Frailty in Older Adults with Heart Failure.

Frailty is prevalent in older adults with heart failure (HF), which increases their risk for basic and instrumental activities of daily living (ADL/IADL) disability and a diminished quality of life (QOL). However, the issue of conceptualizing frailty remains unresolved. To date, the two predominant frailty models are the Fried model, which defines frailty as purely physical, and the Gobben model, which defines frailty as multi-domain with physical, psychological, and social domains. An integrative literature review of frailty components in existing frailty measures was conducted. The most commonly used frailty components were mobility and balance, nutrition, and cognitive function. Next, a cross-sectional, secondary data analysis was conducted using data from the Health and Retirement Study (HRS) to compare the capacity of the Fried model and the Gobbens model to predict ADL/IADL disability and QOL. Compared to the Fried physical frailty model, the inclusion of psychological components from the Gobbens model significantly increased the power to predict ADL/IADL disability, while the psychological and social components from the Gobbens’ model significantly increased the ability to predict QOL. These findings support the view that frailty is a multidimensional syndrome with three domains (physical, psychological, and social). The levels of the three frailty domains were then compared, and older adults with HF were found to have higher levels of frailty across all three domains compared to older adults without HF. Lastly, a longitudinal examination of multidimensional frailty in older adults with HF was conducted, using HRS data collected at two time-points (2006/2008 to 2010/2012) from two cohorts. Across the two time-points, older adults with HF had higher levels of frailty across all three domains compared to older adults without HF. All HF and three frailty domains were associated with increased risks of ADL/IADL disability and decreased QOL. Each frailty domain mediated the relationship between HF and outcomes (ADL/IADL disability and QOL). The findings in this dissertation support frailty as a multidimensional syndrome. These findings have implications for the development of tailored, broad-based intervention aimed at preventing frailty or delaying its onset to reduce adverse outcomes of ADL/IADL disability and decreased QOL.PhDNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/113571/1/xieboqin_1.pd

PSR J1926-0652: A Pulsar with Interesting Emission Properties Discovered at FAST

We describe PSR J1926-0652, a pulsar recently discovered with the Five-hundred-meter Aperture Spherical radio Telescope (FAST). Using sensitive single-pulse detections from FAST and long-term timing observations from the Parkes 64-m radio telescope, we probed phenomena on both long and short time scales. The FAST observations covered a wide frequency range from 270 to 800 MHz, enabling individual pulses to be studied in detail. The pulsar exhibits at least four profile components, short-term nulling lasting from 4 to 450 pulses, complex subpulse drifting behaviours and intermittency on scales of tens of minutes. While the average band spacing P3 is relatively constant across different bursts and components, significant variations in the separation of adjacent bands are seen, especially near the beginning and end of a burst. Band shapes and slopes are quite variable, especially for the trailing components and for the shorter bursts. We show that for each burst the last detectable pulse prior to emission ceasing has different properties compared to other pulses. These complexities pose challenges for the classic carousel-type models.Comment: 13pages with 12 figure

Nursing teamwork and time to respond to call lights: an exploratory study

AIM: The aim of this exploratory study was to determine whether the level of nursing teamwork is correlated to call light answering time in acute care hospital patient care units. Background: Teamwork has been shown to improve productivity. In this study, we examine the relationship between unit call light response time as a measure of productivity and the level of teamwork on the unit. METHOD: The Nursing Teamwork Survey was administered to nursing staff on 18 inpatient units in 3 hospitals. In addition to the overall teamwork score, the NTS has 5 subscales. Call light response times were collected from electronic systems which measures the time it takes for nursing staff on a given unit to respond to patient call lights. RESULTS: There was no significant relationship between call light response time and teamwork overall or on the five subscales. Shared mental models, which comprise the conceptual understanding of the roles and responsibilities of each team member, however was moderately correlated with call-light answering times. CONCLUSIONS: It is logical that shared mental models would be associated with call light response time since a common problem in patient units is the "it's not my job syndrome" where nursing staff do not answer call lights for patients assigned to someone else. More research with a larger number of patient units is needed to validate these findings

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

SOCIAL COHESION AFFECTS THE ASSOCIATION BETWEEN FRAILTY AND DISABILITY IN COMMUNITY-DWELLING OLDER ADULTS

Abstract The relationships between physical frailty and perceived neighborhood social cohesion (PNSC) and functional disability among community-dwelling older adults are poorly understood. This study aims to (1) examine the associations of frailty and PNSC with disability; and (2) evaluate low PNSC as a risk factor in the association between frailty and disability. A sample of 1645 older adults using multi-stage sampling method in Shanghai were randomly selected in this cross-sectional study. Frailty operationalized as Cardiovascular Health Study criteria (OR=2.4, 95%CI 1.16-4.96 for pre-frailty; OR=7.28, 95%CI 3.37-15.73 for frailty) and PNSC measured as Neighborhood Cohesion Scale (OR=1.81, 95%CI 1.23-2.67) were independently associated with basic and instrumental activities of daily living disability. A significant interaction of frailty and PNSC on disability (F (2, 66)=4.31, P=.014) was found, using a two-way analysis of covariance (ANCOVA). Compared to robust individuals with high PNSC, pre-frailty with high PNSC was not significantly associated with disability while pre-frailty with low PNSC was associated with approximate 4-fold increased prevalence of disability (OR=3.87, 95%CI 1.46-10.24, p=.006). Frailty with high PNSC was associated with higher likelihood of disability (OR=6.47, 95%CI 2.35-17.87) and frail individuals with low PNSC stood out with 10-fold increased prevalence of disability (OR=9.94, 95%CI 3.50-28.26). All analyses were controlled for demographical and clinical covariates. Our results suggest high level of social cohesion serves as a buffer against the impact of physical frailty on functional disability. These findings notably imply to the development of interventions for older frail adults from the neighborhood perspective.</jats:p

Association of Grip Strength with Quality of Life in the Chinese Oldest Old

Emerging studies have suggested an association between grip strength and health-related quality of life (QOL). However, evidence for which specific domains of QOL are associated with grip strength remains limited and inconsistent. Particularly, such evidence is scarce in the oldest old, who constitute one of the most vulnerable populations. This cross-sectional study aimed to examine the association between grip strength and overall QOL as well as specific domains in the oldest old. It included 400 community-dwelling older adults aged 80 years or older from Shanghai, China. QOL was assessed using the WHO Quality of Life of Older Adults instrument, and grip strength was measured using a digital spring-type dynamometer. On average, the overall QOL score was 54.68 (SD = 12.05). Estimates of risk-adjusted linear regressions indicated that higher grip strength was associated with better overall QOL (β = 4.40, p &lt; 0.001) as well as the domains of autonomy (β = 6.74, p &lt; 0.001); fulfillment with past, present, and future activities and achievements (β = 3.52, p = 0.004); and satisfaction with social participation (β = 6.72, p &lt; 0.001). Our findings highlight the importance of maintaining or improving grip strength in delaying or reducing the decline in QOL among the community-dwelling oldest old. Also noteworthy is that the associations between grip strength and specific domains of QOL in the oldest old vary.</jats:p