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The article discusses a case study of a 72-year-old woman undergoing peritoneal dialysis who presented with confusion and lethargy, accompanied by retiform purpura and elevated creatinine levels, ultimately diagnosed with calcific uremic arteriolopathy. Topics include the clinical presentation and management of this rare, life-threatening syndrome characterized by vascular calcification, highlighting the challenges in its treatment and the high mortality associated with the disease.

Termitomyces species are known edible mushrooms in Nigeria, believed to have exceptional culinary and nutraceutical properties. Methanol extract from fruiting bodies of Termitomyces robustus was evaluated for antidiabetic activity using in vitro α-amylase and α-glucosidase assays. The isolation and structural elucidation of metabolites from the T. robustus extract afforded five compounds including a new natural product γ-glutamyl-β-phenylethylamine 3 and four known phenyl derivatives: tryptophan 1, 4-hydroxyphenylacetic acid 2, 4-hydroxyphenylpropionic acid 4, and phenyllactic acid 5. Structures were elucidated from analyses of spectroscopic data (1 D and 2 D NMR, HRESIMS) and all isolated compounds were tested for α-amylase and α-glycosidase inhibitory activity. The in vitro assay established crude extract to possess α- amylase and α-glucosidase inhibition with IC50 of 78.05 µg/mL and 86.10 µg/mL, respectively. The isolated compounds compared favourably with the standard drug, acarbose with IC50 ranging from 6.18-15.08 µg/mL and 18.28-44.63 µg/mL for α-amylase and glucosidase, respectively. [ABSTRACT FROM AUTHOR]

Four ursane-type triterpenoid glycosides (1-4), two benzophenone glycosides (5 and 6), and one iridoid glucoside (7) were isolated and characterized from the dried roots of Vangueria agrestis. Compounds 1 (3-O-[α-L-rhamnopyranosyl-(1→2)-β-D-xylopyranosyl]pomolic acid 28-O-β-D-glucopyranosyl ester) and 5 (2-O-[β-D-apiofuranosyl-(1→6)-β-D-glucopyranosyl]-6,4′-dihydroxy-4-methoxy benzophenone) were found to be new metabolites. The identity of all compounds has been accomplished, primarily, based on 1 D and 2 D NMR and HRESMS analysis. Compounds 6 and 2, showed inhibitory effect against Trypanosoma brucei with IC50 22.3 µM for 6 and IC50 11.1 µM, IC90 12.3 µM for 2. [ABSTRACT FROM AUTHOR]

Massive stars are rarely seen to form in isolation. It has been proposed that association with companions or clusters in the formative stages is vital to their mass accumulation. In this paper, we study IRAS 18144-1723, a massive young stellar object (YSO) that had been perceived in early studies as a single source. In the CO(3–2) line, we detect an outflow aligned well with the outflow seen in H2 in this region. We show that there are at least two YSOs here and that the outflow is most likely to be from a deeply embedded source detected in our infrared imaging. Using multiwavelength observations, we study the outflow and the embedded source and derive their properties. We conclude that IRAS 18144 hosts an isolated cloud, in which at least two massive YSOs are being born. From our submillimetre observations, we derive the mass of the cloud and the core hosting the YSOs. [ABSTRACT FROM AUTHOR]

