The reduction of disability in community-dwelling frail older people: design of a two-arm cluster randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Frailty among older people is related to an increased risk of adverse health outcomes such as acute and chronic diseases, disability and mortality. Although many intervention studies for frail older people have been reported, only a few have shown positive effects regarding disability prevention. This article presents the design of a two-arm cluster randomized controlled trial on the effectiveness, cost-effectiveness and feasibility of a primary care intervention that combines the most promising elements of disability prevention in community-dwelling frail older people.</p> <p>Methods/design</p> <p>In this study twelve general practitioner practices were randomly allocated to the intervention group (6 practices) or to the control group (6 practices). Three thousand four hundred ninety-eight screening questionnaires including the Groningen Frailty Indicator (GFI) were sent out to identify frail older people. Based on their GFI score (≥5), 360 participants will be included in the study. The intervention will receive an interdisciplinary primary care intervention. After a comprehensive assessment by a practice nurse and additional assessments by other professionals, if needed, an individual action plan will be defined. The action plan is related to a flexible toolbox of interventions, which will be conducted by an interdisciplinary team. Effects of the intervention, both for the frail older people and their informal caregivers, will be measured after 6, 12 and 24 months using postal questionnaires and telephone interviews. Data for the process evaluation and economic evaluation will be gathered continuously over a 24-month period.</p> <p>Discussion</p> <p>The proposed study will provide information about the usefulness of an interdisciplinary primary care intervention. The postal screening procedure was conducted in two cycles between December 2009 and April 2010 and turned out to be a feasible method. The response rate was 79.7%. According to GFI scores 29.3% of the respondents can be considered as frail (GFI ≥ 5). Nearly half of them (48.1%) were willing to participate. The baseline measurements started in January 2010. In February 2010 the first older people were approached by the practice nurse for a comprehensive assessment. Data on the effect, process, and economic evaluation will be available in 2012.</p> <p>Trial Registration</p> <p>ISRCTN31954692</p

Effect of carbon starvation on toluene degradation activity by toluene monooxygenase-expressing bacteria

Subsurface bacteria commonly exist in a starvation state with only periodic exposure to utilizable sources of carbon and energy. In this study, the effect of carbon starvation on aerobic toluene degradation was quantitatively evaluated with a selection of bacteria representing all the known toluene oxygenase enzyme pathways. For all the investigated strains, the rate of toluene biodegradation decreased exponentially with starvation time. First-order deactivation rate constants for TMO-expressing bacteria were approximately an order of magnitude greater than those for other oxygenase-expressing bacteria. When growth conditions (the type of growth substrate and the type and concentration of toluene oxygenase inducer) were varied in the cultures prior to the deactivation experiments, the rate of deactivation was not significantly affected, suggesting that the rate of deactivation is independent of previous substrate/inducer conditions. Because TMO-expressing bacteria are known to efficiently detoxify TCE in subsurface environments, these findings have significant implications for in situ TCE bioremediation, specifically for environments experiencing variable growth-substrate exposure conditions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45353/1/10532_2005_Article_9014.pd

The restoration of fens in the Netherlands

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Restoration of brook valley meadows in the Netherlands

Until recently, restoration measures in Dutch brook valley meadows consisted of re-introducing traditional management techniques, such as mowing without fertilisation and low-intensity grazing. In the Netherlands, additional measures, such as rewetting and sod cutting, are now carried out on a large scale to combat negative influences of drainage and acidifying influences by atmospheric deposition. An analysis of successful and unsuccessful projects shows that restoration of brook valley meadows is most successful if traditional management techniques are applied in recently abandoned fields that had not been drained or fertilised. Large-scale topsoil removal in former agricultural fields that had been used intensively for several decades is often unsuccessful since seed banks are depleted, while hydrological conditions and seed dispersal mechanisms are sub-optimal. In areas with an organic topsoil, long-term drainage had often led to irreversible changes in chemical and physical properties of the soil. Successful sites were all characterised by a regular discharge of calcareous groundwater provided by local or regional hydrological systems, and, where not very long ago, populations of target species existed. On mineral soils, in particular, sod removal in established nature reserves was a successful measure to increase the number of endangered fen meadow species. It is argued that attempts to restore species-rich meadows should be avoided on former agricultural fields, where pedological processeshave led to almost irreversible changes in the soil profile and where soil seed banks have been completely depleted. From a soil conservation point of view, such areas should be exploited as eutrophic wetlands that are regularly flooded