Text message conversations between peer supporters and women to deliver infant feeding support using behaviour change techniques: A qualitative analysis.

OBJECTIVE: To analyse text message conversations between peer supporters (called Infant Feeding Helpers - IFHs) and new mothers using qualitative methods to understand how peer support can influence and support women's feeding experiences. DESIGN: Qualitative analysis of text messages conversations using both inductive thematic and deductive content approaches to coding. Thematic analysis of the text message transcripts and deductive content analysis was used to code if Behaviour Change Techniques (BCTs) were employed by IFHs in their interactions with women. BCTs coded in text messages were then compared with those tabulated from antenatal meeting recordings and documented in interview transcripts. PARTICIPANTS AND SETTING: 18 primiparous women and 7 Infant Feeding Helpers from one community site in South-West England. FINDINGS: Three key themes were identified in the18 text message conversations (1679 texts): 'breastfeeding challenges', 'mother-centred conversations', and 'emotional and practical support'. The core BCTs of 'social support' and 'changing the social environment' were found at least once in 17 (94 %) and 18 (100 %) text message conversations respectively. Meanwhile, 'instruction to perform the behaviour' was used at least once in over 50 % of conversations. Generally, the use of BCTs was greatest between birth and two weeks during a period of daily texts when women reported many feeding challenges. The number and range of BCTs used in text messages were similar to those documented in audio-recorded meetings and interview accounts. CONCLUSION AND IMPLICATIONS: Infant Feeding Helpers were able to provide engaging and successful breastfeeding peer support through text messages. Messaging was shown to be an appropriate and accessible method of delivering BCTs focussing on 'social support' and 'changing the social environment'. Peer supporters delivering BCTs via text messages is acceptable and appropriate to use if in-person support is limited due to unforeseen circumstances such as the COVID-19 pandemic.

Improving Prospective Memory Performance in Community-dwelling Older Adults: Goal Management Training and Implementation Intentions.

Aim: The present study tested a compensatory executive intervention for prospective memory (goal management training) for the first time in older adults. Prospective memory (the ability to remember and execute a task in the future) declines with age, with significant implications for older adults' activities of daily living and quality of life. Prospective memory interventions have focused primarily on the retrospective component of prospective memory (e.g., implementation intentions). However, executive dysfunction is also implicated in age-related prospective memory decline.Methods: Community-dwelling older adults were randomly allocated to receive goal management training, implementation intentions or no intervention. Prospective memory was assessed before and after the intervention with a well-validated laboratory-based prospective memory measure. Results: Contrary to predictions, neither goal management training nor implementation intentions were successful at improving prospective memory in healthy older adults. Participants who received goal management training were more likely to have difficulty comprehending the intervention. Post-hoc analyses suggested implementation intentions improved prospective memory specifically for participants with poorer baseline prospective memory. Conclusions: These results represent important cautionary findings about the possible limitations of goal management training to improve prospective memory in older adults. Future research should also consider the role of baseline prospective memory ability in affecting response to compensatory intervention.

Sleep Mediates Age-Related Executive Function for Older Adults with Limited Cognitive Reserve.

OBJECTIVE: Sleep quantity and quality are associated with executive function (EF) in experimental studies, and in individuals with sleep disorders. With advancing age, sleep quantity and quality decline, as does the ability to perform EF tasks, suggesting that sleep disruption may contribute to age-related EF declines. This cross-sectional cohort study tested the hypothesis that poorer sleep quality (i.e., the frequency and duration of awakenings) and/or quantity may partly account for age-related EF deficits. METHOD: Community-dwelling older adults (N = 184) completed actigraphic sleep monitoring then a range of EF tasks. Two EF factors were extracted using exploratory structural equation modeling. Sleep variables did not mediate the relationship between age and EF factors. Post hoc moderated mediation analyses were conducted to test whether cognitive reserve compensates for sleep-related EF deficits, using years of education as a proxy measure of cognitive reserve. RESULTS: We found a significant interaction between cognitive reserve and the number and frequency of awakenings, explaining a small (approximately 3%), but significant amount of variance in EF. Specifically, in individuals with fewer than 11 years of education, greater sleep disturbance was associated with poorer EF, but sleep did not impact EF in those with more education. There was no association between age and sleep quantity. CONCLUSIONS: This study highlights the role of cognitive reserve in the sleep-EF relationship, suggesting individuals with greater cognitive reserve may be able to counter the impact of disturbed sleep on EF. Therefore, improving sleep may confer some protection against EF deficits in vulnerable older adults.

