Latitudinal Adaptation of Switchgrass Populations

Switchgrass (Panicum virgatum L.) is a widely adapted warm-season perennial that has considerable potential as a biofuel crop. Evolutionary processes and environmental factors have combined to create considerable ecotypic differentiation in switchgrass. The objective of this study was to determine the nature of population x location interaction for switchgrass, quantifying potential differences in latitudinal adaptation of switchgrass populations. Twenty populations were evaluated for biofuel and agronomic traits for 2 yr at five locations ranging from 36 to 46° N lat. Biomass yield, survival, and plant height had considerable population x location interaction, much of which (53-65%) could be attributed to the linear effect of latitude and to germplasm groups (Northern Upland, Southern Upland, Northern Lowland, and Southern Lowland). Differences among populations were consistent across locations for maturity, dry matter, and lodging. Increasingly later maturity and the more rapid stem elongation rate of more southern-origin ecotypes (mainly lowland cytotypes) resulted in high biomass yield potential, reduced dry matter concentration, and longer retention of photosynthetically active tissue at more southern locations. Conversely, increasing cold tolerance of more northern-origin ecotypes (mainly upland cytotypes) resulted in higher survival, stand longevity, and sustained biomass yields at more northern locations, allowing switchgrass to thrive at cold, northern latitudes. Although cytotype explained much of the variation among populations and the population x location interaction, ecotypic differentiation within cytotypes accounted for considerable variation in adaption of switchgrass populations

Development of the GeriatrICS, an ICF-based and person-centred assessment tool for evaluation of health-related problems in community-living older adults

Introduction: Ideally, older adults should receive person-centred care and support that meets their individual needs and wishes, taking all relevant health-related problems into account. The International Classification of Functioning, Disability and Health ICF might offer a basis for identification of these problems as it provides a unified language for evaluation of functioning and disability associated with someone’s health status. ICF Core Sets have been developed to describe the spectrum of disabilities of specific patient populations. Therefore, aim of this study was to develop a valid Geriatric ICF Core Set GeriatrICS reflecting all relevant health-related problems of community-living older adults without dementia. Methods: This study consisted of two sub-studies: 1 a written Delphi study to select ICF categories, and 2 assessing content validity in a cross-sectional study. For the Delphi study, a representative panel of experts older adults and non-medical experts on health-related problems due to ageing was constituted. Panel members had to select second-level categories from the ICF-classification relevant to community-living, non-demented older adults 75+, and had to reach consensus on this selection. For the validation study, older adults frail or with complex care needs were visited by a case manager district nurse or social worker who used the initial GeriatrICS as an assessment tool. Older adults had to rate all categories on a scale ranging from 0 no problem to 10 complete problem. Content validity of a category was guaranteed if ≥10% indicated a problem with that category. Results: 41 Delphi panel members obtained consensus in two rounds on 30 ICF-categories. Next, 267 older adults participated in the validation study. All categories met the criterion for content validity except for d530 Toileting. The final GeriatrICS consists of 29 categories: fourteen Body Functions categories, nine Activities and Participation categories and six Environmental Factors categories. Discussions and conclusions: This study resulted in a valid ICF Core Set GeriatrICS including 29 ICF categories representing the most relevant health-related problems among community-living older adults without the diagnosis of dementia. The GeriatrICS included categories from all ICF components, showing that older people’s health is a multidimensional construct. Compared to commonly used, profession-based tools, the GeriatrICS is unique as it is a population-based, cross-domain tool. Therefore, the GeriatrICS is a good starting point for the delivery of person-centred and integrated care. Lessons learned: The GeriatrICS may be used in person-centred and integrated care practice as an assessment tool, in order to tailor care and support to the needs of older adults. Analysis and interpretation of an older adult’s outcomes, and translation into an appropriate care plan, requires highly competent and experienced professionals. Limitations: Older adults with dementia or cognitive impairments may have been included in the validation study since dementia was not an exclusion criterion. Impact on the results is expected to be trivial as case managers were experienced interviewers and a partner or family member participated in the assessment in case of cognitive problems. Suggestions for future research: Future research should investigate the health-related problems of older adults with dementia and robust older adults

Health-related problems in adult cancer survivors:Development and validation of the Cancer Survivor Core Set

Improved survival rates from cancer have increased the need to understand the health-related problems of cancer treatment. We aimed to develop and validate the "Cancer Survivor Core Set" representing the most relevant health-related problems in adult cancer survivors using the International Classification of Functioning, Disability, and Health (ICF).First, a Delphi study was conducted to select ICF categories representing the most relevant health-related problems. There were three Dutch expert panels, one each for lung, colorectal, and breast cancer. Each panel comprised lay experts and professionals. The experts reached within- and between-panel consensus in two rounds (ae70 % agreement). Second, a validation study was performed. Generic cancer survivorship questionnaires assessing health-related problems or quality of life among cancer survivors were selected. Items of selected questionnaires were linked to the best-fitting ICF category and to the selected ICF categories from the Delphi study, respectively.In total, 101 experts were included, of which 76 participated in both rounds, reaching consensus on 18 ICF categories. The Distress Thermometer and Problem List, the Impact of Cancer (v2), and the Quality of Life in Adult Cancer Survivors questionnaires were selected for the validation study, which led to the inclusion of one additional ICF category.The developed Cancer Survivor Core Set consisted of 19 ICF categories representing the most relevant health-related problems in adult cancer survivors: five from the "body functions and structures" component, eight from the "activities and participation" component, and six from the "environmental factors" component.aEuro cent Many adult cancer survivors have persistent health-related problems.aEuro cent The Cancer Survivor Core Set was developed using the Delphi method.aEuro cent The patients' perspectives were prioritized in this Delphi studyaEuro cent Content validity was confirmed by validated cancer survivorship questionnaires.aEuro cent The Cancer Survivor Core Set may help optimize care for cancer survivors.</p

