Time to question diabetes self-management support for Arabic-speaking migrants: exploring a new model of care.

AIM: The objective of this study was to explore a new model for diabetes self-management support in Arabic-speaking migrants. METHODS: Two qualitative methods were used: face-to-face semi-structured individual interviews and focus groups. Interviews were audio-taped, transcribed verbatim and coded thematically. Arabic-speaking migrants with Type 2 diabetes were recruited from several primary, secondary and tertiary healthcare settings in metropolitan Melbourne, Australia. These settings were purposefully selected to obtain a diverse group of participants. Data collection continued until saturation was reached. This is the first study that involved members of Arabic-speaking communities in Australia in a formal process of consumer and public involvement to inform research design and recruitment in order to provide evidence for a new model of diabetes self-management for Arabic-speaking migrants. RESULTS: No self-management support was offered to Arabic-speaking migrants beyond the initial diagnosis period. Significant knowledge gaps and skills deficits in all self-management domains were evident. The provision of tailored self-management support was considered crucial. When asked about preferred structure and delivery modalities, a strong preference was reported for face-to-face storytelling interactions over telephone- or internet-based interventions. Gender-specific group education and self-management support sessions delivered by Arabic-speaking diabetes health professionals, lay peers or social workers trained in diabetes self-management were highly regarded. CONCLUSIONS: A patient and public involvement approach allows genuine engagement with Arabic-speaking migrants with diabetes. There is urgent need for a new model for self-management support among Arabic-speaking migrants. Findings yielded new recommendations for diabetes health professionals working with these migrant communities to support behaviour change.

Predictors of outcomes of psychological treatments for disordered gambling: A systematic review.

This systematic review aimed to synthesise the evidence relating to pre-treatment predictors of gambling outcomes following psychological treatment for disordered gambling across multiple time-points (i.e., post-treatment, short-term, medium-term, and long-term). A systematic search from 1990 to 2016 identified 50 articles, from which 11 socio-demographic, 16 gambling-related, 21 psychological/psychosocial, 12 treatment, and no therapist-related variables, were identified. Male gender and low depression levels were the most consistent predictors of successful treatment outcomes across multiple time-points. Likely predictors of successful treatment outcomes also included older age, lower gambling symptom severity, lower levels of gambling behaviours and alcohol use, and higher treatment session attendance. Significant associations, at a minimum of one time-point, were identified between successful treatment outcomes and being employed, ethnicity, no gambling debt, personality traits and being in the action stage of change. Mixed results were identified for treatment goal, while education, income, preferred gambling activity, problem gambling duration, anxiety, any psychiatric comorbidity, psychological distress, substance use, prior gambling treatment and medication use were not significantly associated with treatment outcomes at any time-point. Further research involving consistent treatment outcome frameworks, examination of treatment and therapist predictor variables, and evaluation of predictors across long-term follow-ups is warranted to advance this developing field of research.

Examining the 16-year trajectories of mental health and wellbeing through the transition into widowhood.

BACKGROUND: Becoming widowed is a significant event. There is considerable evidence that surviving partners report substantial changes in their wellbeing and mental health. Changes can occur prior to partner's death as an anticipatory effect and consequently during the period after partner's death. For most, declines in wellbeing and mental health dissipate over time. However, there is a limited long-term evidence to compare age-normative trajectories in mental health and wellbeing with the trajectories of those who transition into widowhood. METHODS: Participants (n = 652) were older adults (aged 65-94 years at baseline) from the 16-year Melbourne Longitudinal Studies on Healthy Ageing project who were either married or de facto (n = 577), or recently widowed (n = 75). Generalized Estimating Equations (GEE) examined the immediate and long-term impact of widowhood. GEE piecewise regression analyses examined the trajectories of wellbeing and mental health in those who transitioned into widowed with time centered at time of partner's death. Analyses were stratified by gender. RESULTS: For both men and women, becoming widowed was strongly related to a strong decline in positive affect post partner's death. Otherwise, no long-term impact of widowhood on negative affect or depressive symptomology was reported. CONCLUSIONS: The impact of widowhood reports differential impacts on different indicators of wellbeing and mental health, which were inconsistent between men and women.

Gender differences in the trajectories of late-life depressive symptomology and probable depression in the years prior to death.