Does the Key Task Measure Prospective Memory? Cautionary Findings from Parallel Studies in HIV Disease and Older Adults.

OBJECTIVE: Despite its brevity and face validity, little is known about the construct validity of the naturalistic "Key Task" of prospective memory (PM), in which an examinee is instructed to remind the examiner at a designated time to retrieve keys (or another belonging) placed out of sight. METHOD: Study 1 included 162 HIV+ and 52 HIV- comparison participants who completed the Key Task alongside well-validated measures of PM and a comprehensive neuropsychological battery that included everyday functioning measures. Study 2 used broadly parallel methods in 168 older community-dwelling Australians. RESULTS: Overall, the Key Task was not reliably associated with neurocognitive functioning (including clinical and experimental measures of PM), PM symptoms, or everyday functioning in either sample. CONCLUSIONS: The Key Task did not demonstrate compelling evidence of construct validity among persons living with HIV disease or older adults, which raises doubts regarding its clinical usefulness as a measure of PM.

Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): Normative Data for Older Adults.

OBJECTIVE: Provide updated older adult (ages 60+) normative data for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Form A, using regression techniques, and corrected for education, age, and gender. METHOD: Participants (aged 60-93 years; N = 415) were recruited through the Healthy Ageing Research Program (HARP), University of Western Australia, and completed Form A of the RBANS as part of a wider neuropsychological test battery. Regression-based techniques were used to generate normative data rather than means-based methods. This methodology allows for the control of demographic variables using continuous data. To develop norms, the data were assessed for: (1) normality; (2) associations between each subtest score and age, education, and gender; (3) the effect of age, education, and gender on subtest scores; and (4) residual scores which were converted to percentile distributions. RESULTS: Differences were noted between the three samples, some of which were small and may not represent a clinically meaningful difference. Younger age, more years of education, and female gender were associated with better scores on most subtests. Frequency distributions, means, and standard deviations were produced using unstandardized residual scores to remove the effects of age, education, and gender. CONCLUSIONS: These normative data expand upon past work by using regression-based techniques to generate norms, presenting percentiles, as well as means and standard deviations, correcting for the effect of gender, and providing a free-to-use Excel macro to calculate percentiles.

Sleep disruption explains age-related prospective memory deficits: implications for cognitive aging and intervention.

The high prevalence of sleep disruption among older adults may have implications for cognitive aging, particularly for higher-order aspects of cognition. One domain where sleep disruption may contribute to age-related deficits is prospective memory-the ability to remember to perform deferred actions at the appropriate time in the future. Community-dwelling older adults (55-93 years, N = 133) undertook assessment of sleep using actigraphy and participated in a laboratory-based prospective memory task. After controlling for education, sleep disruption (longer awakenings) was associated with poorer prospective memory. Additionally, longer awakenings mediated the relationship between older age and poorer prospective memory. Other metrics of sleep disruption, including sleep efficiency and wake after sleep onset, were not related to prospective memory, suggesting that examining the features of individual wake episodes rather than total wake time may help clarify relationships between sleep and cognition. The mediating role of awakening length was partially a function of greater depression and poorer executive function (shifting) but not retrospective memory. This study is among the first to examine the association between objectively measured sleep and prospective memory in older adults. Furthermore, this study is novel in suggesting sleep disruption might contribute to age-related prospective memory deficits; perhaps, with implications for cognitive aging more broadly. Our results suggest that there may be opportunities to prevent prospective memory decline by treating sleep problems.

Seizure-related hospital admissions, readmissions and costs: Comparisons with asthma and diabetes in South Australia.

