Resident Council: A Guide to Creating and Sustaining an Effective Council, April 6, 2015

A guide to creating and sustaining an effective Resident council in a nursing facility

Family Councils Facilitator Handbook: A Guide to Creating and Sustaining an Effective Council, May 13, 2015

A guide to creating and sustaining an effective Family Council in a facility.

Facility and Programs Roles and Responsibilities in Suspected Dependent Adult Abuse, October 2, 2013

Explanation of vital role in protecting residents/tenants living in long-term care facilities and assisted living programs.

Holiday Visits and Gifts, November 2014

With the holidays fast approaching questions inevitably arise concerning a resident’s right and ability to leave a nursing facility. Residents often want to join in family festivities but may believe that leaving a nursing facility for a period of time is not an option because they may lose their source of payment from Medicare, Medicaid, or a long term care insurance policy or lose their room all together.

Resident Councils in Nursing Facilities, 2015

Explanation of a Resident Council, the goals, who should attend and the benefits and purpose of a resident council in a facility. Suggestions of how to start a Resident Council.

Insulin-Like Growth Factor-I (IGF-1), IGF-Binding Protein-3 (IGFBP-3) and mammographic features

Introduction. The IGF system has recently been shown to play an important role in the regulation of breast tumor cell proliferation. However, also breast density is currently considered as the strongest breast cancer risk factor. It is not yet clear whether these factors are interrelated and if and how they are influenced by menopausal status. The purpose of this study was to examine the possible effects of IGF-1 and IGFBP-3 and IGF-1/IGFBP-3 molar ratio on mammographic density stratified by menopausal status. Patients and methods. A group of 341 Italian women were interviewed to collect the following data: family history of breast cancer, reproductive and menstrual factors, breast biopsies, previous administration of hormonal contraceptive therapy, hormone replacement therapy (HRT) in menopause and lifestyle information. A blood sample was drawn for determination of IGF-1, IGFBP-3 levels. IGF-1/ IGFBP-3 molar ratio was then calculated. On the basis of recent mammograms the women were divided into two groups: dense breast (DB) and non-dense breast (NDB). Student’s t-test was employed to assess the association between breast density and plasma level of IGF-1, IGFBP-3 and molar ratio. To assess if this relationship was similar in subgroups of pre- and postmenopausal women, the study population was stratified by menopausal status and Student’s t-test was performed. Finally, multivariate analysis was employed to evaluate if there were confounding factors that might influence the relationship between growth factors and breast density. Results. The analysis of the relationship between mammographic density and plasma level of IGF-1, IGFBP-3 and IGF-1/ IGFBP-3 molar ratio showed that IGF-1 levels and molar ratio varied in the two groups resulting in higher mean values in the DB group (IGF-1: 109.6 versus 96.6 ng/ml; p= 0.001 and molar ratio 29.4 versus 25.5 ng/ml; p= 0.001) whereas IGFBP-3 showed similar values in both groups (DB and NDB). Analysis of plasma level of IGF-1, IGFBP-3 and IGF-1/IGFBP-3 molar ratio compared to breast density after stratification of the study population by menopausal status (premenopausal and postmenopausal) showed that there was no association between the plasma of growth factors and breast density, neither in premenopausal nor in postmenopausal patients. Multivariate analysis showed that only nulliparity, premenopausal status and body mass index (BMI) are determinants of breast density. Conclusions. Our study provides a strong evidence of a crude association between breast density and plasma levels of IGF-1 and molar ratio. On the basis of our results, it is reasonable to assume that the role of IGF-1 and molar ratio in the pathogenesis of breast cancer might be mediated through mammographic density. IGF-1 and molar ratio might thus increase the risk of cancer by increasing mammographic density.

