RN staffing levels fall much lower than CMS standards in most nursing homes, according to a study published July 1 in Health Affairs.
“Seventy-five percent of nursing homes were almost never in compliance with what CMS expected their RN staffing level to be,” the study’s authors wrote. They also found half of skilled nursing facilities only met standard staffing benchmarks on 19 days or fewer between April 2017 and March 2018.
The study supports previous analyses that also revealed staffing problems in nursing homes, according to Skilled Nursing News. The problems came to light when CMS stopped using self-reported data in favor of the payroll-based journal system in April 2018. CMS gave almost 1,400 nursing homes one-star ratings after The New York Times and Kaiser Health News analyzed the PBJ data and found a large gap between self-reported and payroll-based staffing records.
Going forward, the study’s authors advise improved measures of staffing levels based on day-to-day variation rather than averages, among other measures.
Parkinson’s disease, a neurodegenerative disorder that affects more than 6 million people worldwide, is caused by the buildup of alpha-synuclein proteins in the brain. The biological function of alpha-synuclein is still not well understood, but because of its role in neurodegenerative diseases, researchers are actively studying this protein to understand the mechanisms of the disease and to look for new treatment strategies.
A new study from Elizabeth Rhoades and postdoc Melissa Birol found that when alpha-synuclein binds to extracellular glycoproteins, proteins with added sugar molecules, it can be taken up by neurons more easily. The paper also identified a specific presynaptic protein, neurexin 1?, as a key regulator in this process and a potential therapeutic target. Their findings were published in the journal PLOS Biology.
In one possible model for the pathology of Parkinson’s disease, bundles of alpha-synuclein proteins, known as aggregates, form inside a neuron. This then leads to cell death and the release of alpha-synuclein protein clusters that are taken up by other neurons. Since neurodegenerative diseases have typical progression patterns, knowing how alpha-synuclein moves between neurons in the brain helps researchers understand disease propagation.
Previous work from the Rhoades lab implicated the presence of a glycan binding site on alpha-synuclein. This finding, combined with Birol’s experience in analyzing protein-membrane interactions, led to this study of how alpha-synuclein interacts with cell membranes.
Birol was able to enzymatically remove specific glycans from the cell surface to see how their presence or absence would change how alpha-synuclein was taken up by neurons. The study found that when glycans were removed, the amount of alpha-synuclein clusters taken up by cells was greatly reduced.
And by analyzing giant plasma membrane vesicles, synthetic membranes derived from components of real cells that have the same protein and lipid composition, Birol was also able to see the detailed physical interactions between alpha-synuclein and glycans. “There’s a structural basis for the alpha-synuclein binding to the glycan, and when the glycans are removed, it changes the nature of the interaction of alpha-synuclein with the cell membrane,” explains Rhoades.
This research focused on the acetylated form of alpha-synuclein proteins, which is present in both healthy and diseased neurons and is less frequently studied. They found that the acetylated form was more effective at forming clusters of proteins inside neurons and was required for interactions with glycans. “No one’s really stressed the importance of these acetylated versions,” Birol says. “Generally, we need take a step back in trying to understand how this protein may be propagating between cells, and I think glycans could be an aspect.”
Rhoades and Birol say that the most unexpected finding was the discovery of neurexin 1? as a potential partner in how alpha-synuclein is taken up by neurons. They hope that future research on this presynaptic protein could provide insights into new treatment strategies for Parkinson’s and other neurodegenerative diseases.
In the near term, Rhoades and her group hope to obtain higher-resolution structural information of alpha-synuclein proteins bound to glycans. They also hope that this study will inspire future research on alpha-synuclein acetylation and the role of glycans in the progression of the disease and will provide an impetus to look at previously unstudied protein modifications that might be connected to Parkinson’s disease.
“Some cells spontaneously internalize these [alpha-synuclein] proteins and some do not. It has generally been assumed that there are alpha-synuclein specific receptors on the cells that do internalize aggregates. That may or may not be true, but [our study] suggests that it’s not just the protein receptors but the glycans that are also important,” says Rhoades.
