Is nitrification inhibition the bottleneck of integrating hydrothermal liquefaction in wastewater treatment plants?

Sewage sludge management poses challenges due to its environmental impact, varying composition, and stringent regulatory requirements. In this scenario, hydrothermal liquefaction (HTL) is a promising technology for producing biofuel and extracting phosphorus from sewage sludge. However, the toxic nature of the resulting process water (HTL-PW) raises concerns about integrating HTL into conventional wastewater treatment processes. This study investigated the inhibitory effects of HTL-PW on the activity of the main microbial functions in conventional activated sludge. Upon recirculation of the HTL-PW from the excess sludge into the wastewater treatment plant, the level of COD in the influent is expected to increase by 157 mgO2⋅L-1, resulting in 44% nitrification inhibition (IC50 of 197 mg⋅L-1). However, sorption of inhibitory compounds on particles can reduce nitrification inhibition to 27% (IC50 of 253 mg⋅L-1). HTL-PW is a viable carbon source for denitrification, showing nearly as high denitrification rates as acetate and only 17% inhibition at 157 mgO2⋅L-1 COD. Under aerobic conditions, heterotrophic organic nitrogen and organic matter conversion remains unaffected up to 223 mgO2⋅L-1 COD, with COD removal higher than 94%. This study is the first to explore the full integration of HTL in wastewater treatment plants for biofuel production from the excess activated sludge. Potential nitrification inhibition is concerning, and further long-term studies are needed to fully investigate the impacts.

Self- and proxy-reported impaired social interaction in young adults with simple congenital heart defects.

Background: Simple Congenital Heart Defects such as septal defects constitute a large proportion of Congenital Heart Defects. New research has demonstrated more co-morbidities than previously thought. In particular, co-morbidities involving neurocognitive, psychiatric, and social difficulties have been described. Neurocognitive and psychiatric morbidities affect social interaction. Social interaction is important in everyday social life (education, work life, family life). In this study, we investigated social interaction through self- and proxy-answered Social Responsiveness Scale 2 (SRS-2) in young adults with simple Congenital Heart Defects and compared their social interaction profile to healthy matched controls. Methods: We included a total of 80 patients with either atrial or ventricular septal defect (age 26.6 years) and 38 heart-healthy, age, sex, and ISCED educational matched controls (age: 25.3 years). A close relative proxy from each participant took part in the study as well. All participants answered the Social Responsiveness Scale 2 (SRS-2) (n = 225). Our primary and secondary outcomes were the SRS-2 Total score and the SRS-2 sub-scores. Results: In the Congenital Heart Defects group, 31.3% had a Total score above 60 compared to 7.9% in the control group (p = 0.005, RR = 3.96). The participants with a septal defect had a higher Total score (52.5 vs. 45.5, p = 0.004), a higher Social Cognition sub-score (55.0 vs. 47.0, p = 0.0004), and a higher Social Motivation sub-score (50.0 vs. 45.0, p = 0.003) than the heart-healthy participants. We found no difference between the two groups regarding the sub-scores of Social Awareness and Social Communication. A multiple linear regression model showed that the variable that explained most of the variation in Total Score was having a previously diagnosed psychiatric disorder. Conclusion: We found that young adults with atrial or ventricular septal defects have a fourfold increased risk of social interaction difficulties compared to heart-healthy peers. They have a social interaction profile, with difficulties in social cognition and social motivation, and preserved social awareness and social communication. Psychiatric morbidity explained most of the variation in social interaction problems. As social difficulties and psychiatric morbidities are intertwined, social interaction difficulties could be an indication of already underlying psychiatric morbidities or a risk factor for future psychiatric morbidity.

Psychiatric co-morbidity in children and adolescents with CHDs: a systematic review.

The population of long-term survivors with CHDs is increasing due to better diagnostics and treatment. This has revealed many co-morbidities including different neurocognitive difficulties. However, the prevalence of psychiatric disorders among children and adolescents and the specific types of disorders they may experience are unclear. We systematically reviewed the existing literature, where psychiatric diagnoses or psychiatric symptoms were investigated in children and adolescents (age: 2-18 aged) with CHDs and compared them with a heart-healthy control group or normative data. The searches were done in the three databases PubMed, psychINFO, and Embase. We included 20 articles reporting on 8035 unique patients with CHDs. Fourteen articles repoted on psychological symptoms, four reported on psychiatric diagnoses, and two reported on both symptoms and diagnoses. We found that children and adolescents with a CHD had a higher prevalence of attention deficit hyperactivity disorder (ranging between 1.4 and 9 times higher) and autism (ranging between 1.8 and 5 times higher) than controls, but inconsistent results regarding depression and anxiety.