Protein quality and distribution determines anabolic signaling, cellular energetics, and body composition

Building and maintaining muscle is critical to the quality of life for adults and elderly. Physical activity and nutrition are important factors for long-term muscle health. In particular, dietary protein – including protein distribution and quality – are under-appreciated determinants of muscle health for adults. The most unequivocal evidence for the benefit of optimal dietary protein at individual meals is derived from studies of weight management. During the catabolic condition of weight loss, higher protein diets attenuate loss of lean tissue and partition weight loss to body fat when compared with commonly recommended high carbohydrate, low protein diets. Muscle protein turnover is a continuous process in which proteins are degraded, and replaced by newly synthesized proteins. Muscle growth occurs when protein synthesis exceeds protein degradation. Regulation of protein synthesis is complex, with multiple signals influencing this process. The mammalian target of rapamycin (mTORC1) pathway has been identified as a particularly important regulator of protein synthesis, via stimulation of translation initiation. Key regulatory points of translation initiation effected by mTORC1 include assembly of the eukaryotic initiation factor 4F (eIF4F) complex and phosphorylation of the 70 kilodalton ribosomal protein S6 kinase (S6K1). Assembly of the eIF4F initiation complex involves phosphorylation of the inhibitory eIF4E binding protein-1 (4E-BP1), which releases the initiation factor eIF4E and allows it to bind with eIF4G. Binding of eIF4E with eIF4G promotes preparation of the mRNA for binding to the 43S pre-initiation complex. Consumption of the amino acid leucine (Leu) is a key factor determining the anabolic response of muscle protein synthesis (MPS) and mTORC1 signaling to a meal. Research from this dissertation demonstrates that the peak activation of MPS following a complete meal is proportional to the Leu content of a meal and its ability to elevate plasma Leu. Leu has also been implicated as an inhibitor of muscle protein degradation (MPD). In particular, there is evidence suggesting that in muscle wasting conditions Leu supplementation attenuates expression of the ubiquitin-proteosome pathway, which is the primary mode of intracellular protein degradation. However, this is untested in healthy, physiological feeding models. Therefore, an experiment was performed to see if feeding isonitrogenous protein sources with different Leu contents to healthy adult rats would differentially impact ubiquitin-proteosome (protein degradation) outcomes; and if these outcomes are related to the meal responses of plasma Leu. Results showed that higher Leu diets were able to attenuate total proteasome content but had no effect on ubiquitin proteins. This research shows that dietary Leu determines postprandial muscle anabolism. In a parallel line of research, the effects of dietary Leu on changes in muscle mass overtime were investigated. Animals consuming higher Leu diets had larger gastrocnemius muscle weights; furthermore, gastrocnemius muscle weights were correlated with postprandial changes in MPS (r=0.471, P<0.01) and plasma Leu (r=0.400, P=0.01). These results show that the effect of Leu on ubiquitin-proteosome pathways is minimal for healthy adult rats consuming adequate diets. Thus, long-term changes in muscle mass observed in adult rats are likely due to the differences in MPS, rather than MPD. Factors determining the duration of Leu-stimulated MPS were further investigated. Despite continued elevations in plasma Leu and associated translation initiation factors (e.g., S6K1 and 4E-BP1), MPS returned to basal levels ~3 hours after a meal. However, administration of additional nutrients in the form of carbohydrate, Leu, or both ~2 hours after a meal was able to extend the elevation of MPS, in a time and dose dependent manner. This effect led to a novel discovery that decreases in translation elongation activity was associated with increases in activity of AMP kinase, a key cellular energy sensor. This research shows that the Leu density of dietary protein determines anabolic signaling, thereby affecting cellular energetics and body composition.

Delaware Water Gap National Recreation Area, Pennsylvania and New Jersey, river guide /

Shows boating, camping, and canoe rental facilities.

"Learning together, growing with family": the implementation and evaluation of a family support programme

The "Learning together, growing with family" programme is targeted to at-risk parents and children from 6 to 11 years old, with a preventive focus on promoting positive parent-child relationships. In this study, we examined the quality of the programme implementation and its influence on the programme results in a sample of 425 parents and 138 facilitators drawn from the first trial. Mixed methods were used, consisting of: parental self-reports on parenting dimensions, professionals' records on parental attendance and appraisals on six topics of the implementation process, and focus group discussions in which facilitators reported on the initial steps of the implementation. Results showed a high quality of implementation with respect to the group facilitator and the programme organization factors, followed by the coordination with services and the support facilities offered to participants and, finally, by the factors of fidelity and prior organization steps. Results of the focus groups confirmed that the prior steps were challenging and offered the more effective strategies. Better quality in the implementation factors predicted better parenting styles and parental competencies after the programme, as well as a higher attendance rate. In sum, this study demonstrates the importance of good implementation in at-risk contexts and provides some clues as to the key elements that moderate programme effectiveness.