BACKGROUND: Gender differences in depression are well established. Whether these differences persist into late life and in the years preceding death is less clear. There is a suggestion that there is no increased likelihood of depression in late life, but that there is an increase in depressive symptomology, particularly with proximity to death. We compared trajectories of probable depression and depressive symptomology between men and women over age and distance-to-death metrics to determine whether reports of depressive symptoms are more strongly related to age or mortality. METHODS: Participants (N = 2,852) from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project had a mean age of 75 years (SD = 5.68 years) at baseline and were observed for up to 16 years prior to death. Multi-level regression models estimated change in depressive symptomology and probable depression over two time metrics, increasing age, and distance-to-death. RESULTS: Increases in depressive symptomology were reported over increasing age and in the years approaching death. Only male participants reported increased probable depression in the years preceding death. Models that utilized distance-to-death metrics better represented changes in late-life depression, although any changes in depression appear to be accounted for by co-varying physical health status. CONCLUSIONS: As death approaches, there are increases in the levels of depressive symptomology even after controlling for socio-demographic and health covariates. In line with increases in suicide rates in late life, male participants were at greater risk of reporting increases in depressive symptomology.

Direct modulation of a tuneable slotted Fabry-Pérot laser with adaptive modulation OFDM.

Next generation optical access networks will require low cost lasers in conjunction with network flexibility and higher data rates. This work presents the direct modulation of a low cost tuneable slotted Fabry-Pérot laser (tuneable over 14 nm) with AM-OFDM. Characteristics of this dual section laser are presented and transmission of 10 Gb/s over 50 km is achieved with this device.

Pharmacological characterization of GSK1004723, a novel, long-acting antagonist at histamine H(1) and H(3) receptors.

BACKGROUND AND PURPOSE: Preclinical pharmacological characterization of GSK1004723, a novel, dual histamine H(1) and H(3) receptor antagonist. EXPERIMENTAL APPROACH: GSK1004723 was characterized in vitro and in vivo using methods that included radioligand binding, intracellular calcium mobilization, cAMP production, GTPγS binding, superfused human bronchus and guinea pig whole body plethysmography. KEY RESULTS: In cell membranes over-expressing human recombinant H(1) and H(3) receptors, GSK1004723 displayed high affinity, competitive binding (H(1) pKi = 10.2; H(3) pKi = 10.6). In addition, GSK1004723 demonstrated slow dissociation from both receptors with a t(1/2) of 1.2 and 1.5 h for H(1) and H(3) respectively. GSK1004723 specifically antagonized H(1) receptor mediated increases in intracellular calcium and H(3) receptor mediated increases in GTPγS binding. The antagonism exerted was retained after cell washing, consistent with slow dissociation from H(1) and H(3) receptors. Duration of action was further evaluated using superfused human bronchus preparations. GSK1004723 (100 nmol·L(-1) ) reversed an established contractile response to histamine. When GSK1004723 was removed from the perfusate, only 20% recovery of the histamine response was observed over 10 h. Moreover, 21 h post-exposure to GSK1004723 there remained almost complete antagonism of responses to histamine. In vivo pharmacology was studied in conscious guinea pigs in which nasal congestion induced by intranasal histamine was measured indirectly (plethysmography). GSK1004723 (0.1 and 1 mg·mL(-1) intranasal) antagonized the histamine-induced response with a duration of up to 72 h. CONCLUSIONS AND IMPLICATIONS: GSK1004723 is a potent and selective histamine H(1) and H(3) receptor antagonist with a long duration of action and represents a potential novel therapy for allergic rhinitis.

Performance improvement of 10 Gb/s direct modulation OFDM by optical injection using monolithically integrated Discrete Mode lasers.

Performance improvement of a directly modulated 10 Gb/s OFDM system by optical injection of monolithically integrated lasers is shown experimentally over differing fibre lengths. The modulation and optical injection is performed using monolithically integrated Discrete Mode lasers. It is shown that optical injection with this device reduces third order inter-modulation distortion by up to 10dB and this results in an improvement in system performance from above a forward error correction BER threshold of 1 × 10(-3) to significantly below it.

Release, biological potency, and biochemical integrity of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) combined with Augment(TM) Bone Graft or GEM 21S beta-tricalcium phosphate (beta-TCP).

