Frailty training among healthcare professionals.

As the population ages worldwide, frailty becomes more prevalent, leading to a higher risk of poor outcomes. Therefore, there is an increased need to educate healthcare providers in the areas of frailty screening, assessment, and treatment. In our review of the current state of frailty education worldwide we showed that, with the exception of a few European countries, education of clinicians on frailty screening, assessment, and treatment is inadequate. Interprofessional team competencies, quality measures and clinical guidelines that require screening, assessment and management of frailty are needed to propel frailty education forward. It is evident that there is much-needed collaboration between high-, mid-, and low-income countries to reach consensus and create worldwide recommendations for frailty education.

Early visual perceptual processing is altered in obsessive-compulsive disorder.

OBJECTIVE: Existing studies have shown changes in attention and emotion processing of disorder-relevant visual stimuli in those with obsessive compulsive disorder (OCD). However, early visual processing in OCD has not been assessed, as previous studies did not examine the entire time course of visual processing but instead assessed potential differences in pre-determined visual evoked potentials (VEPs). This study investigates the entire visual processing stream in OCD compared to healthy age-matched controls (HC) using emotionally-neutral visual stimuli and a data-driven rather than hypothesis-driven approach. METHODS: 35 HC and 26 participants with OCD underwent EEG recording while completing a modified Eriksen flanker task. Permutation-controlled t-tests were used to identify group differences in the data's full time course of visual evoked potentials. Baseline-corrected amplitudes at time points where the groups were significantly different were analyzed using ANCOVAs with BDI, BAI, and SNAP-inattentiveness scores included as covariates. RESULTS: This analysis identified enhanced P1 amplitudes to two visual stimuli (the initial flanker and the stimulus), corresponding to time windows of 65-93 ms and 157-187 ms post-flanker presentation in the OCD group compared to controls. Group (OCD vs. HC) was the strongest predictor of VEP amplitude during both time windows, with no significant influences of any covariates. CONCLUSIONS: This study showed an enhanced P1 component in people with OCD to neutral visual stimuli, potentially reflecting either inefficient or excessive early visual processing in this population. Additional inquiry is necessary to determine whether altered visual processing is associated with the sensory hypervigilance observed in those with OCD. SIGNIFICANCE: This work identifies early visual processing alterations in OCD using neutral stimuli and a data-driven approach.

Perennials as Future Grain Crops: Opportunities and Challenges.

Perennial grain crops could make a valuable addition to sustainable agriculture, potentially even as an alternative to their annual counterparts. The ability of perennials to grow year after year significantly reduces the number of agricultural inputs required, in terms of both planting and weed control, while reduced tillage improves soil health and on-farm biodiversity. Presently, perennial grain crops are not grown at large scale, mainly due to their early stages of domestication and current low yields. Narrowing the yield gap between perennial and annual grain crops will depend on characterizing differences in their life cycles, resource allocation, and reproductive strategies and understanding the trade-offs between annualism, perennialism, and yield. The genetic and biochemical pathways controlling plant growth, physiology, and senescence should be analyzed in perennial crop plants. This information could then be used to facilitate tailored genetic improvement of selected perennial grain crops to improve agronomic traits and enhance yield, while maintaining the benefits associated with perennialism.

Accelerated Domestication of New Crops: Yield is Key.

Sustainable agriculture in the future will depend on crops that are tolerant to biotic and abiotic stresses, require minimal input of water and nutrients and can be cultivated with a minimal carbon footprint. Wild plants that fulfill these requirements abound in nature but are typically low yielding. Thus, replacing current high-yielding crops with less productive but resilient species will require the intractable trade-off of increasing land area under cultivation to produce the same yield. Cultivating more land reduces natural resources, reduces biodiversity and increases our carbon footprint. Sustainable intensification can be achieved by increasing the yield of underutilized or wild plant species that are already resilient, but achieving this goal by conventional breeding programs may be a long-term prospect. De novo domestication of orphan or crop wild relatives using mutagenesis is an alternative and fast approach to achieve resilient crops with high yields. With new precise molecular techniques, it should be possible to reach economically sustainable yields in a much shorter period of time than ever before in the history of agriculture.

Delaying or delivering: identification of novel NAM-1 alleles that delay senescence to extend wheat grain fill duration.

