lder pain struggle to resolve conflicts between evidence-based recommendations, clinical experience, their own shoulder pain beliefs and patient expectations and preferences.Stronger collaboration across professional disciplines is needed to address the current lack of consensus on the management of shoulder pain.Many HCP's find it difficult to engage patients with shoulder pain in exercise and they work hard to "sell" this approach to patients using strategies such as education, shared decision making and therapeutic alliance.Quantifying the tool-tissue interaction forces in surgery can be used in the training process of novice surgeons to help them better handle surgical tools and avoid exerting excessive forces. A significant challenge concerns the development of proper statistical learning techniques to model the relationship between the true force exerted on the tissue and several outputs read from sensors mounted on the surgical tools. We propose a nonparametric bootstrap technique and a Bayesian multilevel modeling methodology to estimate the true forces. We use the linear exponential loss function to asymmetrically penalize the over and underestimation of the applied forces to the tissue. We incorporate the direction of the force as a group factor in our analysis. A weighted approach is used to account for the nonhomogeneity of read voltages from the surgical tool. Our proposed Bayesian multilevel models provide estimates that are more accurate than those under the maximum likelihood and restricted maximum likelihood approaches. Moreover, confidence bounds are much narrower and the biases and root mean squared errors are significantly smaller in our multilevel models with the linear exponential loss function.Elderly people are at increased risk for infections such as with Clostridium difficile. This can colonize their gut and cause various gastro-intestinal manifestations. Our survey investigated its prevalence in a nursing home in Iran. Faecal samples were collected and tested by polymerase chain reaction for identification of A, B and binary toxin genes. From 289 samples, 42(14.5%) isolates were found. Toxin genes were positive in 19 isolates (17 AþBþ and 2 isolates ABþ). The elderly are especially at risk and great attention should be paid to contamination within their nursing homes. This is not an isolated regional problem.Laparoscopic surgery has the potential to improve care in resource-deprived low- and-middle-income countries (LMICs). This study aims to analyse the barriers to training in laparoscopic surgery in LMICs. Medline, Embase, Global Health and Web of Science were searched using 'LMIC', 'Laparoscopy' and 'Training'. Two researchers screened results with mutual agreement. Included papers were in English, focused on abdominal laparoscopy and training in LMICs. PRISMA guidelines were followed; 2992 records were screened, and 86 full-text articles reviewed to give 26 key papers. Thematic grouping identified seven key barriers funding; availability and maintenance of equipment; local access to experienced laparoscopic trainers; stakeholder dynamics; lack of knowledge on effective training curricula; surgical departmental structure and practical opportunities for trainees. In low-resource settings, technological advances may offer low-cost solutions in the successful implementation of laparoscopic training and improve access to surgical care.Studies indicate that asymptomatic bacteriuria in medical inpatients is often inappropriately treated with antibiotics. We prospectively studied the proportion of asymptomatic bacteriuria among 200 positive urine cultures which were ordered in hospitalised medical inpatients of a teaching hospital in southern India. We used pre-defined criteria to classify patients as urinary tract infection and asymptomatic bacteriuria. Median age of patients was 53.5 (42-65) years, and 51% were male. In all, 157 (78.5%) patients had urinary tract infection (131 [66.5%] definite and 26 [13%] probable) and 43 (21.5%) had asymptomatic bacteriuria. In patients with asymptomatic bacteriuria, 18 (41.8%) received urinary tract infection-directed antibiotics; broad spectrum antibiotics were used in 10 (23%). Patients with asymptomatic bacteriuria were younger, more likely to be on a urinary catheter, had higher prevalence of chronic kidney disease and congestive cardiac failure and had lower prevalence of pyuria and lower total leucocyte counts. Urine cultures should be ordered only in indicated patients. Inappropriate antibiotic treatment in patients with asymptomatic bacteriuria should be avoided.Objectives Both experiencing loneliness and having a lonely partner can be psychosocial stressors, with implications for health. Yet, marital support may buffer against the cardiometabolic effects of loneliness. This study examines (1) whether own and/or partner's loneliness predict changes in HbA1c over 4 years and (2) whether marital support moderates these effects. Methods Actor-partner interdependence models analyzed data from 1,854 older couples who provided psychosocial and biomarker data at two timepoints (2008/2012 or 2010/2014) of the Health and Retirement Study. Results Neither partner's loneliness predicted changes in HbA1c overall. However, significant interactions indicated that both own baseline loneliness and partner's baseline loneliness predicted significant increases to HbA1c over 4 years among those who reported below-average marital support. Discussion Both the experience of loneliness and loneliness of a dyadic partner may have longitudinal consequences for cardiometabolic health.  https://www.selleckchem.com/products/msa-2.html  However, these effects are contingent upon perceived quality of the marriage, specifically marital support.Omega-3 Long-chain polyunsaturated fatty acids (n-3 LC-PUFA) are beneficial to human health. Since the industrial revolution, with the tremendous increase of human population, the supply of natural n-3 LC-PUFA is far lower than the nutritional need of n-3 LC-PUFA. Therefore, a new alternative source of natural n-3 LC-PUFA is urgently needed to reduce the supply and demand gap of n-3 LC-PUFA. Mollusks, mainly bivalves, are rich in n-3 LC-PUFA, but the information of bivalves' lipid profile is not well organized. Therefore, this study aims to analyze the published fatty acid profiles of bivalves and reveal the potential of bivalve aquaculture in meeting the nutritional needs of human for n-3 LC-PUFA. There are growing evidence show that the nutritional quality of bivalve lipid is not only species-specific, but also geographical specific. To date, bivalve aquaculture has not been evenly practiced across the globe. It can be seen that aquaculture is predominant in Asia, especially China. Unlike fish aquaculture, bivalve aquaculture does not rely on fishmeal and fish oil inputs, so it has better room for expansion.