Evaluation of the methane paradox in four adjacent pre-alpine lakes across a trophic gradient.

Contrasting the paradigm that methane is only produced in anoxic conditions, recent discoveries show that oxic methane production (OMP, aka the methane paradox) occurs in oxygenated surface waters worldwide. OMP drivers and their contribution to global methane emissions, however, are not well constrained. In four adjacent pre-alpine lakes, we determine the net methane production rates in oxic surface waters using two mass balance approaches, accounting for methane sources and sinks. We find that OMP occurs in three out of four studied lakes, often as the dominant source of diffusive methane emissions. Correlations of net methane production versus chlorophyll-a, Secchi and surface mixed layer depths suggest a link with photosynthesis and provides an empirical upscaling approach. As OMP is a methane source in direct contact with the atmosphere, a better understanding of its extent and drivers is necessary to constrain the atmospheric methane contribution by inland waters.

Parents' views on and need for an intervention during their chronically ill child's transfer to adult care.

Parents of chronically ill adolescents play a significant role during their child's transition and transfer to adult care. Parents seek help and support, but appropriate initiatives are still lacking. Thus, there is an urgent call for knowledge regarding parents' needs and views on such support. The aim of this study was to examine, in relation to parents of chronically ill adolescents: 1) views and experiences regarding their child's transfer from paediatric to adult care, and 2) which initiatives parents preferred in relation to the transfer. The study was based on the interpretive description method, and data were collected through face-to-face or telephone interviews with parents of chronically ill adolescents aged 16-19 (n = 11). We found three overall findings: 'Feeling acknowledged vs. feeling excluded', 'Perceived differences between paediatric and adult care' and 'Feeling safe vs. entering the unknown', together with three preferred initiatives: 1) Joint consultations, 2) Educational events and 3) Online support/website. In general, we found that some parents were extremely worried about the transfer, while others were not. Our results suggest that transfer initiatives targeting parents should focus on knowledge, expectations, relationships and goals in accordance with the social-ecological model of adolescent and young adult readiness to transition (SMART).

Parents to chronically ill adolescents have ambivalent views on confidential youth consultations - a mixed methods study.

BACKGROUND: Confidential youth consultations aiming at enhancing adolescent autonomy are a cornerstone of transitional care. At the same time, parental support is essential. These conflicting considerations result in a clinical dilemma. OBJECTIVE: The aim of this study was to examine the attitudes of parents to chronically ill adolescents regarding confidential youth consultations and to explore the underlying reasons. METHODS: A sequential explanatory mixed methods design consisting of a cross-sectional questionnaire survey (n = 117) and three focus group interviews among parents (n = 12) to chronically ill adolescents (12-19 years) was used. Quantitative data were analyzed descriptively. Qualitative data were analyzed using King's template method. RESULTS: The parents preferred independent youth consultations starting around the age of 14-15 years. Around 60% of the parents had one or more concerns regarding independent youth consultations. Although 64% of the parents supported conditional or full confidentiality during adolescence, 95% wanted information even though their child did not consent. In the qualitative analysis, the parents described caring for a child with chronic disease as a term of life perceiving themselves as an "octopus" with numerous roles related to daily care and treatment and at the same time with thoughts and worries regarding the future. We found four themes: 'a life with chronic disease', 'responsibility', 'protection' and 'apprenticeship'. The parents' attitudes were influenced by their roles and their perception of the adolescent's competences as well as their experience with the healthcare system. CONCLUSIONS: Our findings suggest that parents need transitional care too.

Appointed by young people - a qualitative study on young patients recruiting hospital staff in Denmark.

BACKGROUND: There is a lack of knowledge about young peoples'wishes for the qualifications including skills and personal traits of hospital staff during the recruitment process. OBJECTIVE: The aim of this qualitative study was to explore which qualifications, skills and personal traits young people prefer when recruiting hospital staff. METHODS: A Youth Recruitment Committee (YRC) consisting of four young people performed six job interviews in parallel to conventional job interviews at Copenhagen University Hospital Rigshospitalet, Denmark. The interviews with the candidates and the subsequent YRC deliberation were observed and recorded, and data were analyzed using thematic analysis. RESULTS: Four main themes with matching sub-themes emerged from the data: (1) Personality (appearance and commitment), (2) Professional skills (approach, mentality and activities), (3) Project management (skills and experience), (4) Communication (during the interview and experiential approach to youth). It was important to the YRC that the candidate had professional experience working with young people as well as being a skilled project manager. The YRC also assessed the candidates´ communication during the interview. CONCLUSIONS: By inviting young people in as a separate recruitment committee, their perspectives and preferences were noted without interference from professionals. Our findings are in line with previous research regarding young peoples´ preferences on youth-friendly health services. Furthermore, this approach made it possible to evaluate candidates´ communication skills with young people as they were assessed during the job interviews.

