Intensive Care Unit Nurses' Perceptions of and Coping Strategies for Motherhood Experiences: A Qualitative Study.

This qualitative study explored the perception of intensive care unit nurses in relation to their motherhood experiences and coping strategies. Ten intensive care unit nurses (aged 28-37 years) with children under 3 years old were recruited. In-depth 90-min interviews were conducted, and the contents of the audio recordings were translated into verbatim transcripts. From the results of the research analysis, three themes were identified: challenges and conflicts of motherhood, dilemma in life and work balance, and maternal engagement. The "challenges and conflicts of motherhood" and "dilemma in life and work" represent the maternal experiences, while "maternal engagement" is the coping strategy used. To establish a friendly working environment and policies, nursing managers should consider improving the friendliness of work units and encourage co-workers to support each other in the hospital.

CoachMS, an innovative closed-loop, interdisciplinary platform to monitor and proactively treat MS symptoms: A pilot study.

BACKGROUND: There are numerous challenges to treating co-occurring symptoms in multiple sclerosis (MS). OBJECTIVE: To pilot the feasibility of a novel symptom management platform, CoachMS, to monitor MS symptoms (bladder function, ambulation, and mood: BAM) and respond to changes in real-time. METHODS: In this 12-week randomized controlled pilot trial, participants' symptoms were monitored using weekly questionnaires and remote ambulatory monitoring (Fitbit Flex2®). Behavioral change principles used included shared goal setting at 2 weeks. Between weeks 2-12, the CoachMS group received targeted contact and interventions if symptoms worsened; the control group were treated through usual clinic practice. Our outcomes were feasibility (retention, adherence and acceptability; primary) and proportion of recommended treatments pursued (secondary); efficacy was explored. RESULTS: Of 21 participants enrolled, 13 (62%) completed the study; protocol adherence was excellent. CoachMS participants demonstrated greater follow-through with clinical recommendations than controls (OR 9.3, 95% CI (0.9, 97.6)). As a cohort, each BAM symptom tended to improve. Suicidality was detected in one control participant, resulting in urgent evaluation and hospitalization. CONCLUSIONS: The innovative CoachMS platform was feasible and acceptable in this cohort with baseline BAM symptoms. It could represent an accessible, cost-effective tool to monitor MS symptoms in real-time; a larger trial is planned.

A Pilot Study of Hip Corrective Taping Using Kinesio Tape for Pain and Lower Extremity Joint Kinematics in Basketball Players with Patellofemoral Pain.

PURPOSE: This pilot study aimed to determine the feasibility of hip corrective taping to improve self-reported knee pain and lower extremity joint kinematics in basketball players with patellofemoral pain. PATIENTS AND METHODS: A single group pre-test and post-test design. Collegiate basketball players with patellofemoral pain were recruited. Three-dimensional hip and knee joint kinematics were measured during two tasks, single-leg squat (SLS) and lay-up jump (LUJ), and each task was conducted under no-taping and taping conditions. Subjective report of pain was compared between no-taping and taping conditions only during SLS. RESULTS: Twelve collegiate basketball players with patellofemoral pain (median age, 22.7 [2.5] years; mean height, 173.8 ± 7.4 cm; mean weight, 72.5 ± 12.8 kg) participated in this study. Compared with no-taping, the use of hip corrective taping significantly increased the hip abduction angle at the instant of the maximal vertical ground reaction force during LUJ (no-taping vs taping: 0.6° ± 6.3° vs 3.3° ± 5.1°, p = 0.029), and also caused a trend of decreased maximal hip internal rotation angle during SLS (no-taping vs taping: 8.0° ± 6.6° vs 4.7° ± 6.9°, p = 0.050). Hip corrective taping also improved self-reported knee pain during SLS (no-taping vs taping: 3.4 ± 1.7 vs 2.6 ± 1.0, p = 0.046). CONCLUSION: Hip corrective taping may be used as an effective intervention for athletes with patellofemoral pain during basketball-related tasks.