Hyperactivity and Inattention in Young Patients Born With an Atrial Septal or Ventricular Septal Defect.

Background: Patients with congenital heart defects have a well-established risk of neuropsychiatric comorbidities. Inattention and hyperactivity are three to four times more frequent in children with complex congenital heart defects. We have previously shown a higher burden of overall attention deficit/hyperactivity disorder (ADHD) symptoms in adults with simple congenital heart defects as well. However, it is unknown whether the higher burden of ADHD symptoms is mainly driven by hyperactivity, inattention, or both. Methods: The participants [simple congenital heart defect = 80 (26.6 years old), controls = 36 (25.3 years old)] and a close relative for each (n = 107) responded to the long version of the Conners' Adults ADHD Rating Scales questionnaire. Our primary and secondary outcomes are mean T-scores in the ADHD scores and symptom sub-scores. Results: Patients with simple congenital heart defects reported a higher mean T-score at all three DSM-IV ADHD scores (ADHD-combined: 52.8 vs. 44.9, p = 0.007, ADHD-inattention: 55.5 vs. 46.4, p = 0.002, and ADHD-hyperactivity: 49.4 vs. 44.0, p = 0.03) and in all four ADHD symptom sub-scores (inattention/memory problems: 50.3 vs. 44.2, p = 0.001, hyperactivity/restlessness: 49.7 vs. 45.9, p = 0.03, impulsivity/emotional lability: 50.0 vs. 41.3, p = 0.001, and self-esteem problems: 53.8 vs. 46.3, p = 0.003). The results were maintained after the removal of outliers (incongruent responses), albeit the hyperactivity/restlessness ADHD symptom sub-score lost significance. Self- and informant ratings differed significantly on the ADHD-inattention score for the congenital heart defect group, where informants rated the ADHD-inattention scores better than the congenital heart defect patients rated themselves. Conclusions: Patients with a simple congenital heart defect have a higher symptom burden across all ADHD scores and all symptom sub-scores. The higher burden of ADHD is driven by both inattention and hyperactivity symptoms, though the inattention symptoms seem more prominent. Close relatives were less aware of the inattention symptoms than the congenital heart defect patients themselves. Routine screening for ADHD symptoms may be warranted to facilitate adequate help and guidance as these symptoms are easily overlooked. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03871881.

Classification of MSH6 Variants of Uncertain Significance Using Functional Assays.

Lynch syndrome (LS) is one of the most common hereditary cancer predisposition syndromes worldwide. Individuals with LS have a high risk of developing colorectal or endometrial cancer, as well as several other cancers. LS is caused by autosomal dominant pathogenic variants in one of the DNA mismatch repair (MMR) genes MLH1, MSH2, PMS2 or MSH6, and typically include truncating variants, such as frameshift, nonsense or splicing variants. However, a significant number of missense, intronic, or silent variants, or small in-frame insertions/deletions, are detected during genetic screening of the MMR genes. The clinical effects of these variants are often more difficult to predict, and a large fraction of these variants are classified as variants of uncertain significance (VUS). It is pivotal for the clinical management of LS patients to have a clear genetic diagnosis, since patients benefit widely from screening, preventive and personal therapeutic measures. Moreover, in families where a pathogenic variant is identified, testing can be offered to family members, where non-carriers can be spared frequent surveillance, while carriers can be included in cancer surveillance programs. It is therefore important to reclassify VUSs, and, in this regard, functional assays can provide insight into the effect of a variant on the protein or mRNA level. Here, we briefly describe the disorders that are related to MMR deficiency, as well as the structure and function of MSH6. Moreover, we review the functional assays that are used to examine VUS identified in MSH6 and discuss the results obtained in relation to the ACMG/AMP PS3/BS3 criterion. We also provide a compiled list of the MSH6 variants examined by these assays. Finally, we provide a future perspective on high-throughput functional analyses with specific emphasis on the MMR genes.

Dietary Micronutrient Intake of Participants in a "Partners Together in Health" Cardiac Rehabilitation Intervention.

