MATHEMATICAL FINANCE, Issue 1 2006
G. Yin
By focusing on computational aspects, this work is concerned with numerical methods for stock selling decision using stochastic approximation methods. Concentrating on the class of decisions depending on threshold values, an optimal stopping problem is converted to a parametric stochastic optimization problem. The algorithms are model free and are easily implementable on-line. Convergence of the algorithms is established, second moment bound of estimation error is obtained, and escape probability from a neighborhood of the true parameter is also derived. Numerical examples using both daily closing prices and intra-day data are provided to demonstrate the performance of the algorithms. [source]

From Model to Forecasting: A Multicenter Study in Emergency Departments

ACADEMIC EMERGENCY MEDICINE, Issue 9 2010
Mathias Wargon MD
ACADEMIC EMERGENCY MEDICINE 2010; 17:970,978 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, This study investigated whether mathematical models using calendar variables could identify the determinants of emergency department (ED) census over time in geographically close EDs and assessed the performance of long-term forecasts. Methods:, Daily visits in four EDs at academic hospitals in the Paris area were collected from 2004 to 2007. First, a general linear model (GLM) based on calendar variables was used to assess two consecutive periods of 2 years each to create and test the mathematical models. Second, 2007 ED attendance was forecasted, based on a training set of data from 2004 to 2006. These analyses were performed on data sets from each individual ED and in a virtual mega ED, grouping all of the visits. Models and forecast accuracy were evaluated by mean absolute percentage error (MAPE). Results:, The authors recorded 299,743 and 322,510 ED visits for the two periods, 2004,2005 and 2006,2007, respectively. The models accounted for up to 50% of the variations with a MAPE less than 10%. Visit patterns according to weekdays and holidays were different from one hospital to another, without seasonality. Influential factors changed over time within one ED, reducing the accuracy of forecasts. Forecasts led to a MAPE of 5.3% for the four EDs together and from 8.1% to 17.0% for each hospital. Conclusions:, Unexpectedly, in geographically close EDs over short periods of time, calendar determinants of attendance were different. In our setting, models and forecasts are more valuable to predict the combined ED attendance of several hospitals. In similar settings where resources are shared between facilities, these mathematical models could be a valuable tool to anticipate staff needs and site allocation. [source]

Board Structure, Process and Performance: evidence from public-listed companies in Singapore

CORPORATE GOVERNANCE, Issue 2 2005
David Wan
Past literature in board research has centred on board structure and company performance. Over the years, empirical studies do not reveal a conclusive relationship between these two variables (Dalton and Daily, 1999. Across the Board, March, 28,32). Until recently, the literature on board processes has been sparse. The reason for insufficient empirical work on board processes possibly is due to the difficulty of gaining access to boards. In this paper, we propose a conceptual model and tested the model on publicly listed companies in Singapore. Based on a sample of 212 company responses and 299 directors, we conclude that board structure does not affect board process while board process is related to board performance. In terms of individual parameters, effort norms, cognitive conflict and the presence and usage of skills are positively related to board roles and board transparency. Also, affective and process conflicts are negatively related to board roles and board transparency. Finally, board process does not mediate the relationship between board structure and board performance. [source]

Daily and developmental modulation of "premotor" activity in the birdsong system,

DEVELOPMENTAL NEUROBIOLOGY, Issue 12 2009
Nancy F. Day
Abstract Human speech and birdsong are shaped during a sensorimotor sensitive period in which auditory feedback guides vocal learning. To study brain activity as song learning occurred, we recorded longitudinally from developing zebra finches during the sensorimotor phase. Learned sequences of vocalizations (motifs) were examined along with contemporaneous neural population activity in the song nucleus HVC, which is necessary for the production of learned song (Nottebohm et al. 1976: J Comp Neurol 165:457,486; Simpson and Vicario 1990: J Neurosci 10:1541,1556). During singing, HVC activity levels increased as the day progressed and decreased after a night of sleep in juveniles and adults. In contrast, the pattern of HVC activity changed on a daily basis only in juveniles: activity bursts became more pronounced during the day. The HVC of adults was significantly burstier than that of juveniles. HVC bursting was relevant to song behavior because the degree of burstiness inversely correlated with the variance of song features in juveniles. The song of juveniles degrades overnight (Deregnaucourt et al. 2005: Nature 433:710,716). Consistent with a relationship between HVC activity and song plasticity (Day et al. 2008: J Neurophys 100:2956,2965), HVC burstiness degraded overnight in young juveniles and the amount of overnight degradation declined with developmental song learning. Nocturnal changes in HVC activity strongly and inversely correlated with the next day's change, suggesting that sleep-dependent degradation of HVC activity may facilitate or enable subsequent diurnal changes. Collectively, these data show that HVC activity levels exhibit daily cycles in adults and juveniles, whereas HVC burstiness and song stereotypy change daily in juveniles only. In addition, the data indicate that HVC burstiness increases with development and inversely correlates with song variability, which is necessary for trial and error vocal learning. © 2009 Wiley Periodicals, Inc. Develop Neurobiol, 2009 [source]

A prospective baseline study of frail older people before the introduction of an intermediate care service

HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2005
John Young MB MSC FRCP
Abstract This paper describes the first part of a two-stage research project designed to investigate the clinical and service outcomes of a comprehensive intermediate care service. It is a baseline study of patients presenting to two elderly care departments as emergencies with the clinical syndromes of falls, incontinence, confusion or poor mobility before the introduction of a city-wide intermediate care service. The outcome measures were: mortality; disability (Barthel Index, BI); social activities (Nottingham Extended Activities of Daily Living); service use; and carer distress (General Health Questionnaire ,28). These were measured at 3, 6 and 12 months after recruitment. Eight hundred and twenty-three patients were recruited (median age = 84 years; proportion of women = 70%; proportion with cognitive impairment = 45%; median BI score = 15). There was a high mortality rate (36%), evidence for incomplete recovery, a gradual decline in independence over 12 months and a high degree of carer stress. There was little use of rehabilitation services (< 5%), about 25% required readmission to hospital by each assessment point and there was a gradual increase in institutional care admissions. These findings support a needs-based argument for a more comprehensive community service for frail older people. [source]

