Hospital-based caregiver intervention for people following hip fracture surgery (HIP HELPER): multicentre randomised controlled feasibility trial with embedded qualitative study in England.

OBJECTIVES: To assess the feasibility of conducting a pragmatic, multicentre randomised controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture surgery. DESIGN: Two-arm, multicentre, pragmatic, open, feasibility RCT with embedded qualitative study. SETTING: National Health Service (NHS) providers in five English hospitals. PARTICIPANTS: Community-dwelling adults, aged 60 years and over, who undergo hip fracture surgery and their informal caregivers. INTERVENTION: Usual care: usual NHS care. EXPERIMENTAL: usual NHS care plus a caregiver-patient dyad training programme (HIP HELPER). This programme comprised three, 1 hour, one-to-one training sessions for a patient and caregiver, delivered by a nurse, physiotherapist or occupational therapist in the hospital setting predischarge. After discharge, patients and caregivers were supported through three telephone coaching sessions. RANDOMISATION AND BLINDING: Central randomisation was computer generated (1:1), stratified by hospital and level of patient cognitive impairment. There was no blinding. MAIN OUTCOME MEASURES: Data collected at baseline and 4 months post randomisation included: screening logs, intervention logs, fidelity checklists, acceptability data and clinical outcomes. Interviews were conducted with a subset of participants and health professionals. RESULTS: 102 participants were enrolled (51 patients; 51 caregivers). Thirty-nine per cent (515/1311) of patients screened were eligible. Eleven per cent (56/515) of eligible patients consented to be randomised. Forty-eight per cent (12/25) of the intervention group reached compliance to their allocated intervention. There was no evidence of treatment contamination. Qualitative data demonstrated the trial and HIP HELPER programme was acceptable. CONCLUSIONS: The HIP HELPER programme was acceptable to patient-caregiver dyads and health professionals. The COVID-19 pandemic impacting on site's ability to deliver the research. Modifications are necessary to the design for a viable definitive RCT. TRIAL REGISTRATION NUMBER: ISRCTN13270387.

[Tracheostoma valves and their associated risks]. / Tracheostomaventile und ihre Risiken.

Tracheostoma valves have proven to be very effective for voice restoration in patients with a tracheotomy or laryngectomy. Nevertheless, in recent years there have been a number of reports about life-threatening incidents with tracheostoma valves. An analysis of these incidents and the commercially available tracheostoma valves, their functions and limitations enables typical risk situations to be derived. The most reported incidents were caused by inadvertently filling the cuff of the tracheostomy tube while the tracheostoma valve was in place and by confusing a heat and moisture exchanger (HME) filter with a tracheostoma valve. These mistakes caused a complete obstruction of the expiratory airway leading to a barotrauma of the lungs with pneumothorax and asphyxia. Another typical risk in mechanically ventilated patients is insufficient monitoring during the use of the tracheostoma valve. Clear marking of tracheostoma valves and a specific training of hospital personnel with respect to the typical risks of tracheostoma valves could effectively reduce the associated dangers.

[Caregiver intervention studies : Recommendations on endpoints and outcome measures for cognitively impaired care recipients]. / Interventionsstudien zur Unterstützung häuslicher Pflege : Empfehlungen zu Endpunkten und Assessment-Instrumenten bei kognitiv eingeschränkten Pflegebedürftigen.

