The Impact of Education on Fear of Falling in Elderly Women

Context: More than one third of individuals 65 and older fall each year. Approximately 85% of these falls occur in the homes of independent older adults. Falls can lead to an increased fear of falling, defined as a pervasive concern that a fall may occur. Fear of falling can decrease quality of life due to a lower sense of well-being, limiting mobility, and reduction of social interaction. Reduction in activity can result in a sedentary lifestyle and poor balance which increases the risk of falling. Fifty percent of women 75 years and older participate in no physical activity beyond activities of daily living. Older women, on average, participate in half the amount of moderate and vigorous activity as young women. Activity and education based programs have been shown to increase balance confidence in all participants independent of the program they participated in.The aim of the intervention utilized in this study was to decrease fear of falling in elderly women and improve their overall quality of life. Objective: The purpose of the study was to determine how an educational intervention that utilized balance training and home safety assessment would impact fear of falling in elderly women at different activity levels based on the results from activPAL technology. Setting: All subject were tested at Butterfield Trail Village in Fayetteville, AR for all assessments. Participants: Eight older women; 3 in the high activity group, 2 in the moderate activity group, and 3 in the low activity group. The mean age was 79.1 years, the mean height was 161.7 cm, and the mean weight was 61.1 kg. Methods: The participants were recruited from Butterfield Trail senior living community. The participants were given a health history questionnaire and informed consent. The pre-assessment given was the Falls Efficacy Scale- International (FES-I) to determine the participants’ fear of falling. activPAL monitors were given to each participant to wear for 7 days to determine activity level. A one-on-one education session was conducted with each participant after activity assessment. A post FES-I assessment was given after completion of the education session. Main Outcome Measures: A dependent t-test was conducted to compare pre and post FES-I scores. Differences between groups (group x time) were assessed using a repeated measures ANOVA. Statistical significance was set at α = .05. Correlational analysis was conducted to examine the relationship between fear of falling and activity level Results: Statistical significance was not found in any of the outcome measures. Mean FES-I scores dependent t-test: pre 25.5 + 5.9, post 30.5 + 7.2, mean difference -1.9, p-value .58. Repeated measures ANOVA: low activity pre 27.7 + 3.5 post 32.3 + 8.1, moderate activity pre 31.0 + 1.4 post 33.5 + 6.4, high activity pre 19.0 + 3.0 post 26.7 + 7.6. Correlational analysis: a moderate correlation (-.63) was found between activity level and fear of falling. Conclusion: The education intervention utilized in this study that used a variety of materials and techniques was not effective in reducing fear of falling in elderly women across all activity levels

Spitzer View of Massive Star Formation in the Tidally Stripped Magellanic Bridge

The Magellanic Bridge is the nearest low-metallicity, tidally stripped environment, offering a unique high-resolution view of physical conditions in merging and forming galaxies. In this paper we present analysis of candidate massive young stellar objects (YSOs), i.e., {\it in situ, current} massive star formation (MSF) in the Bridge using {\it Spitzer} mid-IR and complementary optical and near-IR photometry. While we definitely find YSOs in the Bridge, the most massive are $\sim10 M_\odot$, $\ll45 M_\odot$ found in the Large Magellanic Cloud (LMC). The intensity of MSF in the Bridge also appears decreasing, as the most massive YSOs are less massive than those formed in the past. To investigate environmental effects on MSF, we have compared properties of massive YSOs in the Bridge to those in the LMC. First, YSOs in the Bridge are apparently less embedded than in the LMC: 81% of Bridge YSOs show optical counterparts, compared to only 56% of LMC sources with the same range of mass, circumstellar dust mass, and line-of-sight extinction. Circumstellar envelopes are evidently more porous or clumpy in the Bridge's low-metallicity environment. Second, we have used whole samples of YSOs in the LMC and the Bridge to estimate the probability of finding YSOs at a given \hi\ column density, N(HI). We found that the LMC has $\sim3\times$ higher probability than the Bridge for N(HI) $>10\times10^{20}$ cm$^{-2}$, but the trend reverses at lower N(HI). Investigating whether this lower efficiency relative to HI is due to less efficient molecular cloud formation, or less efficient cloud collapse, or both, will require sensitive molecular gas observations.Comment: 41 pages, 20 figures, 6 tables; accepted for publication in ApJ; several figures are in low resolution due to the size limit here and a high resolution version can be downloaded via http://www.astro.virginia.edu/~cc5ye/ms_bridge20140215.pd

The Dust-to-Gas Ratio in the Small Magellanic Cloud Tail

The Tail region of the Small Magellanic Cloud (SMC) was imaged using the MIPS instrument on the Spitzer Space Telescope as part of the SAGE-SMC Spitzer Legacy. Diffuse infrared emission from dust was detected in all the MIPS bands. The Tail gas-to-dust ratio was measured to be 1200 +/- 350 using the MIPS observations combined with existing IRAS and HI observations. This gas-to-dust ratio is higher than the expected 500-800 from the known Tail metallicity indicating possible destruction of dust grains. Two cluster regions in the Tail were resolved into multiple sources in the MIPS observations and local gas-to-dust ratios were measured to be ~440 and ~250 suggests dust formation and/or significant amounts of ionized gas in these regions. These results support the interpretation that the SMC Tail is a tidal tail recently stripped from the SMC that includes gas, dust, and young stars.Comment: 6 pages, 3 figures, ApJ Letters, in press, (version with full resolution figures at http://www.stsci.edu/~kgordon/papers/PS_files/sage-smc_taildust_v1.62.pdf

Use of the ODD-Luciferase Transgene for the Non-Invasive Imaging of Spontaneous Tumors in Mice

