Home and community care services: a major opportunity for preventive health care

BACKGROUND In Australia, the Home and Community Care (HACC) program provides services in the community to frail elderly living at home and their carers. Surprisingly little is known about the health of people who use these services. In this study we sought to describe health-related factors associated with use of HACC services, and to identify potential opportunities for targeting preventive services to those at high risk. METHODS We obtained questionnaire data from the 45 and Up Study for 103,041 men and women aged 45 years and over, sampled from the general population of New South Wales, Australia in 2006-2007, and linked this with administrative data about HACC service use. We compared the characteristics of HACC clients and non-clients according to a range of variables from the 45 and Up Study questionnaire, and estimated crude and adjusted relative risks for HACC use with generalized linear models. RESULTS 4,978 (4.8%) participants used HACC services in the year prior to completing the questionnaire. Increasing age, female sex, lower pre-tax household income, not having a partner, not being in paid work, Indigenous background and living in a regional or remote location were strongly associated with HACC use. Overseas-born people and those speaking languages other than English at home were significantly less likely to use HACC services. People who were underweight, obese, sedentary, who reported falling in the past year, who were current smokers, or who ate little fruit or vegetables were significantly more likely to use HACC services. HACC service use increased with decreasing levels of physical functioning, higher levels of psychological distress, and poorer self-ratings of health, eyesight and memory. HACC clients were more likely to report chronic health conditions, in particular diabetes, stroke, Parkinson's disease, anxiety and depression, cancer, heart attack or angina, blood clotting problems, asthma and osteoarthritis. CONCLUSIONS HACC clients have high rates of modifiable lifestyle risk factors and health conditions that are amenable to primary and secondary prevention, presenting the potential for implementing preventive health care programs in the HACC service setting.This study was supported by a HACC grant from the NSW Department of Ageing, Disability and Home Care

Does diabetes mellitus influence pathologic complete response and tumor downstaging after neoadjuvant chemoradiation for esophageal and gastroesophageal cancer? A two-institution report.

BACKGROUND: Esophageal carcinoma is an aggressive disease that is often treated with neoadjuvant therapy followed by surgical resection. Diabetes mellitus (DM) has been associated with reduced efficacy of chemoradiation (CRT) in other gastrointestinal cancers. The goal of this study was to determine if DM affects response to neoadjuvant CRT in the management of gastroesophageal carcinoma. METHODS: We retrospectively reviewed the esophageal cancer patient databases and subsequently analyzed those patients who received neoadjuvant CRT followed by surgical resection at two institutions, Thomas Jefferson University (TJUH) and Fox Chase Cancer Center (FCCC). Comparative analyses of rates of pathologic complete response rate (pCR) and pathologic downstaging in DM patients versus non-DM patients was performed. RESULTS: Two hundred sixty patients were included in the study; 36 patients had DM and 224 were non-diabetics. The average age of the patients was 61 years (range 24-84 years). The overall pCR was 26%. The pCR rate was 19% and 27% for patients with DM and without DM, respectively (P = 0.31). Pathologic downstaging occurred in 39% of study patients, including of 33% of DM patients and 40% of non-DM patients (P = 0.42). CONCLUSIONS: Although the current analysis does not demonstrate a significant reduction in pCR rates or pathologic downstaging in patients with DM, the observed trend suggests that a potential difference may be observed with a larger patient population. Further studies are warranted to evaluate the influence of DM on the effectiveness of neoadjuvant CRT in esophageal cancer

Characterization of Genotype by Planting Date Effects on Runner-Type Peanut Seed Germination and Vigor Response to Temperature

Experiments evaluated the genotype by environment effects on seed germination and vigor of the peanut runner-type cultivars ‘Georgia Green’, ‘AT3085R0’, ‘AT271516’, ‘Georgia 03L’, and ‘FR458’ grown under similar production practices, for three planting dates: April, May, and June in Georgia and Alabama. Objectives were to determine if time of planting and harvest dates would subsequently affect germination and vigor when tested using a thermal gradient devise (temperature range14 to 35 °C). Runner-type peanut seed grown in Dawson Georgia in 2008 had the strongest seed vigor with Germ80 of 22 to 40 growing degree days (GDD), and maximum incidence of germination rate 84.8-95.7% when planted April, May, and June 2008 across 15 seed lots. In contrast, seed harvested from plantings of May 2009 at Dawson Georgia exhibited Germ80 of 24 to 40 GDD with maximum incidence of germination rate 79.8-93.6%, but seed from April 2009 plantings had poor vigor of 56.8-72.8% and no amount of GDD could achieve Germ80, with similar results for June 2009 plantings for this location. For Headland April, May, and June 2009 plantings of the same cultivars, all seed had poor vigor, ≤75.6% maximum incidence for germination rate, and none obtained a measurable Germ80

