Pritchardhancock0593

BACKGROUND AND OBJECTIVES There is a substantial body of research on advance care planning (ACP), often originating from English-speaking countries and focused on health care settings. However, studies of content of ACP conversations in community settings remain scarce. We therefore explore community-dwelling, older adults' reasoning about end-of-life (EoL) values and preferences in ACP conversations. RESEARCH DESIGN AND METHODS In this participatory action research project, planned and conducted in collaboration with national community-based organizations, we interviewed 65 older adults without known EoL care needs, about their values and preferences for future EoL care. Conversations were stimulated by sorting and ranking statements in a Swedish version of GoWish cards, called the DöBra cards, and verbatim transcripts were analyzed inductively. RESULTS While participants shared some common preferences about EoL care, there was great variation among individuals in how they reasoned. Although EoL preferences and prioritizations could be identical, different individuals explained these choices very differently. We exemplify this variation using data from four participants who discussed their respective EoL preferences by focusing on either physical, social, existential, or practical implications. DISCUSSION AND IMPLICATIONS A previously undocumented benefit of the GoWish/DöBra cards is how the flexibility of the card statements support substantial discussion of an individual's EoL preferences and underlying values. Such in-depth descriptions of participants' reasoning and considerations are important for understanding the very individual nature of prioritizing EoL preferences. We suggest future users of the DöBra/GoWish cards consider the underlying reasoning of individuals' prioritizations to strengthen person-centeredness in EoL conversations and care provision. © The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America.BACKGROUND AND AIMS Although commonly used in inflammatory bowel disease (IBD), thiopurines frequently cause intolerance and switching to a second thiopurine has only been reported in some small series. Ours aims in this study were to evaluate the safety of switching to a second thiopurine in a large cohort and to assess the impact of age on tolerance.  METHODS Adult IBD patients from the ENEIDA registry who were switched to a second thiopurine due to adverse events (excluding malignancies and infections) were identified. At the beginning of thiopurine treatment, patients were divided by age into two groups 18-50 and over 60 years of age. The rate and concordance of adverse events between the first and second thiopurines, treatment intolerance and persistence with the second thiopurine were evaluated.  RESULTS A total of 1,278 patients (13% over 60 years of age) were switched to a second thiopurine. At 12 months, the cumulative probability of switch intolerance was 43%, while persistence with treatment was 49%. Independent risk factors of switch intolerance were age over 60 years (OR 1.49; 95%CI 1.07-2.07; P=0.017), previous gastrointestinal toxicity (OR 1.4; 95%CI 1.11-1.78; P=0.005), previous acute pancreatitis (OR 6.78; 95%CI 2.55-18.05; P less then 0.001), and exposure to the first thiopurine less then 6 months (OR 1.59; 95%CI 1.14-2.23; P=0.007). CONCLUSIONS In a large series in clinical practice, switching to a second thiopurine proved to be a valid strategy. Tight monitoring of elderly IBD patients switching to a second thiopurine because of adverse events is recommended. © The Author(s) 2020. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. Abexinostat All rights reserved. For permissions, please email journals.permissions@oup.com.A variety of factors affect the success of music therapy students in practica. Many music therapy students may have invisible illnesses or invisible disabilities (II/ID) that affect their work. II/ID have physical or psychological effects but are not apparent to an observer. Such illnesses may include chronic illnesses, mental illnesses, and developmental disabilities. Although researchers have studied the success of post-secondary students with II/ID and the success of music therapy students without II/ID, there is a lack of research on music therapy students who identify with having II/ID. This researcher used an exploratory online survey to investigate the prevalence of II/ID among music therapy students and how it may affect their success in music therapy practica. Quantitative responses were compiled and analyzed into frequencies and percentages, and open-ended responses were coded and analyzed for patterns and themes. Results indicated that music therapy students with II/ID have various reasons for disclosure or nondisclosure. Some music therapy students with II/ID required accommodations, while many did not. Additionally, the effects of II/ID on music therapy practica students included physical, psychosocial, and cognitive symptoms, which led to various choices for disclosure/nondisclosure and the request/use of individualized accommodations. Music therapy students with II/ID self-reported that making decisions regarding appropriate disclosure and determining their need for accommodations or not allowed them to be more successful in practica. © The Author(s) 2020. Published by Oxford University Press on behalf of American Music Therapy Association. