Experience of a systematic approach to care and prevention of fragility fractures in New Zealand.

This narrative review describes efforts to improve the care and prevention of fragility fractures in New Zealand from 2012 to 2022. This includes development of clinical standards and registries to benchmark provision of care, and public awareness campaigns to promote a life-course approach to bone health. PURPOSE: This review describes the development and implementation of a systematic approach to care and prevention for New Zealanders with fragility fractures, and those at high risk of first fracture. Progression of existing initiatives and introduction of new initiatives are proposed for the period 2022 to 2030. METHODS: In 2012, Osteoporosis New Zealand developed and published a strategy with objectives relating to people who sustain hip and other fragility fractures, those at high risk of first fragility fracture or falls and all older people. The strategy also advocated formation of a national fragility fracture alliance to expedite change. RESULTS: In 2017, a previously informal national alliance was formalised under the Live Stronger for Longer programme, which includes stakeholder organisations from relevant sectors, including government, healthcare professionals, charities and the health system. Outputs of this alliance include development of Australian and New Zealand clinical guidelines, clinical standards and quality indicators and a bi-national registry that underpins efforts to improve hip fracture care. All 22 hospitals in New Zealand that operate on hip fracture patients currently submit data to the registry. An analogous approach is ongoing to improve secondary fracture prevention for people who sustain fragility fractures at other sites through nationwide access to Fracture Liaison Services. CONCLUSION: Widespread participation in national registries is enabling benchmarking against clinical standards as a means to improve the care of hip and other fragility fractures in New Zealand. An ongoing quality improvement programme is focused on eliminating unwarranted variation in delivery of secondary fracture prevention.

Problems in the home and community-based long-term care for the elderly in China: A content analysis of news coverage.

PURPOSE: The purpose of this paper is to identify the issues that limited the supply of home and community-based Long-Term-Care (LTC) for the elderly, offer essential insights into the sustainable development of China's LTC. DESIGN/METHODOLOGY/APPROACH: A content analysis of news coverage on 12 major portals in China has been conducted to identify the issues. FINDINGS: The results demonstrate that there are 12 significant problems in the supply of home and community-based LTC for the elderly. For the service providers, the lack of qualified LTC professionals, limited service types/low service quality and unrealised integrated care, lack of steady profit patterns are the three major problems. The deficiencies of the LTC system and the lack of incentive policies and legislation for private investors' participation are the two major problems faced by the government. The public is confronted with a shortage of home and community support resources and unable to adapt to a change due to their mindsets. PRACTICAL IMPLICATIONS: The issues identified in this paper can not only provide some opportunities to various stakeholders in this area but also offer insights into the sustainable development of China's LTC. ORIGINALITY/VALUE: The findings presented in this paper provide the means to understand the home and community-based LTC market in China for private investors and government, which will help to promote the cooperation between the two.

Public-private partnerships in non-profit hospitals: Case study of China.

The gap between supply and demand for health care services is expanding rapidly in China. In order to resolve this problem, the government has implemented supply-side reforms in the health care sector by inviting private capital to increase supply quantity and improve quality. However, health care institutions have high complexity and particular needs, while non-profit hospitals have very strong public interests. This gives rise to complications in the implementation of public-private partnerships (PPPs) for health care services. In this paper, the authors have selected one case each from three different models of non-profit hospital PPP projects in the national PPP project database, operated by the Ministry of Finance, and compared how these projects were operated to identify the differences among them. A content analysis of the vital project documents is the primary analysis technique used for this comparison. Key issues investigated include reasons for model selection, requirements for private sectors and market competition level in different models, risk identification and sharing, design of payment mechanism, operation supervision, and performance appraisal of the project. Based on the comparison, some key lessons and recommendations are discussed to act as a useful reference for future non-profit hospital PPP projects in China.

Cellular scent of influenza virus infection.

Volatile organic compounds (VOCs) emanating from humans have the potential to revolutionize non-invasive diagnostics. Yet, little is known about how these compounds are generated by complex biological systems, and even less is known about how these compounds are reflective of a particular physiological state. In this proof-of-concept study, we examined VOCs produced directly at the cellular level from B lymphoblastoid cells upon infection with three live influenza virus subtypes: H9N2 (avian), H6N2 (avian), and H1N1 (human). Using a single cell line helped to alleviate some of the complexity and variability when studying VOC production by an entire organism, and it allowed us to discern marked differences in VOC production upon infection of the cells. The patterns of VOCs produced in response to infection were unique for each virus subtype, while several other non-specific VOCs were produced after infections with all three strains. Also, there was a specific time course of VOC release post infection. Among emitted VOCs, production of esters and other oxygenated compounds was particularly notable, and these may be attributed to increased oxidative stress resulting from infection. Elucidating VOC signatures that result from the host cells response to infection may yield an avenue for non-invasive diagnostics and therapy of influenza and other viral infections.

Review of capacity assessments and recommendations for examining capacity.