Approximately 60% of older adults complain of dry mouth which may be associated with polypharmacy, common in this population. Existing studies have reported treatment approaches to dry mouth but do not address long-term, preventative measures that would more positively benefit the health and wellbeing of older adults.1 Aim: This rapid systematic review aims to identify the implications of dry mouth on the physical and psychological wellbeing of older adults with polypharmacy to establish the importance of preventing dry mouth. Methods: Studies reporting health implications of dry mouth, in relation to polypharmacy in older adults (>65 years old), were included in this rapid systematic review. MEDLINE, EMBASE, PsycINFO and CINAHL databases were searched using Keywords such as ‘polypharmacy’, ‘dry mouth’, ‘oral health’ and ‘quality of life’ (PROSPERO: CRD42021288945). Joanna Briggs Institute critical appraisal tools were used to assess study quality. Ethical approval was not required for this project due to the methodology of this rapid systematic review. Results: Of the 6,852 citations screened, 9 studies (cross-sectional, n = 8; longitudinal, n = 1) were included which comprised 37,459 participants (mean age range: 68.5-85.0 years). Studies were published between 2005 and 2019. Meta-analysis was not possible due to the heterogenicity of outcomes reported; instead, a narrative synthesis was undertaken. The health implications identified in this review were categorised as ‘physical’, such as tooth loss, or ‘psychological’, such as depression. The main physical health implications reported in the studies related to dental health, such as tooth loss and gingivitis, as well as functional impairments, such as chewing and swallowing difficulties. An increase in the number of medicines taken, from 0 to 5, decreased the number of natural teeth remaining from 16.35 ±8.58 to 11.74 ±7.88, respectively. Additionally, the number of dental complications increased from 1.43 ±2.1 to 2.33 ±2.2 as the number of medicines increased from 1 to >3, respectively. There was a paucity of studies (n = 2) that investigated the psychological health implications of dry mouth upon older adult populations. Depression, was however, identified as a significant consequence of dry mouth in older adults with a prevalence as high as 64%.2 An additional 6 psychological health implications were identified, for example, self-consciousness. Discussion/Conclusion: This review examined the health implications of dry mouth in relation to polypharmacy in older adults, including physical health and psychological health implications. There were limitations in this review; for example, the predominant cross-sectional study design restricted findings due to the inability to establish longitudinal associations. High levels of physical health implications of dry mouth were observed in older adults with polypharmacy and, to a lesser extent, psychological health implications. The modifiable nature of polypharmacy could pave the way for prevention strategies of dry mouth. The optimisation of medication regimens, to effectively treat chronic conditions but also limit the likelihood of dry mouth, is a practical approach to achieve this. [ABSTRACT FROM AUTHOR]

Background: Local neighbourhood environments can influence dietary behavior. There is limited evidence focused on older people who are likely to have greater dependence on local areas and may suffer functional limitations that amplify any neighbourhood impact. Methods: Using multi-level ordinal regression analysis we investigated the association between multiple dimensions of neighbourhood food environments (captured by fine-detail, foot-based environmental audits and secondary data) and self-reported frequency of fruit and vegetable intake. The study was a cross-sectional analysis nested within two nationally representative cohorts in the UK: the British Regional Heart Study and the British Women's Heart and Health Study. Main exposures of interest were density of food retail outlets selling fruits and vegetables, the density of fast food outlets and a novel measure of diversity of the food retail environment. Results: A total of 1124 men and 883 women, aged 69 - 92 years, living in 20 British towns were included in the analysis. There was strong evidence of an association between area income deprivation and fruit and vegetable consumption, with study members in the most deprived areas estimated to have 27% (95% CI: 7,42) lower odds of being in a higher fruit and vegetable consumption category relative to those in the least deprived areas. We found no consistent evidence for an association between fruit and vegetable consumption and a range of other food environment domains, including density of shops selling fruits and vegetables, density of premises selling fast food, the area food retail diversity, area walkability, transport accessibility, or the local food marketing environment. For example, individuals living in areas with greatest fruit and vegetable outlet density had 2% (95% CI: -22, 21) lower odds of being in a higher fruit and vegetable consumption category relative to those in areas with no shops. Conclusions: Although small effect sizes in environment-diet relationships cannot be discounted, this study suggests that older people are less influenced by physical characteristics of neighbourhood food environments than is suggested in the literature. The association between area income deprivation and diet may be capturing an important social aspect of neighbourhoods that influence food intake in older adults and warrants further research. [ABSTRACT FROM AUTHOR]

