Recording from two neurons: second order stimulus reconstruction from spike trains and population coding

We study the reconstruction of visual stimuli from spike trains, recording simultaneously from the two H1 neurons located in the lobula plate of the fly Chrysomya megacephala. The fly views two types of stimuli, corresponding to rotational and translational displacements. If the reconstructed stimulus is to be represented by a Volterra series and correlations between spikes are to be taken into account, first order expansions are insufficient and we have to go to second order, at least. In this case higher order correlation functions have to be manipulated, whose size may become prohibitively large. We therefore develop a Gaussian-like representation for fourth order correlation functions, which works exceedingly well in the case of the fly. The reconstructions using this Gaussian-like representation are very similar to the reconstructions using the experimental correlation functions. The overall contribution to rotational stimulus reconstruction of the second order kernels - measured by a chi-squared averaged over the whole experiment - is only about 8% of the first order contribution. Yet if we introduce an instant-dependent chi-square to measure the contribution of second order kernels at special events, we observe an up to 100% improvement. As may be expected, for translational stimuli the reconstructions are rather poor. The Gaussian-like representation could be a valuable aid in population coding with large number of neurons

Vitality club:a proof-of-principle of peer coaching for daily physical activity by older adults

Many age-related diseases can be prevented or delayed by daily physical activity. Unfortunately, many older adults do not perform physical activity at the recommended level. Professional interventions do not reach large numbers of older adults for a long period of time. We studied a peer-coach intervention, in which older adults coach each other, that increased daily physical activity of community dwelling older adults for over 6 years. We studied the format and effects of this peer coach intervention for possible future implementation elsewhere. Through interviews and participatory observation we studied the format of the intervention. We also used a questionnaire (n = 55) and collected 6-min walk test data (n = 261) from 2014 to 2016 to determine the motivations of participants and effects of the intervention on health, well-being and physical capacity. Vitality Club is a self-sustainable group of older adults that gather every weekday to exercise coached by an older adult. Members attend on average 2.5 days per week and retention rate is 77.5% after 6 years. The members perceived improvements in several health measures. In line with this, the 6-min walk test results of members of this Vitality Club improved with 21.7 meters per year, compared with the decline of 2-7 meters per year in the general population. This Vitality Club is successful in durably engaging its members in physical activity. The members perceive improvements in health that are in line with improvements in a physical function test. Because of the self-sustainable character of the intervention, peer coaching has the potential to be scaled up at low cost and increase physical activity in the increasing number of older adults

Increasing Older Adult Involvement in Geriatric Assessment:A Mixed-Methods Process Evaluation

Objectives: Goal setting and motivational interviewing (MI) may increase well-being by promoting healthy behavior. Since we failed to show improved well-being in a proactive assessment service for community-dwelling older adults applying these techniques, we studied whether implementation processes could explain this. Methods: Goals set during the comprehensive geriatric assessment were evaluated on their potential for behavior change. MI and goal setting adherence wasassessed by reviewing audiotaped interactions and interviewing care professionals. Results: Among the 280 goals set with 230 frail older adults (mean age 77 +/- 6.9 years, 59% women), more than 90% had a low potential for behavior change. Quality thresholds for MI were reached in only one of the 11 interactions. Application was hindered by the context and the limited proficiency of care professionals. Discussion: Implementation was suboptimal for goal setting and MI. This decreased the potential for improved well-being in the participating older adults

Long Term Outcomes of a Geriatric Liaison Intervention in Frail Elderly Cancer Patients

