Social Prescribing for an Aging Population

As the human population is moving toward a demographic of aging individuals, increased levels of stress will be placed on the current health care system. “… As people live longer, there is a tendency or the onset of disease to occur closer to the end of life” (p. 441) and the incidence of mental health illnesses is prevalent in older adults. Currently, the medical model is dominant in the health care system and aims to cure any issue(s) without considerations in the cause or source. Social prescribing/social prescription enables physicians and health care professionals to refer individuals to non-clinical services, such as art and music, to provide holistic care or a response to the current health care system. This paper will provide an overview of the concept of social prescribing, offer examples in the current practices of social prescription, and describe the role of social prescription in older adults and their caregivers

Dietary shifts in vertebrates: factors affecting seed selection in desert rodents

This study uses foraging theory to predict that small vertebrates forage to maximize their net rate of energy gain or minimize risk of starvation. It focuses on an Australian desert rodent, the sandy inland mouse (Pseudomys hermannsburgensis), due its abundance and tractability for hypothesis testing, and because it provides an opportunity to compare its foraging with other desert rodents. My experiments on foraging and seed selection focused on diet shifts under the risk of predation, diet choice in relation to seed characteristics and the background seed base, and the foraging characteristics of animals when seed access was manipulated by burying seeds at different depths and with added moisture. Pseudomys hermannsburgensis is omnivorous, but seeds dominate the diet as shown by observations of foraging animals and analysis of stomach contents. Giving-up density and cafeteria trials with different seeds showed animals to be risk-averse and less active in open compared with sheltered areas. Under low predation risk animals selected preferred seeds and under high risk they were less choosy and quickly took any seeds they encountered. Mice used olfaction to detect seeds buried at depths up to 5 cm, but preferred seeds on the soil surface; adding moisture did not affect seed detection or consumption. Familiar seeds were preferred compared with rare seeds, although other factors such as seed quality are also important. Experimental exclusion of rodents from plots showed that seed predation reduces seed species diversity and abundance, but these effects became clear only after a major rainfall event that triggered an eruption in rodent numbers and predation impact. My research is the first detailed study of the diet and foraging behaviour of an Australian desert rodent. It uncovers a range of novel strategies that allow P. hermannsburgensis to persist in its variable desert environment, and contrasts these strategies with those used by rodents in other world deserts

Design of Low-Voltage Digital Building Blocks and ADCs for Energy-Efficient Systems

Increasing number of energy-limited applications continue to drive the demand for designing systems with high energy efficiency. This tutorial covers the main building blocks of a system implementation including digital logic, embedded memories, and analog-to-digital converters and describes the challenges and solutions to designing these blocks for low-voltage operation

A genome-wide association study identifies protein quantitative trait loci (pQTLs)

There is considerable evidence that human genetic variation influences gene expression. Genome-wide studies have revealed that mRNA levels are associated with genetic variation in or close to the gene coding for those mRNA transcripts - cis effects, and elsewhere in the genome - trans effects. The role of genetic variation in determining protein levels has not been systematically assessed. Using a genome-wide association approach we show that common genetic variation influences levels of clinically relevant proteins in human serum and plasma. We evaluated the role of 496,032 polymorphisms on levels of 42 proteins measured in 1200 fasting individuals from the population based InCHIANTI study. Proteins included insulin, several interleukins, adipokines, chemokines, and liver function markers that are implicated in many common diseases including metabolic, inflammatory, and infectious conditions. We identified eight Cis effects, including variants in or near the IL6R (p = 1.8×10 -57), CCL4L1 (p = 3.9×10-21), IL18 (p = 6.8×10-13), LPA (p = 4.4×10-10), GGT1 (p = 1.5×10-7), SHBG (p = 3.1×10-7), CRP (p = 6.4×10-6) and IL1RN (p = 7.3×10-6) genes, all associated with their respective protein products with effect sizes ranging from 0.19 to 0.69 standard deviations per allele. Mechanisms implicated include altered rates of cleavage of bound to unbound soluble receptor (IL6R), altered secretion rates of different sized proteins (LPA), variation in gene copy number (CCL4L1) and altered transcription (GGT1). We identified one novel trans effect that was an association between ABO blood group and tumour necrosis factor alpha (TNF-alpha) levels (p = 6.8×10-40), but this finding was not present when TNF-alpha was measured using a different assay , or in a second study, suggesting an assay-specific association. Our results show that protein levels share some of the features of the genetics of gene expression. These include the presence of strong genetic effects in cis locations. The identification of protein quantitative trait loci (pQTLs) may be a powerful complementary method of improving our understanding of disease pathways. © 2008 Melzer et al

