, acceleration, and deceleration were evident when the distractor was narrower or wider than the target. The impact of the orientation of the distractor, conversely, was not marked. We discuss the results in the context of physiological findings and models of selective attention.

The reach-to-grasp movement in Parkinson's disease before and after dopaminergic medication.

The aim of the present study was to assess the effects of dopaminergic medication on the organisation of the reach-to-grasp movement in Parkinson's disease. A three-dimensional kinematic system (ELITE, B/T/S Italy) was used to record reach-to-grasp movements to objects of either small (0.7 cm) or large (8 cm) diameter placed at a reaching distance of either 20 or 30 cm. Vision of the reaching limb and target was also manipulated. Parkinson's disease participants (N = 14) were assessed in 'OFF' (12 h without medication) and 'ON' (1-2 h post-administration of medication) states. In the 'ON' state, movement duration and the time spent in arm deceleration were significantly less than in the 'OFF' state. The amplitudes of peak reaching velocity, acceleration and deceleration were all higher in the 'ON' than in the 'OFF' state. Further, in the 'ON' state, the acceleration profile no longer exhibited small irregular adjustments, the number of significant correlations between parameters measured from the transport and manipulation components was greater, and the movement was more direct in both the mediolateral horizontal and vertical planes. These results indicate that dopaminergic medication is of benefit in reducing bradykinesia and in fine-tuning kinematic parameterisation of a selected reach-to-grasp action.

Sudden and gradual presentation of distractor objects: differential interference effects.

In solving the selection-for-action problem, it is believed that attentional mechanisms enable dominance of target over non-target objects. However, under some conditions, information from non-target objects "interferes" with the action to a relevant target. We investigated the possibility that this interference may result when the irrelevant object activates a specific subset of visuomotor pathways. Participants reached to grasp three-dimensional stimuli while actively attending to a nearby flanker object. The means by which the flanker was presented was manipulated. This relevant object was illuminated either abruptly or gradually. The parvocellular pathway in early visual processing is equally activated in both conditions. The magnocellular pathway is strongly activated by abrupt presentation and weakly activated with gradual presentation of the flanker object. Kinematics of the reach-to-grasp action to the target showed signs of interference only in the sudden illumination condition. This suggests a dissociation between dorsal and ventral cortical streams in terms of relevance for action. Our data suggests that this effect is not due to early visual-pathway differences, but instead reveals a property of a transient object-based visual attention mechanism.

Covert orienting and focusing of attention in children with attention deficit hyperactivity disorder.

Performance on the covert visuo-spatial attentional functions of orienting and focusing by a group of ADHD children (n = 20) was compared to that of age and sex-matched control children. In Experiment 1, responses were given to cued targets at valid and invalid locations. In Experiment 2, responses were given to targets presented in small, medium-sized or large visual field locations. For both experiments, the hypotheses that reaction times of ADHD children would be greater than those of control children and that performance would be asymmetrical, were supported. For Experiment 1, ADHD children showed bilaterally greater 'benefits' from having directed attention to the cued location and greater 'costs' in having to relocate the attentional focus than controls. In Experiment 2, the hypothesis that the function of focusing attention by ADHD children may show breakdown in the usual pattern of an increase in reaction time with focus area was partly supported by the finding of similar reaction times to targets presented in medium-sized and large regions of the left visual hemifield. These results have been interpreted as reflecting a stronger anchorage of attention by ADHD children upon a cued location and an inability to shift covert attention easily to an alternative location. The breakdown of the focusing function suggests adoption of similar time response sets across focus area size by the more compromised right hemisphere.

The effect of unilateral posteroventral pallidotomy on the kinematics of the reach to grasp movement.

OBJECTIVE: To assess postoperative effects of unilateral posteroventral pallidotomy on the organisation of upper limb movement. METHODS: A three dimensional kinematic system (ELITE, B/T/S/ Italy) was used to record reach to grasp movements to objects of either small (0.7 cm) or large (8 cm) diameter placed at a reaching distance of either 20 or 30 cm. Four patients with Parkinson's disease were assessed in "off" (12 hours without medication) and "on" (1 hour after administration of medication) preoperatively and postoperatively. RESULTS: Duration of the movement and the time spent in arm deceleration were significantly reduced after surgery. However, movement patterning according to object size was adversely affected. Postoperatively, all four patients showed an abnormal pattern of a longer movement duration, and three showed a longer time of reaching arm deceleration, for reach to grasp movements to the large object than for those to the small object. CONCLUSION: Posteroventral pallidotomy seems to be beneficial in reducing bradykinesia of upper limb movements but may have "costs" to movement patterning, particularly for reach to grasp movements to objects of differing sizes. This study raises interesting questions about the role of the globus pallidus interna in coordinating stimulus bound visual information with appropriate motor patterning.