An Educational Intervention Using Steno Balance Cards to Improve Glycemic Control in Patients With Poorly Controlled Type 2 Diabetes Mellitus.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is largely attributableto lifestyle factors. Although physiological and medical care needs must be met, psychosocial factors should not be neglected. PURPOSE: The aim of this study was to determine whether a 6-month intervention consisting of educational sessions using Steno Balance Cards, which involves guided group dialogue, resulted in better glycemic outcomes than conventional diabeteseducation. METHODS: Patients with T2DM whose glycolated hemoglobin A1c levels were higher than 8% were recruited from September to October 2015. Ninety-two patients were assigned to either the psychosocial balance dialogue (PBD) group (n = 46) or the standard care (SC) group (n = 46). The PBD group received instructions about diabetes using the Steno "Balance Card" method, which involves the use of themed picture cards to elicit group dialogue. The Balance Cards were developed by the Danish Steno Diabetes Center. In the SC group, patients received general diabetes education using a conventional teachingmode. RESULTS: In the PBD group, glycolated hemoglobin A1c decreased 1.3% from 8.1% ± 0.7% to 6.8% ± 0.8%, whereas it decreased 0.6% in the SC group from 8.0% ± 0.6% to 7.4% ± 0.7%, with p < .05. At the end of the 6-month study period, the PBD group and the SC group completed a health-related quality of life questionnaire(12-item Short-Form Health Survey) and a well-being index (WHO-5) questionnaire. In the PBD group, the difference before and after the intervention showed that the well-being (WHO-5) score increased by 45.4 points, whereas the physiological score increased by 28.0, and the mental component score increased by 29.0. In the SC group, the well-being (WHO-5) score increased by 6.4, whereas the physiological score increased by 4.7, and the mental component score increased by 9.6. There were statistically significant differences in questionnairescores between the two groups (p < .05). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results of this study indicate that the dialogue sessions using Steno Balance Cards are beneficial for patients with T2DM in terms of improved glycemic control and quality of life.

Gender differences in the association of smartphone use with the vitality and mental health of adolescent students.

OBJECTIVE: The present study examined variations in the degree of smartphone use behavior among male and female adolescents as well as the association between various degrees of smartphone use behavior and the vitality and mental health of each gender. PARTICIPANTS: A total of 218 adolescents were recruited from a junior college in September 2014. METHODS: All the participants were asked to answer questionnaires on smartphone use. RESULTS: The findings showed that adolescent females as compared with adolescent males exhibited significantly higher degrees of smartphone dependence and smartphone influence. Positive correlations were observed between the duration of smartphone use on weekends and the vitality/mental health of the male adolescents; negative correlations were found between smartphone dependence and the vitality/mental health of males. CONCLUSION: The findings demonstrate that adolescent females are deeply affected by their smartphone use. Smartphone dependence may decrease the vitality and mental health of male adolescents.

Association Between Smartphone Use and Musculoskeletal Discomfort in Adolescent Students.

Despite the substantial increase in the number of adolescent smartphone users, few studies have investigated the behavioural effects of smartphone use on adolescent students as it relates to musculoskeletal discomfort. The purpose of this study was to explore the association between smartphone use and musculoskeletal discomfort in students at a Taiwanese junior college. We hypothesised that the duration of smartphone use would be associated with increased instances of musculoskeletal discomfort in these students. This cross-sectional study employed a convenience sampling method to recruit students from a junior college in southern Taiwan. All the students (n = 315) were asked to answer questionnaires on smartphone use. A descriptive analysis, stepwise regression, and logistic regression were used to examine specific components of smartphone use and their relationship to musculoskeletal discomfort. Nearly half of the participants experienced neck and shoulder discomfort. The stepwise regression results indicated that the number of body parts with discomfort (F = 6.009, p < 0.05) increased with hours spent using ancillary smartphone functions. The logistic regression analysis showed that the students who talked on the phone >3 h/day had a higher risk of upper back discomfort than did those who talked on the phone <1 h/day [odds ratio (OR) = 4.23, p < 0.05]. This study revealed that the relationship between smartphone use and musculoskeletal discomfort is related to the duration of smartphone ancillary function use. Moreover, hours spent talking on the phone was a predictor of upper back discomfort.

Comparison of Different Models of Structured Self-Monitoring of Blood Glucose in Type 2 Diabetes.