PURPOSE: Current guidelines for cardiovascular health emphasize a "dietary pattern" approach that could be expected to increase intakes of micronutrients in addition to altering the macronutrient profile. However, the effect of interventions such as cardiac rehabilitation on the micronutrient quality of the diet has not been evaluated. Therefore, the goal of this study was to investigate changes in micronutrient intake of cardiac rehabilitation participants over time. METHODS: This was a secondary analysis of data from a randomized clinical trial that assessed the effects of the Partners Together in Health intervention on physical activity and healthy eating behaviors. The intake of 9 micronutrients important in cardiovascular health was assessed using 3-d food records. A micronutrient adequacy score was evaluated at 3 time points (baseline, 3 and 6 mo). Changes over time in micronutrient intake were assessed using a general linear model. RESULTS: Sixty-eight participants who were enrolled in the Partners Together in Health interventional trial completed the study. There was no significant difference in the mean micronutrient score at any time point. Intake of individual micronutrients did not improve over the 6-mo time frame with the exception of vitamin E, (8.7 mg vs 6.5 mg for at 6 vs 3 mo, P = .02). The proportion of participants with intakes meeting the Dietary Recommended Intake for each nutrient also remained the same over time. CONCLUSION: Although cardiac rehabilitation programs may be effective in altering the macronutrient composition, improvements to overall diet quality may be tempered by a lack of improvement in intake of micronutrients.

Archaeal lipids in oral delivery of therapeutic peptides.

Archaea contain membrane lipids that differ from those found in the other domains of life (Eukarya and Bacteria). These lipids consist of isoprenoid chains attached via ether bonds to the glycerol carbons at the sn-2,3 positions. Two types of ether lipids are known, polar diether lipids and bipolar tetraether lipids. The inherent chemical stability and unique membrane-spanning characteristics of tetraether lipids render them interesting for oral drug delivery purposes. Archaeal lipids form liposomes spontaneously (archaeosomes) and may be incorporated in conventional liposomes (mixed vesicles). Both types of liposomes are promising to protect their drug cargo, such as therapeutic peptides, against the acidic environment of the stomach and proteolytic degradation in the intestine. They appear to withstand lipolytic enzymes and bile salts and may thus deliver orally administered therapeutic peptides to distant sections of the intestine or to the colon, where they may be absorbed, eventually by the help of absorption enhancers. Archaeal lipids and their semisynthetic derivatives may thus serve as biological source for the next generation oral drug delivery systems. The aim of this review is to present a systematic overview over existing literature on archaea carrying diether and tetraether lipids, lipid diversity, means of lipid extraction and purification, preparation and in vitro stability studies of archaeal lipid-based liposomal drug carriers and in vivo proof-of concepts studies.

[Endogenous retroviruses are associated with autoimmune diseases].

Retroviruses can be transmitted in two fundamentally different ways: 1) They can be horizontally transmitted as infectious virus, or 2) they can integrate in the germ line and be transmitted to offspring and the offsprings' offspring as DNA. The latter is called endogenous viruses. The mode of transmission is called vertical. Viral variants of importance for development of disease must be more frequent among diseased persons than among healthy individuals. Multiple sclerosis, diabetes and rheumatoid arthritis are all associated with sets of endogenouos retroviruses but not the same sets. If a virus grows and this contributes to disease, one should be able to alleviate disease with antiretroviral drugs. We call for clinical trials to elucidate this issue.

Two endogenous retroviral loci appear to contribute to Multiple Sclerosis.

BACKGROUND: Two endogenous retroviral loci seem to be involved in the human disease Multiple sclerosis (MS). RESULTS: The two retroviral loci synergize in and contribute to MS (shown by ANOVA). Synergy probably means recombination or complementation of the activated viruses. Similar observations may be true for Type 1 Diabetes and Rheumatoid arthritis. In MS the genes also synergize with the immune system; this could well be a common phenomenon. CONCLUSION: We formulate various theories about the role of the viruses. Also, the concept is developing that some forms of autoimmunity should be treatable with antiretrovirals. In the case of MS, this idea is gradually gaining weight.

Are human endogenous retroviruses triggers of autoimmune diseases? Unveiling associations of three diseases and viral loci.

Autoimmune diseases encompass a plethora of conditions in which the immune system attacks its own tissue, identifying them as foreign. Multiple factors are thought to contribute to the development of immune response to self, including differences in genotypes, hormonal milieu, and environmental factors. Viruses including human endogenous retroviruses have long been linked to the occurrence of autoimmunity, but never proven to be causative factors. Endogenous viruses are retroviral sequences embedded in the host germline DNA and transmitted vertically through successive generations in a Mendelian manner. In this study by means of genetic epidemiology, we have searched for the involvement of endogenous retroviruses in three selected autoimmune diseases: multiple sclerosis, type 1 diabetes mellitus, and rheumatoid arthritis. We found that at least one human endogenous retroviral locus was associated with each of the three diseases. Although there was a significant overlap, most loci only occurred in one of the studied disease. Remarkably, within each disease, there was a statistical interaction (synergy) between two loci. Additional synergy between retroviral loci and human lymphocyte antigens is reported for multiple sclerosis. We speculate the possibility that recombinants or mixed viral particles are formed and that the resulting viruses stimulate the innate immune system, thereby initiating the autoimmune response.