Integrated Care for Older Adults Improves Perceived Quality of Care:Results of a Randomized Controlled Trial of Embrace

BACKGROUND: All community-living older adults might benefit from integrated care, but evidence is lacking on the effectiveness of such services for perceived quality of care. To examine the impact of Embrace, a community-based integrated primary care service, on perceived quality of care. Stratified randomized controlled trial. Integrated care and support according to the "Embrace" model was provided by 15 general practitioners in the Netherlands. Based on self-reported levels of case complexity and frailty, a total of 1456 community-living older adults were stratified into non-disease-specific risk profiles ("Robust," "Frail," and "Complex care needs"), and randomized to Embrace or control groups. Embrace provides integrated, person-centered primary care and support to all older adults living in the community, with intensity of care dependent on risk profile. Primary outcome was quality of care as reported by older adults on the Patient Assessment of Integrated Elderly Care (PAIEC). Effects were assessed using mixed model techniques for the total sample and per risk profile. Professionals' perceived level of implementation of integrated care was evaluated within the Embrace condition using the Assessment of Integrated Elderly Care. Older adults in the Embrace group reported a higher level of perceived quality of care than those in the control group (B = 0.33, 95 % CI = 0.15-0.51, ES d = 0.19). The advantages of Embrace were most evident in the "Frail" and "Complex care needs" risk profiles. We found no significant advantages for the "Robust" risk profile. Participating professionals reported a significant increase in the perceived level of implementation of integrated care (ES r = 0.71). This study shows that providing a population-based integrated care service to community-living older adults improved the quality of care as perceived by older adults and participating professionals

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

Contains fulltext : 212370.pdf (publisher's version ) (Open Access

Influenza pandemic and professional duty: family or patients first? A survey of hospital employees

BACKGROUND: Conflicts between professional duties and fear of influenza transmission to family members may arise among health care professionals (HCP). METHODS: We surveyed employees at our university hospital regarding ethical issues arising during the management of an influenza pandemic. RESULTS: Of 644 respondents, 182 (28%) agreed that it would be professionally acceptable for HCP to abandon their workplace during a pandemic in order to protect themselves and their families, 337 (52%) disagreed with this statement and 125 (19%) had no opinion, with a higher rate of disagreement among physicians (65%) and nurses (54%) compared with administrators (32%). Of all respondents, 375 (58%) did not believe that the decision to report to work during a pandemic should be left to the individual HCP and 496 (77%) disagreed with the statement that HCP should be permanently dismissed for not reporting to work during a pandemic. Only 136 (21%) respondents agreed that HCW without children should primarily care for the influenza patients. CONCLUSION: Our results suggest that a modest majority of HCP, but only a minority of hospital administrators, recognises the obligation to treat patients despite the potential risks. Professional ethical guidelines allowing for balancing the needs of society with personal risks are needed to help HCP fulfil their duties in the case of a pandemic influenza

Stability and relative validity of the Neuromuscular Disease Impact Profile (NMDIP)

Abstract Background The aim of this study was to examine the stability and relative validity (RV) of the Neuromuscular Disease Impact Profile (NMDIP) using criterion-related groups. In a previous study the NMDIP-scales showed good internal consistency, convergent and discriminant validity. Known-groups analysis showed that the NMDIP discriminates between categories of extent of limitations. Methods A cross-sectional postal survey study was performed on patients diagnosed with a NMD and registered at the Department of Neurology, University Medical Center Groningen, the Netherlands. Participants were asked to complete the preliminary NMDIP, the Medical Outcome study Short Form Questionnaire (SF-36), the World Health Organization Quality Of Life-abbreviation version (WHOQOL-bref), and two generic domain specific measures: the Groningen Activity Restriction Scale (GARS) and the Impact on Participation and Autonomy Questionnaire (IPAQ). The variables ‘Extent of Limitations’ and ‘Quality of Life’ were used to create criterion-related groups. Stability over time was tested using the Wilcoxon Signed Rank Test for paired samples and the intraclass correlation coefficients for repeated measures. RV was examined by comparing the ability of NMDIP with generic multidimensional health impact measures, and domain specific measures in discriminating between criterion-related subgroups using the Kruskal-Wallis H-test. Results Response rate was 70% (n = 702). The NMDIP-scales showed sufficient stability over time, and satisfactory or strong RV. In general, the NMDIP scales performed as well as or better than the concurrent measurement instruments. Conclusions The NMDIP proved to be a valid and reliable disease-targeted measure with a broad scope on physical, psychological and social functioning