Customary physical activity and gender as precursors for late life personal disturbance.

OBJECTIVES: To examine whether customary physical activity (CPA) and gender are precursors for personal disturbance in later life. DESIGN: The study was part of a longitudinal study, with data collected in 1985 and 1989. Measures of CPA were obtained in men and women who by 1989 had developed elevated levels of personal disturbance. A case-control design was used: the cases were matched with controls on their 1985 levels of personal disturbances, gender and age. METHODS: Levels of personal disturbance were measured using the Symptoms of Anxiety and Depression (SAD) Scale. CPAs were assessed using five continuous and two discrete measures of physical activity, including indoor productive activity, outdoor productive activity and flexibility. The cases were 26 women and 11 men and the controls were 26 women and 11 men. RESULTS: Both CPA and gender were found to be precursors for later elevated personal disturbance. Specifically, indoor and outdoor productive activity and activities requiring flexibility were precursors for elevated personal disturbance. The effects of gender were even more specific: a main effect for gender was found for indoor productive activity (women doing more than men); and an interaction effect was observed between personal disturbance and gender for outdoor productive activity (the difference between depressed and non-depressed men is greater than between depressed and non-depressed women). CONCLUSIONS: The study found that both CPA and gender were precursors for elevated levels of personal disturbance. However, the effects of both CPA and gender were quite specific.

Upper limb movement differentiation according to taxonomic semantic category.

The size or shape of an object, its perceptual features, determine the patterning of an arm and hand action involving that object. Little is known about the role played by the taxonomic semantic attributes of an object for perceptuomotor processing. In this study we investigated whether the semantic relationship between two target stimuli influences the kinematics of a bilateral reach-to-grasp action. The results showed that reach-to-grasp movements preceding the action of putting living-thing pairs together were faster, and showed earlier settings of reach and grasp temporal parameters, than movements involving pairs of non-living things. It is hypothesized that this reflects the recruitment of different categorical perceptuomotor pathways.

Gender and longitudinal changes in physical activities in later life.

OBJECTIVES: to describe gender differences in levels of, and longitudinal changes in, habitual physical activity among older people. DESIGN: longitudinal study. PARTICIPANTS: sub-groups of survivors (with sample sizes dependent on the availability of complete datasets, ranging from 303-344) assessed on three occasions: 1985, 1989 and 1993 in Nottingham, UK. All were 65 years and over in 1985. METHODS: descriptive presentation (median and range values) of quantitative longitudinal data by gender across five activity categories assessed in a recall-based questionnaire. MAIN OUTCOME MEASURES: participation in walking, shopping, indoor, outdoor and leisure activities. RESULTS: while levels of indoor and outdoor activities were marked by decline for both sexes, gender differentials were maintained over the 8 years of the study, with women showing higher levels of activity participation indoors and men showing higher levels of activity participation outdoors. In levels of walking/shopping activity, however, there was evidence of gender differentials reducing over time. CONCLUSIONS: within these cohorts of older people traditional gender roles continue to exert a strong influence on levels and types of habitual physical activity well into later life. In some areas of activity, however, temporal changes provide some evidence of gender convergence consistent with late-life transitions in marital status and dependency.

The bilateral reach-to-grasp movement of Parkinson's disease subjects.