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.PURPOSE The purpose of this study was to quantify the prevalence of impostor phenomenon (IP) and to assess well-being in pharmacy residents, as well as analyze the effects of demographics on these outcomes. METHODS A cross-sectional, survey-based study was performed. Pharmacy residency program directors and pharmacy directors were asked to forward an invitation email to actively enrolled postgraduate year 1 (PGY1) and postgraduate year 2 pharmacy residents in March 2019. The survey used the Clance Impostor Phenomenon Scale (CIPS) to identify IP and the Mayo Clinic Resident/Fellow Well-Being Index (RWBI) to assess resident well-being. RESULTS Survey respondents were mostly female, enrolled in PGY1 programs and single with no children. Of the 720 responses included in the study, 57.5% (n = 414) were identified as "impostors" (CIPS score of ≥62), with a mean CIPS score of 64.0 (SD, 15.0). Prior mental health treatment and increased hours worked per week were significant predictors of IP. The greatest correlation was found in those working greater than 80 hours per week compared to less than 60 hours per week (ß = 9.845; P less then 0.001). The mean RWBI score was 4.2 (SD, 1.8), with 47.8% (n = 344) of residents scoring ≥5, the cutoff for identifying those at greatest risk of distress. Age, previous mental health treatment, and increasing hours worked per week were significant predictors of RWBI ≥5. CIPS and RWBI scores were found to exhibit weak but significant correlation (ρ = 0.357; P less then 0.001). CONCLUSION Pharmacy residents displayed significantly higher prevalence of IP vs comparable groups as well as significantly more distress with potential for a personal and/or professional consequence. © American Society of Health-System Pharmacists 2020. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.BACKGROUND Pain is one of the main symptoms associated with spinal cord injury and may be associated with changes to the central nervous system. PURPOSE This article provides an overview of the evidence relating to central nervous system changes (CNS) (structural and functional) associated with pain in spinal cord injuries (SCI).Data sources. A systematic review was performed, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, on PubMed, EMBASE, and Web of Science in March 2018. STUDY SELECTION Studies were selected if study changes in CNS of patients with SCI regardless of the type of imagery. DATA EXTRACTION Data were extracted by two blinded reviewers. DATA SYNTHESIS There is moderate evidence for impaired electroencephalographic function and metabolic abnormalities in the anterior cingulate in patients experiencing pain. There is preliminary evidence that patients with pain have morphological and functional changes to the somatosensory cortex and alterations to thalamic metabolism. There are conflicting data regarding the relationships between lesion characteristics and pain. In contrast, patients without pain may display protective neuroplasticity. LIMITATIONS AND CONCLUSION Further studies are required to elucidate fully the relationships between pain and neuroplasticity in patients with spinal cord injuries. However, current evidence may support the use of physical therapist treatments targeting central nervous system plasticity in patients with spinal cord injury pain. © 2020 American Physical Therapy Association.We report a COVID-19 family cluster caused by a presymptomatic case. There were 9 family members, including 8 laboratory-confirmed with COVID-19, and a 6-year-old child had no evidence of infection. Amongst the 8 patients, one adult and one 13-month-old infant were asymptomatic, one adult was diagnosed as having severe pneumonia. © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.In eukaryotic cells, with the exception of the specialized genomes of mitochondria and plastids, all genetic information is sequestered within the nucleus. This arrangement imposes constraints on how the information can be tailored for different cellular regions, particularly in cells with complex morphologies like neurons. Although messenger RNAs (mRNAs), and the proteins that they encode, can be differentially sorted between cellular regions, the information itself does not change. RNA editing by adenosine deamination can alter the genome's blueprint by recoding mRNAs; however, this process too is thought to be restricted to the nucleus. In this work, we show that ADAR2 (adenosine deaminase that acts on RNA), an RNA editing enzyme, is expressed outside of the nucleus in squid neurons. Furthermore, purified axoplasm exhibits adenosine-to-inosine activity and can specifically edit adenosines in a known substrate. Finally, a transcriptome-wide analysis of RNA editing reveals that tens of thousands of editing sites (>70% of all sites) are edited more extensively in the squid giant axon than in its cell bodies. These results indicate that within a neuron RNA editing can recode genetic information in a region-specific manner. © The Author(s) 2020. Published by Oxford University Press on behalf of Nucleic Acids Research.BACKGROUND Resting metabolic rate (RMR) tends to decline with aging. The age-trajectory of decline in RMR is similar to changes that occur in muscle mass, muscle strength and fitness but while the decline in these phenotypes have been related to changes of mitochondrial function and oxidative capacity, whether lower RMR is associated with poorer mitochondrial oxidative capacity is unknown. METHODS In 619 participants of the Baltimore Longitudinal Study of Aging, we analyzed the cross-sectional association between RMR (kcal/day), assessed by indirect calorimetry, and skeletal muscle maximal oxidative phosphorylation capacity, assessed as post-exercise phosphocreatine recovery time constant (τPCr), by phosphorous magnetic resonance spectroscopy. Linear regression models were used to evaluate the relationship between τPCr and RMR, adjusting for potential confounders. RESULTS Independent of age, sex, lean body mass, muscle density and fat mass, higher RMR was significantly associated with shorter τPCr, indicating greater mitochondrial oxidative capacity.