Results of a cross-sectional study on health-related problems of community-living older adults using the GeriatrICS, an ICF-based assessment tool

Introduction: Ideally, older adults should receive person-centred care and support that meets their individual needs and wishes, taking all relevant health-related aspects into account. A first step towards that goal is to gain insight into their health-related problems. For that purpose, a person-centred ICF Core Set for community-living older adults, the GeriatrICS, was developed. The objectives of this study were to assess the prevalence and severity of health-related problems in community-living older adults, and to assess the differences between subgroups of older adults: those with complex care needs, frail and robust older adults. Methods: A cross-sectional study was conducted among older adults receiving person-centred and integrated care and support from Embrace, a person-centred and integrated service. Older adults with complex care needs n=163 and frail older adults n=104 were interviewed by case managers, who assessed the older adults using the GeriatrICS. Robust older adults n=274 received a questionnaire version of the GeriatrICS. All older adults had to rate the items on a scale ranging from 0 no problem to 10 complete problem. We examined data per item in terms of prevalence of problems and severity. Differences in prevalence between subgroups was tested using Chi-square tests and differences in severity were tested using Mann-Whitney U tests. Results: Mean age of participants n=541 was 80.7 years SD 4.4, 56% was female, and 51% had a lower educational level.Preliminary analyses showed that, overall, the most prevalent and severe problems were related to the clusters Mobility, Mental Functions and Physical Health. For example, prevalence of Mobility-related problems: Complex care needs 52.0%, Frail 55.6% and Robust 43.6%, and severity: Complex care needs 1.9, Frail 2.4 and Robust 1.0. Although prevalence was comparable among frail older adults and those with complex care needs, results showed a trend in higher severity scores for frail participants. Robust older adults also showed health-related problems e.g. Physical Health: prevalence 33.8%, severity 0.8, but less frequent and less severe compared to participants with complex care needs 45.7%, 1.5 and frail participants 47.1%, 1.8. Discussions and conclusions: We assessed health-related problems due to ageing using the GeriatrICS in a community-sample of older adults. Frail older adults and those with complex care needs showed the highest prevalence of problems, but frail participants experienced them as more severe. Besides, robust older adults already showed health-related problems, indicating the need for prevention. Lessons learned: Prevention of health-related problems in older adults is necessary and should also be targeted at robust older adults.Results suggest that using the GeriatrICS could be a good starting point for the development of person-centred, proactive and preventive care and support programs. Limitations: We may have to deal with common method bias, due to the difference in assessment methods interview by a case manager versus a questionnaire version. However, in both situations, the assessment was self-reported because the older adults had to indicate the severity of their problems. Suggestions for future research: Future studies should examine the concurrent validity of both assessment methods using the GeriatrICS

Effects of a population-based, person-centred and integrated care service on health, wellbeing and self-management of community-living older adults:A randomised controlled trial on Embrace

<div><p>Objective</p><p>To evaluate the effects of the population-based, person-centred and integrated care service ‘Embrace’ at twelve months on three domains comprising health, wellbeing and self-management among community-living older people.</p><p>Methods</p><p>Embrace supports older adults to age in place. A multidisciplinary team provides care and support, with intensity depending on the older adults’ risk profile. A randomised controlled trial was conducted in fifteen general practices in the Netherlands. Older adults (≥75 years) were included and stratified into three risk profiles: Robust, Frail and Complex care needs, and randomised to Embrace or care as usual (CAU). Outcomes were recorded in three domains. The EuroQol-5D-3L and visual analogue scale, INTERMED for the Elderly Self-Assessment, Groningen Frailty Indicator and Katz-15 were used for the domain ‘Health.’ The Groningen Well-being Indicator and two quality of life questions measured ‘Wellbeing.’ The Self-Management Ability Scale and Partners in Health scale for older adults (PIH-OA) were used for ‘Self-management.’ Primary and secondary outcome measurements differed per risk profile. Data were analysed with multilevel mixed-model techniques using intention-to-treat and complete case analyses, for the whole sample and per risk profile.</p><p>Results</p><p>1456 eligible older adults participated (49%) and were randomized to Embrace (n(T0) = 747, n(T1) = 570, mean age 80.6 years (SD 4.5), 54.2% female) and CAU (n(T0) = 709, n(T1) = 561, mean age 80.8 years (SD 4.7), 55.6% female). Embrace participants showed a greater–but clinically irrelevant–improvement in self-management (PIH-OA Knowledge subscale effect size [ES] = 0.14), and a greater–but clinically relevant–deterioration in health (ADL ES = 0.10; physical ADL ES = 0.13) compared to CAU. No differences in change in wellbeing were observed. This picture was also found in the risk profiles. Complete case analyses showed comparable results.</p><p>Conclusions</p><p>This study found no clear benefits to receiving person-centred and integrated care for twelve months for the domains of health, wellbeing and self-management in community-living older adults.</p></div