Senescence is a complex trait under genetic and environmental control, in which resources are remobilized from vegetative tissue into grain. Delayed senescence, or 'staygreen' traits, can confer stress tolerance, with extended photosynthetic activity hypothetically sustaining grain filling. The genetics of senescence regulation are largely unknown, with senescence variation often correlated with phenological traits. Here, we confirm staygreen phenotypes of two Triticum aestivum cv. Paragon ethyl methane sulfonate mutants previously identified during a forward genetic screen and selected for their agronomic performance, similar phenology, and differential senescence phenotypes. Grain filling experiments confirmed a positive relationship between onset of senescence and grain fill duration, reporting an associated ~14% increase in final dry grain weight for one mutant (P<0.05). Recombinant inbred line (RIL) populations segregating for the timing of senescence were developed for trait mapping purposes and phenotyped over multiple years under field conditions. Quantification and comparison of senescence metrics aided RIL selection, facilitating exome capture-enabled bulk segregant analysis (BSA). Using BSA we mapped our two staygreen traits to two independent, dominant, loci of 4.8 and 16.7 Mb in size encompassing 56 and 142 genes, respectively. Combining association analysis with variant effect prediction, we identified single nucleotide polymorphisms encoding self-validating mutations located in NAM-1 homoeologues, which we propose as gene candidates.

Capturing and Selecting Senescence Variation in Wheat.

Senescence is a highly quantitative trait, but in wheat the genetics underpinning senescence regulation remain relatively unknown. To select senescence variation and ultimately identify novel genetic regulators, accurate characterization of senescence phenotypes is essential. When investigating senescence, phenotyping efforts often focus on, or are limited to, the visual assessment of flag leaves. However, senescence is a whole-plant process, involving remobilization and translocation of resources into the developing grain. Furthermore, the temporal progression of senescence poses challenges regarding trait quantification and description, whereupon the different models and approaches applied result in varying definitions of apparently similar metrics. To gain a holistic understanding of senescence, we phenotyped flag leaf and peduncle senescence progression, alongside grain maturation. Reviewing the literature, we identified techniques commonly applied in quantification of senescence variation and developed simple methods to calculate descriptive and discriminatory metrics. To capture senescence dynamism, we developed the idea of calculating thermal time to different flag leaf senescence scores, for which between-year Spearman's rank correlations of r ≥ 0.59, P < 4.7 × 10-5 (TT70), identify as an accurate phenotyping method. Following our experience of senescence trait genetic mapping, we recognized the need for singular metrics capable of discriminating senescence variation, identifying thermal time to flag leaf senescence score of 70 (TT70) and mean peduncle senescence (MeanPed) scores as most informative. Moreover, grain maturity assessments confirmed a previous association between our staygreen traits and grain fill extension, illustrating trait functionality. Here we review different senescence phenotyping approaches and share our experiences of phenotyping two independent recombinant inbred line (RIL) populations segregating for staygreen traits. Together, we direct readers toward senescence phenotyping methods we found most effective, encouraging their use when investigating and discriminating senescence variation of differing genetic bases, and aid trait selection and weighting in breeding and research programs alike.

"Hopes and wishes": Goals of high-need, high-cost older patients and their caregivers.

OBJECTIVE: Integration of patient-identified goals is a critical element of shared decision-making and patient-provider communication. There is limited information on the goals of patients with multiple medical conditions and high healthcare utilization. We aimed to identify and categorize the goals described by "high-need, high-cost" (HNHC) older patients and their caregivers. METHODS: Using conventional content analysis, we used data from interviews conducted with 17 HNHC older patients (mean age 72.5 years) and 4 caregivers. RESULTS: HNHC older patients and their caregivers used language such as "hopes, wishes, and wants" to describe their goals, which fell into eight categories: alleviating discomfort, having autonomy and control, decreasing treatment burden, maintaining physical functioning and engagement, leaving a legacy, extending life, having satisfying and effective relationships, and experiencing security. CONCLUSION: Our results contribute to knowledge of goals of HNHC patients and provides guidance for improving the patient-provider relationship and communication between HNHC older patients and their healthcare providers. PRACTICE IMPLICATIONS: Our findings can inform provider efforts to assess patient goals and engage high-need, high-cost older patients in shared decision-making. Further, this study contributes to an improved understanding of HNHC older patients to support continued development of effective care models for this population.