Over 10 million surgical procedures are performed annually in the United States to treat musculoskeletal injuries, and a significant portion of these involve orthopedic bone grafting. The goals of the study were to evaluate the in vitro and in vivo release kinetics, biological potency and biochemical integrity of rhPDGF-BB combined with large (1000-2000 microm) and small (250-1000 microm) beta-TCP particles. Recombinant human platelet-derived growth factor B homodimer (rhPDGF-BB) is a protein growth factor under development as a therapeutic for accelerating bone healing. Release of the protein was monitored in vitro by ELISA, and in vivo by measurement of radioactive rhPDGF-BB implanted in rat calvarial defects. Biological activity was measured using a cell-based bioassay, and biochemical integrity was determined by SDS-PAGE and high pressure size exclusion chromatography (HPSEC). Release of rhPDGF-BB occurred rapidly from beta-TCP both in vitro and in vivo. Almost 100% of the rhPDGF-BB was recovered from large and small beta-TCP after 90 min in vitro. Approximately 90% of the rhPDGF-BB was depleted from calvarial defect sites within 72 h of implantation. RhPDGF-BB retained 100% of its biological potency compared to reference standard rhPDGF-BB, manifested as a single band at ~30 kDa by SDS-PAGE and a single peak eluted after 13 min by HPSEC following release from beta-TCP. RhPDGF-BB is rapidly released from large and small beta-TCP particles and is biochemically unaltered following release.

Linkage and association study of late-onset Alzheimer disease families linked to 9p21.3.

A chromosomal locus for late-onset Alzheimer disease (LOAD) has previously been mapped to 9p21.3. The most significant results were reported in a sample of autopsy-confirmed families. Linkage to this locus has been independently confirmed in AD families from a consanguineous Israeli-Arab community. In the present study we analyzed an expanded clinical sample of 674 late-onset AD families, independently ascertained by three different consortia. Sample subsets were stratified by site and autopsy-confirmation. Linkage analysis of a dense array of SNPs across the chromosomal locus revealed the most significant results in the 166 autopsy-confirmed families of the NIMH sample. Peak HLOD scores of 4.95 at D9S741 and 2.81 at the nearby SNP rs2772677 were obtained in a dominant model. The linked region included the cyclin-dependent kinase inhibitor 2A gene (CDKN2A), which has been suggested as an AD candidate gene. By re-sequencing all exons in the vicinity of CDKN2A in 48 AD cases, we identified and genotyped four novel SNPs, including a non-synonymous, a synonymous, and two variations located in untranslated RNA sequences. Family-based allelic and genotypic association analysis yielded significant results in CDKN2A (rs11515: PDT p = 0.003, genotype-PDT p = 0.014). We conclude that CDKN2A is a promising new candidate gene potentially contributing to AD susceptibility on chromosome 9p.

Tris-2-(3-methylindolyl)phosphine as an anion receptor.

A C3-symmetric phosphine with indolyl substituents has been synthesized that demonstrates the capability to bind anions through the indole NH sites and coordinate metal centres through the phosphorus centre.

Percutaneous needle biopsy of the spine.

The purpose of this review article is to provide a brief overview of the recent literature on the two main types of percutaneous biopsy methods done in the spinal column: fine needle aspiration biopsy (FNAB) and core needle biopsy (CNB). FNAB is the process of obtaining a sample of cells and bits of tissue for examination by applying suction through a fine needle attached to a syringe. Core needle biopsy involves extracting a cylindrical sample of tissue using a large, hollow needle. The decision for needle biopsy is a joint effort between the clinician, pathologist, radiologist, surgeon, and patient. Specific techniques and approaches with varying needle systems are described for each spinal region. Percutaneous image-guided spine biopsy is a safe and effective procedure. It is the procedure of choice in definitive diagnosis of pathologic lesions of the spine.

Reactions of 2-indolylphosphines with Ru3(CO)12: cluster capping with mu 3,eta 2-indolylphosphine as an anionic six-electron P,N-donor ligand.

