Screening for markers of frailty and perceived risk of adverse outcomes using the Risk Instrument for Screening in the Community (RISC)

BACKGROUND: Functional decline and frailty are common in community dwelling older adults, increasing the risk of adverse outcomes. Given this, we investigated the prevalence of frailty-associated risk factors and their distribution according to the severity of perceived risk in a cohort of community dwelling older adults, using the Risk Instrument for Screening in the Community (RISC). METHODS: A cohort of 803 community dwelling older adults were scored for frailty by their public health nurse (PHN) using the Clinical Frailty Scale (CFS) and for risk of three adverse outcomes: i) institutionalisation, ii) hospitalisation and iii) death, within the next year, from one (lowest) to five (highest) using the RISC. Prior to scoring, PHNs stated whether they regarded patients as frail. RESULTS: The median age of patients was 80 years (interquartile range 10), of whom 64% were female and 47.4% were living alone. The median Abbreviated Mental Test Score (AMTS) was 10 (0) and Barthel Index was 18/20 (6). PHNs regarded 42% of patients as frail, while the CFS categorized 54% (scoring ≥5) as frail. Dividing patients into low-risk (score one or two), medium-risk (score three) and high-risk (score four or five) using the RISC showed that 4.3% were considered high risk of institutionalization, 14.5% for hospitalization, and 2.7% for death, within one year of the assessment. There were significant differences in median CFS (4/9 versus 6/9 versus 6/9, p < 0.001), Barthel Index (18/20 versus 11/20 versus 14/20, p < 0.001) and mean AMTS scores (9.51 versus 7.57 versus 7.00, p < 0.001) between those considered low, medium and high risk of institutionalisation respectively. Differences were also statistically significant for hospitalisation and death. Age, gender and living alone were inconsistently associated with perceived risk. Frailty most closely correlated with functional impairment, r = −0.80, p < 0.001. CONCLUSION: The majority of patients in this community sample were perceived to be low risk for adverse outcomes. Frailty, cognitive impairment and functional status were markers of perceived risk. Age, gender and social isolation were not and may not be useful indicators when triaging community dwellers. The RISC now requires validation against adverse outcomes

The inter-rater reliability of the Risk Instrument for Screening in the Community

Predicting risk of adverse healthcare outcomes is important to enable targeted delivery of interventions. The Risk Instrument for Screening in the Community (RISC), designed for use by public health nurses (PHNs), measures the one-year risk of hospitalisation, institutionalisation and death in community-dwelling older adults according to a five-point global risk score: from low (score 1,2), medium (3) and high (4,5). We examined the inter-rater reliability (IRR) of the RISC between student PHNs (n=32) and expert raters using six cases (two low, medium and high-risk), scored before and after RISC training. Correlations increased for each adverse outcome, statistically significantly for institutionalisation (r=0.72 to 0.80,p=0.04) and hospitalisation, (r=0.51 to 0.71,p<0.01) but not death. Training improved accuracy for low-risk but not all high-risk cases. Overall, the RISC showed good IRR, which increased after RISC training. That reliability reduced for some high-risk cases suggests that the training programme requires adjustment to further improve IRR

Structural Evolution of Early-type Galaxies to z=2.5 in CANDELS

Projected axis ratio measurements of 880 early-type galaxies at redshifts 1<z<2.5 selected from CANDELS are used to reconstruct and model their intrinsic shapes. The sample is selected on the basis of multiple rest-frame colors to reflect low star-formation activity. We demonstrate that these galaxies as an ensemble are dust-poor and transparent and therefore likely have smooth light profiles, similar to visually classified early-type galaxies. Similar to their present-day counterparts, the z>1 early-type galaxies show a variety of intrinsic shapes; even at a fixed mass, the projected axis ratio distributions cannot be explained by the random projection of a set of galaxies with very similar intrinsic shapes. However, a two-population model for the intrinsic shapes, consisting of a triaxial, fairly round population, combined with a flat (c/a~0.3) oblate population, adequately describes the projected axis ratio distributions of both present-day and z>1 early-type galaxies. We find that the proportion of oblate versus triaxial galaxies depends both on the galaxies' stellar mass, and - at a given mass - on redshift. For present-day and z<1 early-type galaxies the oblate fraction strongly depends on galaxy mass. At z>1 this trend is much weaker over the mass range explored here (10^10<M*/M_sun<10^11), because the oblate fraction among massive (M*~10^11 M_sun) was much higher in the past: 0.59+-0.10 at z>1, compared to 0.20+-0.02 at z~0.1. In contrast, the oblate fraction among low-mass early-type galaxies (log(M*/M_sun)1 to 0.72+-0.06 at z=0. [Abridged]Comment: accepted for publication in ApJ; 14 pages; 10 figures; 4 table

Drug resistance and viral tropism in HIV-1 subtype C-infected patients in KwaZulu-Natal, South Africa: implications for future treatment options

Article approval pendingDrug resistance poses a significant challenge for the successful application of highly active antiretroviral therapy (HAART) globally. Furthermore, emergence of HIV-1 isolates that preferentially use CXCR4 as a coreceptor for cell entry, either as a consequence of natural viral evolution or HAART use, may compromise the efficacy of CCR5 antagonists as alternative antiviral therapy