Background The aim of this study was to evaluate the long term effects after discharge of a hospital-based geriatric liaison intervention to prevent postoperative delirium in frail elderly cancer patients treated with an elective surgical procedure for a solid tumour. In addition, the effect of a postoperative delirium on long term outcomes was examined. Methods A three month follow-up was performed in participants of the Liaison Intervention in Frail Elderly study, a multicentre, prospective, randomized, controlled trial. Patients were randomized to standard treatment or a geriatric liaison intervention. The intervention consisted of a preoperative geriatric consultation, an individual treatment plan targeted at risk factors for delirium and daily visits by a geriatric nurse during the hospital stay. The long term outcomes included: mortality, rehospitalisation, Activities of Daily Living (ADL) functioning, return to the independent pre-operative living situation, use of supportive care, cognitive functioning and health related quality of life. Results Data of 260 patients (intervention n = 127, Control n = 133) were analysed. There were no differences between the intervention group and usual-care group for any of the outcomes three months after discharge. The presence of postoperative delirium was associated with: an increased risk of decline in ADL functioning (OR: 2.65, 95% CI: 1.02-6.88), an increased use of supportive assistance (OR: 2.45, 95% CI: 1.02-5.87) and a decreased chance to return to the independent preoperative living situation (OR: 0.18, 95% CI: 0.07-0.49). Conclusions A hospital-based geriatric liaison intervention for the prevention of postoperative delirium in frail elderly cancer patients undergoing elective surgery for a solid tumour did not improve outcomes 3 months after discharge from hospital. The negative effect of a postoperative delirium on late outcome was confirmed

Linking a peer coach physical activity intervention for older adults to a primary care referral scheme

Background Physical inactivity has contributed to the current prevalence of many age-related diseases, including type 2 diabetes and cardiovascular disease. Peer coach physical activity intervention are effective in increasing long term physical activity in community dwelling older adults. Linking peer coach physical activity interventions to formal care could therefore be a promising novel method to improve health in inactive older adults to a successful long-term physical activity intervention. Methods We evaluated the effects of linking a peer coach physical activity intervention in Leiden, The Netherlands to primary care through an exercise referral scheme from July 2018 to April 2020. Primary care practices in the neighborhoods of three existing peer coach physical activity groups were invited to refer patients to the exercise groups. Referrals were registered at the primary care practice and participation in the peer coach groups was registered by the peer coaches of the exercise groups. Results During the study, a total of 106 patients were referred to the peer coach groups. 5.7% of patients participated at the peer coach groups and 66.7% remained participating during the 1 year follow up. The number needed to refer for 1 long term participant was 26.5. The mean frequency of participation of the referred participants was 1.2 times a week. Conclusion Linking a peer coach physical activity intervention for older adults to a primary care referral scheme reached only a small fraction of the estimated target population. However, of the people that came to the peer coach intervention a large portion continued to participate during the entire study period. The number needed to refer to engage one older person in long term physical activity was similar to other referral schemes for lifestyle interventions. The potential benefits could be regarded proportional to the small effort needed to refer

Effect of nozzle geometry on the efficiency of compressed air nozzles

Papers presented to the 11th International Conference on Heat Transfer, Fluid Mechanics and Thermodynamics, South Africa, 20-23 July 2015.This paper evaluates the performance of different nozzle geometries which are all used in industrial blowing applications. Five different geometries were selected: a converging nozzle, a stepped nozzle, a straight pipe, a converging-diverging nozzle and an energy-efficient nozzle. The flow field of the various nozzles was calculated using CFD simulations. The compressible RANS equations were solved using the SST k-omega turbulence model. Different properties, like the total impact force, the impact pressure and the entrainment rate were obtained from the simulations to compare the nozzles with each other. For each of these properties, the most efficient nozzle was the one for which the mass flow rate of compressed air was the lowest. All nozzles showed comparable mass flow rates for the same impact force and the difference was in the order of 5% better than a straight pipe geometry. Only the energy saving nozzle used around 10% less mass flow and is the best solution to reduce compressed air consumption without losing performance.The authors gratefully acknowledge the funding of this study by the Agency for Innovation by Science and Technology (IWT) through the TETRA project nr. 130223.am201

Effects Of Increasing The Involvement Of Community-Dwelling Frail Older Adults In A Proactive Assessment Service:A Pragmatic Trial

