Prevalence and risk factors of sarcopenia among adults living in nursing homes

Objectives: Sarcopenia is a progressive loss of skeletal muscle and muscle function, with significant healthand disability consequences for older adults. We aimed to evaluate the prevalence and risk factors ofsarcopenia among older residential aged care adults using the European Working Group on Sarcopeniain Older People (EWGSOP) criteria.Study design: A cross-sectional study design that assessed older people (n = 102, mean age 84.5 ± 8.2 years)residing in 11 long-term nursing homes in Australia.Main outcome measurements: Sarcopenia was diagnosed from assessments of skeletal mass index bybioelectrical impedance analysis, muscle strength by handheld dynamometer, and physical performanceby the 2.4 m habitual walking speed test. Secondary variables where collected to inform a risk factoranalysis.Results: Forty one (40.2%) participants were diagnosed as sarcopenic, 38 (95%) of whom were categorizedas having severe sarcopenia. Univariate logistic regression found that body mass index (BMI) (Oddsratio (OR) = 0.86; 95% confidence interval (CI) 0.78–0.94), low physical performance (OR = 0.83; 95% CI0.69–1.00), nutritional status (OR = 0.19; 95% CI 0.05–0.68) and sitting time (OR = 1.18; 95% CI 1.00–1.39)were predictive of sarcopenia. With multivariate logistic regression, only low BMI (OR = 0.80; 95% CI0.65–0.97) remained predictive.Conclusions: The prevalence of sarcopenia among older residential aged care adults is very high. Inaddition, low BMI is a predictive of sarcopenia

The incidence of deep vein thrombosis detected by routine surveillance ultrasound in neurosurgery patients receiving dual modality prophylaxis.

The optimal method of thromboprophylaxis and the value of screening ultrasonography for detection of deep venous thrombosis (DVT) in neurosurgery patients remains unclear. The goal of this study was to determine the incidence of DVT in neurosurgical patients who, by hospital protocol, receive surveillance ultrasonography of the lower extremities twice weekly, in addition to prophylaxis with unfractionated heparin and external pneumatic compression sleeves. A retrospective review of 7,298 ultrasound studies carried out on 2,593 patients over 4 years at a university neurosurgical hospital was conducted. There was a 7.4% incidence of proximal lower extremity DVT and a 9.7% total incidence including distal DVT. A greater number of distal DVTs were detected with the implementation of whole-leg ultrasonography in the last 2 years of observation. Chart review of 237 patients diagnosed with DVT demonstrated an admitting diagnosis of subarachnoid hemorrhage in nearly half of the patients. The median hospital length of stay for DVT patients was 18 days. Institutional control data demonstrated non-ruptured aneurysm and cerebrovascular anomalies to be the leading reason for admission, followed closely by subarachnoid hemorrhage. The hospital protocol of biweekly screening ultrasound and dual modality prophylaxis for neurosurgery patients resulted in a proximal DVT incidence consistent with that demonstrated by previous studies of standardized dual modality prophylaxis, and higher than that demonstrated in previous studies that employed ultrasound screening protocols

Research encounters, reflexivity and supervision

Reflexivity in qualitative and ethnographic social science research can provide a rich source of data, especially regarding the affective, performative and relational aspects of interviews with research subjects. This paper explores by means of three case examples different ways of accessing and using such reflexivity. The examples are drawn from an empirical psycho-social study into the identity transitions of first-time mothers in an inner-city multicultural environment. Fieldnotes and supervision were used to engage with researcher subjectivity, to enhance the productive use of reflexivity and to address the emotional work of research. The methodology of the supervision was psychoanalytic, in its use of a boundaried frame and of psychoanalytic forms of noticing oneself, of staying engaged emotionally as well as creating a reflective distance. The examples illustrate how this can enhance the knowledge gained about the research subjects

Capital Fixity and Mobility in Response to the 2008-09 Crisis: Variegated Neoliberalism in Mexico and Turkey

The article examines the 2008-9 crisis responses in Mexico and Turkey as examples of variegated neoliberalism. The simultaneous interests of corporations and banks relative to the national fixing of capital and their mobility in the form of global investment heavily influenced each state authority’s policy responses to the crisis at the expense of the interests of the poor, workers, and peasantry. Rather than pitching this as either evidence of persistent national differentiation or some Keynesian state resurgence, we argue from a historical materialist geographical framework that the responses of capital and state authorities in Mexico and Turkey actively constitute and reconstitute the global parameters of market regulatory design and neoliberal class rule through each state’s distinct domestic policy formation and crisis management processes. While differing in specific content the form of Mexico and Turkey’s state responses to the crisis ensured continuity in their foregoing neoliberal strategies of development and capital accumulation, most notably in the continued oppression of workers. That is, the prevailing strategy of accumulation continues to be variegated neoliberalism

