Physiotherapy students’ perceptions of ageing – Playing narratives as a pedagogical innovation

Introduction and objectivesThere is a considerable lack of structure in training health professionals in geriatrics. The narratives can promote a collaborative reflection on different topics and might be used as a pedagogic strategy for undergraduate health students. This study aimed to explore the adoption of new perspectives on ageing after the implementation of dynamic narratives in the first graduate year for physiotherapy students.Materials and methodsAn exploratory qualitative study was performed. Participants were included if they were: ≥18 years old, physiotherapy students and agreed to participate. Physiotherapy students (n = 44) were recruited from the School of Health Sciences, Polytechnic Institute of Leiria. Two gaming sessions were performed to help students, as narrators, express their visions and ways to deal with the geriatrics field. Students’ perspectives about ageing at baseline (T1) and after the narratives experience (T2) were collected by answering the following question: What is your perception regarding ageing? Two evaluators were involved in qualitative data analysis by performing: (i) an individual analysis of themes/subthemes and a discussion meeting to evaluate discrepancies and to reach a consensus.ResultsNegative perceptions about ageing were referred 39 times at T1 (most of them related to restriction; deterioration subthemes). There were no negative perceptions registered at T2. Positive perceptions increased at T2, from n = 39 to n = 52, and three new subthemes emerged (beginning of something, fighting ageism, challenge).ConclusionThis study demonstrated the potential of narrative-based experiences as a desirable pedagogic methodology (board games-oriented) for geriatric education in undergraduate health students.     

Immunogenicity,effectiveness and safety of COVID-19 vaccine in older adults living in nursing homes: A real-life study

IntroductionBNT162b2 (BioNTech and Pfizer) is a nucleoside-modified mRNA vaccine that provides protection against SARS-CoV-2 infection and is generally well tolerated. However, data about its efficacy, immunogenicity and safety in people of old age or with underlying chronic conditions are scarce.PurposeTo describe BNT162b2 (BioNTech and Pfizer) COVID-19 vaccine immunogenicity, effectiveness and reactogenicity after complete vaccination (two doses), and immunogenicity and reactogenicity after one booster, in elders residing in nursing homes (NH) and healthy NH workers in real-life conditions.MethodsObservational, ambispective, multicenter study. Older adults and health workers were recruited from three nursing homes of a private hospital corporation located in three Spanish cities. The primary vaccination was carried out between January and March 2021. The follow-up was 13 months. Humoral immunity, adverse events, SARS-CoV-2 infections, hospitalizations and deaths were evaluated. Cellular immunity was assessed in a participant subset.ResultsA total of 181 residents (mean age 84.1 years; 89.9% females, Charlson index ≥2: 45%) and 148 members of staff (mean age 45.2 years; 70.2% females) were surveyed (n:329). After primary vaccination of 327 participants, vaccine response in both groups was similar; ≈70% of participants, regardless of the group, had an antibody titer above the cut-off considered currently protective (260 BAU/ml). This proportion increased significantly to ≈ 98% after the booster (p < 0.0001 in both groups). Immunogenicity was largely determined by a prior history of COVID-19 infection. Twenty residents and 3 workers were tested for cellular immunity. There was evidence of cellular immunity after primary vaccination and after booster. During the study, one resident was hospitalized for SARS-CoV-2. No SARS-CoV-2-related deaths were reported and most adverse events were mild.ConclusionsOur results suggest that the BNT162b2 mRNA COVID-19 vaccine is immunogenic, effective and safe in elderly NH residents with underlying chronic conditions.     

Prevalence of transthyretin cardiac amyloidosis in elderly patients diagnosed with heart failure

ObjectiveThere is increased interest in studying ATTR-CA, a pathology that primarily affects patients of geriatric age and is frequently underdiagnosed. We aim to establish the prevalence of ATTR-CA in a cohort of patients with a history of HFpEF and to describe its characteristics.MethodsWe conducted a prospective observational study. Patients ≥75 years, clinical history of HFpEF, atrial dilation ≥34 ml/m² and left ventricular wall thickening >13 mm, were included. Demographic and analytical parameters were collected, and a comprehensive geriatric assessment was performed, along with a transthoracic echocardiogram and cardiac scintigraphy. Finally, telephone follow-up was carried out at 6 and 12 months.Results50 patients were recruited, mean age 86 ± 6 years, 54% women. Age and functional class (I–II vs. III–IV) were factors associated with presenting with ATTR-CA. Patients with positive scintigraphy had a median time to admission of 5.2 months (confidence interval [CI] 95% 0–10.9), while in those with negative scintigraphy, it was 12.2 months (95% CI 11.7–12.8); log-rank: p = 0.064. Patients with positive scintigraphy had a median time to the combined endpoint (death and readmission) of 1.9 months (95% CI 0–6.1), and patients with negative scintigraphy of 11.9 months (95% CI 11.7–12); log-rank: p = 0.027.ConclusionsATTR-CA appears to be a prevalent etiology in elderly patients within the spectrum of HFpEF. Patients with a diagnosis of ATTR-CA had a shorter time to admission for HF and the combined event of death and admission than patients with a negative result on scintigraphy.     