Stepwise bidentate coordination of the novel indolylphosphine ligands HL (1, HL = P(C(6)H(5))(2)(C(9)H(8)N)(diphenyl-2-(3-methylindolyl)phosphine); 2, HL = P(C(6)H(5))(C(9)H(8)N)(2)(phenyldi-2-(3-methylindolyl)phosphine); and 3, HL = P(C(6)H(5))(C(17)H(12)N(2))(di(1H-3-indolyl)methane-(2,12)-phenylphosphine)) to the ruthenium cluster Ru(3)(CO)(12) is demonstrated. Reactions of 1-3 with Ru(3)(CO)(12) led to the formation of Ru(3)(CO)(11)(HL) (4-6), in which HL is mono-coordinated through the phosphorus atom. The X-ray structures of 4-6 show that the phosphorus atom is equatorially coordinated to the triruthenium core. In all cases, gentle heating of Ru(3)(CO)(11)(HL) resulted in the formation of Ru(3)(CO)(9)(mu-H)(mu(3),eta(2)-L)(7-9) in which the NH proton of the indolyl substituent had migrated to the ruthenium core to form a bridging hydride ligand. The X-ray structure of Ru(3)(CO)(9)(mu-H)[mu(3),eta(2)-P(C(6)H(5))(2)(C(9)H(7)N)] (7) shows the deprotonated nitrogen atom of the indolyl moiety bridging over the face of the triruthenium core, bonding to the two ruthenium metal centers to which the phosphorus atom is not bound. The phosphorus atom is forced to adopt an axial bonding mode due to the geometry of the indolylphosphine ligand. Cluster electron counting and X-ray data suggest that the indolylphosphine behaves as a six-electron ligand in this mode of coordination. Compounds 4-9 have been characterized by IR, (1)H, (13)C and (31)P NMR spectroscopy.

Prospecting for new group A streptococcal vaccine candidates.

BACKGROUND & OBJECTIVES: Most group A streptococcal (GAS) vaccine strategies focused on the surface M protein of the GAS. However, vaccine based on M protein have some drawbacks. In the present study, we used two approaches to identify new proteins and peptides that may have utility as vaccine candidates. METHODS: A whole gel elution procedure was used to separate GAS surface antigens into 9 size fractionated pools. Mice were vaccinated with each pool and antibody titre, opsonic ability and protective capacity measured. In an alternative approach BioInformatics was used to identify putative GAS surface proteins. Peptides from within these proteins were then selected on the basis of predicted antigenicity or location. These peptides were conjugated to keyhole lymphocyanin (KLH) and immunogenicity measured in a mouse model. RESULTS: One pool of GAS surface proteins (approximately 29kDa) induced antibodies that were both opsonic and potentially protective. Immunoflourescent microscopy demonstrated that these antibodies bound to the surface of M1 GAS. Amino acid sequencing subsequently identified superoxide dismutase as the major antigen in this pool. A BioInformatic search of the M1 GAS genome and subsequent analysis identified several peptides that fulfilled criteria as potential vaccine candidates. Each peptide when conjugated to KLH was able to induce a strong antibody response. INTERPRETATION & CONCLUSION: Several new antigens were identified that may have potential as vaccine targets. A future GAS vaccine may have multiple peptide epitopes, providing protection against multiple GAS strains.

Communication and psychosocial consequences of sensory loss in older adults: overview and rehabilitation directions.

With increasing longevity among populations, age-related vision and hearing impairments are becoming prevalent conditions in the older adult populations. In combination dual sensory loss occurs. Dual sensory loss is becoming a more common condition seen by clinicians and previous research has shown that 6% of non-institutionalized older adults had a dual sensory impairment, whilst 70% of severely vision-impaired older adults also demonstrated a significant hearing loss. Decreased vision and/or hearing acuity interferes with reception of the spoken message and hence people with sensory loss frequently experience communication breakdown. Many personal, situational and environmental triggers are also responsible for communication breakdown. Limited ability to improve communication performance frequently results in poor psychosocial functioning. Older adults with sensory loss often experience difficulty adjusting to their sensory loss. Depression, anxiety, lethargy and social dissatisfaction are often reported. Sensory loss, decreased communication performance and psychosocial functioning impacts on one's quality of life and feelings of well-being. Rehabilitation services for older adults with age-related sensory loss need to accommodate these difficulties. Improved staff education and rehabilitation programmes providing clients and carers with strategies to overcome communication breakdown is required. A multidisciplinary perspective to the assessment and remediation of older adults is recommended.