We present an analysis of the effect of feedback from O- and B-type stars with data from the integral field spectrograph Multi Unit Spectroscopic Explorer (MUSE) mounted on the Very Large Telescope of pillar-like structures in the Carina Nebular Complex, one of the most massive star-forming regions in the Galaxy. For the observed pillars, we compute gas electron densities and temperatures maps, produce integrated line and velocity maps of the ionized gas, study the ionization fronts at the pillar tips, analyse the properties of the single regions, and detect two ionized jets originating from two distinct pillar tips. For each pillar tip, we determine the incident ionizing photon flux Q0, pil originating from the nearby massive O- and B-type stars and compute the mass-loss rate ... of the pillar tips due to photoevaporation caused by the incident ionizing radiation. We combine the results of the Carina data set with archival MUSE data of a pillar in NGC 3603 and with previously published MUSE data of the Pillars of Creation in M16, and with a total of 10 analysed pillars, find tight correlations between the ionizing photon flux and the electron density, the electron density and the distance from the ionizing sources, and the ionizing photon flux and the mass-loss rate. The combined MUSE data sets of pillars in regions with different physical conditions and stellar content therefore yield an empirical quantification of the feedback effects of ionizing radiation. In agreement with models, we find that ... ∝ Q0.pil1/2. [ABSTRACT FROM AUTHOR]

Background Hearing and vision problems are common in older adults. We investigated the association of self-reported sensory impairment with lifestyle factors, chronic conditions, physical functioning, quality of life and social interaction. Methods A population-based cross-sectional study of participants of the British Regional Heart Study aged 63-85 years. Results A total of 3981 men (82% response rate) provided data. Twenty-seven percent (n = 1074) reported hearing impairment including being able to hear with aid (n = 482), being unable to hear (no aid) (n = 424) and being unable to hear despite aid (n = 168). Three percent (n = 124) reported vision impairment. Not being able to hear, irrespective of use of hearing aid, was associated with poor quality of life, poor social interaction and poor physical functioning. Men who could not hear despite hearing aid were more likely to report coronary heart disease (CHD) [age-adjusted odds ratios (ORs) 1.89(95% confidence interval 1.36-2.63)]. Vision impairment was associated with symptoms of CHD including breathlessness [OR 2.06 (1.38-3.06)] and chest pain [OR 1.58(1.07-2.35)]. Vision impairment was also associated with poor quality of life, poor social interaction and poor physical functioning. Conclusions Sensory impairment is associated with poor physical functioning, poor health and poor social interaction in older men. Further research is warranted on pathways underlying these associations. [ABSTRACT FROM AUTHOR]

A nebular analysis of the central Orion nebula and its main structures is presented.We exploit observations from the integral field spectrograph Multi Unit Spectroscopic Explorer (MUSE) in the wavelength range 4595-9366Å to produce the first O, S and N ionic and total abundance maps of a region spanning 6 arcmin × 5 arcmin with a spatial resolution of 0.2 arcsec.We use the S23(=([S II] λλ6717, 6731+[S III] λ9068)/Hβ) parameter, together with [O II]/[O III] as an indicator of the degree of ionization, to distinguish between the various small-scale structures. The only Orion bullet covered by MUSE is HH 201, which shows a double component in the [Fe II] λ8617 line throughout indicating an expansion, and we discuss a scenario in which this object is undergoing a disruptive event. We separate the proplyds located south of the Bright Bar into four categories depending on their S23 values, propose the utility of the S23 parameter as an indicator of the shock contribution to the excitation of line-emitting atoms, and show that the MUSE data are able to identify the proplyds associated with discs and microjets. We compute the second-order structure function for the Hα, [OIII] λ5007, [S II] λ6731 and [O I] λ6300 emission lines to analyse the turbulent velocity field of the region covered with MUSE. We find that the spectral and spatial resolution of MUSE are not able to faithfully reproduce the structure functions of previous works. [ABSTRACT FROM AUTHOR]

