Psychometric properties of multicomponent tools designed to assess frailty in older adults: a systematic review

Background Frailty is widely recognised as a distinct multifactorial clinical syndrome that implies vulnerability. The links between frailty and adverse outcomes such as death and institutionalisation have been widely evidenced. There is currently no gold standard frailty assessment tool; optimizing the assessment of frailty in older people therefore remains a research priority. The objective of this systematic review is to identify existing multi-component frailty assessment tools that were specifically developed to assess frailty in adults aged ≥60 years old and to systematically and critically evaluate the reliability and validity of these tools. Methods A systematic literature review was conducted using the standardised COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) checklist to assess the methodological quality of included studies. Results Five thousand sixty-three studies were identified in total: 73 of which were included for review. 38 multi-component frailty assessment tools were identified: Reliability and validity data were available for 21 % (8/38) of tools. Only 5 % (2/38) of the frailty assessment tools had evidence of reliability and validity that was within statistically significant parameters and of fair-excellent methodological quality (the Frailty Index-Comprehensive Geriatric Assessment [FI-CGA] and the Tilburg Frailty Indicator [TFI]). Conclusions The TFI has the most robust evidence of reliability and validity and has been the most extensively examined in terms of psychometric properties. However, there is insufficient evidence at present to determine the best tool for use in research and clinical practice. Further in-depth evaluation of the psychometric properties of these tools is required before they can fulfil the criteria for a gold standard assessment tool

Polarization forces in water deduced from single molecule data

Intermolecular polarization interactions in water are determined using a minimal atomic multipole model constructed with distributed polarizabilities. Hydrogen bonding and other properties of water-water interactions are reproduced to fine detail by only three multipoles $\mu_H$, $\mu_O$, and $\theta_O$ and two polarizabilities $\alpha_O$ and $\alpha_H$, which characterize a single water molecule and are deduced from single molecule data.Comment: 4 revtex pages, 3 embedded color PS figure

Putting evolutionary biology back in the ecological theatre: a demographic framework mapping genes to communities

Question: How can we link genotypic, phenotypic, individual, population, and community levels of organization so as to illuminate general ecological and evolutionary processes and provide a framework for a quantitative, integrative evolutionary biology? Framework: We introduce an evolutionary framework that maps different levels of biological diversity onto one another. We provide (1) an overview of maps linking levels of biological organization and (2) a guideline of how to analyse the complexity of relationships from genes to population growth. Method: We specify the appropriate levels of biological organization for responses to selection, for opportunities for selection, and for selection itself. We map between them and embed these maps into an ecological setting

The Doppler Peaks from Cosmic Texture

We compute the angular power spectrum of temperature anisotropies on the microwave sky in the cosmic texture theory, with standard recombination assumed. The spectrum shows `Doppler' peaks analogous to those in scenarios based on primordial adiabatic fluctuations such as `standard CDM', but at quite different angular scales. There appear to be excellent prospects for using this as a discriminant between inflationary and cosmic defect theories.Comment: 14 pages, latex, 3 figures, compressed and uuencoded, replaced version has minor typographical correction

A qualitative investigation of the impact of peer to peer online support for women living with Polycystic Ovary Syndrome

Background: Polycystic Ovary Syndrome is a common, chronic condition which affects women living with the condition both physically and psychologically. Social support may be beneficial to sufferers in coping with chronic conditions and the Internet is becoming a common place for accessing social support and information. The aim of this study was to consider the experiences of women living with Polycystic Ovary Syndrome who access and participate in an online support group discussion forum dedicated to issues surrounding this condition. Methods: Fifty participants responded to a series of open-ended questions via an online survey. Results: Thematic analysis revealed a number of empowering and disempowering experiences associated with online support group participation. The empowering processes reported by members of the group included: Connecting with others who understand; Access to information and advice; Interaction with healthcare professionals; Treatment-related decision making; Improved adjustment and management. In terms disempowering processes, only two were described by group participants: Reading about the negative experiences of others and Feeling like an outsider. Conclusions: For women living with Polycystic Ovary Syndrome, participation within an online support group may help to empower them in a range of important ways however, there may be some disempowering consequences