BACKGROUND: Even though the intervention effects on cognitively impaired care recipients are of interest, the evaluation in dementia caregiver studies on caregiver outcomes is often limited. Furthermore, the comparison of studies and interventions is difficult because of the large variance of endpoints and assessments used in this field. OBJECTIVE: The aim of this study was to give an overview on the most prevalent outcomes for cognitively impaired care recipients and expert based recommendations for assessment. MATERIAL AND METHODS: A written Delphi survey was carried out on 16 assessments from 5 dimensions with 14 experts working in different disciplines in German healthcare and research institutes. RESULTS: The most important outcomes and best rated assessments were 1) for problem behavior: revised memory and behavior problem checklist and neuropsychiatric inventory Q, 2) for depressive symptoms: geriatric depression scale, 3) for quality of life: quality of life in Alzheimer's disease, 4) for cognition: mini mental state examination and 5) for ADL/IADL: Katz activities of daily living and Lawton instrumental activities of daily living. CONCLUSION: Due to the varying experiences of the experts with particular assessments, the ratings were in some cases relatively heterogeneous. Overall previous international recommendations could be confirmed. There is particular need of German validation studies on internationally used instruments within the dimensions of problem behavior and quality of life.

[Psychotherapy with older caregivers]. / Psychotherapie mit älteren pflegenden Angehörigen.

Nursing and caring for a relative can be regarded as an important developmental task, which mainly affects elderly people who provide care for their very old parents or their (spouse) partners. Being responsible for the care of someone can be associated with a severe caregiver burden and experienced as a crisis. Possible psychological consequences are pronounced depressive symptoms or maladaptive stress reactions. For these caregivers, psychotherapeutic counselling can be sensible and helpful in addition to other resources of caregiver support. This applies in particular to improving coping with problematic everyday situations, stressful emotions, and strengthening resources. Multimodal interventions that address methods of cognitive behavioral therapy and acceptance as well as commitment therapy could show good evidence for this target group but have so far received little attention in healthcare programs. Because it is often difficult for caregivers to organize regular visits to the psychotherapist's practice, psychotherapeutic offers would be desirable in more flexible settings (e. g. by telephone or internet-based). The extent to which such supplementary interventions can be embedded and financed in the context of chronic care models is still unclear.

Complement C5a-Induced Changes in Neutrophil Morphology During Inflammation.

The complement and neutrophil defence systems, as major components of innate immunity, are activated during inflammation and infection. For neutrophil migration to the inflamed region, we hypothesized that the complement activation product C5a induces significant changes in cellular morphology before chemotaxis. Exposure of human neutrophils to C5a dose- and time-dependently resulted in a rapid C5a receptor-1 (C5aR1)-dependent shape change, indicated by enhanced flow cytometric forward-scatter area values. Similar changes were observed after incubation with zymosan-activated serum and in blood neutrophils during murine sepsis, but not in mice lacking the C5aR1. In human neutrophils, Amnis high-resolution digital imaging revealed a C5a-induced decrease in circularity and increase in the cellular length/width ratio. Biomechanically, microfluidic optical stretching experiments indicated significantly increased neutrophil deformability early after C5a stimulation. The C5a-induced shape changes were inhibited by pharmacological blockade of either the Cl-/HCO3--exchanger or the Cl- -channel. Furthermore, actin polymerization assays revealed that C5a exposure resulted in a significant polarization of the neutrophils. The functional polarization process triggered by ATP-P2X/Y-purinoceptor interaction was also involved in the C5a-induced shape changes, because pretreatment with suramin blocked not only the shape changes but also the subsequent C5a-dependent chemotactic activity. In conclusion, the data suggest that the anaphylatoxin C5a regulates basic neutrophil cell processes by increasing the membrane elasticity and cell size as a consequence of actin-cytoskeleton polymerization and reorganization, transforming the neutrophil into a migratory cell able to invade the inflammatory site and subsequently clear pathogens and molecular debris.

Motor competence and cardiorespiratory fitness have greater influence on body fatness than physical activity across time.