Tripyrrolylphosphine as a unique bridging ligand in the Rh6CO14(mu2-P(NC4H4)3) cluster: structure, bonding, fluxionality, thermodynamics, and kinetics studies.

Tripyrrolylphosphine reacts with the cluster Rh6CO15(NCMe) to afford the disubstituted Rh6CO14(mu2)-P(NC4H4)3) derivative (2) via the Rh6CO15P(NC4H4)3 intermediate (1) with eta(1)-P coordination. In the solid state, 2 has the phosphine occupying a bridging position where it is bonded to two neighboring Rh atoms in the Rh(6) octahedron through the P-atom and an approximately tetrahedral alpha-carbon atom of one of the pyrrolyl rings. This can be described by the interaction of an electron pair, associated with a negative charge on one of the canonical forms of the NC(4)H(4) ring, with the adjacent Rh center. (1)H NMR spectra show that the solid-state structure is retained in solution, but the phosphine is not rigid, and three distinctive dynamic processes are observed. Each of these represents independent hindered rotation of inequivalent pyrrolyl rings about P-N bonds, the ring involved in the interaction with the Rh(6) skeleton displaying the highest activation barrier with deltaH = 15.8 +/- 0.1 kcal mol(-1) and deltaS = 1.4 +/- 0.3 cal K(-1) mol(-1). The assignment has been confirmed by 1H TOCSY and EXSY experiments, and a mechanism is proposed. The formation of 2 from 1 is reversible in the presence of CO, which is highly unusual for bridged clusters. The kinetics of the forward and reverse reactions have been studied, and the values of DeltaH degrees and DeltaS degrees for formation of 2 (+1.3 +/- 0.5 kcal mol(-1) and -9 +/- 2 cal K(-1) mol (-1), respectively) show that the Rh-C bond in the bridge is comparable in strength with the Rh-CO bond it replaces. The intrinsic entropy of 2 is exceptionally unfavorable, overcoming the favorable entropy caused by CO release, and this allows the reversibility of bridge formation. The reactions proceed via a reactive intermediate that may involve agostic bonding of the ring. The reverse reaction has an exceedingly unfavorable activation entropy that emphasizes the unique nature of 2.

Falls: a comparison of trends in community, hospital and mortality data in older Australians.

BACKGROUND AND AIMS: Falls are major contributors to disability, morbidity and death for older people. Frequently, falls-related data for each of these areas is viewed in isolation. The aim of this study was to establish trends in incidence of falls-related events including: community reporting of falls and falls-related injuries, hospitalizations as a result of accidental falls, and mortality related to accidental falls for older people in two states of Australia (Victoria and South Australia). METHODS: We analysed data sets for falls hospitalizations and mortality rates for the period 1988 to 1997, and from two longitudinal population-based proportional samples during the same time period. RESULTS: Age-standardised falls mortality rates have steadily declined in Victoria, and remained unchanged between 1988 and 1997 in South Australia. In both states, age-standardised falls hospitalization rates have increased significantly (in Victoria, RR=1.32, 95% CI: 1.30-1.34; and South Australia, RR=1.05, 95% CI: 1.03-1.06). In both states, there was a clear age-related effect, with those in the 85-year and older age group having a falls-related mortality rate approximately 40 times that of those aged 65-69 years, and a hospitalization rate 9 times that of those in the 65-69 age group. The community studies indicated that falls rates remain high among older Australians, and that injurious falls occurred in 10% in the first wave of data collection in each of these studies. CONCLUSIONS: The results highlight that various indicators related to falls trends taken in isolation may yield differing conclusions. For a true reflection of the effectiveness of falls prevention programs, falls-related mortality, hospitalization and community data need to be integrated. Increased focus on falls prevention activity in Australia during the 1990's has not reduced the magnitude of this major public health problem.

Communication perceptions of older adults with sensory loss and their communication partners: implications for intervention.