Integral field unit (IFU) data of the iconic Pillars of Creation in M16 are presented. The ionization structure of the pillars was studied in great detail over almost the entire visible wavelength range, and maps of the relevant physical parameters, e.g. extinction, electron density, electron temperature, line-of-sight velocity of the ionized and neutral gas are shown. In agreement with previous authors, we find that the pillar tips are being ionized and photoevaporated by the massive members of the nearby cluster NGC 6611. They display a stratified ionization structure where the emission lines peak in a descending order according to their ionization energies. The IFU data allowed us to analyse the kinematics of the photoevaporative flow in terms of the stratified ionization structure, and we find that, in agreement with simulations, the photoevaporative flow is traced by a blueshift in the position-velocity profile. The gas kinematics and ionization structure have allowed us to produce a sketch of the 3D geometry of the Pillars, positioning the pillars with respect to the ionizing cluster stars.We use a novel method to detect a previously unknown bipolar outflow at the tip of the middle pillar and suggest that it has an embedded protostar as its driving source. Furthermore we identify a candidate outflow in the leftmost pillar. With the derived physical parameters and ionic abundances, we estimate a mass-loss rate due to the photoevaporative flow of 70 M☉ Myr-1 which yields an expected lifetime of approximately 3 Myr. [ABSTRACT FROM AUTHOR]

The K-band Multi Object Spectrograph (KMOS) is a multi-object near-infrared integral field spectrometer with 24 deployable cryogenic pick-off arms. Inevitably, data processing is a complex task that requires careful calibration and quality control. In this paper we describe all the steps involved in producing science-quality data products from the raw observations. In particular, we focus on the following issues: (i) the calibration scheme which produces maps of the spatial and spectral locations of all illuminated pixels on the detectors; (ii) our concept of minimising the number of interpolations, to the limiting case of a single reconstruction that simultaneously uses raw data from multiple exposures; (iii) a comparison of the various interpolation methods implemented, and an assessment of the performance of true 3D interpolation schemes; (iv) the way in which instrumental flexure is measured and compensated. We finish by presenting some examples of data processed using the pipeline. [ABSTRACT FROM AUTHOR]

Context. New instrumental capabilities and the wealth of astrophysical information extractable from the near-infrared wavelength region have led to a growing interest in the field of high resolution spectroscopy at 1-5 μm. Aims. We aim to provide a library of observed high-resolution and high signal-to-noise-ratio near-infrared spectra of stars of various types throughout the Hertzsprung-Russell diagram. This is needed for the exploration of spectral features in this wavelength range and for comparison of reference targets with observations and models. Methods. High quality spectra were obtained using the CRIRES near-infrared spectrograph at ESO's VLT covering the range from 0.97 μm to 5.3μm at high spectral resolution. Accurate wavelength calibration and correction for telluric lines were performed by fitting synthetic transmission spectra for the Earth's atmosphere to each spectrum individually. Results. We describe the observational strategy and the current status and content of the library which includes 13 objects. The first examples of finally reduced spectra are presented. This publication will serve as a reference paper to introduce the library to the community and explore the extensive amount of material. [ABSTRACT FROM AUTHOR]

Canarene (1), a triterpene with an unprecedented carbon backbone, was isolated from Canarium schweinfurthii. It is the first member of a new class of triterpenoids, for which the name “canarane’’ is proposed. 1showed weak α-glucosidase inhibitory activity, and its structure was unambiguously deduced by single-crystal X-ray diffraction. [ABSTRACT FROM AUTHOR]

Duboscic acid (1), a triterpenoid with a unique carbon backbone, was isolated from Duboscia macrocarpaBocq. It is the first member of a new class of triterpenoids, for which the name “dubosane” is proposed. Duboscic acid has a potent α-glucosidase inhibition, and its structure was unambiguously deduced by a single-crystal X-ray diffraction study. [ABSTRACT FROM AUTHOR]

Introduction: There is growing interest in the long term outcomes of critical care. The degree of vocal morbidity suffered by patients surviving intensive care admission has not previously been reported. Objective: To determine the degree of subjective, patient-reported vocal morbidity following discharge from intensive care. Materials and methods: A prospective study was undertaken of patients admitted to intensive care. A total of 273 consecutive admissions were assessed; 181 patients were suitable for inclusion. Main outcome measure: The Voice Symptom Scale questionnaire. Results: Eighty-three patients responded. Twenty-seven patients (33 per cent) reported a degree of vocal morbidity greater than that suffered by patients treated for early laryngeal cancer. Thirteen patients (16 per cent) reported a degree of morbidity greater than that suffered by patients attending voice clinics. Conclusion: Up to one-third of patients who survived admission to an intensive care unit reported suffering significant vocal morbidity. The Voice Symptom Scale could be used in an intensive care follow-up setting to identify and ensure the referral of such patients. [ABSTRACT FROM AUTHOR]