PURPOSE: Seizures are listed as an Ambulatory Care Sensitive Condition (ACSC), where, in some cases, hospitalisation may be avoided with appropriate preventative and early management in primary care. We examined the frequencies, trends and financial costs of first and subsequent seizure-related hospital admissions in the adult and paediatric populations, with comparisons to bronchitis/asthma and diabetes admissions in South Australia between 2012 and 2014. METHODS: De-identified hospital separation data from five major public hospitals in metropolitan South Australia were analysed to determine the number of children and adults admitted for the following Australian Refined Diagnosis Related Groups: seizure related conditions; bronchitis/asthma; and diabetes. Additional data included length of hospital stay and type of admission. Demographic data were analysed to identify whether social determinants influence admission, and a macro costing approach was then applied to calculate the financial costs to the Health Care System. RESULTS: The rate of total seizure hospitalizations was 649 per 100,000; lower than bronchitis/asthma (751/100,000), yet higher than diabetes (500/100,000). The highest proportions of subsequent separations were recorded by children with seizures regardless of complexity (47% +CSCC; 17% -CSCC) compared with asthma (11% +CSCC; 14% -CSCC) or diabetes (14% +CSCC; 13% -CSCC), and by adults with seizures with catastrophic or severe complications/comorbidity (25%), compared with diabetes (22%) or asthma (14%). The mean cost per separation in both children and adults was highest for diabetes (AU$4438/$7656), followed by seizures (AU$2408/$5691) and asthma (AU$2084/$3295). CONCLUSIONS: Following the lead of well-developed and resourced health promotion initiatives in asthma and diabetes, appropriate primary care, community education and seizure management services (including seizure clinics) should be targeted in an effort to reduce seizure related hospitalisations which may be avoidable, minimise costs to the health budget, and maximise health care quality.

"Going with the flow" or not: evidence of positive rheotaxis in oceanic juvenile loggerhead turtles (Caretta caretta) in the South Pacific Ocean Using Satellite Tags and Ocean Circulation Data.

The movement of juvenile loggerhead turtles (n = 42) out-fitted with satellite tags and released in oceanic waters off New Caledonia was examined and compared with ocean circulation data. Merging of the daily turtle movement data with drifter buoy movements, OSCAR (Ocean Surface Current Analyses--Real time) circulation data, and three different vertical strata (0-5 m, 0-40 m, 0-100 m) of HYCOM (HYbrid Coordinate Ocean Model) circulation data indicated the turtles were swimming against the prevailing current in a statistically significant pattern. This was not an artifact of prevailing directions of current and swimming, nor was it an artifact of frictional slippage. Generalized additive modeling was used to decompose the pattern of swimming into spatial and temporal components. The findings are indicative of a positive rheotaxis whereby an organism is able to detect the current flow and orient itself to swim into the current flow direction or otherwise slow down its movement. Potential mechanisms for the means and adaptive significance of rheotaxis in oceanic juvenile loggerhead turtles are discussed.

A model of loggerhead sea turtle (Caretta caretta) habitat and movement in the oceanic North Pacific.

Habitat preferences for juvenile loggerhead turtles in the North Pacific were investigated with data from two several-year long tagging programs, using 224 satellite transmitters deployed on wild and captive-reared turtles. Animals ranged between 23 and 81 cm in straight carapace length. Tracks were used to investigate changes in temperature preferences and speed of the animals with size. Average sea surface temperatures along the tracks ranged from 18 to 23 °C. Bigger turtles generally experienced larger temperature ranges and were encountered in warmer surface waters. Seasonal differences between small and big turtles suggest that the larger ones dive deeper than the mixed layer and subsequently target warmer surface waters to rewarm. Average swimming speeds were under 1 km/h and increased with size for turtles bigger than 30 cm. However, when expressed in body lengths per second (bl s(-1)), smaller turtles showed much higher swimming speeds (>1 bl s (-1) ) than bigger ones (0.5 bl s(-1)). Temperature and speed values at size estimated from the tracks were used to parameterize a habitat-based Eulerian model to predict areas of highest probability of presence in the North Pacific. The model-generated habitat index generally matched the tracks closely, capturing the north-south movements of tracked animals, but the model failed to replicate observed east-west movements, suggesting temperature and foraging preferences are not the only factors driving large-scale loggerhead movements. Model outputs could inform potential bycatch reduction strategies.

Estimating radiation dose from time to emesis and lymphocyte depletion.