Large Angular Scale CMB Anisotropy Induced by Cosmic Strings

We simulate the anisotropy in the cosmic microwave background (CMB) induced by cosmic strings. By numerically evolving a network of cosmic strings we generate full-sky CMB temperature anisotropy maps. Based on $192$ maps, we compute the anisotropy power spectrum for multipole moments $\ell \le 20$. By comparing with the observed temperature anisotropy, we set the normalization for the cosmic string mass-per-unit-length $\mu$, obtaining $G\mu/c^2=1.05 {}^{+0.35}_{-0.20} \times10^{-6}$, which is consistent with all other observational constraints on cosmic strings. We demonstrate that the anisotropy pattern is consistent with a Gaussian random field on large angular scales.Comment: 4 pages, RevTeX, two postscript files, also available at http://www.damtp.cam.ac.uk/user/defects/ to appear in Physical Review Letters, 23 September 199

Evolution of emission line activity in intermediate mass young stars

We present optical spectra of 45 intermediate mass Herbig Ae/Be stars. Together with the multi-epoch spectroscopic and photometric data compiled for a large sample of these stars and ages estimated for individual stars by using pre-main sequence evolutionary tracks, we have studied the evolution of emission line activity in them. We find that, on average, the H_alpha emission line strength decreases with increasing stellar age in HAeBe stars, indicating that the accretion activity gradually declines during the PMS phase. This would hint at a relatively long-lived (a few Myr) process being responsible for the cessation of accretion in Herbig Ae/Be stars. We also find that the accretion activity in these stars drops substantially by ~ 3 Myr. This is comparable to the timescale in which most intermediate mass stars are thought to lose their inner disks, suggesting that inner disks in intermediate mass stars are dissipated rapidly after the accretion activity has fallen below a certain level. We, further find a relatively tight correlation between strength of the emission line and near-infrared excess due to inner disks in HAeBe stars, indicating that the disks around Herbig Ae/Be stars cannot be entirely passive. We suggest that this correlation can be understood within the frame work of the puffed-up inner rim disk models if the radiation from the accretion shock is also responsible for the disk heating.Comment: 39 pages, accepted for publication in Ap

Using Online Support Communities for Tourette Syndrome and Tic Disorders: Online Survey of Users' Experiences

Background:People living with a tic disorder – such as Tourette syndrome (TS) – experience many negative psychological and social challenges arising from chronic tics, such as stigmatisation from peers and poorer quality of life, and these can impact upon their families too. It can be difficult for this population to access face-to-face support for tics, and so online support communities offer one avenue for support from peers facing similar experiences. However little is known about how online support communities may be used by people with TS and other tic disorders, and by others (e.g. parents, caregivers) supporting a person with TS/tic disorder.Objective:The present study aimed to explore users’ experiences of participation in online support communities for TS and tic disorders.Methods:In total, 90 respondents (aged 13-62 yrs; 62% female) from 13 countries completed an online survey exploring their experiences of using online support communities for TS and tic disorders. Respondents were people living with TS/tic disorder themselves (n=68), and/or supportive others of someone with TS/tic disorder (e.g. parent, sibling, spouse; n=22). The online survey contained open-ended questions eliciting their self-reported motivations for using online communities, their benefits and drawbacks of participation, and whether online support communities affected offline management of tics. Responses were analysed using thematic analysis.Results:Seven overarching themes captured experiences of using online support communities for TS/tic disorders. The overwhelming reason for their use was to find accessible support due to a lack of offline face-to-face support. Online support communities were valued sources of informational and emotional support, and also had a positive impact upon helping users’ psychological wellbeing. Online communities helped provided a space where people with TS/tic disorders could feel accepted and reduce the social isolation they felt offline. The suggestible nature of tics and being reminded of the challenging nature of tic disorders were main disadvantages arising from using online support communities, alongside conflict arising within online communities.Conclusions:The findings suggest that online support communities appear offer valuable informational and emotional support to those living with TS/tic disorder and their families too, especially given the lack of locally-available support. This facilitates a sense of community online, which can help users in overcoming longstanding social isolation and aid self-reported improvements in psychosocial wellbeing. Users reported some drawbacks in engaging with online support communities, such as conflict between different types of users and triggering content, which negatively affected experiences of community participation

Cosmic Strings in an Open Universe with Baryonic and Non-Baryonic Dark Matter

We study the effects of cosmic strings on structure formation in open universes. We calculate the power spectrum of density perturbations for two class of models: one in which all the dark matter is non baryonic (CDM) and one in which it is all baryonic (BDM). Our results are compared to the 1 in 6 IRAS QDOT power spectrum. The best candidates are then used to estimate $\mu$, the energy per unit length of the string network. Some comments are made on mechanisms by which structures are formed in the two theories.Comment: uu-encoded compressed tar of postscript files, Imperial/TP/94-95/0