The Relationship Between Agency Characteristics and Quality of Home Care

ABSTRACT. Background. This project assessed the relationship between home care quality indicators HCQIs) and agency characteristics. Methods. Twelve agencies completed a mailed survey on a variety of characteristics, including size of their caseload and for-profit (FP) status of contracted service providers. The HCQIs were derived from standardized assessments completed voluntarily for home care clients in Ontario and in Manitoba, Canada. Results. The average caseload was 121.3 clients per case manager, and over 40% of nursing, personal support and therapy providers were considered FP. For individual HCQIs, few correlations were statistically significant. An overall summary measure of quality was correlated with the size of the population served (r = _0.80; p \u3c 0.05) and the number of clients per case manager (r = _0.56; p \u3c 0.1). Conclusion. These data represent unique information on home care quality and organizational characteristics in Canada. The question remains as to how best to use HCQI data to inform practice in an era of limited resources and increasing caseloads

Interleukin 6 plays a role in the migration of magnetically levitated mesenchymal stem cells spheroids

Mesenchymal stem cells (MSCs) reside quiescently within a specialised ‘niche’ environment in the bone marrow. However, following appropriate signalling cues, MSCs mobilise and migrate out from the niche, typically toward either sites of injury (a regenerative response) or toward primary tumours (an intrinsic homing response, which promotes MSCs as cellular vectors for therapeutic delivery). To date, very little is known about MSC mobilisation. By adopting a 3D MSC niche model, whereby MSC spheroids are cultured within a type I collagen gel, recent studies have highlighted interleukin-6 (IL-6) as a key cytokine involved in MSC migration. Herein, the ability of IL-6 to induce MSC migration was further investigated, and the key matrix metalloproteinases used to effect cell mobilisation were identified. Briefly, the impact of IL-6 on the MSC migration in a two-dimensional model systems was characterised—both visually using an Ibidi chemotaxis plate array (assessing for directional migration) and then via a standard 2D monolayer experiment, where cultured cells were challenged with IL-6 and extracted media tested using an Abcam Human MMP membrane antibody array. The 2D assay displayed a strong migratory response toward IL-6 and analysis of the membrane arrays data showed significant increases of several key MMPs. Both data sets indicated that IL-6 is important in MSC mobilisation and migration. We also investigated the impact of IL-6 induction on MSCs in 3D spheroid culture, serving as a simplistic model of the bone marrow niche, characterised by fluorescently tagged magnetic nanoparticles and identical membrane antibody arrays. An increase in MMP levels secreted by cells treated with 1 ng/mL IL-6 versus control conditions was noted in addition to migration of cells away from the central spheroid mass

An Early Litter for the Opossum (Didelphis Marsupialis) in Ohio

Author Institution: Department of Zoology, The Ohio State UniversityA female opossum, Didelphis marsupialis, was found dead on the road in Columbus, Franklin County, Ohio, on 25 February 1973, with nine young tightly attached to her teats. The size of the young suggests that they were conceived the first week of January and that the female was reproductively active during the last part of December. Early breeding at this latitude (lat. 40° N) is very unusual and is compared with known breeding dates from other areas of temperate North America

Cardiovascular prevention: lifestyle and statins – competitors or companions?

Favourable lifestyles promote cardiovascular protection. Exercise can induce beneficial changes in the genome that decrease low-density lipoprotein cholesterol (LDL-C) and increase anti-inflammatory markers. The Mediterranean dietary pattern, fortified by nuts, while not reducing weight, reduces mortality. Lifestyle changes combined with statin therapy provide potent protection against coronary heart disease, especially when used for secondary prevention after cardiovascular events. Decisions regarding the initiation of statin therapy for primary prevention are more difficult, requiring consideration of both the LDL-C level and the degree of cardiovascular risk for dyslipidaemic patients. Combining intensive exercise and statin therapy substantially reduces the mortality risk, and thus is potentially the ideal risk-reducing combination

Effect of Preventive Home Visits by a Nurse on the Outcomes of Frail Elderly People in the Community: a randomized controlled trial

