Board Characteristics and Capital Structure in Malaysian Market

Using fifty nine construction companies listed in Bursa Malaysia in 2010, this study investigates the impact of selected board of directors' characteristics on the level of leverage in a firm. Debt to equity is used as a measure of leverage. The characteristics on the board of directors that we examine are board size, CEO duality, directors' ownership, and ethnicity of directors. We employ two variables (profitability, and firm size) to control the relationships: Findings show a significant interpretation of capital structure decision by these factors as a whole. Specifically, the outputs of the regression that we run show negative and significant relationships between director ownership, ethnicity of directors, and profitability of firm, and size of firm. While we find that duality role of the CEO as a chairman has a negative but insignificant relationship with leverage, our sample shows that the companies which had CEO duality are few compared to those which had separated roles between a CEO and a chairman. However, there is a positive and significant correlation between debt level in the companies and size of board of director

Disentangling the relationship between falls, fear of falling, physical function and walking by applying a socioecological framework to the International Mobility in Aging Study

Introduction:The relationships between falls, fear of falling, poor mobility, and PA avoidance occur in a cyclic, multi-directional fashion. Aim: This study investigates the concomitant associations of fall history, fear of falling, and physical performance (SPPB) on physical activity using a cross-national sample of community-dwelling older adults from middle and high-income countries.Methods:Linear mixed-effects models looking at the influence of individual and environmental factors were used and participants were nested within each study site.Results:Estimated walking minutes was 52% lower for those with low SPPB compared to high SPPB, 20% lower for those with medium level fear of falling compared to low levels, and 50% lower for those with high level fear of falling compared to low levels.Conclusion:An individual’s fear of falling and physical performance may be important to consider when making PA recommendations to older adults regardless of sex, age, and environment

Childhood adversity and leisure time physical and sports activity in older adults: A cross-sectional analysis from the International Mobility in Aging Study

Aim: The purpose is to examine the relationship between childhood adversity and leisure time physical activity (LTPA) among community-dwelling older adults from high and middle-income sites. Methods: Cross-sectional analysis of 2012 data from older adult ages 64-75 years old from King-ston, Canada; St. Hyacinthe, Canada; Tirana, Albania; Manizales, Colombia; and Natal, Brazil. Principal exposure variables were childhood social and economic adversity. Covariates included participant age, sex, income, and educational attainment. Outcome variables were LTPA and lei-sure time sports activity (LTSA). Results: High-income sites had higher LTPA prevalence than middle-income sites. Females were less likely to engage in LTPA compared to males in Tirana (OR:0.53, 95%CI:0.30-0.94), but were more likely to engage in LTPA in Manizales (OR:2.54, 95%CI:1.54-4.18). Low education was less likely than high education to engage in LTPA in Kingston (OR:0.38, 95%CI:0.19-0.73) and Natal (OR: 0.52, 95%CI:0.28-0.97). Low income was less likely than high income to engage in LTPA in St. Hyacinthe (OR: 0.42, 95%CI:0.20-0.89) and Manizales (OR:0.33, 95%CI:0.16-0.55). In Tirana, low income was more likely than high income to engage in LTPA (OR:5.27, 95%CI:2.06-13.51). Conclusions: Childhood economic and social adversity were not significantly associated with LTPA. Sex, income, and education were associated with older adult PA engagement, however the direction of the association varied by site location. This suggests that the paradigms surrounding PA behavior may vary from city to city. Understanding the site-specific risk factors to PA engage-ment may better inform clinical recommendations and public health approaches to increase PA engagement among older adults across the globe

Respiratory syncytial virus infection in Fischer 344 rats is attenuated by short interfering RNA against the RSV-NS1 gene

BACKGROUND: Respiratory syncytial virus (RSV) causes severe bronchiolitis and is a risk factor for asthma. Since there is no commercially available vaccine against RSV, a short interfering RNA against the RSV-NS1gene (siNS1) was developed and its potential for decreasing RSV infection and infection-associated inflammation in rats was tested. METHODS: Plasmids encoding siNS1 or an unrelated siRNA were complexed with a chitosan nanoparticle delivery agent and administered intranasally. Control animals received a plasmid for a non-specific siRNA. After expression of the plasmid in lung cells for 24 hours, the rats were intranasally infected with RSV. RESULTS: Prophylaxis with siNS1 significantly reduced lung RSV titers and airway hyperreactivity to methacholine challenge compared to the control group. Lung sections from siNS1-treated rats showed a sizable reduction in goblet cell hyperplasia and in lung infiltration by inflammatory cells, both characteristics of asthma. Also, bronchoalveolar lavage samples from siNS1-treated animals had fewer eosinophils. Treatment of rats with siNS1 prior to RSV exposure was effective in reducing virus titers in the lung and in preventing the inflammation and airway hyperresponsiveness associated with the infection that has been linked to development of asthma. CONCLUSION: The use of siNS1 prophylaxis may be an effective method for preventing RSV bronchiolitis and potentially reducing the later development of asthma associated with severe respiratory infections

Trajectories of frailty with aging:Coordinated analysis of five longitudinal studies