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Goal Planning in Person-Centred Care Supports Older Adults to Attain Their Health-Related Goals

Introduction:Care for older adults should preferably be provided in a person-centred way that includes goal planning, a method to enhance patient involvement. However, little is known about the functioning of goal planning within person-centred care. Therefore, the aim of the present study is to gain insight into the processes and results of goal planning using VAS-scores, in a person-centred care setting for community-living older adults of 75-years or older. Methods: We performed a pretest-posttest study within Embrace1, a person-centred and integrated care service. First, a comprehensive geriatric assessment was performed by case managers using the GeriatrICS 2, an ICF-based assessment tool. Next goals were set and goal plans were formulated for those health-related problems that were selected by the older adult, with the aim to improve these problems. For each goal, a severity score and an intended goal score were determined by the older adult. Within one year, these goals were evaluated and an obtained goal score given, again by the older adult. The characteristics of goal plans were identified, the percentage of goals attained was calculated and the results for older adults with different frailty levels and differences within goal domains were compared. Results: In total 233 older adults were included in the study. Mean age of participants was 81.5 years SD 4.7, 68% was women, 47% was living alone, and 54% had a lower education level. In total, 836 goal plans were formulated among 233 older adults. Most prevalent were goal plans in the domains Physical health 64%, Mobility 50%, and Support 49%. Unexpected was the high prevalence of goal plans related to pain 25%. Of the goals set, 74% were fully attained, while the mean differences between intended goal scores and obtained goal scores were trivial. No difference for goal attainment was found between older adults with different frailty levels. Goals related to physical health were more likely to be attained, while goals for mobility and pain were the least likely to be attained. Conclusion:This study showed that older adults are able to formulate and attain health-related goals through collaborative goal planning. We would recommend that future integrated care programmes for older adults incorporate goal planning methods to achieve person-centred care. Lessons learned: Allowing the older adult to take a central role in the goal-planning process, especially in selecting the health-related problems and formulating goal plans to address these problems, and rating the VAS-scores, seems promising. Limitations:The lack of a control group in this study might be seen as a limitation, as we were not able to account for the possibility of response shift, an adaptive strategy that allows someone to feel good about their actual health status despite deteriorating health. Suggestions for future research: Future research should examine the effect of goal planning with VAS in person-centred care on person-reported outcome measures such as quality of life, or healthcare consumption and costs

Explaining experiences of community-dwelling older adults with a pro-active comprehensive geriatric assessment program - a thorough evaluation by interviews

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Goal planning in person-centred care supports older adults receiving case management to attain their health-related goals

Purpose: Care for older adults should preferably be provided in a person-centred way that includes goal planning. The aim of the present cohort study is to gain an insight into the results of goal planning, in a person-centred care setting for community-living older adults. Materials and methods: Within Embrace, a person-centred and integrated care service, older adults set goals with the aim to improve health-related problems. For every goal, they rated severity scores ranging from 0 (no problem) to 10 (extremely severe): a baseline score, a target score and, within one year, an end score to evaluate these goals. The differences between baseline and end scores (goal progress) and target and end scores (goal attainment), and the percentage of goals attained were calculated and compared between health-related domains (i.e., mental health, physical health, mobility, and support). Results: Among 233 older adults, 836 goal plans were formulated of which 74% (95% Confidence Interval: 71-77) were attained. Goals related to physical health were the most likely to be attained and goals for mobility and pain the least likely. Conclusions: Older adults are able to attain health-related goals through collaborative goal planning. We recommend future integrated care programmes for older adults to incorporate goal-planning methods to achieve person-centred care. IMPLICATIONS FOR REHABILITATION Older adults experiencing frailty or complex care needs and receiving individual support within an integrated care setting are able to formulate and attain goals using goal planning with severity scores. Goal plans of community-living older adults mostly aim at improving health-related problems concerning physical health, mobility, or support. Goals related to physical health are the most likely to be attained, while goals for mobility and pain are the least likely to be attained