High Efficacy of Ranitidine Bismuth Citrate, Amoxicillin, Clarithromycin and Metronidazole Twice Daily for Only Five Days in Helicobacter pylori Eradication

HELICOBACTER, Issue 2 2001
Javier P. Gisbert
ABSTRACT Aim. The combination of a proton pump inhibitor (PPI) or ranitidine-bismuth-citrate (Rbc) and two antibiotics for 7,10 days are, at present, the preferred treatments in Helicobacter pylori eradication. However, therapies for fewer than 7 days have been scarcely evaluated and it is unknown whether the length of treatment can be shortened, without a lost of efficacy, if three instead of two antibiotics are used. The aim of our study was to evaluate the efficacy of Rbc plus three antibiotics for only 5 days in H. pylori eradication. Methods. We prospectively studied 80 patients (34% duodenal ulcer, 66% functional dyspepsia) infected by H. pylori. At endoscopy, biopsies were obtained for histological study and rapid urease test, and a 13C-urea breath test was carried out. Urea breath test was repeated 4 weeks after completing eradication treatment with Rbc [400 mg twice a day (bid)], amoxicillin (1 g bid), clarithromycin (500 mg bid) and metronidazole (500 mg bid). All drugs were administered together after breakfast and dinner for 5 days only, and no treatment was administered thereafter. Compliance with therapy was determined from the interrogatory and the recovery of empty envelopes of medications. Results. In 79 out of the 80 patients, H. pylori eradication success or failure was assessed after therapy (one patient was lost from follow-up). All but one of these 79 patients took all the medications (one patient stopped treatment on the day 3 due to nausea/vomiting). Per protocol eradication was achieved in 72/78 (92%; 95% CI, 84,96%) and in 72/80 (90%; 81,95%) by intention-to-treat. Therapy was more effective in patients with duodenal ulcer than in those with functional dyspepsia [100% (87,100%) vs. 85% (73,92%) by intention-to-treat; p < .05]. Adverse effects were described in ten patients (12%), and included the perception of a metallic taste (eight patients), nausea/vomiting (two patients, one of them abandoned the treatment due to this), and diarrhea (two patients). Conclusion. The combination of Rbc, amoxicillin, clarithromycin and metronidazole for only 5 days represents a promising therapy for H. pylori infection, due to its high efficacy, simple posology, low cost and excellent tolerance. [source]

A distributed approach for estimating catchment evapotranspiration: comparison of the combination equation and the complementary relationship approaches

HYDROLOGICAL PROCESSES, Issue 8 2003
Z. X. Xu
Abstract In large river basins, there may be considerable variations in both climate and land use across the region. The evapotranspiration that occurs over a basin may be drastically different from one part of the region to another. The potential influence of these variations in evapotranspiration estimated for the catchment is weakened by using a spatially based distributed hydrological model in such a study. Areal evapotranspiration is estimated by means of approaches requiring only meteorological data: the combination equation (CE) model and the complementary relationship approach,the complementary relationship areal evapotranspiration (CRAE) and advection,aridity (AA) models. The capability of three models to estimate the evapotranspiration of catchments with complex topography and land-use classification is investigated, and the models are applied to two catchments with different characteristics and scales for several representative years. Daily, monthly, and annual evapotranspiration are estimated with different accuracy. The result shows that the modified CE model may underestimate the evapotranspiration in some cases. The CRAE and AA models seem to be two kinds of effective alternatives for estimating catchment evapotranspiration. Copyright © 2003 John Wiley & Sons, Ltd. [source]

Impact of cerebrovascular pathology on behavioural and neuropsychiatric symptoms in patients with Alzheimer's dementia: findings from a retrospective, naturalistic study

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 7 2009
A. Klugman
Summary Aim:, Cerebrovascular disease (CVD) has been associated with depression and a host of neuropsychiatric conditions including dementia. This study assessed the relationship between cerebrovascular findings reported on MRI brain scans and neuropsychiatric symptoms (NPS) and behavioural problems in patients with Alzheimer's disease (AD). Methods:, Medical notes were retrospectively reviewed in patients undergoing brain MRI following referral for cognitive impairment to a memory clinic between January 2004 and June 2008. Patients with AD were graded into four categories of CVD severity based on neuroradiology reports and assessed for behavioural and NPS and activities of daily living using Neuropsychiatric Inventory (NPI), Geriatric Depression Scale (GDS) and Bristol Activities of Daily Living (BADL). Frontal lobe symptoms and parkinsonian features were also evaluated. Results:, Of the initial 232 patients who underwent MRI 72% were diagnosed with AD. 89% of AD patients had CVD findings reported on MRI. Moderate-to-severe CVD was present in 47% of patients. None of the AD patients satisfied a diagnosis of vascular dementia. There was no significant relationship observed between level of MRI CVD findings and scores on NPI (p = 0.57), GDS (p = 0.26) and BADL (p = 0.46). The level of CVD severity did not appear to influence frontal lobe and parkinsonian assessments (p = 0.60). Conclusion:, The contribution of CVD to the pathogenesis of various NPS is still debated. Our study, based on patients diagnosed with AD in a memory clinic setting, suggests that there is no relationship between the extent of CVD pathology and neuropsychiatric and behavioural measures in AD patients. Further prospective quantitative studies are needed to assess the role of CVD, if any, in neuropsychiatric and behavioural symptoms in AD. It is possible that the relatively small pathological contribution of CVD to the development of these symptoms is obscured by the effect of the wider neurodegeneration encountered in AD. [source]

Impact of COPD severity on physical disability and daily living activities: EDIP-EPOC I and EDIP-EPOC II studies

