The Summit on Creativity and Aging in America

This report looks at how the federal government can leverage the arts to foster healthy aging and inclusive design for this growing population. This white paper features recommendations from the May 2015 Summit on Creativity and Aging in America, a convening of more than 70 experts hosted by the National Endowment for the Arts and the National Center for Creative Aging. The paper highlights recommendations on healthy aging, lifelong learning in the arts, and age-friendly community design. The summit was a precursor to the 2015 White House Conference on Aging, which addressed four major issues: retirement security, long-term services and supports, healthy aging, and elder abuse

Early mobilization practices of mechanically ventilated patients : a 1-day point-prevalence study in southern Brazil

OBJECTIVES: To assess early mobilization practices of mechanically ventilated patients in southern Brazilian intensive care units (ICUs) and to identify barriers associated with early mobilization and possible complications. METHODS: A prospective, observational, multicenter, 1-day point-prevalence study was conducted across 11 ICUs and included all mechanically ventilated adult patients. Hospital and ICU characteristics and patients’ demographic data, the highest level of mobilization achieved in the 24 hours prior to the survey and related barriers, and complications that occurred during mobilization were collected in the hospital and the ICU. RESULTS: A total of 140 patients were included with a mean age of 57±17 years. The median and interquartile range was 7 (3-17) days for the length of ICU stay to the day of the survey and 7 (3-16) days for the duration of mechanical ventilation (MV). The 8-level mobilization scale was classified into two categories: 126 patients (90%) remained in bed (level 1–3) and 14 (10%) were mobilized out of bed (level 4–8). Among patients with an endotracheal tube, tracheostomy, and noninvasive ventilation, 2%, 23%, and 50% were mobilized out of bed, respectively (po0.001 for differences among the three groups). Weakness (20%), cardiovascular instability (19%), and sedation (18%) were the most commonly observed barriers to achieving a higher level of mobilization. No complications were reported. CONCLUSIONS: In southern Brazilian ICUs, the prevalence of patient mobilization was low, with only 10% of all mechanically ventilated patients and only 2% of patients with an endotracheal tube mobilized out of bed as part of routine care

Mathematical framework for human SLE Nephritis: disease dynamics and urine biomarkers

<p>Abstract</p> <p>Background</p> <p>Although the prognosis for Lupus Nephritis (LN) has dramatically improved with aggressive immunosuppressive therapies, these drugs carry significant side effects. To improve the effectiveness of these drugs, biomarkers of renal flare cycle could be used to detect the onset, severity, and responsiveness of kidney relapses, and to modify therapy accordingly. However, LN is a complex disease and individual biomarkers have so far not been sufficient to accurately describe disease activity. It has been postulated that biomarkers would be more informative if integrated into a pathogenic-based model of LN.</p> <p>Results</p> <p>This work is a first attempt to integrate human LN biomarkers data into a model of kidney inflammation. Our approach is based on a system of differential equations that capture, in a simplified way, the complexity of interactions underlying disease activity. Using this model, we have been able to fit clinical urine biomarkers data from individual patients and estimate patient-specific parameters to reproduce disease dynamics, and to better understand disease mechanisms. Furthermore, our simulations suggest that the model can be used to evaluate therapeutic strategies for individual patients, or a group of patients that share similar data patterns.</p> <p>Conclusions</p> <p>We show that effective combination of clinical data and physiologically based mathematical modeling may provide a basis for more comprehensive modeling and improved clinical care for LN patients.</p

Comorbid conditions explain the association between posttraumatic stress disorder and incident cardiovascular disease