We investigated the longitudinal associations among physical activity (PA), motor competence (MC), cardiorespiratory fitness (VO2peak ), and body fatness across 7 years, and also analyzed the possible mediation effects of PA, MC, and VO2peak on the relationships with body fatness. This was a seven-year longitudinal study with three measuring points (mean ages [in years] and respective sample size: 6.75±0.37, n=696; 9.59±1.07, n=617; 13.35±0.34, n=513). PA (moderate-to-vigorous PA-MVPA and vigorous PA-VPA) was monitored using accelerometers. MC was assessed by the "Körperkoordinationstest für Kinder-KTK" test battery. VO2peak was evaluated using a continuous running protocol until exhaustion. Body fatness was determined by the sum of four skinfolds. Structural equation modeling was performed to evaluate the longitudinal associations among PA, MC, VO2peak, and body fatness and the potential mediation effects of PA, MC, and VO2peak . All coefficients presented were standardized (z-scores). MC and VO2peak directly influenced the development of body fatness, and VO2peak mediated the associations between MVPA, VPA, MC, and body fatness. MC also mediated the associations between MVPA, VPA, and body fatness. In addition, VO2peak had the largest total association with body fatness (ß=-0.431; P<.05), followed by MC (ß=-0.369; P<.05) and VPA (ß=-0.112; P<.05). As PA, MC, and VO2peak exhibited longitudinal association with body fatness, it seems logical that interventions should strive to promote the development of fitness and MC through developmentally appropriate physical activities, as the synergistic interactions of all three variables impacted body fatness.

Investigating optimal accelerometer placement for energy expenditure prediction in children using a machine learning approach.

Accurate measurement of energy expenditure (EE) is imperative for identifying and targeting health-associated implications. Whilst numerous accelerometer-based regression equations to predict EE have been developed, there remains little consensus regarding optimal accelerometer placement. Therefore, the purpose of the present study was to validate and compare artificial neural networks (ANNs) developed from accelerometers worn on various anatomical positions, and combinations thereof, to predict EE. Twenty-seven children (15 boys; 10.8 ± 1.1 years) participated in an incremental treadmill test and 30 min exergaming session wearing a portable gas analyser and nine ActiGraph GT3X+ accelerometers (chest and left and right wrists, hips, knees, and ankles). Age and sex-specific resting EE equations (Schofield) were used to estimate METs from the oxygen uptake measures. Using all the data from both exergames, incremental treadmill test and the transition period in between, ANNs were created and tested separately for each accelerometer and for combinations of two or more using a leave-one-out approach to predict EE compared to measured EE. Six features (mean and variance of the three accelerometer axes) were extracted within each 15 s window as inputs in the ANN. Correlations and root mean square error (RMSE) were calculated to evaluate prediction accuracy of each ANN, and repeated measures ANOVA was used to statistically compare accuracy of the ANNs. All single-accelerometer ANNs and combinations of two-, three-, and four-accelerometers performed equally (r = 0.77-0.82), demonstrating higher correlations than the 9-accelerometer ANN (r = 0.69) or the Freedson linear regression equation (r = 0.75). RMSE did not differ between single-accelerometer ANNs or combinations of two, three, or four accelerometers (1.21-1.31 METs), demonstrating lower RMSEs than the 9-accelerometer ANN (1.46 METs) or Freedson equation (1.74 METs). These findings provide preliminary evidence that ANNs developed from single accelerometers mounted on various anatomical positions demonstrate equivalency in the accuracy to predict EE in a semi-structured setting, supporting the use of ANNs in improving EE prediction accuracy compared with linear regression.

Assessing the need for psychooncological support: screening instruments in combination with patients' subjective evaluation may define psychooncological pathways.