BACKGROUND: The aim of this study is to compare the effectiveness of different models of structured self-monitoring of blood glucose (SMBG) in non-insulin-treated type 2 diabetes. SUBJECTS AND METHODS: This was a prospective, three-arm, randomized, 36-week trial. There were 138 participants with a mean age of 58.7 years and glycated hemoglobin A1c (HbA1c) level of 8.72% who were allocated to the following groups: six-pair glucose test of pre- and postprandial blood glucose (BG) per week (n = 43); three-pair glucose test of pre- and postprandial BG per week (n = 39); and seven-point BG testing before and after each meal and at bedtime over a course of 3 days in 1 month (n = 40). RESULTS: The intention-to-treat analysis revealed that all three groups showed significant reductions in HbA1c levels. Comparisons among the groups revealed that only the seven-point group had a significant greater reduction of HbA1c level compared with the three-pair group (between-group mean difference of -0.86 and -0.80 from baseline to 24 and 36 weeks, respectively). No severe hypoglycemic events were reported. Diabetes distress was slightly higher in the six-pair group. CONCLUSIONS: Our results demonstrated that BG testing at six pairs/week, three pairs/week, and seven points for 3 days/month were all effective in improving glycemic outcome, with greater reduction of HbA1c level in the seven-point for 3 days/month group, without increasing burdensome distress in SMBG.

Adherence to self-care behavior and glycemic effects using structured education.

AIMS/INTRODUCTION: The purpose of the present study was to examine glycemic control in suboptimally controlled type 2 diabetes provided by a structured education group using the Diabetes Conversation Map™ (CM™) vs usual care in a university-based hospital primary care clinic. MATERIALS AND METHODS: This was a randomized, pragmatic clinical trial. Patients with type 2 diabetes were randomly assigned to structured education or usual care groups. The primary outcome was the difference in the mean change of glycated hemoglobin (HbA1c) from baseline to 12 months. Secondary outcomes included the percentage achieving therapeutic HbA1c goal and self-behavioral changes. RESULTS: A total of 245 patients were randomly assigned to two groups (CM™ group n = 121; usual care group, n = 116). The absolute reduction of HbA1c was significantly greater in the CM™ group at 3 and 6 months (Δ = -0.59% and Δ = -1.13%, P < 0.01), but the difference was no longer statistically significant at 9 and 12 months (Δ = -0.43% and Δ = -0.49%), based on an intention-to-treat analysis. A per-protocol analysis showed the significant change was maintained at 12 months (Δ = -0.67%). In the intervention group, greater percentages of patients achieved their American Association of Diabetes Educators Self-Care Behaviours™ framework (AADE7) behavioral goals at 3 months, in particular being active, problem-solving, reducing risk and health coping. CONCLUSIONS: In type 2 diabetic patients with suboptimally controlled glucose, there were greater improvements in glucose control and self-care behavioral goals in those who underwent the CM™ education program compared with outcomes achieved in patients receiving usual care.

Mechanical energy and power flow analysis of wheelchair use with different camber settings.

It has been suggested that minimisation of energy cost is one of the primary determinants of wheelchair designs. Wheel camber is one important parameter related to wheelchair design and its angle may affect usability during manual propulsion. However, there is little available literature addressing the effect of wheel camber on the mechanical energy or power flow involved in manual wheelchair propulsion. Twelve normal subjects (mean age, 22.3 years; SD, 1.6 years) participated in this study. A video-tracking system and an instrumented wheel were used to collect 3D kinematic and kinetic data. Wheel camber of 0° and 15° was chosen to examine the difference between mechanical power and power flow of the upper extremity during manual wheelchair propulsion. The work calculated from power flow and the discrepancy between the mechanical work and power flow work of upper extremity had significantly greater values with increased camber. The upper arm had a larger active muscle power compared with that in the forearm and hand segments. While propelling the increased camber, the magnitude of both the proximal and distal joint power and proximal muscle power was increased in all three segments. While the propelling wheel with camber not only needs a greater energy cost but also there is greater energy loss.

The effects of rear-wheel camber on the kinematics of upper extremity during wheelchair propulsion.

BACKGROUND: The rear-wheel camber, defined as the inclination of the rear wheels, is usually used in wheelchair sports, but it is becoming increasingly employed in daily propulsion. Although the rear-wheel camber can increase stability, it alters physiological performance during propulsion. The purpose of the study is to investigate the effects of rear-wheel cambers on temporal-spatial parameters, joint angles, and propulsion patterns. METHODS: Twelve inexperienced subjects (22.3±1.6 yr) participated in the study. None had musculoskeletal disorders in their upper extremities. An eight-camera motion capture system was used to collect the three-dimensional trajectory data of markers attached to the wheelchair-user system during propulsion. All participants propelled the same wheelchair, which had an instrumented wheel with cambers of 0°, 9°, and 15°, respectively, at an average velocity of 1 m/s. RESULTS: The results show that the rear-wheel camber significantly affects the average acceleration, maximum end angle, trunk movement, elbow joint movement, wrist joint movement, and propulsion pattern. The effects are especially significant between 0° and 15°. For a 15° camber, the average acceleration and joint peak angles significantly increased (p < 0.01). A single loop pattern (SLOP) was adopted by most of the subjects. CONCLUSIONS: The rear-wheel camber affects propulsion patterns and joint range of motion. When choosing a wheelchair with camber adjustment, the increase of joint movements and the base of support should be taken into consideration.