Detection of pharmacovigilance-related adverse events using electronic health records and automated methods.

Electronic health records (EHRs) are an important source of data for detection of adverse drug reactions (ADRs). However, adverse events are frequently due not to medications but to the patients' underlying conditions. Mining to detect ADRs from EHR data must account for confounders. We developed an automated method using natural-language processing (NLP) and a knowledge source to differentiate cases in which the patient's disease is responsible for the event rather than a drug. Our method was applied to 199,920 hospitalization records, concentrating on two serious ADRs: rhabdomyolysis (n = 687) and agranulocytosis (n = 772). Our method automatically identified 75% of the cases, those with disease etiology. The sensitivity and specificity were 93.8% (confidence interval: 88.9-96.7%) and 91.8% (confidence interval: 84.0-96.2%), respectively. The method resulted in considerable saving of time: for every 1 h spent in development, there was a saving of at least 20 h in manual review. The review of the remaining 25% of the cases therefore became more feasible, allowing us to identify the medications that had caused the ADRs.

A comparison of studies on the quality of life of primary caregivers of stroke survivors: a systematic review of the literature.

BACKGROUND AND PURPOSE: Few studies have been conducted on the quality of life (QOL) of primary caregivers of stroke survivors (with and without aphasia), with little consistency in the methods of evaluation. The purpose of this systematic review of the literature was to determine the appropriateness of study designs and instruments used to assess QOL in caregivers of stroke survivors. METHOD: A comprehensive literature review was conducted to identify peer-reviewed articles of caregiver's QOL where CINAHL, MEDLINE, and PsycINFO databases were searched. RESULTS: Nine studies that met the inclusion criteria used different QOL instruments and study designs. None of the instruments were specific to caregivers of stroke survivors. CONCLUSION: Future studies are warranted to assess the quality of life of caregivers of stroke survivors with and without aphasia.

Caregiver strain and caregiver burden of primary caregivers of stroke survivors with and without aphasia.

Little is known about how the burden and strain of caring for stroke patients with or without aphasia affects primary caregivers. This article (a) critically examines the literature on the burden and strain of care experienced by caregivers of stroke patients and (b) examines the relationship between aphasia and caregiver burden and strain. Two literature reviews of three databases were conducted. Fourteen articles (12 quantitative articles, 1 mixed-design article, and 1 qualitative article) were found to comply with the study criteria for the first literature search. A second literature search focused on the effects of stroke survivors' aphasia on caregiving; none of the articles retrieved met the inclusion criteria. This article suggests that there is a lack of research in this area and that several key initiatives are needed, including the development of an instrument with psychometric properties appropriate for assessing the burden and strain on caregivers of stroke patients. Implications for future nursing practice and research are highlighted.

[Age-related changes in glucocorticoid and mineralocorticoid receptors in lymphocytes of healthy persons and patients with hypertension]. / Vikovi zminy retseptoriv gliuko- i mineralokortykoïdiv v limfotsytakh zdorovykh i khvorykh na gipertonichnu khvorobu liudei.

It has been found that the number of glucocorticoid receptors in lymphocytes of the peripheral blood of healthy elderly subjects increases, while the number of mineralocorticoid receptors decreases. The mechanisms of hormone-receptor interactions in hypertension are activated: the number of glucocorticoid and mineralocorticoid binding sites grows in hypertensive patients. Still a more essential rise in the number of receptors is observed in mid-age hypertensive patients than in elderly ones.

[Effect of antihypertensive therapy with captopril on gluco- and mineralocorticoid receptors of peripheral blood lymphocytes in hypertensive patients of various age]. / Vliianie gipotenzivnoi terapii kaptoprilom na retseptory gliuko- i mineralokortikoidov v limfotsitakh perifericheskoi krovi bol'nykh gipertonicheskoi bolezn'iu raznogo vozrasta.