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2009
J. M. Rodriguez Gonzalez-Moro
Summary Aims:, The severity of chronic obstructive pulmonary disease (COPD) is associated to patients' health-related quality of life (HRQL). Physical impairment increasingly affects daily activities creating economic, social and personal burden for patients and their families. This burden should be considered in the management of COPD patients; therefore, we intended to assess the impact of the disease severity on physical disability and daily activities. Methods:, Two epidemiological observational cross-sectional descriptive studies were carried out in 1596 patients with moderate COPD and 2012 patients with severe or very severe COPD in the routine clinical practice. Demographic and basic clinical-epidemiological data were collected and patients completed questionnaires to assess their physical disability because of COPD [Medical Research Council (MRC)], COPD repercussion on daily activities [London Chest Activity of Daily Living (LCADL)], job, economy and family habits and their health status [EQ-5D visual analogue scale (VAS)]. Results:, In all, 37% of severe/very severe COPD patients and 10% of moderate (p < 0.0001) had MRC grades 4 and 5. Mean global LCADL was significantly higher in severe/very severe than in moderate patients [29.6 (CI 95%: 28.91,30.25) vs. 21.4 (CI 95%: 20.8,21.9); p < 0.0001]. COPD job impact and economic and family habits repercussions were significantly higher and health status significantly worse in severe/very severe cases than in patients with moderate COPD. Conclusions:, COPD severity is highly associated with physical disability by MRC grading, with functionality on daily activities and with impairment of other social and clinical activities. Moderate COPD patients show already a significant degree of impairment in all these parameters. [source]

Prevalence and correlates of alcoholism in community-dwelling elderly living in São Paulo, Brazil

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2009
Edson Shiguemi Hirata
Abstract Objectives To assess the prevalence of alcoholism in elderly living in the city of São Paulo (Brazil) and investigate associated risk factors. Methods A total of 1,563 individuals aged 60 years or older, of both genders of three districts of different socioeconomic classes (high, medium and low) in the city of São Paulo (Brazil) were interviewed. The CAGE screening test for alcoholism was applied and a structured interview was used to assess associated sociodemographic and clinical factors. The tests Mini Mental State Examination, Fuld Object Memory Evaluation, The Informant Questionnaire on Cognitive Decline in the Elderly and Bayer-Activities of Daily Living Scale were used for cognitive and functional assessment. Results Prevalence of alcoholism was 9.1%. Multivariate regression analysis showed that alcoholism was associated with male gender, ,mulatto' ethnicity, smoking, and cognitive and functional impairment. In addition, the younger the individual and the lower the schooling level, the higher the risk for alcoholism. Conclusions The results obtained in this study show that alcoholism is highly frequent in the community-dwelling elderly living in São Paulo, and that it is associated with socio-demographic and clinical risk factors similar to those reported in the literature. This suggests that alcoholism in the elderly of a developing country shares the same basic characteristics seen in developed countries. These findings suggest that it is essential for health services and professional to be prepared to meet this demand that will significantly grow in the next years, especially in developing countries, where the rates of population aging are higher than those of developed countries. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Persistent apathy in Alzheimer's disease as an independent factor of rapid functional decline: the REAL longitudinal cohort study

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2009
L. Lechowski
Abstract Objective To determine the role of persistent apathy in rapid loss of autonomy in Instrumental Activities of Daily Living (IADL) in women with Alzheimer´s disease (AD), taking into account the grade of cognitive decline. Methods The study was conducted on 272 women from the French REAL cohort. At inclusion patients had a Mini-Mental State Examination (MMSE) score between 10,26. A rapid functional decline was defined as a yearly drop of 4 points or more on the 14-point IADL Lawton scale. Persistent apathy was defined as a frequency score equal to 3 or 4 on the Neuro-Psychiatric Inventory at the three consecutive 6-monthly assessments. Results 27.6% of women had rapid functional decline in 1 year and 22.1% of them had persistent apathy. A logistic regression analysis showed that, in addition to cognitive decline, persistent apathy plays a role in rapid functional decline in 1 year. For example, for a 3-point decline in MMSE in 1 year, the probability of a rapid loss in IADL is 0.45 for women with persistent apathy compared with 0.28 for those without persistent apathy. Conlusions In this study, a rapid loss in IADL score was partly explained by persistent apathy. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Anemia and cognitive performance in hospitalized older patients: results from the GIFA study

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2006
Valentina Zamboni
Abstract Background Anemia represents a major risk factor for adverse health-related events in older persons. The aim of this study was to evaluate the association between hemoglobin levels/anemia and cognitive function in hospitalized older persons. Method Data are from the Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA) study. Hemoglobin levels (in g/dL) were measured upon admission to hospital; anemia was defined according to the WHO criteria. Cognitive performance was assessed by the Abbreviated Mental Test (AMT) on admission; an AMT score <7 defined cognitive impairment. Logistic regressions and analyses of covariance were performed to evaluate the relationship between cognitive status and hemoglobin levels/anemia. Results Mean age of the sample (n,=,13,301) was 72.0 years. Participants with cognitive impairment presented a higher prevalence of anemia (47%) compared to those without cognitive impairment (35%, p,<,0.001). Adjusted logistic regressions showed that hemoglobin levels/anemia were significantly associated with cognitive impairment (OR,=,0.96, 95%CI,=,0.94,0.99, p,=,0.004, and OR,=,1.32, 95%CI,=,1.18,1.48, p,<,0.001, respectively). Patients with anemia and cognitive impairment at the hospital admission presented a higher number of impaired Activities of Daily Living compared to those with only one or none of the studied conditions (p for trend,<,0.001). Conclusion Low hemoglobin levels and anemia are independently associated with cognitive performance in older persons admitted to acute care units. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Hypertension, white matter change and response to cholinesterase inhibitors in Alzheimer's disease