Lymphocyte depletion kinetics and time to emesis have previously been shown to correlate with radiation dose. However, the method for estimating dose from lymphocyte counts was cumbersome, and a tabulation of estimated dose vs. time to emesis published by the International Atomic Energy Agency did not agree well with a regression of data from many (>100) radiation accident cases. The time-to-emesis data have been reanalyzed, and the new regression corroborates the previously published table. Also, dose estimation from post-exposure lymphocyte counts has been simplified and no longer requires serial calculations. Instead, dose can be estimated by a simple table lookup, given the ratio of two lymphocyte counts and the time between blood samples.

Potential nuclear and radiological incidents: a summary for clinicians.

Most clinicians will go their entire career without seeing a patient who has been involved in a nuclear or radiological incident, and many health care professionals feel ill equipped to respond to such incidents. To add to this difficulty, the medical response that is most appropriate for such an event varies, depending on the type of incident. As part of an effort to address these and other challenges for the medical community, the Centers for Disease Control and Prevention has developed a quick-reference for clinicians (based on the consensus of numerous stakeholders) that summarizes the key differences between various types of potential nuclear and radiological incidents in relation to some key medical response concerns. This paper is not intended for a clinical audience, but rather presents the and describes the framework upon which the is based, providing the health physics community with a clinical perspective of these events.

Geographic variation in marine turtle fibropapillomatosis.

We document three examples of fibropapillomatosis by histology, quantitative polymerase chain reaction (qPCR), and sequence analysis from three different geographic areas. Tumors compatible in morphology with fibropapillomatosis were seen in green turtles from Puerto Rico and San Diego (California) and in a hybrid loggerhead/ hawksbill turtle from Florida Bay (Florida). Tumors were confirmed as fibropapillomas on histology, although severity of disease varied between cases. Polymerase chain reaction (PCR) analyses revealed infection with the fibropapilloma-associated turtle herpesvirus (FPTHV) in all cases, albeit at highly variable copy numbers per cell. Alignment of a portion of the polymerase gene from each fibropapilloma-associated turtle herpesvirus isolate demonstrated geographic variation in sequence. These cases illustrate geographic variation in both the pathology and the virology of fibropapillomatosis.

Closure of median sternotomy in dogs: suture versus wire.

Twenty normal, large-breed dogs underwent median sternotomy. Median sternotomies were closed with 20-gauge orthopedic wire in 10 dogs and no. 2 polybutester in 10 dogs. Closure with suture was faster than with wire (6.7 +/- 1.8 minutes versus 9.1 +/- 1.9 minutes, respectively). Significant differences were not observed in degree of postoperative pain or wound complication rates. Sternotomies closed with wire showed a trend to be more stable and had significantly less displacement on radiographic evaluation at 28 days. All sterna closed with wire examined histopathologically showed evidence of chondral or osteochondral bridging, while sterna closed with suture only showed fibrous union.

Evaluation of a novel hemostatic device in an ovine parenchymal organ bleeding model of normal and impaired hemostasis.

Bleeding is a problem encountered by many surgeons, often complicated by the presence of coagulopathy or anticoagulant. The hemostatic effectiveness of CoStasis Surgical Hemostat (with bovine collagen, bovine thrombin, and autologous plasma) was evaluated and compared to a collagen sponge and to two investigational fibrin-sealant preparations under conditions of normal and impaired coagulation. A liver resection and controlled incisions in spleens and kidneys were made in sheep. Time to complete hemostasis and total blood loss were measured. Tissue response was evaluated at 7, 30, 60, and 75 days. CoStasis-treated sites demonstrated significantly shorter time to hemostasis (all surgical sites combined) compared with fibrin sealant (investigational fibrin sealant 1) (p= .005) or collagen sponge (p=0.013). In anticoagulated animals, CoStasis and fibrin sealant (investigational fibrin sealant 2) had comparable mean times to hemostasis, and CoStasis-treated sites exhibited lowered average blood loss compared to investigational fibrin-sealant-2 treated sites. CoStasis-treated sites demonstrated higher levels of tissue repair (lower inflammation, more extensive tissue repair, and less residual implant) compared to fibrin-sealant- or collagen-sponge-treated sites in Phases I and II. These findings demonstrate that CoStasis is a highly effective hemostatic agent for control of bleeding from parenchymal organs. Furthermore, under conditions of compromised coagulation, treatment with CoStasis demonstrates a reduction in average blood loss when compared to treatment with fibrin sealant.