Influence of magnesium on biochemical parameters of iron and oxidative stress in patients with type 2 diabetes

Introduction: Studies have shown that oxidative stress, found in patients with type 2 diabetes, may be due to changes in the metabolism of minerals, such as magnesium and iron. Data related to compartmentalization of these minerals in diabetes are scarce and controversial. Objective: This study assessed the influence of magnesium on biochemical parameters of iron and oxidative stress in patients with type 2 diabetes. Methods: A case-control study in male and female subjects aged 27-59 years, divided into two groups: type 2 diabetes (n=40) and control (n=48). Intake of magnesium and iron was assessed by three-day food record. Plasma, erythrocyte and urinary levels of magnesium, serum iron, ferritin, total iron binding capacity, fasting glucose, glycated hemoglobin, insulin, creatinine clearance and plasma thiobarbituric acid reactive substances (TBARS) were analyzed. Results and Discussion: Magnesium intake and plasma magnesium were lower in diabetic subjects. There was low urinary magnesium excretion, with no difference between groups. Although normal, the diabetic group had lower serum iron and ferritin concentrations compared to control subjects. Plasma TBARS in diabetic patients was higher than control while creatinine clearance was lower. An inverse correlation between erythrocyte magnesium and serum iron and ferritin was observed in the diabetes group. Conclusions: Diabetes induced hypomagnesemia and this, associated with chronic hyperglycemia, may have enhanced oxidative stress. Erythrocyte magnesium may have contributed to prevent iron overload and worsening of oxidative stress and hyperglycemic status.

Circulating leukocyte heat shock protein 70 (HSP70) and oxidative stress markers in rats after a bout of exhaustive exercise

A novel method to measure oxidative stress resulting from exhaustive exercise in rats is presented. In this new procedure we evaluated the erythrocyte antioxidant enzymes, catalase ( CAT) and glutathione reductase (GR), the plasma oxidative attack markers, reactive carbonyl derivatives (RCD) and thiobarbituric reactive substances (TBARS). Muscular tissue damage was evaluated by monitoring plasma creatine kinase (CK) and plasma taurine ( Tau) concentrations. Also, we monitored total sulphydryl groups (TSG) and uric acid (UA), and the level of the 70 kDa heat shock protein (HSP70) in leukocytes as a marker of oxidative stress. In the study we found a correspondence between erythrocyte CAT and GR activities and leukocyte HSP70 levels, principally 3 h after the acute exercise, and this suggested an integrated mechanism of antioxidant defense. The increase in levels of plasma Tau was coincident with the increasing plasma levels of CK and TBARS, principally after two hours of exercise. Thus tissue damage occurred before the expression of any anti-oxidant system markers and the monitoring of Tau, CK or TBARS may be important for the estimation of oxidative stress during exhaustive exercise. Furthermore, the integrated analyses could be of value in a clinical setting to quantify the extent of oxidative stress risk and reduce the need to perform muscle biopsies as a tool of clinical evaluation.

PREVALENCE OF IRON DEFICIENCY ANAEMIA AND DIETARY IRON INTAKE AMONG INFANTS AGED SIX TO NINE MONTHS IN KEIYO SOUTH SUB COUNTY, KENYA