BACKGROUND AND OBJECTIVES: There is an urgent need to better understand frailty and its predisposing factors. Although numerous cross-sectional studies have identified various risk and protective factors of frailty, there is a limited understanding of longitudinal frailty progression. Furthermore, discrepancies in the methodologies of these studies hamper comparability of results. Here, we use a coordinated analytical approach in 5 independent cohorts to evaluate longitudinal trajectories of frailty and the effect of 3 previously identified critical risk factors: sex, age, and education. RESEARCH DESIGN AND METHODS: We derived a frailty index (FI) for 5 cohorts based on the accumulation of deficits approach. Four linear and quadratic growth curve models were fit in each cohort independently. Models were adjusted for sex/gender, age, years of education, and a sex/gender-by-age interaction term. RESULTS: Models describing linear progression of frailty best fit the data. Annual increases in FI ranged from 0.002 in the Invecchiare in Chianti cohort to 0.009 in the Longitudinal Aging Study Amsterdam (LASA). Women had consistently higher levels of frailty than men in all cohorts, ranging from an increase in the mean FI in women from 0.014 in the Health and Retirement Study cohort to 0.046 in the LASA cohort. However, the associations between sex/gender and rate of frailty progression were mixed. There was significant heterogeneity in within-person trajectories of frailty about the mean curves. DISCUSSION AND IMPLICATIONS: Our findings of linear longitudinal increases in frailty highlight important avenues for future research. Specifically, we encourage further research to identify potential effect modifiers or groups that would benefit from targeted or personalized interventions

Contributions of the MyD88-Dependent Receptors IL-18R, IL-1R, and TLR9 to Host Defenses following Pulmonary Challenge with Cryptococcus neoformans

Signaling via the adapter protein, MyD88, is important in the host defense against Cryptococcus neoformans infection. While certain Toll-like receptors (TLRs) can enhance the clearance of Cryptococcus, the contributions of MyD88-dependent, TLR-independent pathways have not been fully investigated. We examined the roles of IL-1R and IL-18R in vivo by challenging C57BL/6 mice with a lethal strain of Cryptococcus. We found that the absence of IL-18R, but not IL-1R, causes a shift in the survival curve following pulmonary delivery of a virulent strain of C. neoformans (H99). Specifically, IL-18R-deficient mice have significantly shorter median survival times compared to wild-type mice following infection. Cytokine analysis of lung homogenates revealed that deficiency of IL-IR, IL-18R, or MyD88 is associated with diminished lung levels of IL-1β. In order to compare these findings with those related to TLR-deficiency, we studied the effects of TLR9-deficiency and found that deficiency of TLR9 also affects the survival curve of mice following challenge with C. neoformans. Yet the lungs from infected TLR9-deficient mice have robust levels of IL-1β. In summary, we found that multiple signaling components can contribute the MyD88-dependent host responses to cryptococcal infection in vivo and each drives distinct pulmonary responses

Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR): study protocol for a phase II randomised feasibility study of a multidisciplinary rehabilitation package following hip fracture

Objective: To conduct a rigorous feasibility study for a future definitive parallel-group randomised controlled trial (RCT) and economic evaluation of an enhanced rehabilitation package for hip fracture.Setting: Recruitment from 3 acute hospitals in North Wales. Intervention delivery in the community.Participants: Older adults (aged ≥65) who received surgical treatment for hip fracture, lived independently prior to fracture, had mental capacity (assessed by clinical team) and received rehabilitation in the North Wales area.Intervention: Remote randomisation to usual care (control) or usual care+enhanced rehabilitation package (intervention), including six additional home-based physiotherapy sessions delivered by a physiotherapist or technical instructor, novel information workbook and goal-setting diary.Primary and secondary outcome measures: Primary: Barthel Activities of Daily Living (BADL). Secondary measures included Nottingham Extended Activities of Daily Living scale (NEADL), EQ-5D, ICECAP capability, a suite of self-efficacy, psychosocial and service-use measures and costs. Outcome measures were assessed at baseline and 3-month follow-up by blinded researchers.Results: 62 participants were recruited, 61 randomised (control 32; intervention 29) and 49 (79%) completed 3-month follow-up. Minimal differences occurred between the 2 groups for most outcomes, including BADL (adjusted mean difference 0.5). The intervention group showed a medium-sized improvement in the NEADL relative to the control group, with an adjusted mean difference between groups of 3.0 (Cohen's d 0.63), and a trend for greater improvement in self-efficacy and mental health, but with small effect sizes. The mean cost of delivering the intervention was £231 per patient. There was a small relative improvement in quality-adjusted life year in the intervention group. No serious adverse events relating to the intervention were reported.Conclusions: The trial methods were feasible in terms of eligibility, recruitment and retention. The effectiveness and cost-effectiveness of the rehabilitation package should be tested in a phase III RCT

Hip fracture rehabilitation: where are we now and where are we going?