The importance of methylthio-IMP for methylmercaptopurine ribonucleoside (Me-MPR) cytotoxicity in Molt F4 human malignant T-lymphoblasts

The importance of methyl-thioIMP (Me-tIMP) formation for methylmercaptopurine ribonucleoside (Me-MPR) cytotoxicity was studied in Molt F4 cells. Cytotoxicity of Me-MPR is caused by Me-tIMP formation with concomitant inhibition of purine de novo synthesis. Inhibition of purine de novo synthesis resulted in decreased purine nucleotide levels and enhanced 5-phosphoribosyl-1-pyrophosphate (PRPP) levels, with concurrent increased pyrimidine nucleotide levels. The Me-tIMP concentration increased proportionally with the concentration of Me-MPR. High Me-tIMP concentration also caused inhibition of PRPP synthesis. Maximal accumulation of PRPP thus occurred at low Me-MPR concentrations. As little as 0.2 μM Me-MPR resulted already after 2 h in maximal inhibition of formation of adenine and guanine nucleotides, caused by inhibition of purine de novo synthesis by Me-tIMP. Under these circumstances increased intracellular PRPP concentrations could be demonstrated, resulting in increased levels of pyrimidine nucleotides. So, in Molt F4 cells, formation of Me-tIMP form Me-MPR results in cytotoxicity by inhibition of purine de novo synthesis.     

ploidyfrost: Reference-free estimation of ploidy level from whole genome sequencing data based on de Bruijn graphs

Polyploidy is ubiquitous and its consequences are complex and variable. A change of ploidy level generally influences genetic diversity and results in morphological, physiological and ecological differences between cells or organisms with different ploidy levels. To avoid cumbersome experiments and take advantage of the less biased information provided by the vast amounts of genome sequencing data, computational tools for ploidy estimation are urgently needed. Until now, although a few such tools have been developed, many aspects of this estimation, such as the requirement of a reference genome, the lack of informative results and objective inferences, and the influence of false positives from errors and repeats, need further improvement. We have developed ploidyfrost , a de Bruijn graph-based method, to estimate ploidy levels from whole genome sequencing data sets without a reference genome. ploidyfrost provides a visual representation of allele frequency distribution generated using the ggplot2 package as well as quantitative results using the Gaussian mixture model. In addition, it takes advantage of colouring information encoded in coloured de Bruijn graphs to analyse multiple samples simultaneously and to flexibly filter putative false positives. We evaluated the performance of ploidyfrost by analysing highly heterozygous or repetitive samples of Cyclocarya paliurus and a complex allooctoploid sample of Fragaria × ananassa. Moreover, we demonstrated that the accuracy of analysis results can be improved by constraining a threshold such as Cramér's V coefficient on variant features, which may significantly reduce the side effects of sequencing errors and annoying repeats on the graphical structure constructed.     

Holocene vegetation and water level history in two bogs of the Cordillera de Talamanca, Costa Rica

Pollen records of Holocene sediment cores from the Costa Rican Cordillera de Talamanca (La Chonta bog, 2310 m and La Trinidad bog, 2700 m) show the postglacial development of the montane oak forest zone from ca. 9500 to 1500 yr BP. During the early Holocene (ca. 9500–700 yr BP), alder vegetation covered the La Chonta and La Trinidad bogs and their adjacent hills. The upper forest line is inferred to be at 2800–3000 m elevation. A Podocarpus-Quercus forest characterised the middle Holocene (ca. 7000–4500 yr BP). The upper forest line is located at >3000 m reaching the present-day altitudinal distribution. A Quercus forest characterised the late Holocene (ca. 4500–1500 yr BP). Compared to modern conditions, the early Holocene has similar average temperatures, but the moisture level was probably higher. Pollen evidence for the late Holocene indicates drier environmental conditions than today. In order to improve the paleoecological interpretation, we described the local vegetation and used moss samples as pollen traps at both montane bogs along strong soil moisture gradients.The Netherlands Centre for Geo-ecological Research, ICG     

An evaluation of ‘rapid review’ as a method of quality control of cervical smears using the AxioHOME microscope