The Effects of Temperature and Growth Phase on the Lipidomes of Sulfolobus islandicus and Sulfolobus tokodaii.

The functionality of the plasma membrane is essential for all organisms. Adaption to high growth temperatures imposes challenges and Bacteria, Eukarya, and Archaea have developed several mechanisms to cope with these. Hyperthermophilic archaea have earlier been shown to synthesize tetraether membrane lipids with an increased number of cyclopentane moieties at higher growth temperatures. Here we used shotgun lipidomics to study this effect as well as the influence of growth phase on the lipidomes of Sulfolobus islandicus and Sulfolobus tokodaii for the first time. Both species were cultivated at three different temperatures, with samples withdrawn during lag, exponential, and stationary phases. Three abundant tetraether lipid classes and one diether lipid class were monitored. Beside the expected increase in the number of cyclopentane moieties with higher temperature in both archaea, we observed previously unreported changes in the average cyclization of the membrane lipids throughout growth. The average number of cyclopentane moieties showed a significant dip in exponential phase, an observation that might help to resolve the currently debated biosynthesis pathway of tetraether lipids.

Synergy of two human endogenous retroviruses in multiple myeloma.

Multiple myeloma (MM) is a severe, incurable neoplasm of the plasma cells. In this study we have used genetic epidemiology to associate the risk of MM with endogenous retroviral loci in humans. We used SNP analysis on a Sequenom platform and statistical analysis in SPSS. Markers near two endogenous retroviral loci, HERV-Fc1 on chromosome X and HERV-K on chromosome 1, were associated with MM. Moreover, there was strong gene-gene interaction in relation to risk of MM. We take this as indirect confirmation of the association.

Liposomes containing lipids from Sulfolobus islandicus withstand intestinal bile salts: An approach for oral drug delivery?

In an attempt to design an oral drug delivery system, suited to protect labile drug compounds like peptides and proteins against the harsh environment in the stomach and upper intestine, we have prepared liposomes from phospholipids, cholesterol and archaeal lipids. As source for the archaeal lipids we used Sulfolobus islandicus, a hyperthermophilic archaeon, whose lipids have not been used in liposomes before. Culturing conditions and extraction protocols for its membrane lipids were established and the lipid composition of the crude lipid extract was characterized. The extracted membrane lipid fraction of S. islandicus consisted primarily of diether lipids with only a small fraction of tetraether lipids. Small unilamellar liposomes with 18% (mol/mol) of crude archaeal lipid extract were from S. islandicus were produced, for the first time and proven to be stabilized against aggressive bile salts as determined by loss of entrapped marker (calcein). At 4.4mM taurocholate (physiological taurocholate level) liposomes containing archaeal lipids retained entrapped marker better than liposomes made of egg phosphatidylcholine (PC) alone and to an extent similar to liposomes made of egg PC and cholesterol. Our findings showed that crude archaeal lipid extracts have, to a certain extent, stabilizing effects on liposomes similar to purified tetraether lipid fractions tested previously.

Structural characterization of ether lipids from the archaeon Sulfolobus islandicus by high-resolution shotgun lipidomics.

The molecular structures, biosynthetic pathways and physiological functions of membrane lipids produced by organisms in the domain Archaea are poorly characterized as compared with that of counterparts in Bacteria and Eukaryota. Here we report on the use of high-resolution shotgun lipidomics to characterize, for the first time, the lipid complement of the archaeon Sulfolobus islandicus. To support the identification of lipids in S. islandicus, we first compiled a database of ether lipid species previously ascribed to Archaea. Next, we analyzed the lipid complement of S. islandicus by high-resolution Fourier transform mass spectrometry using an ion trap-orbitrap mass spectrometer. This analysis identified five clusters of molecular ions that matched ether lipids in the database with sub-ppm mass accuracy. To structurally characterize and validate the identities of the potential lipid species, we performed structural analysis using multistage activation on the ion trap-orbitrap instrument as well as tandem mass analysis using a quadrupole time-of-flight machine. Our analysis identified four ether lipid species previously reported in Archaea, and one ether lipid species that had not been described before. This uncharacterized lipid species features two head group structures composed of a trisaccharide residue carrying an uncommon sulfono group (-SO3) and an inositol phosphate group. Both head groups are linked to a glycerol dialkyl glycerol tetraether core structure having isoprenoid chains with a total of 80 carbon atoms and 4 cyclopentane moieties. The shotgun lipidomics approach deployed here defines a novel workflow for exploratory lipid profiling of Archaea.