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2005
Peter J. Connelly
Abstract Background Cholinesterase inhibitors are used to treat mild to moderate Alzheimer's disease. Their role in patients with concurrent cerebrovascular disease has been less well studied, and the influence of vascular risk factors on response to treatment is uncertain. We investigated the effect of hypertension and white matter lesions (WML) on response. Methods A retrospective sample of 160 consecutive out-patients who had blood pressure measured and the presence or absence of WML recorded at baseline and who completed six months treatment with a cholinesterase inhibitor was studied. Subjects scored either zero or one on the Modified Hachinski Ischaemic Scale. Subjects were assessed using the Mini-Mental State Examination (MMSE), the Digit Symbol Substitution test (DSST) and both the Instrumental Activities of Daily Living (IADL) and Social Behaviour (SB) sub-scales of the Nurses Observation Scale for Geriatric Patients (NOSGER). Results 43.9% of the total study population were classified as good responders using our criteria. Neither the presence of hypertension nor the presence of WML alone influenced outcome. However, there was a statistically significant interaction between blood pressure and WML on outcome variables on multiple analysis of variance (MANOVA) (F(4,,139),=,5.60, p,<,0.0005). Subjects with both hypertension and WML deteriorate to a significantly greater extent in IADL and SB scores than any other group (p,<,0.05 in each case). This effect could not be explained by age or by smoking status. Conclusion Our results support the hypothesis that there is an interaction between hypertension and WML that adversely influences functional change during cholinesterase inhibitor treatment. Our results are a contrast to suggestions that subjects with vascular disease show a better response to cholinesterase inhibitors. We recommend careful exploration of factors that may influence outcome. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Does arm length indicate cognitive and functional reserve?

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2005
Seul-Ki Jeong
Abstract Background This study aimed to examine whether arm length and height were associated with cognitive and functional abilities. Methods Screening interviews were conducted in 235 community dwelling individuals aged 65 and over. The assessment scales included the Korean version of modified Mini-Mental State Examination (K-mMMSE) for cognition, and the Korean Instrumental Activities of Daily Living (K-IADL) for functional ability. All the participants were examined clinically and a diagnosis of dementia was ascertained. Anthropometric measurements included total arm span and height. Results Both arm length and height correlated significantly with the cognitive and functional scales. In the multivariate regression models, their associations were significant, independent of age, sex, education, and other variables. Shorter arm length was also significantly associated with dementia; while, height lost significance after an adjustment for the potential confounders. Conclusions Arm length and height could indicate cognitive and functional ability. Arm length, which was known to be less prone to degenerative processes, might be more stable as an indicator for cognitive and functional reserve capacity than height. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Role of behavioural disturbance in the loss of autonomy for activities of daily living in Alzheimer patients

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 11 2003
L. Lechowski
Abstract Background Cognitive impairment is associated with functional impairment in patients with Alzheimer's disease (AD). Behavioural disturbance is very common in these patients. Nevertheless, there has been very little research into the relations between behavioural disturbance and functional status in AD. The purpose of this study is to investigate the relationship between behavioural disturbance and functional status after taking account of cognitive impairment. Material and methods 579 patients were prospectively evaluated at 16 French hospitals, all referents for AD, and were diagnosed with possible or probable AD. These patients were assessed with NeuroPsychiatric Inventory (NPI), cognitive subscales of the Alzheimer's Disease Assessment Scale (ADAS-cog), Clinical Dementia Rating scale (CDR) and Instrumental Activities of Daily Living scale (IADL). Results The number of men with available data for IADL total score was too small to make any analysis. ,Group A' gathered 256 women for whom the relation between autonomy for Activities of Daily Living (ADL) and the other variables were determined. ,Group B', pooled 85 women for whom relations found were verified. Linear regression was used for the analysis. With age, cognitive impairment allows us to explain best (38%) the loss of autonomy for ADL. Conclusion The role of behavioural disturbances in the loss of autonomy for ADL was not determinant in our study, whereas cognitive impairment and age were better able to determine the loss of autonomy for ADL. Further study is needed to explain the decline of functional status in AD patients. Copyright © 2003 John Wiley & Sons, Ltd. [source]

A new approach to the qualitative evaluation of functional disability in dementia

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 11 2003
X. Kurz
Abstract Background Dementia patients suffer from the progressive deterioration of cognitive and functional abilities. Instrumental disabilities usually appear in the earlier stages of the disease while basic disabilities appear in the more advanced stages. In order to differentiate between mild, moderate and severe patients both instrumental and basic functional disabilities should be taken into account simultaneously. Objectives The objective of this study was to find a new method for classifying dementia patients based on their disabilities by using a basic and an instrumental Activities of Daily Living (ADL) scale. Methods Functional disability was assessed in a Belgian cohort of dementia patients using the Katz and Lawton Instrumental Activities of Daily Living (IADL) scales. A k -means derived clustering method allocated patients to disability clusters according to their Katz and Lawton scores. In order to validate the classification, we compared socio-demographic, clinical and costs parameters between the groups. Results The clustering method allocated patients between three clusters: dependent, non-dependent with instrumental functional disability (ND-IFD) and non-dependent. Dependence, as defined by these clusters, significantly correlates with age, residential setting, MMSE, patient's quality of life and costs. Conclusion This new classification of patients suffering from dementia will provide better understanding of functional disabilities and will complement the evaluation of disease severity based on cognitive function. Copyright © 2003 John Wiley & Sons, Ltd. [source]