An evaluation of ‘rapid review’ as a method of quality control of cervical smears using the AxioHOME miscroscope One method of quality control which has recently been recommended by professional bodies in the UK is the ‘rapid review’ method. This involves the microscopic 30 s review of all negative cervical smears with the intention of flagging potential missed abnormalities. Although it has been suggested that rapid review is better than 10% random rescreening of negative smears, the efficiency and efficacy of this method of quality control have not been thoroughly evaluated. We have used the AxioHOME system, which can record the area of a slide covered and the screening time, to investigate slide coverage during rapid review quality control, as performed by 15 cytoscreeners and MLSOs reviewing a test set of 22 slides each. The test set comprised 18 negative slides, three positive slides, and one unsatisfactory slide. We have recorded two distinct methods of rapid review in use amongst cytotechnologists, the step method and the whole slide method. The data show that rapid review takes longer on average than the recommended 30 s, the mean screening times being 76 s and 82 s for the step and whole slide methods, respectively. Abnormal smears were missed on three of 15 occasions by the step method (sensitivity 80%, positive predictive value 85%), and on seven of 30 occasions by the whole slide method (sensitivity 76.6%, positive predictive value 45%). However, the 95% confidence intervals were wide (57.7–90.7% for the step method, and 51.9–95.7% for the whole slide method). Analysis of scanning tracks and screening rates shows significant flaws in the methodology of rapid review. Abnormal cells were not identified, although dyskaryotic cells were included in the scanning track on nine occasions, seven using the whole slide method and two using the step method. On one occasion (using the step method) abnormal cells were not identified because they were not included in the scanning track. Further research is in progress to determine optimal methods of rapid review, and whether the rapid review technique is as effective as automated screening systems for quality assurance in cytology. Evaluation de la technique de ‘Relecture Rapide’ comme méthode de contrôle de qualité des frottis cervico-utérins, à l'aide du microscope AxioHOME Une des méthodes de contrôle de qualité récemment recommandée par le corps professionnel du Royaume Uni est la méthode dite de ‘relecture rapide’. Cette méthode consiste en une deuxième lecture d'une durée de trente secondes de tous les frottis cervicaux négatifs et dont l'objectif est de détecter les anomalies ayant pu échapper au premier examen. Bien qu'il ait été suggéré que cette méthode de relecture rapide soit meilleure que la relecture de 10% des frottis négatifs tirés au sort, le rendement et l'efficacité de cette méthode de contrôle de qualité n'ont pas été évalués complètement. Nous avons utilisé le système AxioHOME capable d'enregistrer la plage de la lame qui a été explorée ainsi que le temps de lecture afin d'étudier la surface explorée au cours de cette relecture rapide telle qu'elle a pu être pratiquée par quinze cytotechniciens et MLSOs, chacun ayant relu une série test de vingt deux lames. Cette série test comprenait dix huit lames négatives, trois lames positives et un frottis non satisfaisant. Nous avons noté que les cytotechniciens utilisaient deux méthodes de relecture rapide différentes, la méthode ‘pas à pas’ et la méthode ‘globale’. Les données montrent que la relecture rapide prend, en moyenne, un temps supérieur aux trente secondes recommandées, la moyenne des temps de lecture étant de 76 secondes et de 82 secondes respectivement pour la méthode ‘pas à pas’ et la méthode ‘globale’. Les anomalies n'ont pas été détectées dans trois cas sur quinze par la méthode ‘pas à pas’ (sensibilité 80%, valeur prédictive positive 85%), et dans 7 cas sur 30 par la méthode globale (sensibilité 76,6%, valeur prédictive positive 45%). Toutefois, l'intervalle de confiance à 95% est important (57,7%-90,7% pour la méthode ‘pas à pas’ et 51,9%-95,7% pour la méthode globale). L'analyse des surfaces balayées et des taux de détection montre des points faibles significatifs de cette méthodologie de relecture rapide. Dans 9 cas, les anomalies n'ont pas été identifiées alors que des cellules dyskaryotiques étaient présentes dans les plages balayées au cours de la relecture (sept utilisant la méthode globale et deux utilisant la méthode ‘pas à pas’). Dans un cas (avec la méthode ‘pas à pas’) les cellules anormales n'ont pas été identifiées parce qu'elles étaient absentes des plages de relecture. Des études sont en cours afin de déterminer quelles sont les méthodes optimales de relecture rapide et si ces techniques de relecture rapide sont aussi efficaces que les systèmes de lecture automatisée pour l'assurance de qualité en cytologie cervico-utérine. ‘Rapid Review’ als Methode der Qualitätskontrolle gynäkologischer Abstriche, Überprüfung mit dem AxioHOME-Mikroskop Die empfohlene ‘Rapid Review’ Kontrolle aller negativen Abstriche in nur 30 Sekunden anstelle des Nachscreenens von 10% der Präparate ist in ihrer Zuverlässigkeit bislang nicht überprüft worden. Mit Hilfe des AxioHOME-Mikroskops ist es möglich sowohl die ausgewertete Fläche, als auch die erforderliche Zeit zu erfassen. 15 Auswerter prüften mit der Methode jeweils einen Testsatz von 22 Präparaten. Er enhielt 18 negative, 3 positive und 1 nichtauswertbaren Abstrich. Getestet wurden zwei verschiedene Vorgehensweisen: die schrittweise und die das ganze Präparat erfassende. Beide erfordern mehr Zeit als 30 Sekunden; der mittlere Zeitaufwand betrug für die Schrittmethode 76 und für die Ganzheitsmethode 82 Sekunden. Die Schrittmethode verfehlte 3/15 Anomalien (Sensitivität 80%, positiver prädiktiver Wert 85%), die Ganzheitsmethode 7/30 (Sensitivität 76,6%, positiver prädiktiver Wert 45%). Der 95% Konfi denzbereich reichte für die Schrittmethode von 57,5–90,7% und für die Ganzheitsmethode von 51,9–95,7%). Die Analyse deckt wesentliche Schwachstellen des Rapid Review-Verfahrens auf. In 9 Fällen lagen nicht erkannte Zellatypien in den kontroll ierten Bahnen (7 bei des Schrittmethode, 2 bei der Ganzheitsmethode). Einmal lagen sie bei der Schrittmethode ausserhalb der geprüften Bahnen. Weitere Studien werden prüfen ab das Rapid Review-Verfahren automatisierten Systemen vergleichbar ist.     

