Effects Of Increasing The Involvement Of Community-Dwelling Frail Older Adults In A Proactive Assessment Service: A Pragmatic Trial.

BACKGROUND: Older adults and care professionals advocate a more integrated and proactive care approach. This can be achieved by proactive outpatient assessment services that offer comprehensive geriatric assessments to better understand the needs of older adults and deliver person-centered and preventive care. However, the effects of these services are inconsistent. Increased involvement of the older adult during the assessment service could increase the effects on older adult's well-being. METHODS: We studied the effect of an assessment service (Sage-atAge) for community-dwelling frail adults aged ≥65 years. After studying the local experiences, this service was adapted with the aim to increase participant involvement through individual goal setting and using motivational interviewing techniques by health-care professionals (Sage-atAge+). Within Sage-atAge+, when finishing the assessment, a "goal card" was written together with the older adult: a summary of the assessment, including goals and recommendations. We measured well-being with a composite endpoint consisting of health, psychological, quality of life, and social components. With regression analysis, we compared the effects of the Sage-atAge and Sage-atAge+ services on the well-being of participants. RESULTS: In total, 453 older adults were eligible for analysis with a mean age of 77 (± 7.0) years of whom 62% were women. We found no significant difference in the change in well-being scores between the Sage-atAge+ service and the original Sage-atAge service (B, 0.037; 95% CI, -0.188 to 0.263). Also, no change in well-being scores was found even when selecting only those participants for the Sage-atAge+ group who received a goal card. CONCLUSION: Efforts to increase the involvement of older adults through motivational interviewing and goal setting showed no additional effect on well-being. Further research is needed to explore the relationship between increased participant involvement and well-being to further develop person-centered care for older adults.

Differential Transmission of Two Isolates of Wheat streak mosaic virus by Five Wheat Curl Mite Populations.

Wheat streak mosaic virus (WSMV), type member of the genus Tritimovirus in the family Potyviridae, is an economically important virus causing annual average yield losses of approximately 2 to 3% in winter wheat across the Great Plains. The wheat curl mite (WCM), Aceria tosichella, transmits WSMV along with two other viruses found throughout the Great Plains of the United States. Two common genotypes of WSMV (Sidney 81 and Type) in the United States share 97.6% nucleotide sequence identity but their transmission relationships with the WCM are unknown. The objective of this study was to determine transmission of these two isolates of WSMV by five WCM populations ('Nebraska', 'Montana', 'South Dakota', 'Type 1', and 'Type 2'). Nonviruliferous mites from each population were reared on wheat source plants mechanically inoculated with either Sidney 81 or Type WSMV isolates. For each source plant, individual mites were transferred to 10 separate test plants and virus transmission was determined by a double-antibody sandwich enzyme-linked immunosorbent assay. Source plants were replicated nine times for each treatment (90 individual mite transfers). Results indicate that three mite populations transmitted Sidney 81 at higher rates compared with Type. Two mite populations (Nebraska and Type 2) transmitted Sidney 81 and Type at higher rates compared with the other three populations. Results from this study demonstrate that interactions between virus isolates and mite populations influence the epidemiology of WSMV.

Resilience in Pre-Columbian Caribbean House-Building: Dialogue Between Archaeology and Humanitarian Shelter.

This paper responds to questions posed by archaeologists and engineers in the humanitarian sector about relationships between shelter, disasters and resilience. Enabled by an increase in horizontal excavations combined with high-resolution settlement data from excavations in the Dominican Republic, the paper presents a synthesis of Caribbean house data spanning a millennium (1400 BP- 450 BP). An analysis of architectural traits identify the house as an institution that constitutes and catalyses change in an emergent and resilient pathway. The "Caribbean architectural mode" emerged in a period of demographic expansion and cultural transition, was geographically widespread, different from earlier and mainland traditions and endured the hazards of island and coastal ecologies. We use archaeological analysis at the house level to consider the historical, ecological and regional dimensions of resilience in humanitarian action.

Impact of Wheat streak mosaic virus and Triticum mosaic virus Coinfection of Wheat on Transmission Rates by Wheat Curl Mites.

Wheat streak mosaic virus (WSMV) and Triticum mosaic virus (TriMV) are transmitted by the wheat curl mite (WCM, Aceria tosichella), and coinfections of wheat by these viruses are common in the field. Previous work has shown that mite genotypes vary in their ability to transmit TriMV. However, the degree to which coinfection of wheat modifies WCM vector competence has not been studied. The objective was to determine whether mite genotypes differed in virus transmission ability when feeding on wheat coinfected by WSMV and TriMV. First, WCM genotype type 2 was used to determine virus transmission rates from mock-, WSMV-, TriMV-, and coinfected wheat plants. Transmission rates were determined by using single-mite transfers from replicated source plants. Coinfection reduced WSMV transmission by type 2 WCM from 50 to 35.6%; however, coinfection increased TriMV transmission from 43.3 to 56.8%. Mite survival on single-mite transfer test plants indicates that the reduction in WSMV transmission may result from poor mite survival when TriMV is present. In a second study, two separate colonies of WCM genotype type 1 were tested to assess the impact of coinfection on transmission. Type 1 mites did not transmit TriMV from coinfected plants but the two colonies varied in transmission rates for WSMV (20.9 to 36.5%). Even though these changes in mite transmission rates are moderate, they help explain the high relative incidence of TriMV-positive plants that are coinfected with WSMV in field observations. These findings begin to demonstrate the complicated interactions found in this mite-virus complex.