DFT Study of Planar Boron Sheets: A New Template for Hydrogen Storage

We study the hydrogen storage properties of planar boron sheets and compare them to those of graphene. The binding of molecular hydrogen to the boron sheet (0.05 eV) is stronger than that to graphene. We find that dispersion of alkali metal (AM = Li, Na, and K) atoms onto the boron sheet markedly increases hydrogen binding energies and storage capacities. The unique structure of the boron sheet presents a template for creating a stable lattice of strongly bonded metal atoms with a large nearest neighbor distance. In contrast, AM atoms dispersed on graphene tend to cluster to form a bulk metal. In particular the boron-Li system is found to be a good candidate for hydrogen storage purposes. In the fully loaded case this compound can contain up to 10.7 wt. % molecular hydrogen with an average binding energy of 0.15 eV/H2.Comment: 19 pages, 7 figures, and 3 table

Rationale and design for SHAREHD: a quality improvement collaborative to scale up Shared Haemodialysis Care for patients on centre based haemodialysis.

BACKGROUND: The study objective is to assess the effectiveness and economic impact of a structured programme to support patient involvement in centre-based haemodialysis and to understand what works for whom in what circumstances and why. It implements a program of Shared Haemodialysis Care (SHC) that aims to improve experience and outcomes for those who are treated with centre-based haemodialysis, and give more patients the confidence to dialyse independently both at centres and at home. METHODS/DESIGN: The 24 month mixed methods cohort evaluation of 600 prevalent centre based HD patients is nested within a 30 month quality improvement program that aims to scale up SHC at 12 dialysis centres across England. SHC describes an intervention where patients who receive centre-based haemodialysis are given the opportunity to learn, engage with and undertake tasks associated with their treatment. Following a 6-month set up period, a phased implementation programme is initiated across 12 dialysis units using a randomised stepped wedge design with 6 centres participating in each of 2 steps, each lasting 6 months. The intervention utilises quality improvement methodologies involving rapid tests of change to determine the most appropriate mechanisms for implementation in the context of a learning collaborative. Running parallel with the stepped wedge intervention is a mixed methods cohort evaluation that employs patient questionnaires and interviews, and will link with routinely collected data at the end of the study period. The primary outcome measure is the number of patients performing at least 5 dialysis-related tasks collected using 3 monthly questionnaires. Secondary outcomes measures include: the number of people choosing to perform home haemodialysis or dialyse independently in-centre by the end of the study period; end-user recommendation; home dialysis establishment delay; staff impact and confidence; hospitalisation; infection and health economics. DISCUSSION: The results from this study will provide evidence of impact of SHC, barriers to patient and centre level adoption and inform development of future interventions to support its implementation. TRIAL REGISTRATION: ISRCTN Number: 93999549 , (retrospectively registered 1st May 2017); NIHR Research Portfolio: 31566

Increased waterborne blaNDM-1 resistance gene abundances associated with seasonal human pilgrimages to the Upper Ganges River

Antibiotic resistance (AR) is often rooted in inappropriate antibiotic use, but poor water quality and inadequate sanitation exacerbate the problem, especially in emerging countries. An example is increasing multi-AR due to mobile carbapenemases, such as NDM-1 protein (coded by blaNDM-1 genes), which can produce extreme drug-resistant phenotypes. In 2010, NDM-1 positive isolates and blaNDM-1 genes were detected in surface waters across Delhi and have since been detected across the urban world. However, little is known about blaNDM-1 levels in more pristine locations, such as the headwaters of the Upper Ganges River. This area is of particular interest because it receives massive numbers of visitors during seasonal pilgrimages in May/June, including visitors from urban India. Here we quantified blaNDM-1 abundances, other AR genes (ARG) and coliform bacteria in sediments and water column samples from seven sites in the Rishikesh-Haridwar region of the Upper Ganges and five sites on the Yamuna River in Delhi to contrast blaNDM-1 levels and water quality conditions between season and region. Water quality in the Yamuna was very poor (e.g., anoxia at all sites), and blaNDM-1 abundances were high across sites in water (5.4 ± 0.4 log(blaNDM-1·mL-1); 95% confidence interval) and sediment (6.3 ± 0.7 log(blaNDM-1·mg-1)) samples from both seasons. In contrast, water column blaNDM-1 abundances were very low across all sites (2.1 ± 0.6 log(blaNDM-1·mL-1)) in February in the Upper Ganges and water quality was good (e.g., near saturation oxygen). However, per capita blaNDM-1 levels were 20 times greater in June in the Ganges water column relative to February and blaNDM-1 levels significantly correlated with fecal coliform levels (r=0.61; p=0.007). Given waste management infrastructure is limited in Rishikesh-Haridwar; data imply blaNDM-1 levels are higher in visitor's wastes than local residents, which results in seasonally higher blaNDM-1 levels in the river. Pilgrimage areas without adequate waste treatment are possible "hot spots" for AR transmission, and waste treatment must be improved to reduce broader AR dissemination via exposed returning visitors