Correction to: Functional Capacity Evaluation in Different Societal Contexts: Results of a Multicountry Study.

The original version of this article unfortunately contained a mistake in the Table 2. The data under column head "Left handgrip strength (n = 336)" was erroneously omitted during the production process. The corrected Table 2 is given below.

Functional Capacity Evaluation in Different Societal Contexts: Results of a Multicountry Study.

Purpose To examine factors associated with Functional Capacity Evaluation (FCE) results in patients with painful musculoskeletal conditions, with focus on social factors across multiple countries. Methods International cross-sectional study was performed within care as usual. Simple and multiple multilevel linear regression analyses which considered measurement's dependency within clinicians and country were conducted: FCE characteristics and biopsychosocial variables from patients and clinicians as independent variables; and FCE results (floor-to-waist lift, six-minute walk, and handgrip strength) as dependent variables. Results Data were collected for 372 patients, 54 clinicians, 18 facilities and 8 countries. Patients' height and reported pain intensity were consistently associated with every FCE result. Patients' sex, height, reported pain intensity, effort during FCE, social isolation, and disability, clinician's observed physical effort, and whether FCE test was prematurely ended were associated with lift. Patient's height, Body Mass Index, post-test heart-rate, reported pain intensity and effort during FCE, days off work, and whether FCE test was prematurely ended were associated with walk. Patient's age, sex, height, affected body area, reported pain intensity and catastrophizing, and physical work demands were associated with handgrip. Final regression models explained 38‒65% of total variance. Clinician and country random effects composed 1-39% of total residual variance in these models. Conclusion Biopsychosocial factors were associated with every FCE result across multiple countries; specifically, patients' height, reported pain intensity, clinician, and measurement country. Social factors, which had been under-researched, were consistently associated with FCE performances. Patients' FCE results should be considered from a biopsychosocial perspective, including different social contexts.

Behavioral Health Needs of Older Adults in the Emergency Department.

Behavioral health disorders are common among older adults and, owing to limited access to resources for mental health care in the community, emergency department providers are often on the front lines of mental health crises. This article reviews the available literature regarding the care of behavioral health emergencies in older adults and provides a framework for navigating the evaluation and management of older adults presenting to the emergency department with behavioral health concerns.

Development and preliminary evaluation of the resident coordinated-transitional care (RC-TraC) program: A sustainable option for transitional care education.

Older adults often face poor outcomes when transitioning from hospital to home. Although physicians play a key role in overseeing transitions, there is a lack of practice-based educational programs that prepare resident physicians to manage care transitions of older adults. An educational intervention to provide residents with real-life transitional care practice was therefore developed-Resident-coordinated Transitional Care (RC-TraC). RC-TraC adapted the evidence-based Coordinated-Transitional Care (C-TraC) nurse role for residents, providing opportunities to follow patients during the peri-hospital period without additional costs to the residency program. Between July 2010 and June 2013, 31 internal medicine residents participated in RC-TraC, caring for 721 patients. RC-TraC has been a sustainable, low-cost, practice-based education experience that is recognized as transitional care education by residents and continues in operation to this day. RC-TraC is a promising option for geriatric-based transitional care education of resident physicians and could also be adapted for nonphysician learners.

Using a Continuum-Based Framework for Behavioral Health Integration Into Primary Care in New York State.

Behavioral health integration with primary care has long been shown to be an essential part of improving health care and, more recently, of achieving the "triple aim" as part of national reform. Many states are promoting integration activities as part of Medicaid reform, using different models and strategies. The purpose of this column is to describe a framework developed to support behavioral health integration into primary care settings in New York State and how it is specifically linked to key policy initiatives. The framework is designed to be adaptable to practices of varying sizes and with various resources and organizational structures. Its use in groundbreaking New York State integration initiatives is discussed.

Goals Set by Patients Using the ICF Model before Receiving Botulinum Injections and Their Relation to Spasticity Distribution.

