Patient-generated subjective global assessment:innovation from paper to digital app

Purpose: The Patient-Generated Subjective Global Assessment (PG-SGA), including the PG-SGA Short Form (SF, aka ‘abridged’), was originally developed in the mid 1990’s as a scored, patient self-report, paperbased instrument and has been widely validated. The PG-SGA (SF) has been used for screening, assessment and monitoring, triageing for multimodal intervention and for evaluation of clinical and health economic outcomes. There have been ad hoc translations, often with permission of the originator (FDO) but broad international use requires consistent, medically accurate, and certified translations. Although the PG-SGA (or SF) is known to be quick and easy, current advances in technology could further improve and facilitate quick and easy use of global patient screening and assessment, standardized scoring algorithms, limiting inter-observer variability, and global collaboration and communication. We aimed to develop a user friendly, cross-culturally validated, multilingual digital app and resources to support the clinical and research applications of the PG-SGA (SF) and Pt-Global app in the context of a global centralized database and research consortium. Methods: After completion of a Dutch PG-SGA cross-cultural adaptation project, a digital app based on the English and Dutch PG-SGA was developed. Steps included: 1) development and testing of standardized scoring and decision-making algorithms based on the validated PG-SGA scoring system; 2) compatibility with iOS, Android and WindowsPhone platforms; 3) development and pilot testing of prototype by an international test panel (n=35; professionals testing the app on patients as part of routine care process, researchers, and lay persons) from Australia, Belgium, Canada, Norway, Sweden, The Netherlands and USA, evaluating the app on lay-out, user friendliness, relevance and time of completion; 4) improvement based on input; 5) launch of app and supportive website at www.pt-global.org on 12 Jun 2014, including complimentary introductory use; 5) international education activities; 6) digital presence through Twitter, Facebook, LinkedIn and YouTube; 7) launch of web-based version on 15 September 2014. Results: 15 professionals (Pros; 11 dietitians, 1 doctor, 1 physiotherapist) and 2 lay persons participated in the pilot testing. Included settings were: 9 hospitals, 4 cancer centers, 2 nursing homes, 3 research. 8/15 had experience with the PG-SGA, 7/15 PG-SGA were naïve. 5 Pros tested on 1-5 patients, and 9 on 6-10 patients. 88% rated layout (very) good with feedback: calm, professional, clear, intuitive, easy; 88% rated good for user friendliness. 75% rated flow/user interface (very) good. In 88% Patient screens were completed by Pros. Reported time to complete Patient screens was: 65% in 0-5 minutes, 29% in 5-10 min; 6% (n=1) >10 minutes. Interestingly, patients started completing the app spontaneously. Some issues with concerns about touch screen were expressed. 87% completed the professional section in

Liberation of Recalcitrant Cell Wall Sugars From Oak Barrels Into Bourbon Whiskey During Aging

Oak barrels have been used by humans for thousands of years to store and transport valuable materials. Early settlers of the United States in Kentucky began charring the interior of new white oak barrels prior to aging distillate to create the distinctively flavored spirit we know as bourbon whiskey. Despite the unique flavor and cultural significance of America\u27s Spirit , little is known about the wood-distillate interaction that shapes bourbon whiskey. Here, we employed an inverse method to measure the loss of specific wood polysaccharides in the oak cask during aging for up to ten years. We found that the structural cell wall wood biopolymer, cellulose, was partially decrystallized by the charring process. This pyrolytic fracturing and subsequent exposure to the distillate was accompanied by a steady loss of sugars from the cellulose and hemicellulose fractions of the oak cask. Distinct layers of structural degradation and product release from within the barrel stave are formed over time as the distillate expands into and contracts from the barrel staves. This complex, wood-sugar release process is likely associated with the time-dependent generation of the unique palate of bourbon whiskey

Using Microbial Community Interactions within Plant Microbiomes to Advance an Evergreen Agricultural Revolution

Innovative plant breeding and technology transfer fostered the Green Revolution (GR), which transformed agriculture worldwide by increasing grain yields in developing countries. The GR temporarily alleviated world hunger, but also reduced biodiversity, nutrient cycling, and carbon (C) sequestration that agricultural lands can provide. Meanwhile, economic disparity and food insecurity within and among countries continues. Subsequent agricultural advances, focused on objectives such as increasing crop yields or reducing the risk of a specific pest, have failed to meet food demands at the local scale or to restore lost ecosystem services. An increasing human population, climate change, growing per capita food and energy demands, and reduced ecosystem potential to provide agriculturally relevant services have created an unrelenting need for improved crop production practices. Meeting this need in a sustainable fashion will require interdisciplinary approaches that integrate plant and microbial ecology with efforts to advance crop production while mitigating effects of a changing climate. Metagenomic advances are revealing microbial dynamics that can simultaneously improve crop production and soil restoration while enhancing crop resistance to environmental change. Restoring microbial diversity to contemporary agroecosystems could establish ecosystem services while reducing production costs for agricultural producers. Our framework for examining plant-microbial interactions at multiple scales, modeling outcomes to broadly explore potential impacts, and interacting with extension and training networks to transfer microbial based agricultural technologies across socioeconomic scales, offers an integrated strategy for advancing agroecosystem sustainability while minimizing potential for the kind of negative ecological and socioeconomic feedbacks that have resulted from many widely adopted agricultural technologies

Anomalously large oxygen-ordering contribution to the thermal expansion of untwinned YBa2Cu3O6.95 single crystals: a glass-like transition near room temperature

