Non-pharmacological interventions to improve mental health outcomes among female carers of people living with a neurological condition: a systematic review.

PURPOSE: This systematic review aims to examine the effectiveness of non-pharmacological interventions for improving mental health outcomes among female carers of people living with a neurological condition. MATERIALS AND METHODS: A narrative synthesis of English-language randomized controlled trials was undertaken. RESULTS: 18 unique studies were included. Intervention components that were found to have improved mental health outcomes were: delivered in person, to groups, on an intermittent schedule with ≥10 sessions; had a duration between 3-6 months; and were facilitated by research staff or allied health professionals. As the review had few robust studies, results of mental health outcomes reported in studies assessed as low risk of bias were highlighted in the review. Psychoeducation interventions, cognitive behavioural interventions, and support group interventions were found to improve depression. Psychoeducation interventions were also found to improve burden. CONCLUSIONS: There is a clear need for adequately powered, high-quality randomised controlled trials to determine the effectiveness of non-pharmacological interventions for female carers of people living with a neurological condition.

Female carers experience worse mental health and well-being outcomes and are at a higher risk of developing chronic health issues compared to their male counterparts.This review identified only very few, generally small, randomised controlled trials of non-pharmacological interventions in female carers of patients with neurological conditions.Interventions that provide psychoeducation, are group-based, face-to-face, and have an intervention duration between >3 months and <6 months, may be successful in improving some mental health outcomes, such as depression and coping.

Carer-supported home-based exercises designed to target physical activity levels and functional mobility after stroke: a scoping review.

PURPOSE: To explore the literature on carer-supported home-based exercise programs for people after stroke, as a form of physical activity. The review focus was to examine the training carers receive, the content of programs, and investigate the physical activity levels and functional mobility of people after stroke. MATERIALS AND METHODS: A scoping review was undertaken, guided by Joanna Briggs Institute methodology. The concept of home-based carer-supported exercise, in people after stroke, was searched across five databases. Outcomes of interest were physical activity levels and functional mobility. RESULTS: We screened 2285 references and included 10 studies: one systematic review, five randomised controlled trials, one trial with non-equivalent control, and four uncontrolled studies. Carer training ranged from one to twelve sessions. Exercise interventions commonly including walking, other whole body functional exercises and balance activities. In eight studies interventions were in addition to standard care. Five studies reported significant between-group differences for functional mobility, favouring the intervention. One study reported physical activity levels. CONCLUSION: There was large variation in the volume and content of training provided to carers. Physical activity levels were infrequently objectively reported. Future studies should include greater details on their protocols to allow for replication and implementation into clinical practice.

Carer-supported home-based exercises may improve functional mobility once home after a stroke.The optimal length, content, and model of delivery of carer training, so carers can provide better targeted home-based exercise support to people after stroke, is not known.Better monitoring of participation in home-based exercise and reporting of short and long-term physical activity is needed.

Perceived benefits and barriers to yoga participation after stroke: A focus group approach.

BACKGROUND: and Purpose: There is increasing evidence to suggest yoga can be beneficial to health and wellbeing after stroke. The purpose of this study was to identify perceived benefits and barriers to yoga participation among adults with chronic stroke. MATERIALS AND METHODS: Twenty-six community dwelling adults (14 female, 12 male) who were at least 6-months post-stroke participated in four focus groups held at local stroke recovery meetings. Data was recorded and transcripts were analysed thematically. RESULTS: Participants identified whole body benefits, the return of connection and feeling health in mind as the primary benefits of yoga. Perceived barriers included physical barriers to participation, cognitive challenges, environmental access, and financial limitations. CONCLUSION: Stroke survivors perceive yoga practice provides benefits in 'connectedness'. Future interventions should recognize the importance of yoga instructor training, focus on the mind-body connection aspects of yoga, and modifying activities to safely accommodate the physical abilities of the participants.

"FIND Technology": investigating the feasibility, efficacy and safety of controller-free interactive digital rehabilitation technology in an inpatient stroke population: study protocol for a randomized controlled trial.