The likely mortality benefit from pre-optimisation of high risk surgical patients depends on the baseline risk of death. The baseline risk estimated from the control groups of studies of pre-optimisation may not reflect the risk in other institutions. We determined the 28-day mortality of 'high risk' adult surgical patients in our institution by performing a retrospective cohort study of 554 patients undergoing major or ultra-major general or vascular surgery lasting more than two hours. Patients were identified as being high risk based on the presence of risk factors used in previous studies of pre-optimisation. The 28-day mortality (95% CI) was 0% for patients with no risk factors and 2.3 (0.8 to 3.7)% for patients with at least one risk factor. These data indicate that the risk of death amongst high risk surgical patients may vary considerably between institutions. [ABSTRACT FROM AUTHOR]

In March 2005, excavations were undertaken by Glasgow University Archaeological Research Division (GUARD) at the Craig Tara Holiday Park, Dunure Road, Ayr in advance of proposed development. Two main archaeological sites were examined. The first, a flat cist cemetery covered by an earthen mound, comprised 23 separate burial features of varying morphology from two separate phases of burial, including cists, pits and what has been interpreted as a 'boat-shaped' setting. Nine cremations and four possible inhumations were recovered from within the burial features as well as a range of material culture including Food Vessels, flint artefacts and a bone pin. Dating of cremated bone from the cists indicated that activity at the site stretched from the late third to the early second millennium BC. The second site, a demolished or fallen standing stone, was located some 35m to the north and east of the first. Although the sequence of monument construction and demolition is clear, the reasons for the demolition of the stone are less so. However, a rare opportunity to date the stone was presented with the identification of a cremation deposit within the construction pit backfill. This indicated that the stone was constructed in the last quarter of the second millennium BC, suggesting a continuum of activity in the area late into the second millennium BC. [ABSTRACT FROM AUTHOR]

Excavation at the chambered cairn of Bookan, Sandwick, Orkney, in June 2002 revealed that the cairn excavated by James Farrer in 1861, and later described and planned by George Petrie and Henry Dryden, was only the primary phase in the history of the site. After the site had fallen into disrepair or been deliberately slighted, the original cairn, c 7m in diameter, was incorporated in a stepped cairn or platform, c 16m in diameter, bounded by three concentric revetments. The role of Bookan as the type-site for a variety of early style of chambered cairn is reconsidered, along with the 'monumentalization' of the site in an Orcadian context. [ABSTRACT FROM AUTHOR]

This article presents a study of institutionalized mentally retarded patients in Manitoba. During analysis of data on 406 severely and profoundly mentally retarded children and their families in Manitoba a marked excess of Canadian Indian children was observed. There was no evidence to suggest that the over-representation by native children was due to an increased propensity of Indian families to institutionalize their children nor were these patients more profoundly retarded or more physically handicapped than the non-Indian children studied. Further analysis showed that Indian children were primarily over-represented in the groups with acquired retardation, autosomal recessive genetic disorders, idiopathic retardation with seizures and idiopathic retardation with malformations or dysmorphic signs.

The incidence of skin disorders increases with age because of changes in skin structures and a lifetime accumulation of environmental insults. Photoaging, resulting from exposure to harmful ultraviolet wavelengths in sunlight, is responsible for many common skin disorders, from wrinkles to melanoma. Older patients also see their physicians with complaints of various types of dermatitis, including contact and seborrheic. Although skin disorders vary in severity, they all adversely affect an older patient's health and/or quality of life. Early recognition, prevention, and treatment of skin diseases by the primary care physician is therefore an important element in the overall care of the middle-aged and older patient. [ABSTRACT FROM AUTHOR]