The increased prevalence of iron deficiency among infants can be attributed to the consumption of an iron deficient diet or a diet that interferes with iron absorption at the critical time of infancy, among other factors. The gradual shift from breast milk to other foods and liquids is a transition period which greatly contributes to iron deficiency anaemia (IDA). The purpose of this research was to assess iron deficiency anaemia among infants aged six to nine months in Keiyo South Sub County. The specific objectives of this study were: to establish the prevalence of infants with iron deficiency anaemia and dietary iron intake among infants aged 6 to 9 months. The cross sectional study design was adopted in this survey. This study was conducted in three health facilities in Keiyo South Sub County. The infants were selected by use of a two stage cluster sampling procedure. Systematic random sampling was then used to select a total of 244 mothers and their infants. Eighty two (82) infants were selected from Kamwosor sub-district hospital and eighty one (81) from both Nyaru and Chepkorio health facilities. Interview schedules, 24-hour dietary recall and food frequency questionnaires were used for collection of dietary iron intake. Biochemical tests were carried out by use of the Hemo-control photochrometer at the health facilities. Infants whose hemoglobin levels were less than 11g/dl were considered anaemic. Further, peripheral blood smears were conducted to ascertain the type of nutritional anaemia. Data was analyzed using the Statistical Package for Social Sciences (SPSS) computer software version 17, 2009. Dietary iron intake was analyzed using the NutriSurvey 2007 computer software. Results indicated that the mean hemoglobin values were 11.3± 0.84 g/dl. Twenty one percent (21.7%) of the infants had anaemia and further 100% of peripheral blood smears indicated iron deficiency anaemia. Dietary iron intake was a predictor of iron deficiency anaemia in this study (t=-3.138; p=0.01). Iron deficiency anaemia was evident among infants in Keiyo South Sub County. The Ministry of Health should formulate and implement policies on screening for anaemia and ensure intensive nutrition education on iron rich diets during child welfare clinics.