Purpose: Goal Attainment Scaling (GAS) is used to assess functional gains in response to treatment. Specific characteristics of the functional goals set by individuals receiving botulinum toxin type A (BoNTA) injections for spasticity management are unknown. The primary objectives of this study were to describe the characteristics of the goals set by patients before receiving BoNTA injections using the International Classification of Functioning, Disability and Health (ICF) and to determine whether the pattern of spasticity distribution affected the goals set. Methods: A cross-sectional retrospective chart review was carried out in an outpatient spasticity-management clinic in Toronto. A total of 176 patients with a variety of neurological lesions attended the clinic to receive BoNTA injections and completed GAS from December 2012 to December 2013. The main outcome measures were the characteristics of the goals set by the participants on the basis of ICF categories (body functions and structures, activity and participation) and the spasticity distribution using Modified Ashworth Scale scores. Results: Of the patients, 73% set activity and participation goals, and 27% set body functions and structures goals (p<0.05). In the activity and participation category, 30% of patients set moving and walking goals, 28% set self-care and dressing goals, and 12% set changing and maintaining body position goals. In the body functions and structures category, 18% set neuromuscular and movement-related goals, and 8% set pain goals. The ICF goal categories were not related to the patterns of spasticity (upper limb vs. lower limb or unilateral vs. bilateral spasticity) or type of upper motor neuron (UMN) lesion (p>0.05). Conclusion: Our results show that patients receiving BoNTA treatment set a higher percentage of activity and participation goals than body functions and structures goals. Goal classification was not affected by type of spasticity distribution or type of UMN disorder.

Objectif : l'échelle de réalisation des objectifs (Goal Attainment Scaling ou GAS) est employée pour évaluer les gains fonctionnels en réponse à un traitement. On ne connaît pas les caractéristiques des objectifs fonctionnels établis par les personnes recevant des injections de toxine botulinique de type A (BoNTA) pour la prise en charge de la spasticité. Cette étude vise à décrire les caractéristiques des objectifs établis par les patients avant de recevoir des injections de BoNTA à l'aide de la Classification internationale du fonctionnement, du handicap et de la santé (CIF) et à déterminer si le modèle de distribution de la spasticité avait un effet sur les objectifs établis. Méthodologie : on a mené une revue rétrospective transversale des dossiers d'une clinique ambulatoire de prise en charge de la spasticité à Toronto. Au total, 176 patients ayant diverses lésions neurologiques sont venus à la clinique pour recevoir des injections de BoNTA et ont rempli la GAS entre décembre 2012 et décembre 2013. On a recensé les caractéristiques des objectifs en fonction des catégories de la CIF (fonctions organiques et structures anatomiques, activités et participation) et de la distribution de la spasticité à l'aide de l'échelle d'Ashworth modifiée. Résultats : de tous les patients, 73 % ont établi des objectifs liés aux activités et à la participation et 27 %, des objectifs liés aux fonctions organiques et aux structures anatomiques (p<0,05). Dans la catégorie des activités et de la participation, 30 % de tous les patients ont établi des objectifs par rapport à « marcher et se déplacer ¼, 28 % ont établi des objectifs par rapport aux « soins personnels ¼ et à « s'habiller ¼, et 12 %, par rapport à « modifier et maintenir sa position corporelle ¼. Dans la catégorie des fonctions organiques et des structures anatomiques, 18 % des participants ont établi des objectifs liés aux « fonctions de l'appareil locomoteur et au mouvement ¼ et 8 % ont établi des objectifs par rapport à la « douleur ¼. Les catégories d'objectifs de la CIF n'étaient pas liées aux modèles de spasticité (spasticité des membres supérieurs par rapport aux membres inférieurs ou spasticité unilatérale par rapport à bilatérale) ou au type de lésion des motoneurones supérieurs (p>0,05). Conclusion : nos résultats montrent que les patients qui reçoivent un traitement de BoNTA établissent un pourcentage plus élevé d'objectifs liés aux activités et à la participation qu'aux fonctions organiques et aux structures anatomiques. Le type de distribution de la spasticité ou le type de lésion des motoneurones n'a pas eu d'effet sur la classification des objectifs.

Residents' Exposure to Educational Experiences in Facilitating Hospital Discharges.