Hip fracture is a major public health problem in many developed nations. An estimated 30,000 hip fractures occur each year in Canada. To initiate adequate preventive measures, a thorough understanding of hip fracture patients' characteristics and the healthcare services they receive over the continuum of care is warranted. The global objective of this thesis is to contribute to our knowledge base concerning current and future needs, gaps, and solutions to provide optimal care for people with hip fractures.The first part describes the recovery process of patients with hip fractures and its definition. A post acute cohort was followed up to a one year after fracture and the patients' course of recovery was characterized using two methods to define recovery. This study demonstrated that the degree and time course of functional recovery after hip fracture varied on the basis of definition and the pre-fracture functional status. Despite the initial improvement, the functional status of the patients declined following cessation of rehabilitation services.Studying hip fracture patients' care and recovery at a single site over a limited time led to investigating the characteristics of the broader hip fracture population in the province of Quebec. What do we know about hip fracture trends, changes in health profile, and what might this information mean for the future? This guided the author to use an administrative database (Med-Echo) to answer these questions. The results confirmed the hypothesis that the hip fracture population is becoming frailer, which will increase the resources needed, and that the population's health profile differed on the basis of age and sex.The inside-hospital mortality rate and the proportion of patients who are discharged to rehabilitation after fracture are declining over time; consequently, increases the demand on community services. Finding the gaps and describing the needs is the first step to improve the quality of care, but this is not adequate. Therefore, the last part proposes potential solutions. A systematic review aimed at finding solutions to the previously identified gaps, specifically, the fact that hip fracture patients' functional status deteriorates following cessation of rehabilitation and that the need for community rehabilitation services will increase. Therefore, the reported effect in the literature of an extended exercise rehabilitation program was reviewed and quantified. This meta-analysis is the first to show that a clinically significant functional improvement can be gained later than is usually believed with elderly hip fracture patients. Such an improvement suggests that there is no 'plateau' for recovery. Finally, the methodology to evaluate and create a comprehensive program to serve hip fracture patients over the continuum of care is discussed and a simulated multidisciplinary program is proposed as a model.La fracture de la hanche est un problème de santé publique majeur dans de nombreux pays développés. Environ 30 000 fractures de la hanche surviennent chaque année au Canada. Afin d'initier des mesures préventives adéquates, il est nécessaire d'avoir une compréhension approfondie des caractéristiques des cas de fracture de la hanche et des services que les patients reçoivent dans le continuum des soins. L'objectif global de cette thèse est de contribuer à la base de connaissances des besoins actuels et futurs, des lacunes, et des solutions permettant d'offrir des soins optimaux aux personnes ayant souffert de fracture de la hanche. La première partie définit et décrit le processus de rétablissement des patients ayant subit une fracture de la hanche. Une cohorte post soins aiguës a été suivie pendant un an suivant la fracture et le processus de guérison du patient a été étudié en utilisant deux différentes façons de définir le rétablissement. Cette étude a démontré que le degré et le temps de récupération fonctionnelle après fracture de la hanche varient sur la base de la définition du rétablissement choisie et de l'état fonctionnel avant la fracture. Malgré l'amélioration initiale, l'état fonctionnel des patients a diminué suivant l'arrêt des soins de réadaptation. L'étude des soins et du rétablissement des patients ayant une fracture de la hanche dans un seul site pendant un temps limité a mené à examen des caractéristiques de la population souffrant d'une fracture de la hanche dans la province de Québec. Que savons-nous sur les tendances des fractures de la hanche, sur les changements dans le profil de la santé, et qu'est-ce que cette information pourrait signifier pour l'avenir? Ceci a conduit l'auteur à utiliser une base de données administrative (Med-Echo) pour répondre à ces questions. Les résultats ont confirmé l'hypothèse selon laquelle la population de patients ayant une fracture de la hanche devient de plus en plus fragile, ce qui nécessitera une augmentation des ressources. De plus, le profil de santé de cette population comparée à celle la population générale diffère sur les critères de l'âge et du sexe.Le taux de mortalité pendant l'hospitalisation suivant une fracture de hanche est en déclin ainsi que la proportion des patients envoyés en réadaptation à leur congé. Cela a comme conséquence d'augmenter de la demande de services en communauté. Rechercher les lacunes et décrire les besoins constituent une première étape vers l'amélioration de la qualité des soins, mais elle demeure insuffisante. Le but de la dernière partie est de proposer des solutions potentielles. Un examen systématique de la littérature a été mené dans le but de trouver des solutions aux lacunes identifiées précédemment, en particulier, le fait que l'état fonctionnel des patients ayant subit une fracture de la hanche se détériore après l'arrêt de la réadaptation et la nécessité d'augmenter les services de réadaptation communautaires. L'effet rapporté dans la littérature d'un programme d'exercices de réadaptation prolongée a été examiné et quantifié. Cette méta-analyse est la première à démontrer qu'une amélioration cliniquement significative du fonctionnement peut être acquise plus tard qu'on ne le croyait chez les personnes âgées ayant souffert d'une fracture de la hanche. Une telle amélioration suggère qu'il n'y a pas de «plateau» pour la récupération. Enfin, la méthodologie pour évaluer et créer un programme complet visant à servir les patients suivant une fracture de la hanche au cours du continuum des soins est discutée et un programme de simulation multidisciplinaire est proposé en tant que modèle