The performance of simultaneous movements is said to be disrupted in Parkinson's disease, yet there are some indications that this dysfunction is less evident for bilateral inter-limb actions, as opposed to unilateral simultaneous actions. Focussing specifically upon natural actions, this study uses a three-dimensional kinematics system (ELITE) to assess the movement kinematics of a bilateral non-homologous reach-to-grasp action. The target device consisted of a large cylinder (diameter 8 cm) to which a handle (diameter 0.8 cm) was attached. The task was to reach and grasp the cylinder with one hand (gross grasp) while reaching to grasp the handle with the contralateral hand (precision grasp). Overall the results indicated that Parkinson's disease subjects, like controls, showed independent and appropriate kinematic parameterization of each limb. For example, and as a reflection of task precision requirements, the time taken to decelerate upon the item to be grasped was longer for the limb grasping the handle than for the limb grasping the cylinder. Subtle indications of compensatory mechanisms, in response to left upper limb inadequacies of Parkinson's disease subjects, were suggested by findings of an earlier timing of maximum hand grip aperture for the left than for the right hand, and adjustments to the final transport phase of the left arm under bilateral conditions. It is proposed that left-right hand differences are more evident with basal ganglia dysfunction, but that these differences are compensated for by CNS mechanisms so that natural non-homologous reach-to-grasp actions are performed in a functional, coordinated and appropriate manner.

A longitudinal study of wellbeing in widowed women.

Changes in mental and physical health, morale and social functioning were assessed in a random sample of elderly women widowed during the course of an 8-year study, compared with never-married and still-married controls. The sample as a whole showed age-related declines in mental and physical health. As a function of ageing there were increases in personal disturbance and in physical health problems and declines in both morale and social engagement. However, over and above these age-related changes the windows showed significant changes in mental health. There were decreases in morale after widowhood, followed by slight increases in morale in the longer term. Similarly, there were increases in personal disturbance following widowhood, with slight decreases later. The results confirm that, even after several years, widowhood has differential effects on wellbeing and morale.

Processing efficiency of the orienting and the focusing of covert attention in relation to the level of disability in Parkinson's disease.

This study assessed covert visuo-spatial attentional mechanisms in Parkinson's disease (PD). Reaction times (RTs) of subjects at early and late disease stages, and of matched control subjects, were compared. The task was to respond to a stimulus in a square positioned in either the left or right hemifield. To assess the orienting of attention, the stimulus was preceded by an arrow which gave a valid (stimulus appeared in the indicated square) or an invalid (stimulus appeared in the square which had not been indicated) cue. Both hemifields were indicated in the case of neutral trials. To assess the focusing of attention, the square could be small (1 x 1 degrees ), medium-sized (2 x 2 degrees ) or large (4 x 4 degrees ). To compare voluntary and reflexive mechanisms, the cue(s) could be central or peripheral, respectively. For the orienting of attention, controls and "early" PD subjects showed greater RTs for centrally cued invalid than for neutral trials. "Late" PD subjects showed no such difference. In contrast, the pattern of results for peripherally cued stimuli was similar across all groups. With respect to focusing, "late" PD subjects showed the normal pattern of an increase of reaction time with square size, both for centrally and peripherally cued trials; however, this increase was greater than that of the control and "early" PD subjects. "Late" PD subjects showed greater reaction times for centrally than for peripherally cued trials; however, unlike controls and "early" PDs, this difference was reduced for invalid trials, and absent for trials to the small and medium-sized squares. It is concluded that Parkinson's disease compromises both endogenous and exogenous visuo-spatial functions. However, it is particularly processes which have a more endogenous component which show the greatest deterioration at later disease stages.

Three-dimensional covert attentional functions in Parkinson's disease subjects.

This study assessed the ability of mildly affected Parkinson's disease (PD) subjects (n = 16) to perform attentional cognitive tasks within a three-dimensional object. A hollow cube was displayed on a computer screen and the subject was required to respond as quickly as possible to the highlighting of one of the cube angles by pressing the spacebar of the keyboard. Prior to the appearance of this imperative stimulus, the same ("valid" trials) or an alternative ("invalid" trials) angle was highlighted. For the invalid trials this meant that the subject oriented attention to the cued angle but, on imperative stimulus appearance, was unexpectedly required to redirect attention to another angle, which could be on a different cube face to that which had been cued. For one experimental session the cube was stationary, that is, object-centred and viewer-centred coordinates of a cube angle corresponded. For another session, the cube rotated such that the viewer-centred coordinates of an angle changed between appearance of the cue and appearance of the stimulus, but the angle's object-centred coordinates remained constant. The finding of lower reaction times for the valid than for the invalid trials, even when the cube was rotating, indicated that PD subjects could operate attention using an object-centred coordinate system. However, PD subjects showed exaggerated reaction times when the stimulus appeared in a cube face that was opposite to, rather than the same as, that of the invalidly cued angle. It is suggested that this reflects a dysfunction in the grouping of the structural components of the whole object at an attentional level.