Extradenticle and Homothorax Control Adult Muscle Fiber Identity in Drosophila

SummaryHere we identify a key role for the homeodomain proteins Extradenticle (Exd) and Homothorax (Hth) in the specification of muscle fiber fate in Drosophila. exd and hth are expressed in the fibrillar indirect flight muscles but not in tubular jump muscles, and manipulating exd or hth expression converts one muscle type into the other. In the flight muscles, exd and hth are genetically upstream of another muscle identity gene, salm, and are direct transcriptional regulators of the signature flight muscle structural gene, Actin88F. Exd and Hth also impact muscle identity in other somatic muscles of the body by cooperating with Hox factors. Because mammalian orthologs of exd and hth also contribute to muscle gene regulation, our studies suggest that an evolutionarily conserved genetic pathway determines muscle fiber differentiation

A CANDELS - 3D-HST Synergy: Resolved Star Formation Patterns at 0.7 < z < 1.5

We analyze the resolved stellar populations of 473 massive star-forming galaxies at 0.7 < z < 1.5, with multi-wavelength broad-band imaging from CANDELS and Halpha surface brightness profiles at the same kiloparsec resolution from 3D-HST. Together, this unique data set sheds light on how the assembled stellar mass is distributed within galaxies, and where new stars are being formed. We find the Halpha morphologies to resemble more closely those observed in the ACS I band than in the WFC3 H band, especially for the larger systems. We next derive a novel prescription for Halpha dust corrections, which accounts for extra extinction towards HII regions. The prescription leads to consistent SFR estimates and reproduces the observed relation between the Halpha/UV luminosity ratio and visual extinction, both on a pixel-by-pixel and on a galaxy-integrated level. We find the surface density of star formation to correlate with the surface density of assembled stellar mass for spatially resolved regions within galaxies, akin to the so-called 'main sequence of star formation' established on a galaxy-integrated level. Deviations from this relation towards lower equivalent widths are found in the inner regions of galaxies. Clumps and spiral features, on the other hand, are associated with enhanced Halpha equivalent widths, bluer colors, and higher specific star formation rates compared to the underlying disk. Their Halpha/UV luminosity ratio is lower than that of the underlying disk, suggesting the ACS clump selection preferentially picks up those regions of elevated star formation activity that are the least obscured by dust. Our analysis emphasizes that monochromatic studies of galaxy structure can be severely limited by mass-to-light ratio variations due to dust and spatially inhomogeneous star formation histories.Comment: Accepted by The Astrophysical Journal, 18 pages, 1 table, 10 figure

Smooth(er) Stellar Mass Maps in CANDELS: Constraints on the Longevity of Clumps in High-redshift Star-forming Galaxies

We perform a detailed analysis of the resolved colors and stellar populations of a complete sample of 323 star-forming galaxies at 0.5 < z < 1.5, and 326 star-forming galaxies at 1.5 < z < 2.5 in the ERS and CANDELS-Deep region of GOODS-South. Galaxies were selected to be more massive than 10^10 Msun and have specific star formation rates above 1/t_H. We model the 7-band optical ACS + near-IR WFC3 spectral energy distributions of individual bins of pixels, accounting simultaneously for the galaxy-integrated photometric constraints available over a longer wavelength range. We analyze variations in rest-frame color, stellar surface mass density, age, and extinction as a function of galactocentric radius and local surface brightness/density, and measure structural parameters on luminosity and stellar mass maps. We find evidence for redder colors, older stellar ages, and increased dust extinction in the nuclei of galaxies. Big star-forming clumps seen in star formation tracers are less prominent or even invisible on the inferred stellar mass distributions. Off-center clumps contribute up to ~20% to the integrated SFR, but only 7% or less to the integrated mass of all massive star-forming galaxies at z ~ 1 and z ~ 2, with the fractional contributions being a decreasing function of wavelength used to select the clumps. The stellar mass profiles tend to have smaller sizes and M20 coefficients, and higher concentration and Gini coefficients than the light distribution. Our results are consistent with an inside-out disk growth scenario with brief (100 - 200 Myr) episodic local enhancements in star formation superposed on the underlying disk. Alternatively, the young ages of off-center clumps may signal inward clump migration, provided this happens efficiently on the order of an orbital timescale.Comment: Accepted by The Astrophysical Journal, 27 pages, 1 table, 16 figure

Harnessing person-generated health data to accelerate patient-centered outcomes research: the Crohn’s and Colitis Foundation of America PCORnet Patient Powered Research Network (CCFA Partners)

The Crohn’s and Colitis Foundation of America Partners Patient-Powered Research Network (PPRN) seeks to advance and accelerate comparative effectiveness and translational research in inflammatory bowel diseases (IBDs). Our IBD-focused PCORnet PPRN has been designed to overcome the major obstacles that have limited patient-centered outcomes research in IBD by providing the technical infrastructure, patient governance, and patient-driven functionality needed to: 1) identify, prioritize, and undertake a patient-centered research agenda through sharing person-generated health data; 2) develop and test patient and provider-focused tools that utilize individual patient data to improve health behaviors and inform health care decisions and, ultimately, outcomes; and 3) rapidly disseminate new knowledge to patients, enabling them to improve their health. The Crohn’s and Colitis Foundation of America Partners PPRN has fostered the development of a community of citizen scientists in IBD; created a portal that will recruit, retain, and engage members and encourage partnerships with external scientists; and produced an efficient infrastructure for identifying, screening, and contacting network members for participation in research