BACKGROUND: Cancer patients suffer from severe distress. About one third show mental comorbidities. Nevertheless, there is no common agreement on how to measure distress or identify patients in need for psychooncological services using screening questionnaires. PATIENTS AND METHODS: A sample of N = 206 patients with confirmed breast cancer, being inpatient for surgical treatment, filled in distress assessment instruments: Distress Thermometer, Hospital Anxiety and Depression Scale, Patient Health Questionnaire 2, Hornheider Screening Instrument and parts of the EORTC-QLQ-C30. Additionally, they were asked for their subjective need for psychooncological counselling. RESULTS: The correlation between the assessment instruments is low to medium. The number of patients above the cut-off criteria varies quite a lot according to the instrument (10% to 66%). Therefore, the congruence between the instruments' indications is quite low. Patients with and without subjective need do not differ in personal data but in distress scores. CONCLUSIONS: Recommended instruments for distress assessment in psychooncology measure different areas of distress. They do not sufficiently agree in indicating a patient's need for psychooncological treatment. Hence, one should neither compare results of studies using different assessment instruments nor implement a screening without reflecting the used instrument's characteristics compared to the others. The subjective need seems to provide additional information to the assessment. At present, the combination of an assessment instrument and patients' subjective need is seen as a best practice for identifying patients in need of psychooncological treatment.

Comparative effects of beta-adrenergic agonist supplementation on the yield and quality attributes of selected subprimals from calf-fed Holstein steers.

Mechanical portioning tests were performed on beef rib, strip loin, tenderloin, and top sirloin subprimals obtained from calf-fed Holstein steers to characterize the influence of zilpaterol hydrochloride (ZH), ractopamine hydrochloride (RH), or no ß-adrenergic agonist (ßAA; CON) on subprimal and steak yield. In addition, ßAA effects on tenderness, composition, and raw and cooked color of steaks from the aforementioned strip loin subprimals were characterized. At 14 to 15 d (ribs, tenderloins, and top sirloin) or 16 d (strip loin) postmortem, subprimals were portioned into steaks using a mechanical portioning machine. The appropriate variables were measured before and after portioning to determine ßAA influence on trimmed and untrimmed subprimal weight, subprimal length (rib only), steak weight and yield, and steak thickness (rib only). Steaks obtained from the strip loin subprimals were subjected to analysis of raw instrument color (L*, a*, b*), proximate composition, and pH. In addition, strip steaks were aged (16 or 23 d) before analysis of cooked internal color, Warner-Bratzler shear force (WBSF), and slice shear force (SSF). Briefly, ZH supplementation increased (P < 0.01) the weight of all subprimals when compared to CON. Furthermore, subprimals from CON animals consistently had fewer and lighter steaks (P ≤ 0.04) than subprimals from ZH-fed steers. Additionally, raw steaks from ZH cattle were a less vivid red (lower a* and saturation index values; P < 0.01) when compared to CON and RH steaks, which did not differ (P > 0.05). There was no interaction between ßAA treatment and postmortem aging length for WBSF or SSF (P > 0.10). However, CON steaks (3.25 kg) had lower WBSF values (P < 0.05) than ZH or RH steaks (3.68 and 3.67 kg, respectively). Regardless, aging for 23 d vs. 16 d resulted in decreased WBSF and SSF (P < 0.01) for all ßAA treatments. Although differences were numerically small, evaluations indicated the internal cooked surfaces of ZH and RH steaks were less red (P < 0.05) than CON steaks. Overall, these data reemphasize increased subprimal weights due to ßAA supplementation, particularly ZH. However, the data are not indicative of increased steak yield due to ßAA supplementation. Furthermore, the data demonstrate ßAA supplementation increases the shear force of calf-fed Holstein strip steaks regardless of postmortem aging period. However, no differences in shear force between the ßAA treatments (ZH or RH) were noted.

The 3-year evolution of a preschool physical activity intervention through a collaborative partnership between research interventionists and preschool teachers.

Despite evidence that preschoolers spend the majority of their time in sedentary activities, few physical activity interventions have focused on preschool-age children. Health promotion interventions that can be integrated into the daily routines of a school or other setting are more likely to be implemented. The Study of Health and Activity in Preschool Environments employed a flexible approach to increasing physical activity opportunities in preschools' daily schedules through recess, indoor physical activity and physical activity integrated into academic lessons. Eight preschools were randomly assigned to receive the study's physical activity intervention. Teachers in these schools partnered with university-based interventionists across 3 years to design and implement a flexible and adaptive intervention. The intervention approach included trainings and workshops, site visits and feedback from intervention personnel, newsletters, and physical activity equipment and materials. Teachers reported a high acceptability of the intervention. The purpose of this article is to describe the evolution of a multi-component physical activity intervention in preschools, including (i) a description of the intervention components, (ii) an explanation of the intervention process and approach, and (iii) a report of teachers' perceptions of barriers to implementation.