The impact of video gaming on cognitive functioning of people with schizophrenia (GAME-S): study protocol of a randomised controlled trial

Background: Video gaming is a promising intervention for cognitive and social impairment in patients with schizophrenia. A number of gaming interventions have been evaluated in small-scale studies with various patient groups, but studies on patients with schizophrenia remain scarce and rarely include the evaluation of both clinical and neurocognitive outcomes. In this study, we will test the effectiveness of two interventions with gaming elements to improve cognitive and clinical outcomes among persons with schizophrenia.Methods: The participants will be recruited from different outpatient units (e.g., outpatient psychiatric units, day hospitals, residential care homes). The controlled clinical trial will follow a three-arm parallel-group design: 1) cognitive training (experimental group, CogniFit), 2) entertainment gaming (active control group, SIMS 4), and 3) treatment as usual. The primary outcomes are working memory function at 3-month and 6-month follow-ups. The secondary outcomes are patients' other cognitive and social functioning, the ability to experience pleasure, self-efficacy, and negative symptoms at 3-month and 6-month follow-ups. We will also test the effectiveness of gaming interventions on neurocognitive outcomes (EEG and 3 T MRI plus rs-fMRI) at a 3-month follow-up as an additional secondary outcome. Data will be collected in outpatient psychiatric services in Hong Kong. Participants will have a formal diagnosis of schizophrenia and be between 18 and 60 years old. We aim to have a total of 234 participants, randomly allocated to the three arms. A sub-sample of patients (N = 150) will be recruited to undergo an EEG. For neuroimaging assessment, patients will be randomly allocated to a subset of patients (N=126). We will estimate the efficacy of the interventions on the primary and secondary outcomes based on the intention-to-treat principle. Behavioural and EEG data will be analysed separately.Discussion: The study will characterise benefits of gaming on patients' health and well-being, and contribute towards the development of new treatment approaches for patients with schizophrenia.</p

Interprofessional education—situations of a university in Hong Kong and major hurdles to teachers and students

Studies have provided evidence that Interprofessional Education (IPE) can improve learners’ attitudes, knowledge, skills, behaviors, and competency. Traditionally, IPE is commonly seen in the healthcare professional training in tertiary education. Aging is a global issue that requires more than just a single healthcare sector. It requires interdisciplinary collaboration and understanding to tackle the issues. Therefore, IPE is essential for nurturing university students to tackle the ever-changing global challenges. In addition, different hurdles can hinder IPE development. To have a better understanding of the feasibility, acceptance, and educational value of IPE in Hong Kong, we conducted a cross-sectional quantitative study. We invited teachers and students from a Hong Kong university to fill in an online survey that evaluated their understanding and participation in IPE, their attitude toward IPE, and the barriers to developing IPE from March to June 2020. Among the 37 academic staff and 572 students who completed the survey, 20 (54.1%) teachers and 422 (73.8%) students had never heard of IPE before, and 26 (70.3%) teachers and 510 (89.2%) students had never participated in any IPE activities. Major barriers reported by teachers included an increase in teaching load (72.9%), lack of administrative support (72.9%), lack of financial support and limited budget (67.5%), difficulty to make logistic arrangements (64.8%), and problems with academic schedules and calendars (62.1%). The survey findings revealed that despite the positive attitude of university teachers and students toward IPE, barriers that could hinder the development of IPE included heavy teaching and administrative load and logistic arrangement for classroom arrangement and academic scheduling involving multiple faculties

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Platinum impact assessment

This paper presents a comprehensive strategic analysis of Company X\u27s strategies to mitigate its risks from volatile platinum prices, since Platinum is a critical component of fuel cells. It is recommended that Company X consider leasing platinum to lower cash flow requirements to meet its platinum demand over the next 5 years. A shorter platinum leasing period will reduce Company X\u27s platinum market risk. OEMs can set up metal accounts with catalyst suppliers to eliminate Company X from platinum transaction, and reduce OEMs\u27 platinum cost. It is also recommended that Company X avoid recycling platinum for OEMs. Recommended alternatives are based on the evaluation of the alternatives on the various criteria for the specific properties of each market. Options are evaluated on a number of criteria including: platinum value in products and application solutions, product lifetime, end-user type, average deal size per customer, and catalyst suppliers