Análisis teórico del contacto plasma-superficie y sus aplicaciones industriales

Actualmente, la física de plasmas constituye una parte importante de la investigación en física que está siendo desarrollada. Su campo de aplicación varía desde el estudio de plasmas interestelares y cósmicos, como las estrellas, las nebulosas, el medio intergaláctico, etc.; hasta aplicaciones más terrenales como la producción de microchips o los dispositivos de iluminación. Resulta particularmente interesante el estudio del contacto de una superficie metálica con un plasma. Siendo la razón que, la dinámica de la interfase formada entre un plasma imperturbado y una superficie metálica, resulta de gran importancia cuando se trata de estudiar problemas como: la implantación iónica en una oblea de silicio, el grabado por medio de plasmas, la carga de una aeronave cuando atraviesa la ionosfera y la diagnosis de plasmas mediante sondas de Langmuir. El uso de las sondas de Langmuir está extendido a través de multitud de aplicaciones tecnológicas e industriales como método de diagnosis de plasmas. Algunas de estas aplicaciones han sido mencionadas justo en el párrafo anterior. Es más, su uso también es muy popular en la investigación en física de plasmas, por ser una de las pocas técnicas de diagnosis que proporciona información local sobre el plasma. El equipamiento donde es habitualmente implementado varía desde plasmas de laboratorio de baja temperatura hasta plasmas de fusión en dispositivos como tokamaks o stellerators. La geometría más popular de este tipo de sondas es cilíndrica, y la principal magnitud que se usa para diagnosticar el plasma es la corriente recogida por la sonda cuando se encuentra polarizada a un cierto potencial. Existe un interes especial en diagnosticar por medio de la medida de la corriente iónica recogida por la sonda, puesto que produce una perturbación muy pequeña del plasma en comparación con el uso de la corriente electrónica. Dada esta popularidad, no es de extrañar que grandes esfuerzos se hayan realizado en la consecución de un modelo teórico que explique el comportamiento de una sonda de Langmuir inmersa en un plasma. Hay que remontarse a la primera mitad del siglo XX para encontrar las primeras teorías que permiten diagnosticar parámetros del plasma mediante la medida de la corriente iónica recogida por la sonda de Langmuir. Desde entonces, las mejoras en estos modelos y el desarrollo de otros nuevos ha sido una constante en la investigación en física de plasmas. No obstante, todavía no está claro como los iones se aproximan a la superficie de la sonda. Las dos principales, a la par que opuestas, aproximaciones al problema que están ampliamente aceptadas son: la radial y la orbital; siendo el problema que ambas predicen diferentes valores para la corriente iónica. Los experimentos han arrojado resultados de acuerdo con ambas teorías, la radial y la orbital; y lo que es más importante, una transición entre ambos ha sido recientemente observada. La mayoría de los logros conseguidos a la hora de comprender como los iones caen desde el plasma hacia la superficie de la sonda, han sido llevados a cabo en el campo de la dinámica de fluidos o la teoría cinética. Por otra parte, este problema puede ser abordado mediante el uso de simulaciones de partículas. La principal ventaja de las simulaciones de partículas sobre los modelos de fluidos o cinéticos es que proporcionan mucha más información sobre los detalles microscópicos del movimiento de las partículas, además es relativamente fácil introducir interacciones complejas entre las partículas. No obstante, estas ventajas no se obtienen gratuitamente, ya que las simulaciones de partículas requieren grandísimos recursos. Por esta razón, es prácticamente obligatorio el uso de técnicas de procesamiento paralelo en este tipo de simulaciones. El vacío en el conocimiento de las sondas de Langmuir, es el que motiva nuestro trabajo. Nuestra aproximación, y el principal objetivo de este trabajo, ha sido desarrollar una simulación de partículas que nos permita estudiar el problema de una sonda de Langmuir inmersa en un plasma y que está negativamente polarizada con respecto a éste. Dicha simulación nos permitiría estudiar el comportamiento de los iones en los alrededores de una sonda cilíndrica de Langmuir, así como arrojar luz sobre la transición entre las teorías radiales y orbitales que ha sido observada experimentalmente. Justo después de esta sección introductoria, el resto de la tesis está dividido en tres partes tal y como sigue: La primera parte está dedicada a establecer los fundamentos teóricos de las sondas de Langmuir. En primer lugar, se realiza una introducción general al problema y al uso de sondas de Langmuir como método de diagnosis de plasmas. A continuación, se incluye una extensiva revisión bibliográfica sobre las diferentes teorías que proporcionan la corriente iónica recogida por una sonda. La segunda parte está dedicada a explicar los detalles de las simulaciones de partículas que han sido desarrolladas a lo largo de nuestra investigación, así como los resultados obtenidos con las mismas. Esta parte incluye una introducción sobre la teoría que subyace el tipo de simulaciones de partículas y las técnicas de paralelización que han sido usadas en nuestros códigos. El resto de esta parte está dividido en dos capítulos, cada uno de los cuales se ocupa de una de las geometrías consideradas en nuestras simulaciones (plana y cilíndrica). En esta parte discutimos también los descubrimientos realizados relativos a la transición entre el comportamiento radial y orbital de los iones en los alrededores de una sonda cilíndrica de Langmuir. Finalmente, en la tercera parte de la tesis se presenta un resumen del trabajo realizado. En este resumen, se enumeran brevemente los resultados de nuestra investigación y se han incluido algunas conclusiones. Después de esto, se enumeran una serie de perspectivas futuras y extensiones para los códigos desarrollados.

Nitretação iônica sem efeito de borda :desenvolvimento e avaliação de uma nova técnica

The ionic nitriding process presents some limitations related with the control of the thickness of the layer and its uniformity. Those limitations that happen during the process, are produced due to edge effects, damage caused by arcing arc and hollow cathode, mainly in pieces with complex geometry and under pressures in excess of 1 mbar. A new technique, denominated ASPN (active screen shapes nitriding) it has been used as alternative, for offering many advantages with respect to dc plasma conventional. The developed system presents a configuration in that the samples treated are surrounded by a large metal screen at high voltage cathodic potencials, (varying between 0 and 1200V) and currents up to 1 A. The sample is placed in floting potential or polarized at relatively lower bias voltages by an auxiliary source. As the plasma is not formed directly in the sample surface but in the metal screen, the mentioned effects are eliminated. This mechanism allows investigate ion of the transfer of nitrogen to the substrate. Optical and electronic microscopy are used to exam morphology and structure at the layer. X-ray difration for phase identification and microhardness to evaluate the efficiency of this process with respect to dc conventional nitriding

Development of combined acidification and separation of slurry: effect on slurry fractions composition and gaseous emission

Doutoramento em Engenharia do Ambiente - Instituto Superior de Agronomia - UL