Determination of anti-Müllerian hormone at estrus during a synchronized and a natural bovine estrous cycle.

Anti-Müllerian hormone (AMH) has been correlated with phenotypic indicators of fertility. However, the effects of exogenous hormones used during estrus synchronization on AMH have not been evaluated. Therefore, the objective of this experiment was to determine whether concentrations of AMH at estrus are similar between a synchronized compared with a natural estrous cycle. Nulliparous dairy and beef heifers (n = 68) were synchronized with the Select Synch + controlled internal drug release (CIDR) protocol (GnRH + CIDR-7 d-CIDR removal + PG). Heifers were observed for expression of estrus every 6 h until 84 h after the injection of PG. Visual detection of the subsequent estrus, considered natural estrus, occurred every 6 h from day 16 to 24 after synchronized estrus. At the time of standing estrus, ovarian structures in heifers were evaluated by transrectal ultrasonography. Blood samples were collected at estrus for analysis of concentrations of AMH during the synchronized and natural estrous cycles. The GLM and CORR procedures of SAS were used to analyze data. Concentrations of AMH between natural and synchronized estrus were positively correlated (r = 0.67; P < 0.001). Mean concentration of AMH did not differ (P > 0.05) between the natural (0.0543 ± 0.0076 ng/mL) or synchronized (0.0428 ± 0.0076 ng/mL) estrous cycles. In conclusion, concentrations of AMH were similar between natural and synchronized estrous cycles. Concentrations of AMH in natural and synchronized estrous cycles were highly correlated within individual heifers and varied among heifers with beef heifers having increased (P < 0.05) concentrations of AMH compared with dairy heifers (0.0638 ± 0.01 and 0.0402 ± 0.01 ng/mL, respectively).

Modifying the double-Ovsynch protocol to include human chorionic gonadotropin to synchronize ovulation in dairy cattle.

The objectives were to determine whether rates of conception, ovulation, presynchronization, or follicle and CL characteristics were altered after modifying the Double-Ovsynch (DO) protocol to include hCG compared with the DO protocol. Primiparous and multiparous lactating dairy cows (N = 183), and nulliparous dairy heifers (N = 51) were used. Cows were blocked by parity and heifers were stratified by age and breed before being randomly assigned to one of two treatments. All females received either 100 µg GnRH or 2000 IU hCG im, at initiation of the Pre-Ovsynch (PO) portion of the DO protocol (PO: GnRH/hCG, 7 days PGF(2α) and 3 days GnRH). After 7 days, females started the Breeding-Ovsynch portion of the DO protocol (Breeding-Ovsynch: GnRH, 7 days, PGF(2α), 48 or 56 h and GnRH 16 hours timed artificial insemination with sex-sorted semen). Transrectal ultrasonography and blood samples were used to assess ovarian structures, ovulation, pregnancy diagnosis, and concentration of progesterone in plasma. Conception rates were similar in females treated with GnRH or hCG in cows (32.2 and 25.0%) and in heifers (30.8 and 36.0%). Ovulation rates in cows at the onset of PO were increased with hCG compared to GnRH (77.2 vs. 62.2%, P < 0.05). Concentrations of progesterone 7 days post-hCG or GnRH were greater in cows treated with hCG compared with GnRH (least significant mean ± SEM; 4.3 ± 0.3 and 3.0 ± 0.3 ng/mL, P < 0.01), but did not differ in heifers (4.5 ± 0.9 and 2.9 ± 0.9 ng/mL). More cows ovulated within 7 days post-hCG and a greater proportion of these cows tended to have failed luteal regression by Day 3 post-PGF(2α) compared with cows that had ovulated to GnRH (29.6 vs. 16.1%, P ≤ 0.10). The overall percentage of females which were synchronized to PO did not differ between GnRH- or hCG-treated cows (61.5% and 52.2%) and heifers (42.3% and 40.0%). In conclusion, no overall improvement in fertility was achieved by replacing the first injection of GnRH in the DO protocol with hCG.