[Self-treatment with baking soda can lead to severe metabolic alkalosis].

This case report describes a 66-year-old man, previously healthy besides mild hypertension. He ingested a self-made folk remedy consisting of baking soda and water against acid reflux in dosages that resulted in severe metabolic alkalosis (pH 7.8). Diagnosing and treating MA is easy and cheap, but if the condition is not treated, consequences can be severe. The challenge is to uncover patients' use of non prescription medications and folk remedies in the diagnostic process. Having this information it is possible to prevent MA in both high- and low-risk patients.

Long-term use of metformin and colorectal cancer risk in type II diabetics: a population-based case-control study.

In vitro and animal studies indicate that metformin prevents colorectal cancer (CRC). Epidemiological studies, however, have been equivocal. We undertook this study to assess whether metformin prevents CRC in individuals with type II diabetes. We performed a nested case-control study restricted to Danish citizens with type II diabetes. Data were collected from four Danish nationwide registries. Cases were type II diabetics with a primary CRC between 2000 and 2009, and controls were sampled among subjects with type II diabetes. Long-term exposure to metformin was defined by the redeeming of prescriptions for a cumulative dose of 2000 g within 5 years prior to the index date. To control for potential confounders, we used unconditional logistic regression. We generated adjusted odds ratios (OR) for the association between metformin and CRC and performed subanalyses for selected subgroups and for the dose-response relation. We identified 2088 cases and 9060 controls during the study period. The association between long-term metformin use and CRC gave an adjusted OR at 0.83 (95% CI 0.68-1.00). A protective effect on CRC with long-term use of metformin was only evident for women (OR 0.66 vs. 0.99 for men). There was a significant dose-response association of metformin use >250 defined daily dose (DDD) and for the duration of metformin use >1 year. We found an indication of a protective effect of long-term metformin use against CRC in type II diabetics, although this effect was only seen in women.

Demographics and nutrition-related patient care encounters: a survey of physician assistants in Nebraska.

PURPOSE: To collect information regarding demographics, nutrition-related patient care encounters, and comfort levels in addressing nutrition-related problems in a population of physician assistants (PA) currently practicing in Nebraska. METHODS: A survey was developed by faculty members in the Medical Nutrition Education and Physician Assistant Education programs, School of Allied Health Professions, College of Medicine, University of Nebraska Medical Center. Data were analyzed using descriptive statistics and Fisher's exact test. A P-value of < .05 was considered statistically significant. RESULTS: The return rate of the survey was 70% (N = 266). A high percentage of PAs (86%) reported they often or occasionally encounter nutrition-related issues with patients. In contrast, only 27% of survey respondents felt "very comfortable" in addressing nutrition-related issues. Encountering nutrition issues often and having patients that ask questions about nutrition were significantly associated with a PA's comfort in addressing nutrition issues (P < .001 for both). CONCLUSION: PAs are very likely to encounter nutrition-related issues in their practice. Attention to nutrition-related topics in the PA curriculum and continuing education may be beneficial in increasing the comfort of PAs in addressing these issues.

Hair care practices in diverse populations: what makes the difference?

This study examines whether sociodemographic factors and/or hair attributes are better predictors of hair wash frequency. A total of 96 patients were recruited from the general dermatology outpatient clinic to complete an 18-item questionnaire by self-report. Three linear regression models were constructed and compared to determine whether sociodemographic factors, hair wash frequency, or a combination of the two would best predict wash frequency. Results showed that sociodemographic factors, specifically race, sex, and age group, are all better predictors of hair wash frequency than hair attributes such as hair type, texture, length, and scalp type (adjusted R2 = 0.59 vs 0.27, respectively).

Metal-centered deltahedral Zintl ions: synthesis of [Ni@Sn9]4- by direct extraction from intermetallic precursors and of the vertex-fused dimer [{Ni@Sn8(µ-Ge)(1/2)}2]4-.