Background: Timely recognition and prevention of health problems among elderly people have been shown to improve their health. In this randomized controlled trial the authors examined the impact of preventive home visits by a nurse compared with usual care on the outcomes of frail elderly people living in the community. Methods: A screening questionnaire identified eligible participants (those aged 70 years or more at risk of sudden deterioration in health). Those randomly assigned to the visiting nurse group were assessed and followed up in their homes for 14 months. The primary outcome measure was the combined rate of deaths and admissions to an institution, and the secondary outcome measure the rate of health services utilization, during the 14 months; these rates were determined through a medical chart audit by a research nurse who was blind to group allocation. Results: The questionnaire was mailed to 415 elderly people, of whom 369 (88.9%) responded. Of these, 198 (53.7%) were eligible, and 142 consented to participate and were randomly assigned to either the visiting nurse group (73) or the usual care group (69). The combined rate of deaths and admissions to an institution was 10.0% in the visiting nurse group and 5.8% in the usual care group (p = 0.52). The rate of health services utilization did not differ significantly between the 2 groups. Influenza and pneumonia vaccination rates were significantly higher in the visiting nurse group (90.1% and 81.9%) than in the usual care group (53.0% and 0%) (p \u3c 0.001). Interpretation: The trial failed to show any effect of a visiting nurse other than vastly improved vaccination coverage

Screening Seniors for Risk of Functional Decline: Results of a Survey in Family Practice

To measure functional status, determine risk of functional decline and assess consistency between responses and standardized instruments. Design: A mailed survey which measured functional impairment, recent hospitalization and bereavement. A positive response on at least one of these factors indicated that the individual was “at risk” for functional decline. A random sample (n=73) of “at risk” subjects (specifically, family practice patients aged 70 and older) were assessed by a nurse. Results: The response rate was 89% (369/415), 59% of seniors were female and the mean age was 77.1 (SD=5.5) years. Self-reported risk, based on activities of daily living (ADLs), was associated with impairment in at least one basic ADL (p\u3c0.0005) using a standardized instrument. The positive predictive value of the survey for ADL impairment was 65%. Conclusion: Response to a mailed survey was high and self-reported ADL risks were consistent with findings from standardized assessment tools

Color Stability of Restorative Resins Under Accelerated Aging

The color stability of seven commercial composite resins, an unfilled resin, and three glazes was studied under conditions of accelerated aging by reflection spectrophotometry and visually with Munsell color tabs. After aging for 900 hours, most of the resins had lower values of luminous reflectance and excitation purity and higher values of dominant wavelength and contrast ratio compared to values at baseline.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66937/2/10.1177_00220345780570111101.pd

Color Stability of a Pigmented Elastomer for Maxillofacial Appliances

The color stability of a series of eleven maxillofacial pigments was determined after accelerated aging using reflection spectrophotometry. The results indicate that seven of the pigments demonstrated good to excellent color stability, while four of the pigments were less promising for clinical use.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67027/2/10.1177_00220345790580050301.pd

Wear of Composites by Abrasives of Varying Hardness

The relationship between the wear of three composite resins and the hardness of the abrasive was studied by a two-body abrasion test. The wear rates of the composites increased linearly with abrasive hardness from 530 to 2080 KHN. Measurement of the slope of the wear rate versus abrasive hardness over this range provided a sensitive method for ranking the composites.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68031/2/10.1177_00220345790580031201.pd

Column-free optical deconvolution of intrinsic fluorescence for a monoclonal antibody and its product-related impurities

The quantification of monoclonal antibody (mAb) aggregates and fragments using high pressure liquid chromatography-size exclusion chromatography (HPLC-SEC) typically requires off-line measurements that are time-consuming and therefore not compatible with real-time monitoring. However, it has been crucial to manufacturing and process development, and remains the industrial standard in the assessment of product-related impurities. Here we demonstrate that our previously established intrinsic time-resolved fluorescence (TRF) approach can be used to quantify the bioprocess critical quality attribute (CQA) of antibody product purity at various stages of a typical downstream process, with the potential to be developed for in-line bioprocess monitoring. This was directly benchmarked against industry-standard HPLC-SEC. Strong linear correlations were observed between outputs from TRF spectroscopy and HPLC-SEC, for the monomer and aggregate-fragment content, with R2 coefficients of 0.99 and 0.69, respectively. At total protein concentrations above 1.41 mg/mL, HPLC-SEC UV-Vis chromatograms displayed signs of detector saturation which reduced the accuracy of protein quantification, thus requiring additional sample dilution steps. By contrast, TRF spectroscopy increased in accuracy at these concentrations due to higher signal-to-noise ratios. Our approach opens the potential for reducing the time and labour required for validating aggregate content in mAb bioprocess stages from the several hours required for HPLC-SEC to a few minutes per sample