Exposure of beef females to the biostimulatory effects of bulls with or without deposition of seminal plasma prior to AI.

The objective of this experiment was to evaluate the biostimulatory effect of bull exposure, with or without the deposition of seminal plasma, on expression of estrus and pregnancy rate to AI in cattle. Beef heifers (n=86) and cows (n=193) were allocated to one of three treatments: (1) no bull exposure (CON; n=95), (2) exposure to a bull with a surgically-deviated penis for 21 d prior to AI (DB; n=88), or (3) exposure to a vasectomized bull for 21 d prior to AI (VB; n=96). The DB treatment provided the physical presence of a bull but prevented intromission, whereas the VB treatment allowed for intromission and deposition of seminal plasma but not spermatozoa. The estrous cycles of all females were synchronized using the Select Synch+CIDR protocol (GnRH+CIDR-7d-CIDR removal+PGF(2α), detection of estrus+AI 12h later for 84 h-clean-up TAI+GnRH). Pregnancy was detected via transrectal ultrasonography on d 35 post-AI. At the onset of the experiment, 75.7% of heifers and 86.1% of cows were estrous cycling. The percentages of females that displayed estrus were similar (P>0.05) among treatments (71.4%, 76.8%, and 74.4% for CON, DB, and VB, respectively). Pregnancy rates tended to be greater (P=0.06) in females in the DB treatment (60.5%) compared to females in the VB treatment (42.2%), with the control group intermediate (49.5%). In conclusion, biostimulation did not affect the expression of estrus but females exposed to the DB treatment tended to have an increased pregnancy rate.

Physiologic responses to running with a jogging stroller.

The purpose of this study was to assess the effect of running with a jogging stroller (JS) on oxygen consumption (VO2), heart rate (HR), and rating of perceived exertion (RPE). This study included 2 parts: Part 1 involved participants (N=15) running on an indoor track and Part 2 involved participants (N=12) running on a paved greenway. All participants completed 6, one-mile trials randomized over 2 visits: 3 were completed at a predetermined pace (160.8 m·min (- 1)) without a JS (NoJS), with 11.36 kg in the JS (JS1), and 22.72 kg in the JS (JS2) and 3 were self-paced and included NoJS, JS1, and JS2. VO2 and HR were measured using a portable metabolic system and telemetry. Repeated measures ANOVAs were used to determine differences among conditions. Part 1, there were no differences in VO2 across conditions, but HR and RPE were significantly higher (P<0.05) during the JS trials compared to the NoJS trials. Part 2, VO2 and RPE during JS trials were higher than NoJS trials (P<0.05). No significant differences were found in HR. The results indicate that it is feasible to run while pushing a JS with minimal increases in exertion compared to running without a JS.

Microlenses with defined contour shapes.

Ink-jet printing of optical ink over SU-8 pillars is here proposed as a technology for obtaining microlenses with shape control. To demonstrate the flexibility of this method, microlenses with five different contour shapes (ranging from circular and elliptical to toric or more advanced geometries) have been fabricated. Furthermore, the optical properties of the different fabricated lenses have been experimentally investigated. Focal distance, numerical aperture (NA) and full-width at half maximum (FWHM) of the microlenses have been determined. Arrays of microlenses showed an identical behavior with a standard deviation in the total intensity of only 7%. Additionally, the focal plane of the fabricated symmetric microlenses and the Sturm interval of the non-symmetric ones have been obtained. The experimental results demonstrate the validity and flexibility of the proposed technology.