Evaluation of NOC Measures in Home Care Nursing Practice

INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003
Gail M. Keenan
PURPOSE To evaluate the reliability, validity, usefulness, and sensitivity of 89 NOC outcomes in two Visiting Nurse Associations in Michigan. METHODS Of a total 190 NOC outcomes 89 were assigned for testing. Interrater reliability and criterion validity were assessed a total of 50 times per outcome (on 50 different patients) across the study units. The total number of times the reliability and validity were assessed for each of the 89 measures studied ranged from 5,45. Three RN research assistants (RNRAs) oversaw and participated in data collection with the help of 15 clinicians. Convenience sampling was used to identify subjects. A roster of outcomes to be studied was maintained and matched with patient conditions whenever possible until the quota of outcomes assigned had been evaluated. Clinicians and RNRAs independently rated the outcomes and indicators applicable to the patient. NANDA diagnoses, NIC interventions, and medical diagnoses were recorded. FINDINGS A total of 258 patients (mean age 62) enrolled; 60% were women, 23% were from minority groups, and 78% had no college degree. Thirty-six of the 89 NOC measures were designated "clinically useful." The 10 outcomes with the highest interrater reliability were Caregiver Home Care Readiness; Caregiver Stressors; Caregiving Endurance Potential; Infection Status; Mobility Level; Safety Status: Physical Injury; Self-Care: Activities of Daily Living; Self-Care: Bathing; Self-Care: Hygiene; and Wound Healing: Secondary Intention. Criterion measurement and repeated ratings provided evidence to support the validity and sensitivity of the NOC outcomes. Evidence also suggested that NOC label level ratings could be a feasible, reliable, and valid method of evaluating nursing outcomes under actual use. For some measures, adjustments in the scales and anchors are needed to enhance reliability. For others, it may be unrealistic to reliably score in one encounter, thus scoring should be deferred until the clinician has adequate knowledge of the patient. CONCLUSIONS Continued study and refinement that are coordinated and integrated systematically strongly recommended. Comprehensive study in an automated system with a controlled format will increase the efficiency of future studies. [source]

Comparative Effects of NaCl and Polyethylene Glycol on Germination, Emergence and Seedling Growth of Cowpea

JOURNAL OF AGRONOMY AND CROP SCIENCE, Issue 4 2002
B. Murillo-Amador
Abstract Seeds of Paceño and Cuarenteño cultivars of cowpea (Vigna unguiculata L. Walp.) were tested for salt and drought tolerance at germination, seedling emergence and early seedling growth in NaCl and PEG-8000 solutions of different osmotic potentials (0, ,0.2, ,0.4, ,0.6, and ,0.8 MPa). Daily and final germination and emergence percentage, as well as germination and seedling emergence rate, and seedling growth were recorded under controlled conditions. Results showed that germination and emergence rate were delayed by both solutions in both cultivars, with differences between cultivars among growth stages, given that cultivar Cuarenteño, showed a higher germination rate than Paceño in NaCl, but Paceño was less affected by NaCl and PEG solutions at the emergence stage. Sodium chloride had a lesser effect on both cultivars in terms of germination rate, emergence rate and the final germination and emergence percentage than did PEG-8000. This conclusively proves that the adverse effect of PEG-8000 on germination, emergence and early seedling growth was due to the osmotic effect rather than the specific ion. Seedling growth was reduced by both stresses, but NaCl usually caused less damage than PEG to cowpea seedlings, suggesting that NaCl and PEG acted through different mechanisms. Zusammenfassung Vergleich der Wirkungen von NaCl und Polyethylenglykol auf die Keimung, das Auflaufen und das Sämlingswachstum von Kuhbohne Samen von Paceño- und Cuarenteño-Kultivaren von Kuhbohne (Vigna unguiculata L. Walp.) wurden hinsichtlich Salz- und Dürretoleranz zum Zeitpunkt der Keimung, des Sämlingsauflaufens und des frühen Sämlingswachstums in NaCl- und PEG-8000-Lösungen mit unterschiedlichem osmotischen Potential (0, ,0.2, ,0.4, ,0.6 und ,0.8 MPa) untersucht. Tägliche und abschließende Keimungs- und Auflaufprozente sowie Keimung und Sämlingsauflaufrate und Sämlingswachstum wurden unter kontrollierten Bedingungen bestimmt. Die Ergebnisse zeigen, dass die Keimung und die Auflaufrate durch beide Lösungen verzögert wurden bei beiden Kultivaren, wobei Unterschiede zwischen den Kultivaren hinsichtlich der Wachstumsstadien auftraten; der Kultivar Cuarenteño zeigte eine höhere Keimungsrate als Paceño in NaCl, während Paceño weniger beeinflusst wurde durch NaCl und PEG-Lösungen im Auflaufstadium. Natriumchlorid hatte einen geringeren Einfluss bei beiden Kultivaren hinsichtlich der Keimungsrate, der Auflaufrate und der abschließenden Keimungs- und Auflaufprozente als PEG-8000. Dies bestätigt, dass der ungünstige Einfluss von PEG-8000 auf die Keimung, das Auflaufen und das frühe Sämlingswachstum eine Folge des osmotischen Einflusses und nicht einer spezifischen Ionenwirkung ist. Sämlingswachstum war durch beide Behandlungen beeinträchtigt, aber NaCl zeigte meist eine geringere Schädigung als PEG bei Kuhbohnensämlingen; das lässt vermuten, dass NaCl und PEG durch unterschiedliche Mechanismen einwirken. [source]

Maximum Daily 6 Minutes of Activity: An Index of Functional Capacity Derived from Actigraphy and Its Application to Older Adults with Heart Failure