BACKGROUND: Stroke results in significant disability, which can be reduced by physical rehabilitation. High levels of repetition and activity are required in rehabilitation, but patients are typically sedentary. Using clinically relevant and fun computer games may be one way to achieve increased activity in rehabilitation. METHODS/DESIGN: A single-blind randomized controlled trial will be conducted to evaluate the feasibility, efficacy and safety of novel stroke-specific rehabilitation software. This software uses controller-free client interaction and inertial motion sensors. Elements of feasibility include recruitment into the trial, ongoing participation (adherence and dropout), perceived benefit, enjoyment and ease of use of the games. Efficacy will be determined by measuring activity and using upper-limb tasks as well as measures of balance and mobility. The hypothesis that the intervention group will have increased levels of physical activity within rehabilitation and improved physical outcomes compared with the control group will be tested. DISCUSSION: Results from this study will provide a basis for discussion of feasibility of this interactive video technological solution in an inpatient situation. Differences in activity levels between groups will be the primary measure of efficacy. It will also provide data on measures of upper-limb function, balance and mobility. TRIAL REGISTRATION: ACTRN12614000427673 . Prospectively registered 17 April 2014.

Leukemic transformation in polycythemia vera: analysis of risk factors.

Forty-eight patients with polycythemia vera (PV) were retrospectively studied for incidence of acute leukemia over a 12 year period. Initial clinical features, hemogram, RBC mass, B12 levels, neutrophil alkaline phosphatase (NAP), and therapy given were studied for association with development of acute leukemia. There were 25 males and mean age at diagnosis was 61.4 years. Initial Hg was 18.38 +/- 1.86 g/dl, WBC 16.44 +/- 12.92 (x 1,000/mm3), platelets 632.94 +/- 303.81 (x 1,000/mm3), B12 1,030.93 +/- 445.20 pg/ml, and neutrophil alkaline phosphatase (NAP) score 136.63 +/- 55.14. Twenty-three patients were treated with phlebotomy alone and 25 received additional myelosuppressive therapy as follows--2 received p32 alone, 4 alkylating agents alone, 8 hydroxyurea (HU) alone, and 11 received 2 or more (multiple) of these agents. None of those treated with phlebotomy alone but 6 of 25 (24%) patients given myelosuppressive therapy developed acute leukemia (P = .03) after a mean period of 46.8 months from start of myelosuppressive therapy. Four of the 11 patients (36%) receiving multiple agent therapy developed acute leukemia (P = .019). Initial hemoglobin levels, but not the other clinical parameters, were significantly higher in patients who developed acute leukemia (P = .002), and this difference persisted in various subgroups receiving myelosuppressive therapy. Thus, high initial hemoglobin and use of any myelosuppressive therapy are associated with an increased risk of leukemic transformation in polycythemia vera. This risk becomes substantial with the use of two or more myelosuppressive agents. Since myelosuppressive therapy does not prolong survival, its role in the management of polycythemia vera should be reexamined.

Pseudoleukemia in Down's syndrome. Analysis of immunophenotype and gene rearrangement.

This report demonstrates a case of transient abnormal myelopoiesis (TAM) evolving in a patient with Down's syndrome. A diagnosis was established after the patient's blast cell count decreased considerably three weeks after the initial leukemic phase. The blast population in the authors' case expressed Leu-9 (CD7), 6D1, and TdT+. Cytochemistries showed some of the blast population to be peroxidase positive and Sudan black positive. Platelet peroxidase by electron microscopic examination showed some positive blasts. Therefore, surface markers and cytochemical studies in this case suggested an abnormal proliferation involving a pluripotential stem cell capable of expressing myeloid and lymphoid characteristics. Cytogenetics was performed at birth and showed 47,XY,+21/48,XY,+21,+mar, confirming the diagnosis of Down's syndrome. The origin of the chromosomal fragment was uncertain. It was of interest that during the remission phase of his pseudoleukemia there was a concomitant decrease in the extra chromosomal fragment. Immunoglobulin and T-cell antigen receptor gene rearrangement studies showed only germline patterns, indicating that the lymphoid cells in the blast population were not clonally expanded. Therefore, immunoglobulin and T-cell antigen receptor rearrangement analysis and immunophenotyping are extremely valuable techniques in distinguishing between TAM and acute lymphoblastic leukemia in patients with Down's syndrome.

Acute lymphoblastic leukemia-hand mirror variant. Analysis for endogenous retroviral antibodies in bone marrow plasma.