Validation and clinical use of a novel diagnostic device for screening of atrial fibrillation.

AIMS: Patients with asymptomatic and undiagnosed atrial fibrillation (AF) are at increased risk of heart failure and ischaemic stroke. In this study, we validated a new diagnostic device, the MyDiagnostick, for detection of AF by general practitioners and patients. It records and stores a Lead I electrocardiogram (ECG) which is automatically analysed for the presence of AF. METHODS AND RESULTS: In total, 192 patients (age 69.4 ± 12.6 years) were asked to hold the MyDiagnostick for 1 min, immediately before a routine 12-lead ECG was recorded. Atrial fibrillation detection and ECGs stored by the MyDiagnostick were compared with the cardiac rhythm on the 12-lead ECG. In a second part of the study, the MyDiagnostick was used to screen for AF during influenza vaccination in the general practitioner's office. Atrial fibrillation was present in 53 out of the 192 patients (27.6%). All AF patients were correctly detected by the MyDiagnostick (sensitivity 100%; 95% confidence interval 93-100%). MyDiagnostick AF classification in 6 out of 139 patients in sinus rhythm was considered false positive (specificity 95.9%; 95% confidence interval 91.3-98.1%). During 4 h of influenza vaccination in 676 patients (age 74 ± 7.1 years), the MyDiagnostick correctly diagnosed AF in all 55 patients (prevalence 8.1%). In 11 patients (1.6%), AF was not diagnosed before, all with a CHA2DS2VASc score of >1. CONCLUSION: The high AF detection performance of the MyDiagnostick, combined with the ease of use of the device, enables large screening programmes for detection of undiagnosed AF.

[Haemophilia A and haemophilia B. Are there relevant clinical differences?]. / Hämophilie A und Hämophilie B. Gibt es relevante klinische Unterschiede?

UNLABELLED: Haemophilia B (HB) was described in 1952 as a single disease for the first time. In comparison to haemophilia A (HA) the bleeding tendency seemed to be less severe. The aim of this study was to investigate this hypothesis in all patients with HA and HB treated in the haemophilia care center of the Vivantes Klinikum. PATIENTS, METHODS: All patients with severe HA and HB treated at the haemophilia care center were included. We evaluated the regimen of replacement therapy and factor concentrate consumption within the last 5 years (1/2004 to 12/2008). Intracerebral bleeds were analysed over the whole life span of the included patients. RESULTS: 111/181 patients with HA had the severe form and 12/34 patients severe HB. 4/12 patients with severe HB had a history of intracerebral bleeding in comparison to 5/111 patients with severe HA. 2/8 adult patients with severe HB used a prophylactic treatment with factor concentrates (mean consumption 1289 IU factor IX/kg BW/year) in contrast to 60/95 adult patients with HA (mean consumption 2109 IU factor VIII /kg BW/year). CONCLUSION: The data suggest a milder bleeding type of patients with severe HB in comparison to patients with severe HA but may be patients with severe HB are at higher risk for intracerebral bleeds.

Fatigue-related changes in motor-unit synchronization of quadriceps muscles within and across legs.

Two experiments were conducted to examine effects of muscle fatigue on motor-unit synchronization of quadriceps muscles (rectus femoris, vastus medialis, vastus lateralis) within and between legs. We expected muscle fatigue to result in an increased common drive to different motor units of synergists within a leg and, hence, to increased synchronization, i.e., an increased coherence between corresponding surface EMGs. We further expected fatigue-related motor overflow to cause motor-unit synchronization of homologous muscles of both legs, although to a lesser extent than for synergists within a leg. In the first experiment, different levels of fatigue were induced by varying posture (knee angle), whereas in the second experiment fatigue was induced in a fixed posture by instructing participants to produce different force levels. EMG coherence was found in two distinct frequency bands (6-11 and 13-18 Hz) and was higher within a leg than between legs. The fatigue-related increase of 6-11 Hz inter-limb synchronization resembled the increased motor overflow during unimanual contractions and thus hinted at an increase in bilateral coupling. Synchronization at 13-18 Hz was clearly different and appeared to be related to posture.

Efficient in vivo gene transfer by PCR amplified fragment with reduced inflammatory activity.

There are many problems associated with plasmid DNA that may limit its use in systemic gene transfer. These problems could be solved by the use of synthetic genes. As a model to test the feasibility of using synthetic genes for gene therapy, we PCR-amplified a fragment containing the CMV promoter, the luciferase gene and a polyadenylation signal. The in vivo expression efficiency of the PCR fragment was determined by using two different methods, a hydrodynamics-based gene transfer of naked DNA to the liver and LPD (a lipid-based vector) mediated gene transfer to the lung. Our results show that linear fragments are at least as active as plasmid DNA following systemic delivery by LPD. However, PCR fragments are much less inflammatory than plasmid DNA as shown by a three-fold reduction in serum levels of both TNF-alpha and IL-12. Our results also showed that PCR fragments are highly efficient in liver gene transfer following systemic administration in a large volume. Thus, these results support the idea of using synthetic genes for gene therapy. Since gene sequence can be easily obtained as a PCR fragment, our results also imply that it may provide a useful and convenient method for determining the physiologic function of a putative gene in intact animals.