We present high-resolution capacitance dilatometry studies from 5 - 500 K of untwinned YBa2Cu3Ox (Y123) single crystals for x ~ 6.95 and x = 7.0. Large contributions to the thermal expansivities due to O-ordering are found for x ~ 6.95, which disappear below a kinetic glass-like transition near room temperature. The kinetics at this glass transition is governed by an energy barrier of 0.98 +- 0.07 eV, in very good agreement with other O-ordering studies. Using thermodynamic arguments, we show that O-ordering in the Y123 system is particularly sensitive to uniaxial pressure (stress) along the chain axis and that the lack of well-ordered chains in Nd123 and La123 is most likely a consequence of a chemical-pressure effect.Comment: 4 pages, 3 figures, submitted to PR

Structural Probe of a Glass Forming Liquid: Generalized Compressibility

We introduce a new quantity to probe the glass transition. This quantity is a linear generalized compressibility which depends solely on the positions of the particles. We have performed a molecular dynamics simulation on a glass forming liquid consisting of a two component mixture of soft spheres in three dimensions. As the temperature is lowered (or as the density is increased), the generalized compressibility drops sharply at the glass transition, with the drop becoming more and more abrupt as the measurement time increases. At our longest measurement times, the drop occurs approximately at the mode coupling temperature $T_C$. The drop in the linear generalized compressibility occurs at the same temperature as the peak in the specific heat. By examining the inherent structure energy as a function of temperature, we find that our results are consistent with the kinetic view of the glass transition in which the system falls out of equilibrium. We find no size dependence and no evidence for a second order phase transition though this does not exclude the possibility of a phase transition below the observed glass transition temperature. We discuss the relation between the linear generalized compressibility and the ordinary isothermal compressibility as well as the static structure factor.Comment: 18 pages, Latex, 26 encapsulated postscript figures, revised paper is shorter, to appear in Phys. Rev.

Prospecting for energy-rich renewable raw materials: agave leaf case study

Plant biomass from different species is heterogeneous, and this diversity in composition can be mined to identify materials of value to fuel and chemical industries. Agave produces high yields of energy-rich biomass, and the sugar-rich stem tissue has traditionally been used to make alcoholic beverages. Here, the compositions of Agave americana and Agave tequilana leaves are determined, particularly in the context of bioethanol production. Agave leaf cell wall polysaccharide content was characterized by linkage analysis, non-cellulosic polysaccharides such as pectins were observed by immuno-microscopy, and leaf juice composition was determined by liquid chromatography. Agave leaves are fruit-like-rich in moisture, soluble sugars and pectin. The dry leaf fiber was composed of crystalline cellulose (47-50% w/w) and non-cellulosic polysaccharides (16-22% w/w), and whole leaves were low in lignin (9-13% w/w). Of the dry mass of whole Agave leaves, 85-95% consisted of soluble sugars, cellulose, non-cellulosic polysaccharides, lignin, acetate, protein and minerals. Juice pressed from the Agave leaves accounted for 69% of the fresh weight and was rich in glucose and fructose. Hydrolysis of the fructan oligosaccharides doubled the amount of fermentable fructose in A. tequilana leaf juice samples and the concentration of fermentable hexose sugars was 41-48 g/L. In agricultural production systems such as the tequila making, Agave leaves are discarded as waste. Theoretically, up to 4000 L/ha/yr of bioethanol could be produced from juice extracted from waste Agave leaves. Using standard Saccharomyces cerevisiae strains to ferment Agave juice, we observed ethanol yields that were 66% of the theoretical yields. These data indicate that Agave could rival currently used bioethanol feedstocks, particularly if the fermentation organisms and conditions were adapted to suit Agave leaf composition.Kendall R. Corbin, Caitlin S. Byrt, Stefan Bauer, Seth DeBolt, Don Chambers, Joseph A. M. Holtum, Ghazwan Karem, Marilyn Henderson, Jelle Lahnstein, Cherie T. Beahan, Antony Bacic, Geoffrey B. Fincher, Natalie S. Betts, Rachel A. Burto

Exercise therapy for prevention of falls in people with Parkinson's disease: A protocol for a randomised controlled trial and economic evaluation

<p>Abstract</p> <p>Background</p> <p>People with Parkinson's disease are twice as likely to be recurrent fallers compared to other older people. As these falls have devastating consequences, there is an urgent need to identify and test innovative interventions with the potential to reduce falls in people with Parkinson's disease. The main objective of this randomised controlled trial is to determine whether fall rates can be reduced in people with Parkinson's disease using exercise targeting three potentially remediable risk factors for falls (reduced balance, reduced leg muscle strength and freezing of gait). In addition we will establish the cost effectiveness of the exercise program from the health provider's perspective.</p> <p>Methods/Design</p> <p>230 community-dwelling participants with idiopathic Parkinson's disease will be recruited. Eligible participants will also have a history of falls or be identified as being at risk of falls on assessment. Participants will be randomly allocated to a usual-care control group or an intervention group which will undertake weight-bearing balance and strengthening exercises and use cueing strategies to address freezing of gait. The intervention group will choose between the home-based or support group-based mode of the program. Participants in both groups will receive standardized falls prevention advice. The primary outcome measure will be fall rates. Participants will record falls and medical interventions in a diary for the duration of the 6-month intervention period. Secondary measures include the Parkinson's Disease Falls Risk Score, maximal leg muscle strength, standing balance, the Short Physical Performance Battery, freezing of gait, health and well being, habitual physical activity and positive and negative affect schedule.</p> <p>Discussion</p> <p>No adequately powered studies have investigated exercise interventions aimed at reducing falls in people with Parkinson's disease. This trial will determine the effectiveness of the exercise intervention in reducing falls and its cost effectiveness. This pragmatic program, if found to be effective, has the potential to be implemented within existing community services.</p> <p>Trial registration</p> <p>The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12608000303347).</p