Background Posttraumatic stress disorder ( PTSD ) is associated with risk of cardiovascular disease ( CVD ). Biopsychosocial factors associated with PTSD likely account for some or all of this association. We determined whether 1, or a combination of comorbid conditions explained the association between PTSD and incident CVD . Methods and Results Eligible patients used 1 of 5 Veterans Health Affairs medical centers distributed across the United States. Data were obtained from electronic health records. At index date, 2519 Veterans Health Affairs ( VA ) patients, 30 to 70 years of age, had PTSD diagnoses and 1659 did not. Patients had no CVD diagnoses for 12 months before index date. Patients could enter the cohort between 2008 and 2012 with follow-up until 2015. Age-adjusted Cox proportional hazard models were computed before and after adjusting for comorbidities. Patients were middle aged (mean=50.1 years, SD ±11.0), mostly male (87.0%), and 60% were white. The age-adjusted association between PTSD and incident CVD was significant (hazard ratio=1.41; 95% CI : 1.21-1.63). After adjustment for metabolic conditions, the association between PTSD and incident CVD was attenuated but remained significant (hazard ratio=1.23; 95% CI : 1.06-1.44). After additional adjustment for smoking, sleep disorder, substance use disorder, anxiety disorders, and depression, PTSD was not associated with incident CVD (hazard ratio=0.96; 95% CI : 0.81-1.15). Conclusions PTSD is not an independent risk factor for CVD . Physical and psychiatric conditions and smoking that co-occur with PTSD explain why this patient population has an increased risk of CVD . Careful monitoring may limit exposure to CVD risk factors and subsequent incident CVD

A mathematical model of venous neointimal hyperplasia formation

<p>Abstract</p> <p>Background</p> <p>In hemodialysis patients, the most common cause of vascular access failure is neointimal hyperplasia of vascular smooth muscle cells at the venous anastomosis of arteriovenous fistulas and grafts. The release of growth factors due to surgical injury, oxidative stress and turbulent flow has been suggested as a possible mechanism for neointimal hyperplasia.</p> <p>Results</p> <p>In this work, we construct a mathematical model which analyzes the role that growth factors might play in the stenosis at the venous anastomosis. The model consists of a system of partial differential equations describing the influence of oxidative stress and turbulent flow on growth factors, the interaction among growth factors, smooth muscle cells, and extracellular matrix, and the subsequent effect on the stenosis at the venous anastomosis, which, in turn, affects the level of oxidative stress and degree of turbulent flow. Computer simulations suggest that our model can be used to predict access stenosis as a function of the initial concentration of the growth factors inside the intimal-luminal space.</p> <p>Conclusion</p> <p>The proposed model describes the formation of venous neointimal hyperplasia, based on pathogenic mechanisms. The results suggest that interventions aimed at specific growth factors may be successful in prolonging the life of the vascular access, while reducing the costs of vascular access maintenance. The model may also provide indication of when invasive access surveillance to repair stenosis should be undertaken.</p

Pathophysiology and nutritional status assessment of individuals with physical disabilities

A deficiência é definida como perda ou anomalia de uma estrutura ou função psicológica, fisiológica ou anatômica. Em pessoas com deficiência física, auditiva e visual, o estado nutricional pode estar alterado por consequências metabólicas e da deficiência, além da predisposição para doenças crônicas não transmissíveis e associação com comorbidades. O conhecimento dessas alterações por parte do profissional de saúde é importante para determinação do estado nutricional desses indivíduos. O objetivo deste estudo foi realizar uma revisão acerca da fisiopatologia das deficiências físicas (lesão medular, amputação, comprometimento visual e auditivo em diferentes graus) e a implicação sobre o estado nutricional. Para esta revisão, utilizou-se livros e artigos científicos publicados nos seguintes bancos de informações: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Literatura Internacional em Ciências da Saúde (MEDLINE), Scientific Eletronic Library Online (SciELO), Base de dados de Teses e Dissertações do IBICT e na Base de Dados da Editora Elsevier “Science Direct”, com texto, disponibilizado através do Portal da CAPES. Também foram utilizados os portais da Organização Mundial da Saúde (OMS) e no catálogo on-line da UFRGS para levantamento científico em nível internacional sobre o assunto estudado. Os estudos apontam que indivíduos com deficiências apresentam fatores de risco para doenças cardiovasculares, e com isso ressalta-se a importância da avaliação nutricional. No entanto, essa ferramenta deve ser utilizada com cautela e adaptações para este público, atentando-se para as características específicas de cada deficiência.Disability is defined as loss or abnormality of a psychological, physiological, or anatomical structure or function. The nutritional status of individuals with physical, hearing, or visual disability may be abnormal because of metabolic consequences and the disability, as well as a predisposition to chronic, non-communicable diseases and comorbidities. Knowledge of these changes is essential for measuring these individuals’ nutritional status. The objective of the present study was to review the pathophysiology of physical disabilities (spinal cord injury, amputation, visual and hearing impairment to varying degrees) and their impact on nutritional status. Books and scientific papers were searched in the following literature databases: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), MEDLINE, Scientific Electronic Library Online (SciELO), IBICT database of Theses and Dissertations, and the Elsevier “Science Direct” database, through the CAPES (Brazilian Federal Agency for Support and Valuation of Graduate Education) web portal, the WHO web database and the on-line catalog of Universidade Federal do Rio Grande do Sul (UFRGS). The available literature suggests that individuals with disabilities have risk factors for cardiovascular diseases. This makes the nutritional assessment very important. Nevertheless, this tool has to be used cautiously and it has to be adapted for these patients, bearing in mind the specific characteristics of each disability