In humans, imaging of tumors provides rapid, accurate assessment of tumor growth and location. In laboratory animals, however, the imaging of spontaneously occurring tumors continues to pose many technical and logistical problems. Recently a mouse model was generated in which a chimeric protein consisting of HIF-1α oxygen-dependent degradation domain (ODD) fused to luciferase was ubiquitously expressed in all tissues. Hypoxic stress leads to the accumulation of ODD-luciferase in the tissues of this mouse model which can be identified by non-invasive bioluminescence measurement. Since solid tumors often contain hypoxic regions, we performed proof-of-principle experiments testing whether this transgenic mouse model may be used as a universal platform for non-invasive imaging analysis of spontaneous solid tumors.ODD-luciferase transgenic mice were bred with MMTV-neu/beclin1+/- mice. Upon injection of luciferin, bioluminescent background of normal tissues in the transgenic mice and bioluminescent signals from spontaneously mammary carcinomas were measured non-invasively with an IVIS Spectrum imaging station. Tumor volumes were measured manually and the histology of tumor tissues was analyzed.Our results show that spontaneous mammary tumors in ODD-luciferase transgenic mice generate substantial bioluminescent signals, which are clearly discernable from background tissue luminescence. Moreover, we demonstrate a strong quantitative correlation between the bioluminescent tumor contour and the volume of palpable tumors. We further demonstrate that shrinkage of the volume of spontaneous tumors in response to chemotherapeutic treatment can be determined quantitatively using this system. Finally, we show that the growth and development of spontaneous tumors can be monitored longitudinally over several weeks. Thus, our results suggest that this model could potentially provide a practical, reliable, and cost-effective non-invasive quantitative method for imaging spontaneous solid tumors in mice

Weak localization in disordered systems at the ballistic limit

The weak localization (WL) contribution to the two-level correlation function is calculated for two-dimensional disordered conductors. Our analysis extends to the nondiffusive (ballistic) regime, where the elastic mean path is of order of the size of the system. In this regime the structure factor (the Fourier transform of the two-point correlator) exhibits a singular behavior consisting of dips superimposed on a smooth positive background. The strongest dips appear at periods of the periodic orbits of the underlying clean system. Somewhat weaker singularities appear at times which are sums of periods of two such orbits. The results elucidate various aspects of the weak localization physics of ballistic chaotic systems.Comment: 13 pages, 13 figure

Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future

There are a number of limitations to using conventional diagnostic markers for patients with clinical suspicion of infection. As a consequence, unnecessary and prolonged exposure to antimicrobial agents adversely affect patient outcomes, while inappropriate antibiotic therapy increases antibiotic resistance. A growing body of evidence supports the use of procalcitonin (PCT) to improve diagnosis of bacterial infections and to guide antibiotic therapy. For patients with upper and lower respiratory tract infection, post-operative infections and for severe sepsis patients in the intensive care unit, randomized-controlled trials have shown a benefit of using PCT algorithms to guide decisions about initiation and/or discontinuation of antibiotic therapy. For some other types of infections, observational studies have shown promising first results, but further intervention studies are needed before use of PCT in clinical routine can be recommended. The aim of this review is to summarize the current evidence for PCT in different infections and clinical settings, and discuss the reliability of this marker when used with validated diagnostic algorithms

Serotype-specific mortality from invasive Streptococcus pneumoniae disease revisited

BACKGROUND: Invasive infection with Streptococcus pneumoniae (pneumococci) causes significant morbidity and mortality. Case series and experimental data have shown that the capsular serotype is involved in the pathogenesis and a determinant of disease outcome. METHODS: Retrospective review of 464 cases of invasive disease among adults diagnosed between 1990 and 2001. Multivariate Cox proportional hazard analysis. RESULTS: After adjustment for other markers of disease severity, we found that infection with serotype 3 was associated with an increased relative risk (RR) of death of 2.54 (95% confidence interval (CI): 1.22–5.27), whereas infection with serotype 1 was associated with a decreased risk of death (RR 0.23 (95% CI, 0.06–0.97)). Additionally, older age, relative leucopenia and relative hypothermia were independent predictors of mortality. CONCLUSION: Our study shows that capsular serotypes independently influenced the outcome from invasive pneumococcal disease. The limitations of the current polysaccharide pneumococcal vaccine warrant the development of alternative vaccines. We suggest that the virulence of pneumococcal serotypes should be considered in the design of novel vaccines

Subcellular trafficking of the substrate transporters GLUT4 and CD36 in cardiomyocytes

Cardiomyocytes use glucose as well as fatty acids for ATP production. These substrates are transported into the cell by glucose transporter 4 (GLUT4) and the fatty acid transporter CD36. Besides being located at the sarcolemma, GLUT4 and CD36 are stored in intracellular compartments. Raised plasma insulin concentrations and increased cardiac work will stimulate GLUT4 as well as CD36 to translocate to the sarcolemma. As so far studied, signaling pathways that regulate GLUT4 translocation similarly affect CD36 translocation. During the development of insulin resistance and type 2 diabetes, CD36 becomes permanently localized at the sarcolemma, whereas GLUT4 internalizes. This juxtaposed positioning of GLUT4 and CD36 is important for aberrant substrate uptake in the diabetic heart: chronically increased fatty acid uptake at the expense of glucose. To explain the differences in subcellular localization of GLUT4 and CD36 in type 2 diabetes, recent research has focused on the role of proteins involved in trafficking of cargo between subcellular compartments. Several of these proteins appear to be similarly involved in both GLUT4 and CD36 translocation. Others, however, have different roles in either GLUT4 or CD36 translocation. These trafficking components, which are differently involved in GLUT4 or CD36 translocation, may be considered novel targets for the development of therapies to restore the imbalanced substrate utilization that occurs in obesity, insulin resistance and diabetic cardiomyopathy