The Management of the Development of a Geriatric-Friendly Practice Toolkit for Use in the Primary Care Setting: a Multi-Tiered Intervention to Improve the Health of Older Adults

The geriatric population of the United States is growing in size at a rate faster than any other segment of the populace. Providing effective, high quality care for this aging cohort is a critical issue facing our health system. The number of geriatricians – the specialized physicians who are trained to care for this aging population – has not kept pace with the growth of the geriatric population. Geriatricians are helpful in working with the geriatric patient to provide patient- centered care, specifically working to maintain and improve the quality of life as compared to working with significantly younger populations where physicians focus more intensively on the quantity of life. This paper examines the growth of the geriatric population, discusses the problem of the lack of geriatricians in the United States, analyzes best practices with respect to the care of the geriatric patient, and details the creation of a geriatric Toolkit by the Jewish Healthcare Foundation for use in Primary Care Practices. The goal of the Toolkit is to help the primary care practices focus on the patient’s quality, not just quantity, of life. The public health significance of this work is that providing the best care for the geriatric patient improves not just the patient, but society as a whole. By formulating a user-friendly tool, the evidence for how to effectively care for geriatric patients can be presented to practice managers and healthcare providers in an efficient way to assist them in improving the health outcomes of geriatric patients

Maximal Domination and Maximal Total Domination in Digraphs

ABSTRACT Let D=(V, A) be a digraph. A dominating set S of a digraph D is a maximal dominating set if V -S is not a dominating set of D. The maximal domination number m (D) of D is minimum cardinality of a maximal dominating set of D. A total dominating set S of a digraph D is a maximal total dominating set if V -S is not a total dominating set of D. The maximal total domination number mt (D) of D is the minimum cardinality of a maximal total dominating set of D. In this paper, we initiate a study of maximal domination and maximal total domination in digraphs and obtain some results on these two parameters. Mathematics Subject Classification: 05C

Multiplicative Product Connectivity and Sum Connectivity Indices of Chemical Structures in Drugs

In Chemical sciences, the multiplicative connectivity indices are used in the analysis of drug molecular structures which are helpful for chemical and medical scientists to find out the chemical and biological characteristics of drugs. In this paper, we compute the multiplicative product and sum connectivity indices of some important nanostar dendrimers which appeared in nanoscience

Standard surgical treatment in pancreatic cancer

Pancreatic cancer is the third leading neoplasm of the gastrointestinal system and has a dismal prognosis. The majority of patients are no more suitable for resection at time of diagnosis due to early development of distant metastases or major infiltrations of adjacent structures. However, due to the resistance of pancreatic cancers against chemoradiation, curative resection represents the only therapy with a potential for cure. For the surgical treatment of pancreatic head cancer, the classical Whipple operation is still the standard procedure but during the last two decades, pylorus-preserving duodenopancreatectomy has been evolved as a more conservative procedure in order to omit the consequences of partial gastrectomy. For cancer of the pancreatic body and tail, distal pancreatectomy or total pancreatectomy represent the current standard treatment. More radical methods like regional pancreatectomy and resection with extended lymph node dissection have failed so far to demonstrate any improvements in long-term survival compared to the standard types of resection. To further improve the treatment of pancreatic cancer, prospectively randomised trials are needed to compare these extended surgical procedures with the standard types of resectio

Certain topological indices and related polynomials for polysaccharides

A polysaccharide is a large molecule made of many smaller monosaccharides. Monosaccharides are simple sugars, like glucose. Special enzymes bind these small monomers together creating large sugar polymers or polysaccharides. A polysaccharide is also called a glycan. Starch, glycogen, and cellulose are examples of polysaccharides. Depending on their structure, polysaccharides can have a wide variety of functions in nature. Some polysaccharides are used for storing energy, some for sending cellular messages, and others for providing support to cells and tissues. In the present work, we focus on the polysaccharides, namely, amylose and blue starch-iodine complex. Several topological indices and polynomials are determined in view of edge dividing methods. Also, depict their graphic behavior.Publisher's Versio

Looking beyond the brain to improve the pathogenic understanding of Parkinson's disease: implications of whole transcriptome profiling of Patients' skin

BACKGROUND: Parkinson’s Disease is a progressive neurodegenerative disease, characterized by symptoms of motor impairment, resulting from the loss of dopaminergic neurons in the midbrain, however non-neuronal symptoms are also common. Although great advances have been made in the pathogenic understanding of Parkinson’s Disease in the nervous system, little is known about the molecular alterations occurring in other non-neuronal organ systems. In addition, a higher rate of melanoma and non-melanoma skin cancer has been observed in the Parkinson’s Disease population, indicating crosstalk between these diseases. METHODS: To understand the molecular pathogenesis and gene expression alterations of Parkinson’s Disease in peripheral tissues, and in order to explore the possible link between skin cancer and neurodegeneration, whole transcriptomic profiling of patients’ skin was performed. Skin biopsies from 12 patients and matched controls were collected, and processed with high-throughput RNA-sequencing analysis. RESULTS: This analysis resulted in a large collection of over 1000 differentially expressed genes, among which clear biological and functional networks could be distinguished. The central functional processes altered in patients skin can be grouped into six broad categories: impaired cellular metabolism and mitochondrial dysfunction, defective protein metabolism, disturbed skin homeostasis, dysfunctional nuclear processes, altered signalling and tumour pathways, as well as disordered immune regulation. CONCLUSIONS: These results demonstrate that the molecular alterations leading to neurodegeneration in the CNS are systemic and manifest also in peripheral tissues, thereby indicating the presence of “skin-brain” crosstalk in Parkinson’s Disease. In addition, the extensive homeostatic imbalance and basal stress can lead to increased susceptibility to external and internal mutagenic hazards in these patients, and thus provide a possible molecular link for the crosstalk between skin cancer and Parkinson’s Disease. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12883-016-0784-z) contains supplementary material, which is available to authorized users