Oxygen Regulates The Effective Diffusion Distance of Nitric Oxide in The Aortic Wall

Endothelium-derived nitric oxide (NO) is critical in maintaining vascular tone. Accumulating evidence shows that NO bioavailability is regulated by oxygen concentration. However, it is unclear to what extent the oxygen concentration regulates NO bioavailability in the vascular wall. In this study, a recently developed experimental setup was used to measure the NO diffusion flux across the aortic wall at various oxygen concentrations. It was observed that for a constant NO concentration at the endothelial surface, the measured NO diffusion flux out of the adventitial surface at [O2] = 0 μM is around fivefold greater than at [O2] = 150 μM, indicating that NO is consumed in the aortic wall in an oxygen-dependent manner. Analysis of experimental data shows that the rate of NO consumption in the aortic wall is first order with respect to [NO] and first order with respect to [O2], and the rate constant k1 was determined as (4.0 ± 0.3) × 103 M−1 s−1. Computer simulations demonstrate that NO concentration distribution significantly changes with oxygen concentration and the effective NO diffusion distance at low oxygen level ([O2] ≤ 25 μM) is significantly longer than that at high oxygen level ([O2] = 200 μM). These results suggest that oxygen-dependent NO consumption may play an important role in dilating blood vessels during hypoxia by increasing the effective NO diffusion distance

Aspectos fisiopatológicos e avaliação do estado nutricional de indivíduos com deficiências físicas

A deficiência é definida como perda ou anomalia de uma estrutura ou função psicológica, fisiológica ou anatômica. Em pessoas com deficiência física, auditiva e visual, o estado nutricional pode estar alterado por consequências metabólicas e da deficiência, além da pré-disposição para doenças crônicas não-transmissíveis e associação com co-morbidades. O conhecimento dessas alterações por parte do profissional de saúde é importante para determinação do estado nutricional desses indivíduos. O objetivo deste estudo foi realizar uma revisão acerca da fisiopatologia das deficiências físicas (lesão medular, amputação, comprometimento visual e auditivo em diferentes graus) e a implicação sobre o estado nutricional. Para esta revisão, utilizou-se livros e artigos científicos publicados nos seguintes bancos de informações: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Literatura Internacional em Ciências da Saúde (MEDLINE), Scientific Eletronic Library Online (SciELO), Base de dados de Teses e Dissertações do IBICT e na Base de Dados da Editora Elsevier “Science Direct”, com texto, disponibilizado através do Portal da CAPES. Também foram utilizados os portais da Organização Mundial da Saúde (OMS) e no catálogo on-line da UFRGS para levantamento científico em nível internacional sobre o assunto estudado. Os estudos apontam que indivíduos com deficiências apresentam fatores de risco para doenças cardiovasculares, e com isso ressalta-se a importância da avaliação nutricional. No entanto, essa ferramenta deve ser utilizada com cautela e adaptações para este público, atentando-se para as características específicas de cada deficiência

Marcadores de estres oxidativo en saliva de pacientes con infarto agudo de miocardio: estudio preliminar