Comparison of inpatient treatment costs after balloon kyphoplasty and non-surgical treatment of vertebral body compression fractures.

We performed an analysis of following costs after primary conservative or operative treatment with balloon kyphoplasty (BKP) in osteoporotic vertebral fractures. Patients with primary osteoporotic vertebral fractures treated with BKP or conservatively from discharge year 2002-2005 were retrospectively assessed regarding the following hospital treatment in any hospital in Austria from 2002 to 2006. A statistical record linkage between the hospital data and the mortality registry of Statistic Austria was performed. The data search was restricted to ICD-10 and procedures according to the Austrian catalogue of procedures defined as "spine relevant". Number of readmissions, length of hospital stay and DRG related costs were calculated for the surgical and conservative group separately. 324.5 years (mean 2.93 ± 1.40, conservative group) and 343.6 (mean 2.56 ± 0.96, BKP group) of 110 conservative patients and 134 BKP patients were analyzed. There was no statistical difference of the mortality rate with 9 patients (6.7%, BKP) and 11 patients (9.9%, conservative). The number of readmissions was 1.62 times higher (P = 0.039), the length of stay 1.09 times higher (P = 0.046) in the conservative group. No difference in the DRG scores were found (P = 0.11). In conclusion, patients with osteoporotic vertebral fractures showed in the following years after BKP fewer hospital readmissions and shorter hospital stays but no difference in DRG scores in comparison to conservatively treated patients.

Satisfaction and use of personal emergency response systems.

BACKGROUND: Despite a wide distribution, little is known about the relationship between subscriber satisfaction and the extent of use or non-use of personal emergency response systems (PERS). OBJECTIVES: To examine the degree of satisfaction with PERS, the wearing time and its use in case of a fall. STUDY DESIGN AND SETTING: Telephone and face-to-face interviews were conducted with 52 elderly community-dwelling PERS users. RESULTS: PERS subscribers were very satisfied with their device; however, 24% of the participants reported that they never wear the alarm button, and only 14% wear it 24 hours each day. After falls PERS was not activated by 83% (n=11) of the subscribers who fell alone and lay on the floor longer than 5 minutes. None of the five different satisfaction measures and only the subscriber's estimation of relevance of the PERS showed to be a significant predictor of PERS use in daily life. CONCLUSIONS: High rates of non-use of PERS in everyday life and after falls can be found. Subscribers' estimation of relevance but not satisfaction predicts the usage of PERS in everyday life. Further research is needed to better understand the reasons not using a PERS.

In-home consumer and shear force evaluation of steaks from the M. serratus ventralis thoracis.

The M. serratus ventralis thoracis was obtained from US Select arm chucks (n=87) to investigate if this underutilized muscle can be used as a steak alternative. Muscles were assigned randomly into three treatment groups: (1) control; (2) blade tenderization; and (3) injection, containing salt, phosphate, and papain. Steaks were cut from each muscle for in-home consumer evaluation (n=136) and Warner-Bratzler shear (WBS) force determination. The WBS values for injected steaks (13.1N) were lower (P<0.05) than for blade-tenderized (18.4N) and control (19.9N) steaks. Tenderness ratings for the injected steaks were higher (P<0.05) compared to the other treatments when steaks were grilled, oven prepared or were cooked in a skillet; however, this improvement did not significantly influence overall like scores for steaks that were oven prepared or cooked in a skillet. For the most part, degree of doneness did not significantly impact consumer evaluations of steaks prepared by the various cooking methods. However, there was a treatment x degree of doneness interaction for grilled-cooked steaks where increased doneness for blade-tenderized and injected steaks resulted in increased palatability ratings, whereas increased doneness for control steaks generally resulted in lowered palatability ratings. Consumer ratings and WBS values for the M. serratus ventralis thoracis indicate that merchandising steaks from this muscle may be a viable option in the marketplace, especially if blade tenderization or injection processes are used for further enhancement.

