The need to “carer proof” healthcare decisions

yesPopulation ageing and fiscal austerity are set to increase the reliance on family carers, who already provide much of the support for people with long term health conditions. Although most carers are willing, providing care can be hugely stressful, affecting mental and physical health1 and resulting in social isolation and financial hardship.2 When under strain, carers are less likely to be effective, increasing the risk that the care recipient is admitted to hospital or a care home.3 Health systems could reduce strain on family carers by routinely considering carers’ needs alongside patients’ needs in everyday healthcare decisions—a concept we term “carer proofing”.non

An analysis of the complementarity of ICECAP-A and EQ-5D-3L in an adult population of patients with knee pain

BACKGROUND: The ICECAP measures potentially offer a broader assessment of quality of life and well-being, in comparison to measures routinely used in economic evaluation, such as the EQ-5D-3 L. This broader assessment may allow measurement of the full effects of an intervention or treatment. Previous research has indicated that the ICECAP-O (for older people) and EQ-5D-3 L measure provide complementary information. This paper aims to determine similar information for the ICECAP-A (for the entire adult population) in terms of whether the measure is a substitute or complement to the EQ-5D-3 L. METHODS: Data from the BEEP trial - a multi-centre, pragmatic, randomised controlled trial - were used. Spearman rank correlations and exploratory factor analytic methods were used to assess whether ICECAP-A and EQ-5D-3 L are measuring the same, or different, constructs. RESULTS: A correlation of 0.49 (p < 0.01) was found between the ICECAP-A tariff score and the EQ-5D-3 L index. Using the pooled items of the EQ-5D-3 L and the ICECAP-A a two factor solution was optimal, with the majority of EQ-5D-3 L items loading onto one factor and the majority of ICECAP-A items onto another. CONCLUSION: The results presented in this paper indicate that ICECAP-A and EQ-5D-3 L are measuring two different constructs and provide largely different, complementary information. Results showed a similarity to results presented by Davis et al. using the ICECAP-O. TRIAL REGISTRATION: ISRCTN 93634563

A longitudinal assessment of the responsiveness of the ICECAP-A in a randomised controlled trial of a knee pain intervention

PURPOSE: The ICECAP-A is a simple measure of capability well-being for use with the adult population. The descriptive system is made up of five key attributes: Stability, Attachment, Autonomy, Achievement and Enjoyment. Studies have begun to assess the psychometric properties of the measure, including the construct and content validity and feasibility for use. This is the first study to use longitudinal data to assess the responsiveness of the measure. METHODS: This responsiveness study was completed alongside a randomised controlled trial comparing three physiotherapy-led exercise interventions for older adults with knee pain attributable to osteoarthritis. Anchor-based methodologies were used to explore the relationship between change over time in ICECAP-A score (the target measure) and change over time in another measure (the anchor). Analyses were completed using the non-value-weighted and value-weighted ICECAP-A scores. The EQ-5D-3L was used as a comparator measure to contextualise change in the ICECAP-A. Effect sizes, standardised response means and t tests were used to quantify responsiveness. RESULTS: Small changes in the ICECAP-A scores were seen in response to underlying changes in patients' health-related quality of life, anxiety and depression. Non-weighted scores were slightly more responsive than value-weighted scores. ICECAP-A change was of comparable size to change in the EQ-5D-3L reference measure. CONCLUSION: This first analysis of the responsiveness using longitudinal data provides some positive evidence for the responsiveness of the ICECAP-A measure. There is a need for further research in those with low health and capability, and experiencing larger underlying changes in quality of life

Size and emotion or depth and emotion? Evidence, using Matryoshka (Russian) dolls, of children using physical depth as a proxy for emotional charge

Background: The size and emotion effect is the tendency for children to draw people and other objects with a positive emotional charge larger than those with a negative or neutral charge. Here we explored the novel idea that drawing size might be acting as a proxy for depth (proximity).Methods: Forty-two children (aged 3-11 years) chose, from 2 sets of Matryoshka (Russian) dolls, a doll to represent a person with positive, negative or neutral charge, which they placed in front of themselves on a sheet of A3 paper. Results: We found that the children used proximity and doll size, to indicate emotional charge. Conclusions: These findings are consistent with the notion that in drawings, children are using size as a proxy for physical closeness (proximity), as they attempt with varying success to put positive charged items closer to, or negative and neutral charge items further away from, themselves