There is evidence that acute myocardial infarction (AMI) is associated with increasing production of reactive oxygen species and tissue injury. The aim of this study was to assess the presence of oxidative stress indices in saliva 24 and 48h after AMI. Materials and methods: We designed a prospective study comparing salivary levels of biomarkers of oxidative stress in patients with AMI with elevation of the ST segment in electrocardiogram versus clinically healthy subjects. Oxidative stress indices including the rate of oxidation of 2'7' dichlorohydrofluorescein diacetate (DCFHDA) and the activity of the antioxidant enzyme catalase (CAT) were evaluated in saliva from patients with AMI at 24 and 48 hours. At each sampling time, blood was drawn for serum markers of myocardial infarction. Results: This study included ten patients with acute ST-segment elevation myocardial infarction and ten clinically healthy controls. Mean age was 67.8 } 11.1 vs. 48.7 } 4.1 years (p0.05) for AMI vs. controls, respectively. Our results demonstrated an increase in the rate of oxidation of DCFH-DA in the myocardial infarction group as compared with controls (p=0.004), which remained unchanged at 48h. There was no difference in salivary catalase activity between controls and AMI subjects at 24h or at 48h post-diagnosis (p=0.157). The relationship between CAT48 and DCFH-DA48 was fairly significant (r=0.39; p=0.053). Conclusion: This preliminary study showed that biomarkers of oxidative stress are detectable in saliva of patients with acute myocardial infarction. Clinical Relevance: Future studies using a larger population are needed to confirm these observations and to explore the possibility of using the saliva to monitor evolving diagnosis and prognosis in acute coronary syndrome.Existe evidencia que permite establecer una asociacion entre la generacion de especies reactivas del oxigeno y el dano tisular en el sindrome coronario agudo. El objetivo de este trabajo fue detectar en saliva de pacientes con infarto agudo de miocardio (IAM), la presencia de reactantes de estres oxidativo a las 24 y 48 horas. Materiales y metodos: se efectuo un estudio prospectivo de comparacion entre pacientes con IAM con supradesnivel del segmento ST en el electrocardiograma y sujetos sin patologia clinica evidente. La produccion de especies reactivas de oxigeno fue evaluada mediante la tasa de oxidacion de la 2'7' diacetato de diclorohidrofluoreceina (DCFH-DA) y la actividad antioxidante de la enzima catalasa (CAT) en saliva de pacientes con IAM a las 24 y 48 h de producido el sindrome coronario agudo. Simultaneamente, se determinaron en suero los biomarcadores diagnosticos de IAM. Resultados: se incorporaron 10 pacientes con IAM con supradesnivel del ST que fueron comparados con 10 sujetos del grupo control. La edad promedio fue 67.8 } 11.1 vs 48.7 } 4.1 anos, respectivamente (p0.05). La media de la velocidad de oxidacion de la DCFH-DA fue mayor a las 24 h en los pacientes con IAM (p=0.004). Estas diferencias se mantuvieron a las 48 h del infarto sin cambios significativos. No se encontraron diferencias en las medias de actividad de la enzima catalasa entre IAM y control (p>0.05). Se encontro una relacion entre CAT48 y DCFH-DA48 (r=0.39; p=0.053). Conclusiones: En esta poblacion se han detectado reactantes de estres oxidativo en saliva de pacientes con IAM. Relevancia clinica: nuevos estudios con mayor numero de casos seran necesarios para confirmar estas observaciones y evaluar la utilidad de la saliva en el diagnostico, evolucion y pronostico del sindrome coronario agudo.Fil: Rubio, María Cristina. Universidad de Buenos Aires. Facultad de Odontología. Área de Patología y Clínica Bucodental; ArgentinaFil: González, Paula Mariela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Bioquímica y Medicina Molecular. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Bioquímica y Medicina Molecular; ArgentinaFil: Ramos, Cecilia. Universidad de Buenos Aires. Facultad de Odontología; ArgentinaFil: Lewin, Pablo Gastón. Universidad de Buenos Aires. Facultad de Odontología. Área de Patología y Clínica Bucodental; ArgentinaFil: Friedman, Silvia María. Universidad de Buenos Aires. Facultad de Odontología; ArgentinaFil: Puntarulo, Susana Ángela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Bioquímica y Medicina Molecular. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Bioquímica y Medicina Molecular; ArgentinaFil: Nicolosi, Liliana N.. Universidad de Buenos Aires. Facultad de Odontología. Área de Patología y Clínica Bucodental; Argentin