Effect of blade tenderization, aging time, and aging temperature on tenderness of beef longissimus lumborum and gluteus medius.

Purveyors are concerned about the potential food safety risk of nonintact meat products and are seeking strategies to ensure adequate meat tenderness without blade tenderization. This study was conducted to determine the effects of blade tenderization and time and temperature of aging on beef longissimus lumborum (LL) and gluteus medius (GM) tenderness. Beef strip loins (n = 300) and top sirloin butts (n = 300) were assigned to storage at -0.5 or 3.3 degrees C for 12, 26, or 40 d. Cuts were blade tenderized (BT) or not blade tenderized (NBT) before steak cutting. One 2.54-cm steak from each subprimal was used for slice shear force determination and Western blotting of desmin. Desmin degradation was less (P < 0.05) in LL stored at -0.5 degrees C than LL stored at 3.3 degrees C (57 and 65%, respectively). Aging from 12 to 26 d increased (P < 0.05) proteolysis (50 to 65%) in LL. Regardless of aging time, BT reduced (P < 0.05) LL slice shear force values. Aging time did not affect (P > 0.05) slice shear force values of BT LL steaks (10.4, 9.9, and 9.4 kg for 12, 26, and 40 d aging, respectively), but reduced (P < 0.05) NBT steak slice shear force values (15.1, 13.8, and 12.3 kg for 12, 26, and 40 d aging, respectively). Greater temperature did not affect (P > 0.05) slice shear force values of BT LL steaks (10.2 and 9.6 kg for steaks aged at -0.5 and 3.3 degrees C, respectively), but improved (P < 0.05) slice shear force of NBT LL steaks (15.1 and 12.4, respectively). Aging at 3.3 degrees C increased (P < 0.05) proteolysis in GM steaks (43 and 54% for -0.5 and 3.3 degrees C, respectively). Longer aging times increased (P < 0.05) proteolysis (40, 46, and 60% for 12, 26, and 40 d aging, respectively) in GM steaks. Blade-tenderized GM steaks had dramatically less (P < 0.05) slice shear force values than NBT steaks (13.7 and 19.9 kg, respectively). Raising aging temperature from -0.5 to 3.3 degrees C reduced (17.6 vs. 16.0 kg; P < 0.05) and increasing aging time from 12 d to 40 d improved (17.9 vs. 15.2 kg; P < 0.05) slice shear force values of GM steaks. Blade tenderization and increased aging time and temperature all improved tenderness of beef LL and GM steaks, though blade tenderization provided greater improvements than increased aging time and temperature. Longer aging could potentially be used to replace blade tenderization for LL steaks, but not in GM steaks.

[Challenges in the implementation of electronic health care records and patient cards in Austria]. / Herausforderungen bei der Umsetzung der elektronischen Patientenakte und Gesundheitskarte in Osterreich.

Patient-centered, interinstitutional digital documentation and communication in the Austrian health care system is a primary goal of Austria health politics. The implementation of the eCard in the year 2005 was a very important step towards digitalization of the Austria health system. The main responsibility of the Ministry of Health (MoH) is coordinating the implementation of the eHealth infrastructure based on international standards. The Austrian electronic health care record (ELGA) should include all relevant multimedia medical and health-related data of a uniquely identified person. A selection of "relevant" documents must be made. The implementation of ELGA will take place in modules. Because of the importance of the federal states and their role in health care, a special commission was set up to represent the most important stakeholders. Thereby they are included in the decision-making process. This is important with regard to the future use of many already existing information systems and for further investments. The most important steps until now were the implementation of a working group for ELGA as an association of the national health commission in the year 2006 and the implementation of a feasibility study as well as a cost-benefit analysis. Data protection and security are considered very important factors and, with respect to these, the roles for health care providers will be defined. To achieve high acceptance from the public and especially from health care providers, it is important to inform them about the benefits of eHealth.