This research was supported by the Michael J. Fox Foundation for Parkinson’s Research.
Melissa Birol, Slawomir P. Wojcik, Andrew D. Miranker, Elizabeth Rhoades. Identification of N-linked glycans as specific mediators of neuronal uptake of acetylated α-Synuclein. PLOS Biology, 2019; 17 (6): e3000318 DOI: 10.1371/journal.pbio.3000318
In a world first, scientists have found a new way to direct stem cells to heart tissue. The findings, led by researchers at the University of Bristol and published in Chemical Science, could radically improve the treatment for cardiovascular disease, which causes more than a quarter of all deaths in the UK.
To date, trials using stem cells, which are taken and grown from the patient or donor and injected into the patient’s heart to regenerate damaged tissue, have produced promising results.
However, while these next generation cell therapies are on the horizon, significant challenges associated with the distribution of the stem cells have remained. High blood flow in the heart combined with various ’tissue sinks’, that circulating cells come into contact with, means the majority of the stem cells end up in the lungs and spleen.
Now, researchers from Bristol’s School of Cellular and Molecular Medicine have found a way to overcome this by modifying stem cells with a special protein so they ‘home’ to heart tissue.
Dr Adam Perriman, the study’s lead author, Associate Professor in Biomaterials, UKRI Future Leaders Fellow and founder of the cell therapy technology company CytoSeek, explained: “With regenerative cell therapies, where you are trying to treat someone after a heart attack, the cells rarely go to where you want them to go. Our aim is to use this technology to re-engineer the membrane of cells, so that when they’re injected, they’ll home to specific tissues of our choice.
“We know that some bacterial cells contain properties that enable them to detect and ‘home’ to diseased tissue. For example, the oral bacterial found in our mouths can occasionally cause strep throat. If it enters the blood stream it can ‘home’ to damaged tissue in the heart causing infective endocarditis. Our aim was to replicate the homing ability of bacteria cells and apply it to stem cells.”
The team developed the technology by looking at how bacterial cells use a protein called an adhesin to ‘home’ to heart tissue. Using this theory, the researchers were able to produce an artificial cell membrane binding version of the adhesin that could be ‘painted’ on the outside of the stem cells. In an animal model, the team were able to demonstrate that this new cell modification technique worked by directing stem cells to the heart in a mouse.
Dr Perriman added: “Our findings demonstrate that the cardiac homing properties of infectious bacteria can be transferred to human stem cells. Significantly, we show in a mouse model that the designer adhesin protein spontaneously inserts into the plasma membrane of the stem cells with no cytotoxity, and then directs the modified cells to the heart after transplant. To our knowledge, this is the first time that the targeting properties of infectious bacteria have been transferred to mammalian cells.
“This new technique carries enormous potential for the seven million people currently living with heart disease in the UK.”
Dr Perriman’s UKRI Future Leaders fellowship is based on research funded by the Elizabeth Blackwell Institute-funded Catalyst project. He is also a member of the University’s BrisSynBio, a multi-disciplinary research centre part of the Bristol BioDesign Institute, that focuses on the biomolecular design and engineering aspects of synthetic biology.
Dr Perriman is well-known for his pioneering research on the construction and study of novel synthetic biomolecular systems for regenerative engineering.
Wenjin Xiao, Thomas I. P. Green, Xiaowen Liang, Rosalia Cuahtecontzi Delint, Guillaume Perry, Michael S. Roberts, Kristian Le Vay, Catherine R. Back, Raimomdo Ascione, Haolu Wang, Paul R. Race, Adam W. Perriman. Designer artificial membrane binding proteins to direct stem cells to the myocardium. Chemical Science, 2019; DOI: 10.1039/C9SC02650A
When University of Alberta dermatologist Robert Gniadecki was growing up in Denmark, getting a sunburn was part of every family holiday.