Ni-centered deltahedral Sn(9) clusters with a charge of 4-, i.e., [Ni@Sn(9)](4-), were extracted in ethylenediamine in high yield directly from intermetallic precursors with the nominal composition "K(4)Sn(9)Ni(3)". The new endohedral clusters were crystallized and structurally characterized in K[K(18-crown-6)](3)[Ni@Sn(9)]·3benzene (1a, triclinic, P1̅, a = 10.2754(5) Å, b = 19.5442(9) Å, and c = 20.5576(13) Å, α = 73.927(3)°, ß = 79.838(4)°, and γ = 84.389(3)°, V = 3899.6(4) Å(3), Z = 2) and K[K(2,2,2-crypt)](3)[Ni@Sn(9)] (1b, triclinic, P1, a = 15.8028(8) Å, b = 16.21350(9) Å, and c = 20.1760(12) Å, α = 98.71040(10)°, ß = 104.4690(10)°, and γ = 118.3890(10)°, V = 4181.5(4) Å(3), Z = 2). The alternative method of a post-synthetic insertion of a Ni atom in empty Sn(9) clusters by a reaction with Ni(cod)(2) predominantly produces the more-oxidized clusters with a charge of 3-, i.e., the recently reported [Ni@Sn(9)](3-). Nonetheless, using substoichiometric amounts of 18-crown-6 as a cation sequestering agent, we also have been able to isolate the 4- clusters as a minor phase from such reactions. They were structurally characterized in K[K(en)][K(18-crown-6)](2)[Ni@Sn(9)]·0.5en (2, monoclinic, P2(1)/n, a = 10.4153(5) Å, b = 25.6788(11) Å, and c = 20.6630(9) Å, ß = 102.530(2)°, V = 5394.7(4) Å(3), Z = 2). The ability of the Ni-centered clusters to exist with both 3- and 4- charges parallels the same ability of the empty clusters and is very promising for similarly rich chemistry involving electron transfer and flexible "oxidation states". We also report the synthesis and characterization of the endohedral heteroatomic dimer [{Ni@Sn(8)(µ-Ge)(1/2)}(2)](4-) composed of two [Ni@(Sn(8)Ge)]-clusters fused at the Ge-vertex. The dimer was synthesized by reacting an ethylenediamine solution of a ternary precursor with the nominal composition "K(4)Ge(4.5)Sn(4.5)", which is known to produce heteroatomic Ge(9-x)Sn(x) clusters, with Ni(cod)(2). It is isostructural with the reported [{Ni@Sn(8)(µ-Sn)(1/2)}(2)](4-) and is structurally characterized in [K-(2,2,2-crypt)](4)[{Ni@Sn(8)(µ-Ge)(1/2)}(2)]·2en (3, monoclinic, C2/c, a = 30.636(2) Å, b = 16.5548(12) Å, and c = 28.872(2) Å, ß = 121.2140(10)°, V = 12523.5(15) Å(3), Z = 4).

Attitudes of nursing staff working with older people towards nutritional nursing care.

AIM: The aim of this study was to examine attitudes of the nursing staff in geriatric care towards factors of importance for nutritional nursing care. BACKGROUND: Studies show that nutritional risk assessment is seldom performed on older patients as routine and very few patients have a nutritional care plan. Patients in long-term care who are easy to feed are also found to be looked upon more positively than those with high feeding needs. METHODS: A total of 252 registered nurses and nurse aids working at geriatric rehabilitation and medical care clinics and resident homes participated in the study. Attitudes were examined using the Staff Attitudes to Nutritional Nursing Care Geriatric scale. The scale includes 18 items and was designed as a one to five-point Lickert-type scale. It gives a total score and five subscales representing the dimensions 'Norms', 'Habits', 'Assessment', 'Intervention' and 'Individualization'. A higher score indicates a more positive attitude. RESULTS: Of all nursing staff, 53% displayed a positive attitude towards factors of importance for nutritional nursing care and the rest displayed a neutral or negative attitude. The 'Intervention' dimension, dealing with nutritional problems and how to manage them, reflected the highest level of positive attitudes, which represents 71% of the nursing staff. The 'Norms' dimension had the lowest relative frequency of positive attitudes, 27%. The registered nurses held significantly more positive attitudes than the nurse aids did. CONCLUSIONS: Nutritional issues comprise an important and time-consuming responsibility in geriatric care; however, nursing staff do not show an unequivocal positive attitude regarding this responsibility. The consequences this entails for the older patient need to be examined further. Relevance to clinical practice. Nursing staff play an important role in caring for patients who are malnourished or at risk for malnutrition. Positive attitudes might hinder the development of undernourishment or the further worsening of an already undernourished patient's condition.