Crystal structures of rice (Oryza sativa) glyceraldehyde-3-phosphate dehydrogenase complexes with NAD and sulfate suggest involvement of Phe37 in NAD binding for catalysis.

Cytosolic Oryza sativa glyceraldehyde-3-phosphate dehydrogenase (OsGAPDH), the enzyme involved in the ubiquitous glycolysis, catalyzes the oxidative phosphorylation of glyceraldehyde-3-phosphate to 1,3-biphosphoglycerate (BPG) using nicotinamide adenine dinucleotide (NAD) as an electron acceptor. We report crystal structures of OsGAPDH in three conditions of NAD-free, NAD-bound and sulfate-soaked forms to discuss the molecular determinants for coenzyme specificity. The structure of OsGAPDH showed a homotetramer form with each monomer comprising three domains-NAD-binding, catalytic and S-loop domains. NAD binds to each OsGAPDH subunits with some residues forming positively charged grooves that attract sulfate anions, as a simulation of phosphate groups in the product BPG. Phe37 not only forms a bottleneck to improve NAD-binding but also combines with Pro193 and Asp35 as key conserved residues for NAD-specificity in OsGAPDH. The binding of NAD alters the side-chain conformation of Phe37 with a 90° rotation related to the adenine moiety of NAD, concomitant with clamping the active site about 0.6 Å from the "open" to "closed" form, producing an increased affinity specific for NAD. Phe37 exists only in higher organisms, whereas it is replaced by other residues (Thr or Leu) with smaller side chains in lower organisms, which makes a greater distance between Leu34 and NAD of E. coli GAPDH than that between Phe37 and NAD of OsGAPDH. We demonstrated that Phe37 plays a crucial role in stabilizing NAD binding or intermediating of apo-holo transition, resulting in a greater NAD-dependent catalytic efficiency using site-directed mutagenesis. Phe37 might be introduced by evolution generating a catalytic advantage in cytosolic GAPDH.

Crystal structures of Aspergillus japonicus fructosyltransferase complex with donor/acceptor substrates reveal complete subsites in the active site for catalysis.

Fructosyltransferases catalyze the transfer of a fructose unit from one sucrose/fructan to another and are engaged in the production of fructooligosaccharide/fructan. The enzymes belong to the glycoside hydrolase family 32 (GH32) with a retaining catalytic mechanism. Here we describe the crystal structures of recombinant fructosyltransferase (AjFT) from Aspergillus japonicus CB05 and its mutant D191A complexes with various donor/acceptor substrates, including sucrose, 1-kestose, nystose, and raffinose. This is the first structure of fructosyltransferase of the GH32 with a high transfructosylation activity. The structure of AjFT comprises two domains with an N-terminal catalytic domain containing a five-blade beta-propeller fold linked to a C-terminal beta-sandwich domain. Structures of various mutant AjFT-substrate complexes reveal complete four substrate-binding subsites (-1 to +3) in the catalytic pocket with shapes and characters distinct from those of clan GH-J enzymes. Residues Asp-60, Asp-191, and Glu-292 that are proposed for nucleophile, transition-state stabilizer, and general acid/base catalyst, respectively, govern the binding of the terminal fructose at the -1 subsite and the catalytic reaction. Mutants D60A, D191A, and E292A completely lost their activities. Residues Ile-143, Arg-190, Glu-292, Glu-318, and His-332 combine the hydrophobic Phe-118 and Tyr-369 to define the +1 subsite for its preference of fructosyl and glucosyl moieties. Ile-143 and Gln-327 define the +2 subsite for raffinose, whereas Tyr-404 and Glu-405 define the +2 and +3 subsites for inulin-type substrates with higher structural flexibilities. Structural geometries of 1-kestose, nystose and raffinose are different from previous data. All results shed light on the catalytic mechanism and substrate recognition of AjFT and other clan GH-J fructosyltransferases.