A coordinated preventive care approach for healthy ageing in five European cities: a mixed-methods study of process evaluation components

Aims: To evaluate specific process components of the Urban Health Centres Europe (UHCE) approach; a coordinated preventive care approach aimed at healthy ageing by decreasing falls, polypharmacy, loneliness and frailty among older persons in community settings of five cities in the United Kingdom, Greece, Croatia, the Netherlands and Spain. Design: Mixed methods evaluation of specific process components of the UHCE approach: reach of the target population, dose of the intervention actually delivered and received by participants and satisfaction and experience of main stakeholders involved in the approach. Methods: The UHCE approach intervention consisted of a preventive assessment, shared decision-making on a care plan and enrolment in one or more of four coordinated care-pathways that targeted falls, polypharmacy, loneliness and frailty. Quantitative data from a questionnaire and quantitative/qualitative data from logbooks were collected among older persons involved in the approach. Qualitative data from focus groups were collected among older persons, informal caregivers and professionals involved in the approach. Quantitative data were analysed by means of descriptive statistics and multilevel logistic regression models. Qualitative data were analysed through thematic analysis. Results: Having limited function was associated with non-enrolment in falls and loneliness care-pathways (both p < .01). The mean rating of the approach was 8.3/10 (SD 1.9). Feeling supported by a care professional and meeting people were main benefits for older persons. Mistrust towards unfamiliar care providers, lack of confidence to engage in care activities and health constraints were main barriers towards engagement in care. Conclusions: Although the UHCE approach was received generally positively, health constraints and psychosocial barriers prevented older person's engagement in care. Impact: Coordinated preventive care approaches for older community-dwelling persons should address health constraints and psychosocial barriers that hinder older person's engagement in care

El perfil transcriptómico de la célula tumoral circulante (CTD) del mieloma múltiple: un nuevo modelo para comprender la diseminación de la enfermedad

CO-010 Introducción: El número de células tumorales circulantes (CTCs) predice el riesgo de transformación en mieloma múltiple (MM) asintomático, así como la supervivencia en MM activo. Datos recientes sugieren que, conforme el tumor progresa y el microambiente se vuelve más hipóxico, las células plasmáticas (CP) clonales pasan a la circulación sistémica favoreciendo la constante invasión de nuevas regiones en la médula ósea (MO). Habría que señalar que la frecuencia de las CTCs es típicamente baja, por lo que sería concebible que dicha diseminación del MM dependiera de unas pocas células con unas características únicas que inducirían su salida de la médula y la extensión de la enfermedad a través de la sangre periférica (SP). Esta hipótesis no ha sido demostrada hasta ahora debido a que el perfil transcriptómico de la CTC en el MM no ha sido investigado. Objetivos: Determinar funciones moleculares específicas en las CTCs que permitan identificar eventos responsables de la diseminación del MM a través del flujo sanguíneo. ..

Assessment of Osteoarthritis Candidate Genes in a Meta-Analysis of Nine Genome-Wide Association Studies

Objective To assess candidate genes for association with osteoarthritis (OA) and identify promising genetic factors and, secondarily, to assess the candidate gene approach in OA. Methods A total of 199 candidate genes for association with OA were identified using Human Genome Epidemiology (HuGE) Navigator. All of their single-nucleotide polymorphisms (SNPs) with an allele frequency of >5% were assessed by fixed-effects meta-analysis of 9 genome-wide association studies (GWAS) that included 5,636 patients with knee OA and 16,972 control subjects and 4,349 patients with hip OA and 17,836 control subjects of European ancestry. An additional 5,921 individuals were genotyped for significantly associated SNPs in the meta-analysis. After correction for the number of independent tests, P values less than 1.58 × 10−5 were considered significant. Results SNPs at only 2 of the 199 candidate genes (COL11A1 and VEGF) were associated with OA in the meta-analysis. Two SNPs in COL11A1 showed association with hip OA in the combined analysis: rs4907986 (P = 1.29 × 10−5, odds ratio [OR] 1.12, 95% confidence interval [95% CI] 1.06−1.17) and rs1241164 (P = 1.47 × 10−5, OR 0.82, 95% CI 0.74−0.89). The sex-stratified analysis also showed association of COL11A1 SNP rs4908291 in women (P = 1.29 × 10−5, OR 0.87, 95% CI 0.82−0.92); this SNP showed linkage disequilibrium with rs4907986. A single SNP of VEGF, rs833058, showed association with hip OA in men (P = 1.35 × 10−5, OR 0.85, 95% CI 0.79−0.91). After additional samples were genotyped, association at one of the COL11A1 signals was reinforced, whereas association at VEGF was slightly weakened. Conclusion Two candidate genes, COL11A1 and VEGF, were significantly associated with OA in this focused meta-analysis. The remaining candidate genes were not associated

Floor Acquisition Multiple Access with Collision Resolution

Collision avoidance and resolution multiple access (CARMA) protocols are presented and analyzed. These protocols use a floor acquisition multiple access strategy based on carrier sensing, together with collision resolution of floor requests (RTS) based on a tree-splitting algorithm. For analytical purposes, an upper bound is derived for the average costs of resolving collisions of floor requests using the tree-splitting algorithm. This bound is then applied to the computation of the average channel utilization in a fully connected network with a large number of stations. Under light-load conditions, CARMA protocols achieve the same average throughput as floor acquisition multiple access (FAMA) protocols. It is also shown that, as the arrival rate of RTSs increases, the throughput achieved by CARMA protocols is close to the maximum throughput that any FAMA protocol can achieve if propagation delays and the control packets used to acquire the floor are much smaller than the data packet t..

Collision Avoidance and Resolution Multiple Access with Transmission Queues

this paper we describe and analyze a new channel access protocol that combines distributed queues and RTS/CTS handshakes with collision resolution. We call the resulting protocol &quot;Collision Avoidance and Resolution Multiple Access&quot; protocol with non-persistence and transmission queues (CARMA-NTQ). CARMA-NTQ provides dynamic reservations of the channel, together with collision resolution of the reservations requests based on a tree-splitting algorithm [11]. Like GAMA [15], CARMA-NTQ builds a dynamically-sized cycle that grows and shrinks depending upon traffic demand. Each cycle consists of a contention period and a queue-transmission period during which one or more stations transmit data packets without collision. A position in the transmission queue is allocated to an individual station during the contention period, and a station can continue to transmit in this position as long as it has data to send to any other station in the network. Stations compete to acquire the right to be in the transmission queue based on a deterministic tree-splitting algorithm

Seguimiento y evaluacion de las actividades cientificas y tecnicas del CIEMAT en 1990

Two volumesCentro de Informacion y Documentacion Cientifica (CINDOC). C/Joaquin Costa, 22. 28002 Madrid. SPAIN / CINDOC - Centro de Informaciòn y Documentaciòn CientìficaSIGLEESSpai