“The first day at the seaside you would go out in the sunshine, and the next day you would have a bonfire, peel your skin off and throw it in the fire,” he said.
“It’s so disgusting, when you think about it today, but 40 years ago this was a normal thing.”
Gniadecki said these days most of us know that even a tan is a sign of skin cell damage, but sunburn still sneaks up on us from time to time. He shared four surprising ways people can get burned:
Foods that increase your UV sensitivity
Turns out “margarita sunburn” isn’t just a reference to what happens when snowbirds roast on Mexican beaches. There’s a naturally occurring chemical called furocoumarin in limes, some kinds of carrots, celery, dill and other plants that, when ingested, causes your skin to become more sensitive to the sun’s harmful rays.
“And of course people often fall asleep after having a couple of drinks, which doesn’t help either,” said Gniadecki. “A simple thing like sleeping in the sun is terribly dangerous.”
Unexpected weather changes
It even happens to dermatologists.
“I was on a rainy winter hike in the mountains,” Gniadecki said. “Then the clouds cleared and I was left on a snow patch with no protection.”
More UV than you realized
Most of us realize the sun’s rays are stronger at the equator than in our own backyard, and weaker at sunset than at high noon—it’s all about the angle of the sun. What we may not realize is how ultraviolet light is concentrated when we are on water, sand or even snow.
“People often think that in winter, because it’s cold and you don’t feel the warmth of the sun, you will never get a sunburn or you can tolerate more sun,” Gniadecki said. “You can actually tolerate less sun during the winter because of the reflection from the snow.”
He said that sun exposure is almost doubled in the snow, compared with being on grass, while sand reflects 15 to 20 percent more and seawater reflects 25 percent more UV than grass.
Sunscreen spread too thinly
Gniadecki said you need to apply enough sunscreen to create a sheen all over your skin. If you’re using sunscreen that contains titanium or zinc oxide, a white hue should be visible. Be sure to use a product with a sun protection factor (SPF) of at least 20, which lets through just 1/20th of the sun’s harmful rays. That means that if you would normally start to burn in 10 minutes, you can stay out in the sun for 200 minutes. But be realistic about how long your exposure will be, and reapply your sunscreen if you get wet.
“If you sweat a lot, some will wash away, and you can get a sunburn,” said Gniadecki.
He recommended avoiding sunscreens that contain oxybenzone, a common ingredient that was recently shown to be absorbed through the skin into the bloodstream. Gniadecki suggested using other products until the health effects of oxybenzone are better known.
Treating a sunburn
Gniadecki recommends staying away from household remedies—such as applying cooking oil or yogurt, or the Danish prescription of putting lemon slices on your skin—which are not only ineffective, but could also be harmful. He suggests the following steps instead:
Cool the skin with a damp cloth.
Apply a fragrance-free moisturizer or even an over-the-counter hydrocortisone cream.
Take oral ibuprofen. (Don’t use topical painkillers such as those branded with “caine.”)
Rehydrate by drinking lots of water.
If you have small blisters, apply a topical antibiotic to prevent infection.
See a doctor if you are vomiting or if large blisters develop a crust and are visibly infected.
“The short-term effects of sunburn are trivial and you can usually manage them at home,” said Gniadecki, who is also a member of the Cancer Research Institute of Northern Alberta. “But the long-term effects are serious.”
Sunburn, especially in childhood, causes permanent and irreparable damage to the skin that can develop into cancer 20 or 30 years later.
or thousands of years, mothers have sung lullabies to help their babies and children fall asleep. In more recent times, gadgets and devices have been invented and marketed to help the tired child – and weary parent.
One of these devices has been linked in recent years to the tragic deaths of 32 babies. Fisher Price recently recalled its Rock ‘n Play Sleeper after the deaths.
The popularity of the device and others shows the widespread desire for help getting babies and children to sleep. Consider that nearly 30% of young children experience sleep problems that warrant clinical attention.