INTRODUCTION: Vision and hearing loss are prevalent disorders in older adults although their effects on communication are not well documented. METHOD: The purpose of this study was to investigate the perceptions of older adults with sensory loss and their communication partners with regard to their communication, situational difficulties and conversational needs. RESULTS: Questionnaire results revealed that the sensory loss group experienced a range of functional vision and hearing difficulties. Over two-thirds of subjects reported frequent conversational difficulty, particularly in background noise and group conversations. Most subjects used clarification requests (mainly non-specific clarification and repetition requests) to overcome misunderstandings. By contrast, the communication partners reported few communication difficulties and claimed that they proactively eliminated or controlled environmental, speaker and listener variables to optimize conversation. The most frequently reported strategy was repetition. CONCLUSION: The findings suggest that older adults with sensory loss experience communication disruptions, which in many instances are not resolved. To optimize communication efficacy in this population, a communication training programme for people with sensory loss and their communication partners is highly recommended.

Dual-task performance in right- and left-handed adults: a finger-tapping and foot-tapping study.

The dual-task paradigm has been used extensively to study laterality, with concurrent verbalization interfering with right finger-tapping in right handers. Only a few studies have used this paradigm to study interference patterns in left handers and have found inconsistent results. The dual-task paradigm has not been used to study interference effects with concurrent verbalization and foot-tapping. The objective of this study was to use this paradigm to assess whether verbal interference produces different effects on finger- and foot-tapping rate for right handers as compared to left handers. 12 right-handed and 12 left-handed men were studied, each with uncrossed hand and foot dominance, i.e., all individuals were either right handed and right footed or left handed and left footed. Subjects performed finger- and foot-tapping tasks with and without verbal interference. A significant relationship was found between handedness and finger- and foot-tapping rate; individuals with a stronger right-hand preference tended to tap at a higher rate on the right side and vice-versa. Analogous relationships were not found when participants were tapping and speaking concurrently. With verbal interference, both right and left handers had a significant asymmetric effect with a decremental response in right finger-tapping rate and a facilitative effect on left finger-tapping rate. In contrast, there was a bilateral decremental response in foot-tapping with verbal interference in both right and left handers. The implications of these findings are discussed with reference to cerebral laterality of language systems and to the differential organization and integration of the motor representations of the hand and the foot.

Morphology of the frontal operculum: a volumetric magnetic resonance imaging study of the pars triangularis.

OBJECTIVE: Broca's area, which includes the pars triangularis (PTR), is a neuroanatomical region important in speech and language production. Linear measures of the PTR have been found to be asymmetric, with the direction of the asymmetry correlating with language dominance determined by Wada testing. It is unclear, however, whether these linear measurements correlate with volumetric measures, and it is also unknown whether white matter and/or gray matter contribute differentially to these asymmetries. To investigate these issues, volumetric magnetic resonance imaging methodologies were used to measure the PTR in a group of healthy right-handed men (n = 12). There was a significant leftward asymmetry of the PTR using linear and volumetric measures. Linear measures of the left and right hemispheres were highly correlated with volumetric measures. Underlying gray and white matter both contributed to PTR asymmetry. Anatomical boundaries and four configurations (V, U, Y, and J) are discussed with reference to potential interhemispheric differences.

Community values and preferences in transplantation organ allocation decisions.

This paper is concerned with community values and preferences in organ transplantation allocation decisions. With recent trends in organ shortages, transplant teams face difficult allocation decisions amongst increasing numbers of "worthy" potential recipients. It is argued that the debate about these decisions ought to be informed in part by a systematic knowledge of prevailing community standards. A community sample of 238 adults (140 women and 98 men, with a mean age of 47.0 years) completed a questionnaire concerning which factors ought to affect recipient priority for transplantation. Longer waiting time, better prognosis, younger age and being a parent were the most frequently selected criteria for organ allocation decisions. The participants also rank ordered 16 potential recipients presented in the form of case scenarios in terms of priority for transplantation. The 16 case scenarios were constructed from a factorial combination of four variables: age of recipient (young vs old); the time the recipient had been on a waiting list (long vs short); recipient prognosis (excellent vs fair); and parental status (children vs no children). It was found that one case scenario involving a young parent with an excellent prognosis and long waiting time was ranked first by 75.2% of all participants. Analysis revealed that transplant recipient age and prognosis were the most influential factors in determining the priority rankings for organ allocation. The study has demonstrated that judgement and decision analysis procedures can be used to elicit community values and preferences about complex resource allocation decisions.