Two unusual cases of acute lymphoblastic leukemia-hand mirror variant (ALL-HMV) are presented. One patient demonstrated a mixed immunophenotype with HLA-DR, My7, transferrin receptor surface markers, and terminal deoxynucleotidyl transferase positivity. To the authors' knowledge, this is the first ALL-HMV reported with myeloid antigen. The patient died during induction and did not demonstrate the indolent course noted in the female subgroup with this disorder. The second case initially was not an ALL-HMV but presented as a non-T non-B ALL, and the patient had a relapse six years later with numerous hand mirror cells (HMCs). In the authors' experience, this is the first case of ALL that presented as a non-HMC and relapsed as an ALL-HMV. The patient's immunophenotype revealed he was HLA-DR, transferrin receptor, and TdT positive. Both patients' leukemic cells showed a diffuse granular periodic acid-Schiff on a clear background and acid phosphatase-positive pattern. Immunogenetics revealed a clonal rearrangement of one of the two Ig heavy chain loci in the one patient evaluated. Western blot analysis of the bone marrow plasma of both patients with ALL-HMV showed an increase of cross-reactive IgG to the envelope gp70 and IgM against the core p30 proteins of the baboon endogenous virus (BaEV) and simian sarcoma-associated virus (SSAV). Furthermore, their bone marrow plasma demonstrated IgM antibodies to the gp70 that were not present in any of the other non-hand mirror leukemic patients or the normal controls. These findings strengthen the concept that HMCs in ALL are formed in relation to an immunologic response to increased proteins related to BaEV and/or SSAV.

Chromosome abnormalities in B cell chronic lymphocytic leukemia and their clinical correlations.

Cytogenetic analysis was successfully performed on 31 of 40 patients with chronic B cell leukemia. Clonal abnormalities were seen in 16 patients using various culture methods. Fourteen of these had unstimulated cultures established of which 13 had the clonal abnormality. Trisomy 12 was observed in seven patients while a 14q32 translocation was present in four. Race, age, hemoglobin, WBC, percentage of lymphocytes and prolymphocytes in BM and PB, platelets, Smig, lymph node, spleen, liver, pattern of bone marrow infiltration, therapy free interval, and overall survival were all compared. Significant correlations between the presence of clonal abnormalities and prior therapy (p less than 0.005) and an increase in prolymphocytes in bone marrow (p = 0.05) and/or peripheral blood (p = 0.0014) were observed.

Effect of inhibition of the catalytic activity of cyclic AMP-dependent protein kinase on mitosis in PtK1 cells.

Evidence has suggested that cyclic AMP, acting through activation of the type II cyclic AMP-dependent protein kinase, may play a role in the regulation of interphase and mitotic microtubules. In order to examine the potential role of the type II cAMP-dependent kinase during mitosis, dividing PtK1 cells were microinjected with two specific inhibitors of the catalytic activity of the type II kinase. These inhibitors were a specific protein inhibitor of cAMP-dependent protein kinase (PKI) and an affinity-purified polyclonal antiserum (anti-C) directed against the catalytic subunit of the kinase. Both have been shown previously to inhibit kinase activity in vitro. Microinjection of PKI during early- to mid-prophase significantly delayed the progression of the cells through mitosis, with the greatest delay occurring in metaphase. PKI injected during prometaphase also delayed progression through mitosis but to a lesser extent. Microinjection of anti-C during early- to mid-prophase also caused a significant delay in the completion of mitosis, with many cells becoming "hung up" in prometaphase. Anti-C injected during prometaphase had little effect on subsequent progression through mitosis. Microinjection of either anti-C or PKI during metaphase had no discernible effect. No effect on anaphase movement of chromosomes was observed with any treatment. These results provide further evidence that cAMP-dependent phosphorylation may be involved in the regulation of mitosis, although whether it acts directly through regulation of mitotic spindle microtubules is unclear.

A 14;19 translocation in B-cell chronic lymphocytic leukemia: a new recurring chromosome aberration.

Four of 30 patients with a diagnosis of B-CLL or prolymphocytic transformation of CLL, who had an adequate cytogenetic analysis, had abnormalities involving 14q32. Three of the 4 had a translocation involving chr. 19; in 2 of them it appeared to be t(14;19) (q32;q13.1). The third patient probably had the same translocation. All 3 patients had received therapy prior to cytogenetic analysis.

Lunar soil: size distribution and mineralogical constituents.

The lunar soil collected by Apollo 11 consists primarily of submillimeter material and is finer in grain size than soil previously recorded photographically by Surveyor experiments. The main constituents are fine-grained to glassy rocks of basaltic affinity and coherent breccia of undetermined origin. Dark glass, containing abundant nickel-iron spheres, coats many rocks, mineral, and breccia fragments. Several types of homogeneous glass occur as fragments and spheres. Colorless spheres, probably an exotic component, are abundant in the fraction finer than 20 microns.