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2010
Jason Howell BA
OBJECTIVES: To compare the correlation between the maximum 6 minutes of daily activity (M6min) and standard measures of functional capacity in older adults with heart failure (HF) with that in younger subjects and its prognostic utility. DESIGN: Prospective, cohort study. SETTING: Tertiary care, academic HF center. PARTICIPANTS: Sixty, ambulatory, adults, New York Heart Association (NYHA) Class I to III, stratified into young (50.9 ± 9.4) and older cohorts (76.8 ± 8.0). MEASUREMENTS: Correlation between M6min and measures of functional capacity (6-minute walk test; 6MWT) and peak oxygen consumption (VO2) according to cardiopulmonary exercise testing in a subset of subjects. Survival analysis was employed to evaluate the association between M6min and adverse events. RESULTS: Adherence to actigraphy was high (90%) and did not differ according to age. The correlation between M6min and 6MWT was higher in subjects aged 65 and older than in those younger than 65 (correlation coefficient (r=0.702, P<.001 vs r=0.490, P=.002). M6min was also significantly associated with peak VO2 (r=0.612, P=.006). During the study, 26 events occurred (2 deaths, 10 hospitalizations, 8 emergency department visits, and 6 intercurrent illnesses). The M6min was significantly associated with subsequent events (hazard ratio=2.728, 95% confidence interval=1.10,6.77, P=.03), independent of age, sex, ejection fraction, NYHA class, brain natriuretic peptide, and 6MWT. CONCLUSION: The high adherence to actigraphy and association with standard measures of functional capacity and independent association with subsequent morbid events suggest that it may be useful for monitoring older adults with HF. [source]

The Effect of a High-Intensity Functional Exercise Program on Activities of Daily Living: A Randomized Controlled Trial in Residential Care Facilities

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2009
Håkan Littbrand PT
OBJECTIVES: To evaluate whether a high-intensity functional weight-bearing exercise program reduces dependency in activities of daily living (ADLs) in older people living in residential care facilities, focusing on people with dementia. DESIGN: Randomized, controlled trial. SETTING: Nine residential care facilities. PARTICIPANTS: One hundred ninety-one older people dependent in ADLs and with a Mini-Mental State Examination score of 10 or greater. One hundred (52.4%) of the participants had dementia. INTERVENTION: A high-intensity functional weight-bearing exercise program or a control activity consisting of 29 sessions over 3 months. MEASUREMENTS: The Barthel ADL Index; follow-up at 3 months (directly after the intervention) and 6 months with intention-to-treat analyses. RESULTS: There were no statistically significant differences between the groups regarding overall ADL performance. Analyses for each item revealed that a smaller proportion of participants in the exercise group had deteriorated in indoor mobility at 3 months (exercise 3.5% vs control 16.0%, P=.01) and 6 months (7.7% vs 19.8%, P=.03). For people with dementia, there was a significant difference in overall ADL performance in favor of the exercise group at 3 months (mean difference 1.1, P=.03) but not at 6 months. CONCLUSION: A high-intensity functional weight-bearing exercise program seems to reduce ADL decline related to indoor mobility for older people living in residential care facilities. The program does not appear to have an overall effect on ADLs. In people with dementia, the exercise program may prevent decline in overall ADL performance, but continuous training may be needed to maintain that effect. [source]

Recovery of Activities of Daily Living in Older Adults After Hospitalization for Acute Medical Illness

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2008
Cynthia M. Boyd MD
OBJECTIVES: To compare functional outcomes in the year after discharge for older adults discharged from the hospital after an acute medical illness with a new or additional disability in their basic self-care activities of daily living (ADL) (compared with preadmission baseline 2 weeks before admission) with those of older adults discharged with baseline ADL function and identify predictors of failure to recover to baseline function 1 year after discharge. DESIGN: Observational. SETTING: Tertiary care hospital, community teaching hospital. PARTICIPANTS: Older (aged ,70) patients nonelectively admitted to general medical services (1993,1998). MEASUREMENTS: Number of ADL disabilities at preadmission baseline and 1, 3, 6, and 12 months after discharge. Outcomes were death, sustained decline in ADL function, and recovery to baseline ADL function at each time point. RESULTS: By 12 months after discharge, of those discharged with new or additional ADL disability, 41.3% died, 28.6% were alive but had not recovered to baseline function, and 30.1% were at baseline function. Of those discharged at baseline function, 17.8% died, 15.2% were alive but with worse than baseline function, and 67% were at their baseline function (P<.001). Of those discharged with new or additional ADL disability, the presence or absence of recovery by 1 month was associated with long-term outcomes. Age, cardiovascular disease, dementia, cancer, low albumin, and greater number of dependencies in instrumental ADLs independently predicted failure to recover. CONCLUSION: For older adults discharged with new or additional disability in ADL after hospitalization for medical illness, prognosis for functional recovery is poor. Rehabilitation interventions of longer duration and timing than current reimbursement allows, caregiver support, and palliative care should be evaluated. [source]

Lower Levels of Serum Albumin and Total Cholesterol Associated with Decline in Activities of Daily Living and Excess Mortality in a 12-Year Cohort Study of Elderly Japanese

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2008
Tomonori Okamura MD
OBJECTIVES: To examine the association between levels of serum albumin and total cholesterol (TC) and risk of subsequent mortality and future decline in activities of daily living (ADLs) in elderly people. DESIGN: Population-based cohort study. SETTING: National Integrated Project for Prospective Observation of Non-Communicable Disease and Its Trends in the Aged, 1980. PARTICIPANTS: One thousand eight hundred forty-four Japanese individuals aged 60 to 74 randomly selected throughout Japan and followed for 12.4 years. MEASUREMENTS: Decline in ADLs and mortality. RESULTS: After adjusting for other covariates, the multivariable odds ratios (ORs) of impaired ADLs were highest in the lowest albumin quartile (,40 g/L) for women. The multivariable OR of having a composite outcome of death or impaired ADL for the lowest albumin quartile compared with the highest was 1.56 (95% confidence interval (CI)=1.94,2.57) for men and 3.06 (95% CI=1.89,4.95) for women. Serum albumin was significantly and inversely associated with a composite outcome of death or impaired ADLs in the group below the median of TC in both sexes (multivariable OR for 1-g/L increase in serum albumin=0.88 for men (95% CI=0.79,0.97) and 0.79 for women (95% CI=0.72,0.87)), which was not significantly associated in the group with TC at or above the median. CONCLUSION: In the Japanese general population, low-normal serum albumin and TC levels are associated with loss of activity during old age, especially for women. [source]