Scarier than another storm: values at risk in the mapping and insuring of US floodplains

How do people respond to the ways in which insurance mediates environmental risks? Socio-cultural risk research has characterized and analyzed the experiential dimension of risk, but has yet to focus on insurance, which is a key institution shaping how people understand and relate to risk. Insurance not only assesses and communicates risk; it also economizes it, making the problem on the ground not just one of risk, but also of value. This article addresses these issues with an investigation of the social life of the flood insurance rate map, the central technology of the U.S. National Flood Insurance Program (NFIP), as it grafts a new landscape of ‘value at risk’ onto the physical and social world of New York City in the aftermath of Hurricane Sandy. Like other risk technologies, ubiquitous in modern societies as decision-making and planning tools, the map disseminates information about value and risk in order to tame uncertainty and enable prudent action oriented toward the future. However, drawing together interview, ethnographic, and documentary data, I find that for its users on the ground, the map does not simply measure ‘value at risk’ in ways that produce clear strategies for protecting property values from flooding. Instead, it puts values—beyond simply the financial worth of places—at risk, as well as implicates past, present, and future risks beyond simply flooding. By informing and enlarging the stakes of what needs protecting, and from what, I argue that plural and interacting ‘values at risk’ shape how people live with and respond to environmental risks that are mediated by insurance technologies

Information Rx: Prescribing Good Consumerism and Responsible Citizenship

Recent medical informatics and sociological literature has painted the image of a new type of patient—one that is reflexive and informed, with highly specified information needs and perceptions, as well as highly developed skills and tactics for acquiring information. Patients have been re-named “reflexive consumers.” At the same time, literature about the questionable reliability of web-based information has suggested the need to create both user tools that have pre-selected information and special guidelines for individuals to use to check the individual characteristics of the information they encounter. In this article, we examine suggestions that individuals must be assisted in developing skills for “reflexive consumerism” and what these particular skills should be. Using two types of data (discursive data from websites and promotional items, and supplementary data from interviews and ethnographic observations carried out with those working to sustain these initiatives), we examine how users are directly addressed and discussed. We argue that these initiatives prescribe skills and practices that extend beyond finding and assessing information on the internet and demonstrate that they include ideals of consumerism and citizenship

Developing a community based psychosocial intervention with older people and third sector workers for anxiety and depression: a qualitative study

Background: One-in-five people in the UK experience anxiety and/or depression in later life. However, anxiety and depression remain poorly detected in older people, particularly in those with chronic physical ill health. In the UK, a stepped care approach, to manage common mental health problems, is advocated which includes service provision from non-statutory organisations (including third/voluntary sector). However, evidence to support such provision, including the most effective interventions, is limited. The qualitative study reported here constitutes the first phase of a feasibility study which aims to assess whether third sector workers can deliver a psychosocial intervention to older people with anxiety and/or depression. The aim of this qualitative study is to explore the views of older people and third sector workers about anxiety and depression among older people in order to refine an intervention to be delivered by third sector workers. Methods: Semi-structured interviews with participants recruited through purposive sampling from third sector groups in North Staffordshire. Interviews were digitally recorded with consent, transcribed and analysed using principles of constant comparison. Results: Nineteen older people and 9 third sector workers were interviewed. Key themes included: multiple forms of loss, mental health as a personal burden to bear, having courage and providing/receiving encouragement, self- worth and the value of group activities, and tensions in existing service provision, including barriers and gaps. Conclusions: The experience of loss was seen as central to feelings of anxiety and depression among community- dwelling older people. This study contributes to the evidence pointing to the scale and severity of mental health needs for some older people which can arise from multiple forms of loss, and which present a significant challenge to health, social care and third sector services. The findings informed development of a psychosocial intervention and training for third sector workers to deliver the intervention