Home and community care services: a major opportunity for preventive health care

<p>Abstract</p> <p>Background</p> <p>In Australia, the Home and Community Care (HACC) program provides services in the community to frail elderly living at home and their carers. Surprisingly little is known about the health of people who use these services. In this study we sought to describe health-related factors associated with use of HACC services, and to identify potential opportunities for targeting preventive services to those at high risk.</p> <p>Methods</p> <p>We obtained questionnaire data from the 45 and Up Study for 103,041 men and women aged 45 years and over, sampled from the general population of New South Wales, Australia in 2006-2007, and linked this with administrative data about HACC service use. We compared the characteristics of HACC clients and non-clients according to a range of variables from the 45 and Up Study questionnaire, and estimated crude and adjusted relative risks for HACC use with generalized linear models.</p> <p>Results</p> <p>4,978 (4.8%) participants used HACC services in the year prior to completing the questionnaire. Increasing age, female sex, lower pre-tax household income, not having a partner, not being in paid work, Indigenous background and living in a regional or remote location were strongly associated with HACC use. Overseas-born people and those speaking languages other than English at home were significantly less likely to use HACC services. People who were underweight, obese, sedentary, who reported falling in the past year, who were current smokers, or who ate little fruit or vegetables were significantly more likely to use HACC services. HACC service use increased with decreasing levels of physical functioning, higher levels of psychological distress, and poorer self-ratings of health, eyesight and memory. HACC clients were more likely to report chronic health conditions, in particular diabetes, stroke, Parkinson's disease, anxiety and depression, cancer, heart attack or angina, blood clotting problems, asthma and osteoarthritis.</p> <p>Conclusions</p> <p>HACC clients have high rates of modifiable lifestyle risk factors and health conditions that are amenable to primary and secondary prevention, presenting the potential for implementing preventive health care programs in the HACC service setting.</p

Associations between Cognition, Gender and Monocyte Activation among HIV Infected Individuals in Nigeria.

The potential role of gender in the occurrence of HIV-related neurocognitive impairment (NCI) and associations with markers of HIV-related immune activity has not been previously examined. In this study 149 antiretroviral-naïve seropositive subjects in Nigeria (SP, 92 women and 57 men) and 58 seronegative (SN, 38 women and 20 men) were administered neuropsychological testing that assessed 7 ability domains. From the neuropsychological test scores was calculated a global deficit score (GDS), a measure of overall NCI. Percentages of circulating monocytes and plasma HIV RNA, soluble CD163 and soluble CD14 levels were also assessed. HIV SP women were found to be younger, more educated and had higher CD4+ T cell counts and borderline higher viral load measures than SP men. On the neuropsychological testing, SP women were more impaired in speed of information processing and verbal fluency and had a higher mean GDS than SN women. Compared to SP men, SP women were also more impaired in speed of information processing and verbal fluency as well as on tests of learning and memory. Numbers of circulating monocytes and plasma sCD14 and sCD163 levels were significantly higher for all SP versus all SN individuals and were also higher for SP women and for SP men versus their SN counterparts. Among SP women, soluble CD14 levels were slightly higher than for SP men, and SP women had higher viral load measurements and were more likely to have detectable virus than SP men. Higher sCD14 levels among SP women correlated with more severe global impairment, and higher viral load measurements correlated with higher monocyte numbers and sCD14 and sCD14 levels, associations that were not observed for SP men. These studies suggest that the risk of developing NCI differ for HIV infected women and men in Nigeria and, for women, may be linked to effects from higher plasma levels of HIV driving activation of circulating monocytes

Management of damage by elk (\u3ci\u3eCervus elaphus\u3c/i\u3e) in North America: a review

Abundant populations of elk (Cervus elaphus) are cherished game in many regions of the world and also cause considerable human–wildlife conflicts through depredation on agriculture and specialty crops, lack of regeneration to native ecosystems, collisions with vehicles and transmission of disease between free-ranging and farmed hoofstock. Management of elk varies, depending on current and historical agency objectives, configuration of the landscapes elk occupy, public perception, population density and behaviour of elk. Selection of the method to manage elk often requires knowledge of timing of impacts, duration relief from elk damage is desired, cost-effectiveness of management activities, tolerance of impacts, public perception of management strategies and motivation or habituation of elk to determine the likelihood of success for a proposed management action. We reviewed methods that are available to control abundant populations of elk that include lethal (e.g. hunting, sharpshooting) and non-lethal (e.g. fertility control, frightening) options. We promote an integrated approach that incorporates the timely use of a variety of cost-effective methods to reduce impacts to tolerable levels. Lethal options that include regulated hunting, sharpshooting and aerial gunning vary by likelihood of success, duration needed for population reduction, cost to implement reduction and public perceptions. Several non-lethal options are available to affect population dynamics directly (e.g. fertility control, translocation), protect resources from damage (e.g. fences, repellents) or influence space use of elk on a regular basis (e.g. harassment, frightening, herding dogs, humans). Public perception should be considered by agencies that are looking for feasible methods to control populations of elk. Disturbance to residents or visitors of public property may influence methods of management employed. Future research should explore the duration of harassment needed to avert elk from sensitive areas and costs to implement such programs. Several methods in our review were implemented on deer and additional research on elk and other cervids in conflict with human interests would provide a much needed component to our understanding of management methods available for ungulate species

Packaging, deployment, and panel design concepts for a truss-stiffened 7-panel precision deployable reflector with feed boom

A concept is presented for achieving a remotely deployable truss-stiffened reflector consisting of seven integrated sandwich panels that form the reflective surface, and an integrated feed boom. The concept has potential for meeting aperture size and surface precision requirements for some high-frequency microwave remote sensing applications. The packaged reflector/feed boom configuration is a self-contained unit that can be conveniently attached to a spacecraft bus. The package has a cylindrical envelope compatible with typical launch vehicle shrouds. Dynamic behavior of a deployed configuration having a 216-inch focal length and consisting of 80-inch-diameter, two-inch-thick panels is examined through finite-element analysis. Results show that the feed boom and spacecraft bus can have a large impact on the fundamental frequency of the deployed configuration. Two candidate rib-stiffened sandwich panel configurations for this application are described, and analytical results for panel mass and stiffness are presented. Results show that the addition of only a few rib stiffeners, if sufficiently deep, can efficiently improve sandwich panel stiffness