Rates of Acute Care Admissions for Frail Older People Living with Met Versus Unmet Activity of Daily Living Needs

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2006
Laura P. Sands PhD
OBJECTIVES: To determine whether older people who do not have help for their activity of daily living (ADL) disabilities are at higher risk for acute care admissions and whether entry into a program that provides for these needs decreases this risk. DESIGN: A longitudinal cohort study. SETTING: Thirteen nationwide sites for the Program of All-inclusive Care for the Elderly (PACE). PACE provides comprehensive medical and long-term care to community-living older adults. PARTICIPANTS: Two thousand nine hundred forty-three PACE enrollees with one or more ADL dependencies. MEASUREMENTS: Unmet needs were defined as the absence of paid or unpaid assistance for ADL disabilities before PACE enrollment. Hospital admissions in the 6 months before PACE enrollment and acute admissions in the first 6 weeks and the 7th through 12th weeks after enrollment were determined. RESULTS: Those who lived with unmet ADL needs before enrollment were more likely to have a hospital admission before PACE enrollment (odds ratio (OR)=1.28, 95% confidence interval (CI)=1.01,1.63) and an acute admission in the first 6 weeks after enrollment (OR=1.45, 95% CI=1.00,2.09) but not after 6 weeks of receiving PACE services (OR=0.86, 95% CI=0.53,1.40). CONCLUSION: Frail older people who live without needed help for their ADL disabilities have higher rates of admissions while they are living with unmet ADL needs but not after their needs are met. With state governments under increasing pressure to develop fiscally feasible solutions for caring for disabled older people, it is important that they be aware of the potential health consequences of older adults living without needed ADL assistance. [source]

Clinical Characteristics of Flexed Posture in Elderly Women

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2003
Lara Balzini PT
Objectives: To investigate the relationships between the severity of flexed posture (FP), skeletal fragility, and functional status level in elderly women. Design: Cross-sectional study. Setting: Geriatric rehabilitation research hospital. Participants: Sixty elderly women (aged 70,93) with FP referred to a geriatric rehabilitation department for chronic back pain without apparent comorbid conditions. Measurements: Multidimensional clinical assessment included the severity of FP (standing occiput-to-wall distance) demographic (age) and anthropometric (height, weight) data, clinical profile (number of falls, pain assessment, Mini-Mental State Examination, Comorbidity Severity Index, Geriatric Depression Scale, Multidimensional Fatigue Inventory), measures of skeletal fragility (number of vertebral fractures by spine radiograph, bone mineral density (BMD), and T-score of lumbar spine and proximal femur), muscular impairment assessment (muscle strength and length), motor performance (Short Physical Performance Battery, Performance Oriented Mobility Assessment, instrumented gait analysis), and evaluation of disability (Barthel Index, Nottingham Extended Activities of Daily Living Index). Results: The severity of FP was classified as mild in 11, moderate in 28, and severe in 21 patients. Although there were no differences between FP groups on the skeletal fragility measurements, the moderate and severe FP groups were significantly different from the mild FP group for greater pain at the level of the cervical and lumbar spine. The severe FP group was also significantly different from the mild but not the moderate FP group in the following categories: clinical profile (greater depression, reduced motivation), muscle impairment (weaker spine extensor, ankle plantarflexor, and dorsiflexor muscles; shorter pectoralis and hip flexor muscles), the motor function performance-based tests (lower scores in the balance and gait subsets of the Performance Oriented Mobility Assessment), the instrumented gait analysis (slower and wider base of support), and disability (lower score on the Nottingham Extended Activities of Daily Living Index). The total number of vertebral fractures was not associated with differences in severity of FP, demographic and anthropometric characteristics, clinical profile, muscular function, performance-based and instrumental measures of motor function, and disability, but it was associated with reduced proximal femur and lumbar spine BMD. Conclusion: The severity of FP in elderly female patients (without apparent comorbid conditions) is related to the severity of vertebral pain, emotional status, muscular impairments, and motor function but not to osteoporosis, and FP has a measurable effect on disability. In contrast, the presence of vertebral fractures in patients with FP is associated with lower BMD but not patients' clinical and functional status. Therefore, FP, back pain, and mobility problems can occur without osteoporosis. Older women with FP and vertebral pain may be candidates for rehabilitation interventions that address muscular impairments, posture, and behavior modification. Randomized controlled trials are needed to support these conclusions. [source]

Cognitive, Linguistic and Adaptive Functioning in Williams Syndrome: Trajectories from Early to Middle Adulthood

JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 4 2010
Patricia Howlin
Background, Little is known about trajectories of cognitive functioning as individuals with Williams syndrome (WS) move though adulthood. Method, The present study investigated cognitive, linguistic and adaptive functioning in adults with WS aged 19,55 years, using both cross-sectional and longitudinal approaches. Results, Data from the cross-sectional study (n = 92; mean age = 32 years) indicated that IQ was comparable across age groups (Full-Scale IQ mean = 56,57) with Verbal IQ being slightly higher than Performance IQ. Daily Living Skills (as measured by the Vineland Adaptive Behavior Scales) were significantly higher in older individuals. Language abilities showed no consistent age-related differences. On formal tests of language, comprehension scores were higher than expressive language scores for almost all individuals, although this pattern was not replicated on the Vineland. In the longitudinal study, a follow-up of 47 individuals (mean age = 37 years) first assessed 12 years previously, similar trajectories were found. IQ remained very stable (FSIQ = 61,62 at both time points); there were significant improvements on the Social and Daily Living domains of the Vineland and significant decreases in Maladaptive scores. There were no improvements in language over time. Conclusions, The data indicate that adults with WS (at least up to the age of 50 years) show no evidence of deterioration in cognitive skills. Adaptive abilities continue to develop although language shows relatively little improvement with time. [source]