Serum indole-3-acetic acid in control subjects and newly abstinent alcoholics after an oral loading with L-tryptophan: a preliminary study using liquid chromatography with amperometric detection

Described in this paper is a rapid, isocratic assay for serum indole-3-acetic acid (IAA). The sample preparation involves only protein precipitation using sulfosalicylic acid, and the sensitivity of amperometric detection is in the picogram range. The chromatographic analysis time is approximately 4 min. The devised method was used for a longitudinal study of IAA levels in serum samples from control subjects and newly abstinent alcoholics. Dietary variations were eliminated by administering a 2.0-g loading dose of L-Trp to all subjects investigated. The results are presented in the form of cumulative frequency polygons. Preliminary data indicate no differences in IAA levels between newly abstinent alcoholics and control subjects.     

Etude olfactométrique de l'action de diverses substances allélochimiques végétales dans la recherche de l'hote par Diadromus pulchellus (Hymenoptera,Ichneumonidae)

Résumé La recherche de l'habitat d'un hôte potentiel par D. pulchellus, endoparasite considéré comme spécialiste des nymphes d'A. assectella, est abordée chez les adultes femelles et mâles, en olfactométrie, par l'étude de leur comportement locomoteur. L'activité locomotrice et l'attraction sont ainsi analysées en présence de substances allélochimiques issues ou non de végétaux pouvant abriter un hôte. Que les composés soufrés testés soient stables ou non, ils ne déclenchent pas d'attraction chez les hyménoptères quel que soit leur sexe et le type d'olfactomètre utilisé, contrairement aux imagos du phytophage-hôte, A. assectella, attirés par les composés soufrés instables spécifiques du poireau. L'activité locomotrice des hyménoptères des deux sexes est stimulée par divers composés volatils soufrés de synthèse ou émis naturellement par les Crucifères et par les Allium consommés par les larves d'A. assectella. Les substances efficaces sont généralément stables et sont caractérisées par le groupement actif R-S-, à condition que R ne soit pas un allyle. Par ailleurs, des composés volatils non soufrés contenus dans des végétaux autres que les Allium et les Crucifères ne stimulent pas le comportement locomoteur des hyménoptères. Ces différentes observations permettent d'envisager que D. pulchellus est un spécialiste inféodé à des microlépidoptères s'alimentant sur des végétaux soufrés et non sur les seuls Allium.

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Summary Searching the host habitat by the endoparasite wasp Diadromus pulchellus, considered to be a specialist of Acrolepiopsis assectella nymphs, is studied in females and males by analysis of locomotory behaviour in olfactometers. Thus, locomotor activity and attraction are studied in the presence or absence of air-borne volatiles emitted by plants able to shelter a potential host-moth. Stable and unstable sulphur compounds used do not release attraction in female and male ichneumonids whatever the type of olfactometer used. By contrast, phytophagous host adults are attracted by unstable specific sulphur compounds of the leek. Locomotor activities of D. pulchellus females and males are stimulated by various volatile sulphur compounds of synthetic origin or naturally occurring in Allium eaten by A. assectella larvae and in Crucifera. The effective compounds generally are stable and characterized by the active group R-S — in which the alkyl moiety must not be an allyl one. On the other hand, volatiles without sulphur, emitted by plants which do not belong to Cruciferae or Allium, do not stimulate the hymenopteran locomotor activity. These observations suggest that D. pulchellus is oligophagous, attracted to microlepidoptera developing on plants containing sulphur compounds and not only on Allium.