As behavioral sleep medicine specialists, we completed postdoctoral training in assessment and treatment of behavioral sleep problems in children and teens. Our knowledge of pediatric sleep research suggests children won’t outgrow sleep problems, and sleep problems may even worsen over time. Yet children with sleep problems are not destined to be sleep deprived forever. There are sleep training methods for babies and young children that can work.
Sleep, my child … so I can, too
A mother rocks her baby to sleep.FamVeld/Shutterstock.comWe sleep doctors have seen that sleep problems correlate with a host of daytime problems, such as overactivity and attentional impairments, poor school performance, and excessive moodiness and irritability. As many as 20% of adults experience persistent insomnia, and many can trace their sleep problems to childhood.
The most common sleep problems in young children are difficulties falling asleep at bedtime, disruptive nighttime awakenings, or needing special conditions to fall asleep, such as the presence of a parent. These problems, in turn, are likely to cause parental stress and next-day impairments for the entire family.
People often equate sleep with “tiredness” and “fatigue.” In fact, sleep is its own process. It is an interaction of sleep-promoting brain chemicals and consistent daily rhythms of wake and sleep produced by bright light exposure in the morning. The bright light signals suppression of the sleep-promoting hormone melatonin.
Darkness, on the other hand, signals the brain via direct connection from receptors in the eye: “Produce melatonin; Go to sleep.” At the end of the day, there is nothing parents can do safely to make their children sleep. But there are many things parents can do to teach their children the skills necessary for good sleep.
Insomnia responds well to a number of behavioral treatment interventions.
From crying it out to teaching a skill
Timed checks on a baby can be more effective than constantly watching him or her.Elnur/Shutterstock.comMany families have heard of the conventional “cry it out” approach – formally known as unmodified extinction. Although research supports the effectiveness of this method with infants and young toddlers, it is our clinical experience that few parents find this approach bearable. Furthermore, “cry it out” is not intended for use with older toddlers or preschool-aged children.
Instead, a method called graduated extinction is the mainstay of current behavioral intervention for bedtime resistance and sleep association problems. There are several approaches, used from toddlerhood through middle childhood, consisting of techniques such as timed checks, or the “walking chair.”
In timed checks, parents enter and exit the bedroom on a strictly timed schedule. This breaks the connection between problem child behavior, such as crying and calling out, and parental response.
The walking chair method involves the parent moving further and further from the child’s bed until outside the bedroom door and, eventually, back to the parent’s own bed. Our clinical experience is that sometimes a combination of these methods is needed.
Although these procedures emphasize the importance of limiting attention to problem behavior, they differ from unmodified extinction by providing attention for positive sleep behaviors, such as lying quietly in bed.
Consider a child who has a longstanding history of needing parental presence to fall asleep. The child can be said to have a skill deficit of being unable to fall asleep on her own. Learning to fall asleep can be likened to learning to ride a bike, first with training wheels, then without, and then without the parent steadying the handlebar. Little by little, the parent takes away her hand, and the child learns balance and eventually pedals away on her own.
With sleep training, the parent teaches the child to practice behaviors that are compatible with sleep, such as lying still and quiet in bed with their head on the pillow. When the parent enters the room every five minutes to say, “Good job staying in bed and lying so still” and offers a quick kiss and pat on the back, the child knows exactly what is pleasing to the parent. Once the child learns to lie quiet and still in bed, sleep physiology takes over.
Healthy sleep now, healthy sleep in adulthood
Many parents may incorrectly believe that sleep training is damaging to the parent-child relationship or attachment bond. In fact, we argue that healthy attachment bonds are formed by high rates of reinforcing parent-child interaction such as those used to teach behavior that is compatible with sleep.
Sleep training at younger ages may protect against more serious sleep problems later in life. For instance, at the onset of puberty, most teens experience a natural biological shift that causes them to prefer later bedtime and later wake time.
