Relationships between physical activity across lifetime and health outcomes in older adults: Results from the NuAge cohort

Abstract: Objectives: This study aims to (1) describe participation in four physical activity (PA) domains across life and (2) examine the influence of PA during adolescence, early, mid-life, and later adulthood on health variables at older age. Design: Retrospective, observational, population-based cohort. Setting: Longitudinal study Nutrition as a Determinant of Successful Aging study ParticipantS: 1 378 healthy older adults (667 men; 711 women; aged 67-84 yrs at baseline) Measurements: Using a modified version of the interviewer-administered Lifetime Total Physical Activity Questionnaire (LTPAQ) and life events calendar to facilitate the recall, participants reported the frequency, duration, and intensity of occupational (OPA), commuting (CPA), household (HPA), and leisure time (LTPA) they participated in at the ages of 15, 25, 45, and 65 years and at the first follow-up (aged 68-85 yrs at follow-up). Fat mass, lean body mass, body mass index, waist to hip ratio, fasting glucose, systolic and diastolic blood pressures, self-reported chronic diseases, and socio-demographic were assessed at baseline. Results: Changes in PA differed across sex and PA domain. However, there was a general decline in all PA domains among both sexes after the age of 65. In multiple regression analyses, current LTPA was systematically associated with more favorable waist to hip ratio and fat mass in both sexes, whereas CPA, OPA, and HPA across life were not consistently associated with health variables. Conclusion: PA domains during adolescence, early adulthood, and mid-life were not directly related to health variables at older age, while current LTPA was, suggesting it is never too late to start

Ten essentials for action-oriented and second order energy transitions, transformations and climate change research

The most critical question for climate research is no longer about the problem, but about how to facilitate the transformative changes necessary to avoid catastrophic climate-induced change. Addressing this question, however, will require massive upscaling of research that can rapidly enhance learning about transformations. Ten essentials for guiding action-oriented transformation and energy research are therefore presented, framed in relation to second-order science. They include: (1) Focus on transformations to low-carbon, resilient living; (2) Focus on solution processes; (3) Focus on ‘how to’ practical knowledge; (4) Approach research as occurring from within the system being intervened; (5) Work with normative aspects; (6) Seek to transcend current thinking; (7) Take a multi-faceted approach to understand and shape change; (8) Acknowledge the value of alternative roles of researchers; (9) Encourage second-order experimentation; and (10) Be reflexive. Joint application of the essentials would create highly adaptive, reflexive, collaborative and impact-oriented research able to enhance capacity to respond to the climate challenge. At present, however, the practice of such approaches is limited and constrained by dominance of other approaches. For wider transformations to low carbon living and energy systems to occur, transformations will therefore also be needed in the way in which knowledge is produced and used

Resistance Is Futile: But It Is Slowing the Pace of EHR Adoption Nonetheless

The purpose of this study is to reassess the projected rate of Electronic Health Record (EHR) diffusion and examine how the federal government's efforts to promote the use of EHR technology have influenced physicians' willingness to adopt such systems. The study recreates and extends the analyses conducted by Ford et al.1 The two periods examined come before and after the U.S. Federal Government's concerted activity to promote EHR adoption. Meta-analysis and bass modeling are used to compare EHR diffusion rates for two distinct periods of government activity. Very low levels of government activity to promote EHR diffusion marked the first period, before 2004. In 2004, the President of the United States called for a ?Universal EHR Adoption? by 2014 (10 yrs), creating the major wave of activity and increased awareness of how EHRs will impact physicians' practices. EHR adoption parameters—external and internal coefficients of influence—are estimated using bass diffusion models and future adoption rates are projected. Comparing the EHR adoption rates before and after 2004 (2001–2004 and 2001–2007 respectively) indicate the physicians' resistance to adoption has increased during the second period. Based on current levels of adoption, less than half the physicians working in small practices will have implemented an EHR by 2014 (47.3%). The external forces driving EHR diffusion have grown in importance since 2004 relative to physicians' internal motivation to adopt such systems. Several national forces are likely contributing to the slowing pace of EHR diffusion

Predicting the Adoption of Electronic Health Records by Physicians: When Will Health Care be Paperless?

Objectives: The purpose of this study was threefold. First, we gathered and synthesized the historic literature regarding electronic health record (EHR) adoption rates among physicians in small practices (ten or fewer members). Next, we constructed models to project estimated future EHR adoption trends and timelines. We then determined the likelihood of achieving universal EHR adoption in the near future and articulate how barriers can be overcome in the small and solo practice medical environment. Design: This study used EHR adoption data from six previous surveys of small practices to estimate historic market penetration rates. Applying technology diffusion theory, three future adoption scenarios, optimistic, best estimate, and conservative, are empirically derived. Measurement: EHR adoption parameters, external and internal coefficients of influence, are estimated using Bass diffusion models. Results: All three EHR scenarios display the characteristic diffusion S curve that is indicative that the technology is likely to achieve significant market penetration, given enough time. Under current conditions, EHR adoption will reach its maximum market share in 2024 in the small practice setting. Conclusion: The promise of improved care quality and cost control has prompted a call for universal EHR adoption by 2014. The EHR products now available are unlikely to achieve full diffusion in a critical market segment within the time frame being targeted by policy makers

Donor-Derived Fungal Infections in Organ Transplant Recipients: Guidelines of the American Society of Transplantation, Infectious Diseases Community of Practice†

Donor-derived fungal infections can be associated with serious complications in transplant recipients. Most cases of donor-derived candidiasis have occurred in kidney transplant recipients in whom contaminated preservation fluid is a commonly proposed source. Donors with cryptococcal disease, including those with unrecognized cryptococcal meningoencephalitis may transmit the infection with the allograft. Active histoplasmosis or undiagnosed and presumably asymptomatic infection in the donor that had not resolved by the time of death can result in donor-derived histoplasmosis in the recipient. Potential donors from an endemic area with either active or occult infection can also transmit coccidioidomycosis. Rare instances of aspergillosis and other mycoses, including agents of mucormycosis may also be transmitted from infected donors. Appropriate diagnostic evaluation and prompt initiation of appropriate antifungal therapy are warranted if donor-derived fungal infections are a consideration. This document discusses the characteristics, evaluation and approach to the management of donor-derived fungal infections in organ transplant recipients