Daily and hourly movement of male desert-dwelling elephants

AFRICAN JOURNAL OF ECOLOGY, Issue 1 2010
Keith Leggett
Abstract The daily and hourly movements of eight male desert-dwelling elephants of various ages (12,45 years old) were determined hourly by global positioning system (GPS)/telemetry collars during the wet, cold dry and hot dry seasons of 2006 in northwest Namibia. The average daily movement in the wet season was greater than that observed during either the cold dry or the hot dry seasons. A similar difference was also observed for the movement rates, with the highest average rate of hourly movement recorded during the wet season. The diurnal movements (both distance and rate) were greater than those in the nocturnal hours during the wet season, whilst during the cold dry and hot dry season the reverse was true. The daily cycle of movement also changed seasonally, with greatest movement rates observed during the wet season between 11.00,20.00 hours, during the cold dry season between 14.00,21.00 hours; and between 04.00,11.00 hours during the hot dry season. Periods of decreased movement rates were observed between 09.00,10.00 and 02.00,03.00 hours in the wet season; 03.00,06.00 and 11.00,13.00 hours in the cold dry season; and 01.00,03.00 and 12.00,14.00 hours during the hot dry season. Résumé On a suivi heure par heure les déplacements quotidiens de huit éléphants du désert mâles, d'âge divers (12 à 45 ans), grâce à des colliers GPS (système de positionnement mondial) et télémétriques, au cours des saisons des pluies, sèche chaude et sèche froide de 2006, dans le nord-ouest de la Namibie. Le déplacement quotidien moyen durant la saison des pluies était supérieur à ceux observés en saison sèche froide ou en saison sèche chaude. Une différence semblable fut aussi observée pour le taux de déplacement, le taux moyen le plus élevé par l'heure étant enregistré pendant la saison des pluies. Les mouvements diurnes (aussi bien leur distance que leur rythme) étaient plus grands que les mouvements nocturnes en saison des pluies, alors que pendant la saison sèche froide et la saison sèche chaude, c'était l'inverse. Le cycle quotidien des déplacements changeait aussi avec les saisons, le rythme étant plus élevé en saison des pluies entre 11h00 et 20h00; en saison sèche froide entre 14h00 et 21h00; et en saison sèche chaude entre 04h00 et 11h00. On a observé des périodes de rythme ralenti entre 21h00 et 04h00 en saison des pluies; entre 03h00 et 05h00 et entre 11h00 et 13h00 en saison sèche froide; et entre 01h00 et 03h00 et entre 12h00 et 14h00 en saison sèche chaude. [source]

TCT Daily: ABSORB: Bioabsorbable Coronary Stents Successfully and Safely Deployed

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2007
Article first published online: 30 JAN 200
No abstract is available for this article. [source]

Oral health care status of homebound elderly in Japan

JOURNAL OF ORAL REHABILITATION, Issue 8 2001
Masayuki Morishita
We examined the present conditions of oral health care in order to contribute towards an effective system to provide oral health care for homebound elderly in Japan. A questionnaire was mailed to homebound elderly subjects (n=908) and returned by mail. A 73·6% response was achieved. The questionnaire was designed to elicit information with respect to the general condition of the subjects and independence of oral health care. About 70% of the subjects were chair- or bed-bound. Among all subjects, 37·6% required partial or full assistance on toothbrushing, 55·6% on cleaning dentures and 46·7% on eating. The degree of oral health care tended to be poor for chair- or bed-bound elderly compared with independent or house-bound elderly. Homebound elderly with lower Activities of Daily Living Scale (ADL) required more support for oral health care compared with elderly with higher ADL. [source]

Relationship between Oral Health-Related Quality of Life, Satisfaction, and Personality in Patients with Prosthetic Rehabilitations

JOURNAL OF PROSTHODONTICS, Issue 1 2010
FDS RCS (England), Jordanian Board, Mahmoud K. AL-Omiri BDS
Abstract Purpose: This study investigated the relationship between oral health-related quality of life, satisfaction with dentition, and personality profiles among patients with fixed and/or removable prosthetic rehabilitations. Materials and Methods: Thirty-seven patients (13 males, 24 females; mean age 37.6 ± 13.3 years) with fitted prosthetic rehabilitations and 37 controls who matched the patients by age and gender were recruited into the study. The Dental Impact on Daily Living (DIDL) questionnaire was used to assess dental impacts on daily living and satisfaction with the dentition. The Oral Health Impact Profile (OHIP) was used to measure self-reported discomfort, disability, and dysfunction caused by oral conditions. Oral health-related quality of life was assessed by the United Kingdom Oral Health-Related Quality of Life (OHQoL-UK) measure. Moreover, the NEO five-factor inventory was used to assess participants' personality profiles. Results: Prosthetic factors had no relationship to the DIDL, OHIP, and OHQoL-UK scores. Patients with the least oral health impacts had better oral health-related quality of life (p= 0.023, r =,0.37), higher levels of total satisfaction, and satisfaction with appearance, pain, oral comfort, general performance, and eating (p < 0.05, r =,0.79, ,0.35, ,0.59, ,0.56, ,0.58, and ,0.50, respectively). Patients with better oral health-related quality of life (QoL) had higher total satisfaction, satisfaction with oral comfort, general performance, and eating (p < 0.05, r = 0.34, 0.39, 0.33, and 0.37, respectively). Patients with lower neuroticism scores had less oral health impact (p= 0.006, r = 0.44), better oral health-related QoL (p= 0.032, r =,0.35), higher total satisfaction, satisfaction with appearance, pain, oral comfort, and eating (p < 0.05, r =,0.58, ,0.35, ,0.33, ,0.39, and ,0.35, respectively). Conclusion: Patients' satisfaction with their dentition and prosthetic rehabilitations has positive effects on oral health-related QoL and oral health impacts and improves patients' daily living and dental perceptions. Neuroticism might influence and predict patients' satisfaction with their dentition, oral health impacts, and oral health-related QoL. Satisfaction with the dentition might predict a patient's level of neuroticism. [source]