BACKGROUND: There is an incomplete understanding of the most effective approaches for motivating residents to adopt guideline-recommended practices for hospital discharges. OBJECTIVE: We evaluated internal medicine (IM) residents' exposure to educational experiences focused on facilitating hospital discharges and compared those experiences based on correlations with residents' perceived responsibility for safely transitioning patients from the hospital. METHODS: A cross-sectional, multi-center survey of IM residents at 9 US university- and community-based training programs in 2014-2015 measured exposure to 8 transitional care experiences, their perceived impact on care transitions attitudes, and the correlation between experiences and residents' perceptions of postdischarge responsibility. RESULTS: Of 817 residents surveyed, 469 (57%) responded. Teaching about care transitions on rounds was the most common educational experience reported by residents (74%, 327 of 439). Learning opportunities with postdischarge patient contact were less common (clinic visits: 32%, 142 of 439; telephone calls: 12%, 53 of 439; and home visits: 4%, 18 of 439). On a 1-10 scale (10 = highest impact), residents rated postdischarge clinic as having the highest impact on their motivation to ensure safe transitions of care (mean = 7.61). Prior experiences with a postdischarge clinic visit, home visit, or telephone call were each correlated with increased perceived responsibility for transitional care tasks (correlation coefficients 0.12 [P = .004], 0.1 [P = .012], and 0.13 [P = 001], respectively). CONCLUSIONS: IM residents learn to facilitate hospital discharges most often through direct patient care. Opportunities to interact with patients across the postdischarge continuum are uncommon, despite correlating with increased perceived responsibility for ensuring safe transitions of care.

Survey of kinesiologists' functional capacity evaluation practice in Canada.

BACKGROUND: In Canada, functional capacity evaluations (FCEs) are commonly administered by several health care professions including kinesiologists. Kinesiologists have been recently regulated as health care professionals in Ontario and we know little about their demographics, the frequency of FCE administration, or the types of FCEs used by this group. OBJECTIVE: The purposes of this study were to identify: 1) the demographic characteristics and FCE education of kinesiology FCE practitioners; 2) the FCE systems most used by these practitioners and 3) the constructs from assessments used to determine functional capacity. METHODS: A survey was distributed to members of the Canadian Kinesiology Alliance. Descriptive statistics and frequency distributions were calculated from the survey responses (n = 77). RESULTS: FCE practitioners were represented by kinesiologists (79%) practicing more than 15 years and 1-5 years, who received FCE training from a certification course. ARCON (23%) was the most common FCE system used. Low-level lifting (43%), mid-lift (38%), pulling (38%) and walking (38%) are the most common FCE task components used to assess functional capacity. Although kinesiologists consider multiple factors when making decisions about task component endpoints, biomechanical observations/body mechanics are the primary methods used. CONCLUSIONS: Kinesiologists are conducting FCEs for the primary purpose of preparing return-to-work or workplace accommodation recommendations. Although functional capacity is determined using multiple factors, there is an emphasis on biomechanics and body mechanics. Focusing FCE training and research on these constructs may provide opportunities to further strengthen the reliability and validity of FCE outcomes.

Is there a relationship between ultrasound scanning ability (sonography) and visuospatial perception or psychomotor ability?

BACKGROUND: Competent sonography is thought to include a unique combination of skills not yet fully defined. This presents challenges when recruiting the correct people for training. Skills are thought to include visuospatial perception and psychomotor skills, but little is known about the relationship between these aptitudes and scanning ability. This feasibility study explored such relationships, to identify evaluation techniques which may improve selection and recruitment. METHODS: A sample of 30 experienced ultrasound practitioners and 30 trainees at commencement and on completion of training were administered eight tests. RESULTS: No significant relationships between experienced practitioners' or trainees' visuospatial abilities or psychomotor abilities and scanning abilities were found. Results demonstrated that two of the visuospatial perception tests were not influenced by training and therefore, may be measuring the innate skills of ultrasound practitioners. As ultrasound practitioners had not performed any of the tests previously, ranges of scores for each of the eight tests were established for this group. This included measures for psychomotor skills which added to the current body of knowledge for sonography. CONCLUSIONS: Although no significant correlations were found between participants' visuospatial perception or psychomotor abilities and scanning ability, performance on the Obstetric Structured Assessment Test (combining all the skills required) pre-training gave the best indication of post-training scanning performance. The Obstetric Structured Assessment Test may prove a useful tool for initial assessment of potential trainees but abilities will require further investigation.