Binding of 3H-dexamethasone and 3H-aldosterone by peripheral lymphocyte receptors was investigated in healthy persons and hypertensive patients before and after 2-week captopril treatment. The number of glucocorticoid and mineralocorticoid binding sites was increased in hypertensives vs normotensives. The treatment with the ACE inhibitor captopril led to activation of hormone-receptor interactions. There was a more marked rise of the number of receptors in middle-aged (44-55 years) hypertensives vs elderly (61-80 years) subjects after captopril treatment.

[Hormonal mechanisms in the regulation of arterial pressure and its hemodynamic structure in old age]. / Gormonal'nye mekhanizmy reguliatsii urovnia arterial'nogo davleniia i ego gemodinamicheskoi struktury v starosti.

Age-related increase of vascular resistance determines blood pressure (BP) level in normotensive and hypertensive people. Maintenance of normotension in old age is connected with a decrease of the cardiac output. Increased cardiac output is considered to be an important factor of arterial hypertension in old age. Disturbances in renin-angiotensin-aldosterone and hypophyseal-adrenal systems are observed with advanced age and their degree increases in arterial hypertension. Variability of BP within normal range is closely connected with plasma aldosterone and cortisol concentrations. BP level and increased cardiac output are related to increased plasma ACTH and vasopressin concentrations in hypertensive subjects.

[The effect of sermion on the main hemodynamic indices in patients with the initial manifestations of cerebral atherosclerosis]. / Vliianie sermiona na osnovnye pokazateli gemodinamiki u bol'nykh s nachal'nymi proiavleniiami tserebral'nogo ateroskleroza.

It has been found that the drug sermion (nicergoline)--a synthetic ergot alkaloid with alpha-adrenoblocking action--produces a pronounced vasoactive (spasmolytic) effect in the elderly patients suffering of initial atherosclerotic encephalopathy. A course of sermion treatment improves, via its effect on the brain and lower extremity vessels, the flow in most involved vascular regions. High concentrations of the drug after intravenous administration of 4 mg of sermion (nicergoline) result in a rise of the sympathetic vascular tone, high adrenoblocking action.

[Age-related characteristics of the prostaglandin system in healthy subjects and in patients with arterial hypertension: hypertonic disease and systolic (atherosclerotic) hypertension]. / Vozrastnye osobennosti prostaglandinovoi sistemy u zdorovykh i bol'nykh s arterial'noi gipertenziei: gipertonicheskaia bolezn' i sistolicheskaia (ateroskleroticheskaia) gipertenziia.

A group of 89 apparently healthy subjects and 175 patients with essential hypertension (EH) and systolic (atherosclerotic) hypertension aged 25 to 74 years were surveyed. The healthy subjects were found to have changes in prostaglandin (PG) synthesis and metabolism: a reduction in blood plasma concentration of PGE2 and its urinary excretion, a rise in plasma PGF2 level, and, generally, increase in the pressor and decrease in depressor potentials of the PG system. In the EH patients, changes in the PG synthesis and metabolism were unidirectional and had quantitative variations. The differences in the PG levels of healthy and EH-afflicted individuals were found to become less marked with age. The patients with systolic hypertension exhibited higher plasma prostacyclin concentrations as compared to the age-matching control, which is evidence of a lower pressor potential of the PG system than that of the EH patients. The nature and magnitude of changes in the PG system play a certain role in blood pressure formation and in development of the hemodynamic variant of arterial hypertension.

[Essentiale in the treatment of hypertension in patients in the older age groups]. / Essentsiale v lechenii bol'nykh gipertonicheskoi bolezn'iu starshikh vozrastov.

The authors studied the effect of essentiale on the clinical course, state of central hemodynamics and content of prostaglandins in the blood and urine of patients with hypertensive disease. Age of the patients: middle--from 45 to 59 years and elderly--from 60 to 74 years. It is suggested that the hypotensive effect of essentiale is caused by a reduction of the total peripheral resistance while its humoral basis is an increase of the depressor potential of plasma and renal prostaglandins. Age-related differences in the response to essentiale treatment consist mostly in the effect on the clinical symptoms, arterial pressure, prostaglandins in the blood and urine differing in the elderly as compared with medium-aged patients.