Implementation of a multicomponent telemonitoring intervention to improve nutritional status of community-dwelling older adults: a process evaluation.

OBJECTIVE: The present study aimed to conduct a process evaluation of a multicomponent nutritional telemonitoring intervention implemented among Dutch community-dwelling older adults. DESIGN: A mixed-methods approach was employed, guided by the process evaluation framework of the Medical Research Council and the Unified Theory of Acceptance and Use of Technology. The process indicators reach, dose, fidelity and acceptability were measured at several time points within the 6-month intervention among participants and/or nurses. SETTING: The intervention was implemented in the context of two care organisations in the Netherlands. SUBJECTS: In total, ninety-seven participants (average age 78 years) participated in the intervention and eight nurses were involved in implementation. RESULTS: About 80 % of participants completed the intervention. Dropouts were significantly older, had worse cognitive and physical functioning, and were more care-dependent. The intervention was largely implemented as intended and received well by participants (satisfaction score 4·1, scale 1-5), but less well by nurses (satisfaction score 3·5, scale 1-5). Participants adhered better to weight telemonitoring than to telemonitoring by means of questionnaires, for which half the participants needed help. Intention to use the intervention was predicted by performance expectancy (ß=0·40; 95 % CI 0·13, 0·67) and social influence (ß=0·17; 95 % CI 0·00, 0·34). No association between process indicators and intervention outcomes was found. CONCLUSIONS: This process evaluation showed that nutritional telemonitoring among older adults is feasible and accepted by older adults, but nurses' satisfaction should be improved. The study provided relevant insights for future development and implementation of eHealth interventions among older adults.

Higher processing rates of Alu-containing sequences in kidney tumors and cell lines with overexpressed Alu-mRNAs.

Tumor cell growth and differentiation involve several molecular mechanisms that control gene expression and define specific genomic molecular profiles in cancer cells. Among these mechanisms, it has been shown that Alu-repetitive sequences are capable of regulating gene expression at transcriptional and posttranscriptional levels, and also of modulating cellular growth, differentiation and tumor suppression. Furthermore, repetitive sequences have also been implicated in alternative RNA splicing, although the specific mechanisms involved remain unknown. Nonetheless, exactly what the involvement of Alu-containing sequences in tumor cell growth and differentiation is or to what extent they might be related to tumorigenesis or to alternative splicing is not yet clear. In order to address some of these issues, we analyzed the level of expression of Alu-containing sequences in renal tumors and cell lines and their association with immunoprecipitated ribonucleoprotein splicing complexes in nuclear RNA fractions. Over-expression of Alu-containing sequences was detected in the poly(A)-RNA fractions of all analyzed tumors and cell lines. Furthermore, Alu-sequences were associated with tumor cell growth and differentiation and found overexpressed in purified small nuclear ribonucleoprotein fractions. Overall, our results suggest the involvement of Alu-sequences in the overexpression of Alu-containing-mRNAs in human tumors, and also higher processing rates of Alu-containing sequences at the spliceosome associated with tumor cell growth and differentiation.

Experimental evaluation of a new layered prosthesis exhibiting a low tensile modulus of elasticity: long-term integration response within the rat abdominal wall.

The use of a new type of prosthesis, Bard Composix (BC), constructed of two layers of polypropylene mesh (PP) and one layer of expanded polytetrafluoroethylene (ePTFE), could provide a good solution for hernia repair when both minimal adhesions and maximum collagenous infiltration are necessary. We experimentally evaluated long-term stability of this composite. In 15 Sprague-Dawley rats, a full thickness defect was created in the anterior abdominal wall and repaired with BC. Studies were performed over implantation intervals of 2, 4, and 6 months in strips obtained from the prosthesis-host tissue interfaces. Light microscopy, environmental scanning electron microscopy (ESEM), immunohistochemistry, and tensiometry were used. Overall findings provide evidence that PP and ePTFE association renders the alloy well suited for hernia repair, promoting a robust and durable alloplast-soft tissue union. At all points studied, the patch was well tolerated and meshes did not shrink, come loose, or migrate. Neovascularization continued 6 months after implantation. Ex vivo mechanical characterization demonstrated that the primary advantage of the new device stems from a low modulus of elasticity, a property that can be exploited to enhance mechanical load transfer from prosthetic materials to the relatively frail surrounding tissues. After implantation, adequate tensile strength and a low modulus of elasticity were detected in the restored zone, conferring great adaptability to the abdominal wall. In conclusion, the BC layered prosthesis proved suitable for implantation in abdominal wall defects, exhibiting favorable biocompatibility and integration with minimal side effects.