AIM: To audit the capacity assessments performed since December 2007 by Community Geriatric Services (CGS), Middlemore Hospital, and to develop a resource kit for training health professionals. METHOD: 1343 clinical letters were reviewed. Demographic data, reason for assessment and outcome of assessment were recorded. Data was analysed to reveal trends. RESULTS: There were 87 capacity assessments on 82 unique patients. The numbers of referrals for capacity assessments have increased since December 2007. 63% of patients were female, and the majority were European (75.6%). The mean age was 80.3 years. 66.7% of patients were referred by their general practitioner (GP). Dementia was the most common diagnosis. Fifty patients had more than one reason for referral. Thirty-seven were assessed for appointing an enduring power of attorney (EPOA), 44 for financial welfare, 73 for personal welfare, and two for testamentary capacity. Forty-five lacked capacity for all aspects assessed. Twenty-three did not have an EPOA and appointment of a guardian was recommended for 16 patients. CONCLUSION: The CGS is performing more capacity assessments over time. The majority of the patients are elderly and have dementia. There is a need to train specialist nurses and general practitioners to perform capacity assessments. A resource kit has been developed for this purpose.

Characterization of volatile organic compounds in human leukocyte antigen heterologous expression systems: a cell's "chemical odor fingerprint".

The major histocompatibility complex (MHC), or human leukocyte antigen (HLA) gene-coding region in humans, plays a significant role in infectious disease response, autoimmunity, and cellular recognition. This super locus is essential in mate selection and kin recognition because of the organism-specific odor which can be perceived by other individuals. However, how the unique MHC genetic combination of an organism correlates with generation of the organism-specific odor is not well understood. In the present work, we have shown that human B-cells produce a set of volatile organic compounds (VOCs) that can be measured by GC-MS. More importantly, our results show that specific HLA alleles are related to production of selected VOCs, and that this leads to a cell-specific odor "fingerprint". We used a C1R HLA class I A and B locus negative cell line, along with C1R cell lines that were stably transfected with specific A and B alleles. Our work demonstrates for the first time that HLA alleles can directly influence production of specific odor compounds at the cellular level. Given that the resulting odor fingerprint depends on expression of specific HLA sequences, it may yield information on unique human scent profiles, composition of exhaled breath, as well as immune response states in future studies.

A complex intervention to support 'rest home' care: a pilot study.

AIMS: To describe an intervention supporting Aged Related Residential Care (ARRC) and to report an initial evaluation. METHODS: The intervention consisted of: medication review by a multidisciplinary team; education programmes for nurses; telephone advice 'hotlines' for nursing and medical staff; Advance Care Planning; and implementing existing community programmes for chronic care management and preventing acute hospital admissions. Semi-structured interviews were conducted with members of the multidisciplinary team, rest home nurses and caregivers. Quantitative data were collected on medication changes, hotline use, use of education opportunities and admissions to hospital. RESULTS: Medications were reduced by 21%. Staff noted improvements in the physical and mental state of residents. There was no significant reduction in hospital admissions. Nurses were unable to attend the education offered to them, but it was taken up and valued by caregivers. There was minimal uptake of formal acute and chronic care programmes and Advance Care Planning during the intervention. Hotlines were welcomed and used regularly by the nurses, but not the GP. CONCLUSIONS: The provision of high status specialist support on site was enthusiastically welcomed by ARRC staff. The interventions continue to evolve due to limited uptake or success of some components in the pilot.

Two-dimensional wavelet analysis based classification of gas chromatogram differential mobility spectrometry signals.

This study introduces two-dimensional (2-D) wavelet analysis to the classification of gas chromatogram differential mobility spectrometry (GC/DMS) data which are composed of retention time, compensation voltage, and corresponding intensities. One reported method to process such large data sets is to convert 2-D signals to 1-D signals by summing intensities either across retention time or compensation voltage, but it can lose important signal information in one data dimension. A 2-D wavelet analysis approach keeps the 2-D structure of original signals, while significantly reducing data size. We applied this feature extraction method to 2-D GC/DMS signals measured from control and disordered fruit and then employed two typical classification algorithms to testify the effects of the resultant features on chemical pattern recognition. Yielding a 93.3% accuracy of separating data from control and disordered fruit samples, 2-D wavelet analysis not only proves its feasibility to extract feature from original 2-D signals but also shows its superiority over the conventional feature extraction methods including converting 2-D to 1-D and selecting distinguishable pixels from training set. Furthermore, this process does not require coupling with specific pattern recognition methods, which may help ensure wide applications of this method to 2-D spectrometry data.

Design-of-experiment optimization of exhaled breath condensate analysis using a miniature differential mobility spectrometer (DMS).

Analytical instruments that can measure small amounts of chemicals in complicated biological samples are often useful as diagnostic tools. However, it can be challenging to optimize these sensors using actual clinical samples, given the heterogeneous background and composition of the test materials. Here we use gas chromatography-differential mobility spectrometry (GC/DMS) to analyze the chemical content of human exhaled breath condensate (EBC). Ultimately, this system can be used for non-invasive disease diagnostics. Many parameters can be adjusted within this instrument system, and we implemented a factorial design-of-experiments to systematically test several combinations of parameter settings while concurrently analyzing effects and interactions. We examined four parameters that affect sensitivity and detection for our instrument, requiring a 2(4) factorial design. We optimized sensor function using EBC samples spiked with acetone, a known clinical biomarker in breath. Two outputs were recorded for each experiment combination: number of chemicals detected, and the amplitude of acetone signal. Our goal is to find the best parameter combination that yields the highest acetone peak while also preserving the largest number of other chemical peaks in the spectra. By optimizing the system, we can conduct further clinical experiments with our sensor more efficiently and accurately.