For most, this preference does not subside until young adulthood. If this natural shift in bedtime and wake time is paired with already problematic sleep habits learned in childhood, the results can be serious. Kids can get behind at school because they fall asleep in class, or they may become truant. Furthermore, when teens attempt to self-correct problem sleep schedules, they often find themselves unable to fall asleep easily at an appropriate bedtime. Many end up spending excessive time awake in bed, placing them at risk for chronic insomnia that could persist well into middle age.
So, that conversation that you are thinking about having with your child’s pediatrician: Have it. Your pediatrician also can help you decide when it might be time to seek specialty care with a behavioral sleep specialist or sleep medicine physician.
If your child doesn’t sleep, don’t lose hope. Change is possible. You already have taught and will continue to teach your child many important lessons in life. With persistence, good information and willingness to try new things, healthy sleep habits and a good night’s sleep are within reach.
https://theconversation.com/sleep-training-for-your-kids-why-and-how-it-works-117638
The FDA is behind a horror video game designed to teach teens about the dangers of smoking. Inspired by the statistic that three out of every four high school students who start smoking continue on to adulthood, One Leaves sets players in a cell with three other teens. The free PC and Xbox One game’s objective is to escape the cell, but only one of the players will succeed. The game is being released as part of the FDA’s “The Real Cost” youth tobacco prevention campaign, which is aimed at youth who are 12 to 17 years of age.
The game’s heavy-handedness won’t be lost among its Gen-Z players. As you play the game, you encounter challenges that are also faced by smokers. You can run from the cell, but only in short bursts since your lungs are damaged by smoking. The smoke obscures your vision. The game is structured like a maze, which is meant to be a metaphor for quitting smoking. Much like in the game, quitters often fail and can end up right back where they started.
Anti-smoking and anti-drug campaigns targeting teenagers inspired a lot of eyerolls, and studies suggest they don’t always work and sometimes can have the opposite effect. The FDA is taking a more creative route with the grisly horror imagery of One Leaves, but it’s hard to believe that today’s teenagers are any less jaded than the ones of the past. And unlike yesterday’s youth, today’s teens face a new temptation in the form of e-cigarettes. According to the CDC, the number of high school students using tobacco increased by 38 percent in 2018, due to vaping.
But even if the game doesn’t convince players to drop smoking, One Leaves may still be a compelling distraction. The fact that film director Darren Aronofsky created the trailer doesn’t hurt. The FDA even scored the endorsement of popular Fortnite star Ninja, who tweeted out a playthrough of the game. With that kind of star power, maybe One Leaves will be better-regarded than most anti-smoking PSAs.
Future Netflix original shows rated TV-14 or lower and movies rated PG-13 or below will no longer include depictions of smoking or e-cigarette use, except in cases of historical or factual accuracy. The service will also avoid showing smoking or e-cigarette use in more adult-orientated projects “unless it’s essential to the creative vision of the artist or because it’s character-defining (historically or culturally important),” it toldVariety.
“Netflix strongly supports artistic expression,” a Netflix spokesman said. “We also recognize that smoking is harmful and when portrayed positively on screen can adversely influence young people.” As part of its clampdown, Netflix will also reveal details about smoking in its ratings.
The move follows a report from anti-smoking group Truth Initiative, which states season 2 of Stranger Things had 262 depictions of smoking, up from 182 in the first season. To date, smoking has featured in every episode, the watchdog said. The report, coincidentally or not, dropped a few daysbeforeStranger Things season 3 starts streaming.
Truth Initiative claimed there was an uptick in smoking instances in recent seasons of some other Netflix originals that are popular among folks aged 15-24. Between seasons 2 and 3 of Unbreakable Kimmy Schmidt, depictions of smoking rose to 292 from nine. They jumped from 45 to 233 between seasons 4 and 5 of Orange is the New Black, the group claimed.
It also said 12 of the 13 overall most popular TV shows among that age group prominently feature smoking. Those include Amazon Prime Video’s The Marvelous Mrs. Maisel and Hulu’s Gap Year. Truth Initiative ranked the most popular shows among 15 to 24-year-olds based on 750 survey responses from people in that age group.