Extracellular electrical signals in a neuron-surface junction: model of heterogeneous membrane conductivity

Signals recorded from neurons with extracellular planar sensors have a wide range of waveforms and amplitudes. This variety is a result of different physical conditions affecting the ion currents through a cellular membrane. The transmembrane currents are often considered by macroscopic membrane models as essentially a homogeneous process. However, this assumption is doubtful, since ions move through ion channels, which are scattered within the membrane. Accounting for this fact, the present work proposes a theoretical model of heterogeneous membrane conductivity. The model is based on the hypothesis that both potential and charge are distributed inhomogeneously on the membrane surface, concentrated near channel pores, as the direct consequence of the inhomogeneous transmembrane current. A system of continuity equations having non-stationary and quasi-stationary forms expresses this fact mathematically. The present work performs mathematical analysis of the proposed equations, following by the synthesis of the equivalent electric element of a heterogeneous membrane current. This element is further used to construct a model of the cell-surface electric junction in a form of the equivalent electrical circuit. After that a study of how the heterogeneous membrane conductivity affects parameters of the extracellular electrical signal is performed. As the result it was found that variation of the passive characteristics of the cell-surface junction, conductivity of the cleft and the cleft height, could lead to different shapes of the extracellular signals

Special theme article : science and sociology of footwear

Journal editorial

Moral Behavior

Prosocial and antisocial behaviors take place in sport and correspond to proactive and inhibitive morality. These behaviors could have important consequences not only for the recipient's physical and psychological well being, but also for the quality of the overall sport experience. Thus, understanding the factors that lead to, or inhibit, these behaviors is important. Motivational variables stemming from achievement goal theory and self-determination theory have been associated with both prosocial and antisocial behaviors in sport, highlighting the important role of motivation on moral behavior. Moral disengagement, a strong positive predictor of antisocial behavior, could explain the effects of motivational variables on this behavior. Moral variables are also highly influential with both moral identity and empathy inhibiting antisocial behavior; anticipated guilt has been identified as a mediator in this process, underlining the significance of emotion on moral behavior. Finally, bracketed morality exists in sport, and may be a manifestation of the intergroup bias phenomenon

The catalytic power of magnesium chelatase: a benchmark for the AAA(+) ATPases

In the first committed reaction of chlorophyll biosynthesis, magnesium chelatase couples ATP hydrolysis to the thermodynamically unfavorable Mg(2+) insertion into protoporphyrin IX (ΔGº' of ca. 25-33 kJ/mol). We explored the thermodynamic constraints on magnesium chelatase and demonstrate the effect of nucleotide hydrolysis on both the reaction kinetics and thermodynamics. The enzyme produces a significant rate enhancement (kcat /kuncat of 400 x 10(6) M) and a catalytic rate enhancement, kcat /Km (DIX) K0.5 (mg) Kuncat of 30 x 10(15) M(-1) , increasing to 300 x 10(15) M(-1) with the activator protein Gun4. This is the first demonstration of the thermodynamic benefit of ATP hydrolysis in the AAA(+) family. This article is protected by copyright. All rights reserved

A seasonal cycle in the export of bottom water from the Weddell Sea

Dense water formed over the Antarctic continental shelf rapidly descends into the deep ocean where it spreads throughout the global ocean as Antarctic Bottom Water1, 2. The coldest and most voluminous component of this water mass is Weddell Sea bottom water1, 3, 4, 5, 6, 7. Here we present observations over eight years of the temperature and salinity stratification in the lowermost ocean southeast of the South Orkney Islands, marking the export of Weddell Sea bottom water. We observe a pronounced seasonal cycle in bottom temperatures, with a cold pulse in May/June and a warm one in October/November, but the timing of these phases varies each year. We detect the coldest bottom water in 1999 and 2002, whereas there was no cold phase in 2000. On the basis of current velocities and water mass characteristics, we infer that the pulses originate from the southwest Weddell Sea. We propose that the seasonal fluctuations of Weddell Sea bottom-water properties are governed by the seasonal cycle of the winds over the western margin of the Weddell Sea. Interannual fluctuations are linked to the variability of the wind-driven Weddell Sea gyre and hence to large-scale climate phenomena such as the Southern Annular Mode and El Niño/Southern Oscillation