Home and Community Environmental Features, Activity Performance, and Community Participation among Older Adults with Functional Limitations

This paper describes relationships among home and community environmental features, activity performance in the home, and community participation potential to support aging in place. A subset of data on older adults with functional limitations (N = 122), sixty three (63) with mobility and 59 with other limitations, were utilized in this study from a larger project's subject pool. Results showed significant and positive correlations between environmental barriers, activity dependence and difficulty at home, and less community participation in the mobility limitation group. While kitchen and bathroom features were most limiting to home performance, bathtub or shower was the only home feature, and destination social environment was the only community feature, that explained community participation. Compared to environmental features, home performance explained much more community participation. Study results provide detailed information about environmental features as well as types of home activities that can be prioritized as interventions for aging in place

Glacial Changes Between 1985-2009 and Implications for Volcanic Hazards at Mt. Rainier, Washington

Therrmal Infrared Landsat scenes (Band 6) were collected and analyzed to quantify area changes and rates of change of Mt. Rainier glaciers between 1985 and 2009. Glacier change data was compared to measurements made by the United States Geological Survey (USGS) and the Global Land Ice Measurements from Space (GLIMS) project. The modeled glacier area at Mt. Rainier for the last 10 ka was then compared to the eruptive history of Mt. Rainier and other Cascade volcanoes to examine correlations. Landsat scenes show a steady decrease in glacier area at Mt. Rainier, consistent with USGS and GLIMS measurements. The observed area of Mt. Rainier glaciers decreased from 85.590 km2 to 81.355 km2 (5.32%) from 1985-2009. If glacier loss continues, the risk of hazards such as debris avalanches, lahars, and jkulhlaups (glacial outburst floods) could be enhanced due to the increased amount of glacial melt. Decreases in glacier ice at Mt. Rainier could also lead to an increased risk of eruptions due to decompression of the magma chamber. A continuation of the glacier loss seen in this study could be enough to trigger decompression, especially if Mt. Rainier has a shallow magma chamber. However, it is unclear what the time lag would be between glacier loss and an eruption as well as the amount and rate of glacier loss that would be needed. Previous studies indicate that there was an increase in eruptions ~7.4-5 ka, which is ~3.6-6 ka following the last glacial maximum. During the last ~2.3 ka, eruption rates of Cascade volcanoes have increased during times when the modeled glacier area decreased. This strongly suggests a correlation between eruption rates and glacial coverage. Glaciers at Mt. Rainier should therefore continue to be closely monitored in the future because of a possible increased risk of debris avalanches, lahars, jkulhlaups, and eruptions. Satellite-based remote sensing such as the Landsat scenes used in this study can be a valuable tool for monitoring Mt. Rainier glaciers. Future monitoring through remote sensing would allow glacier areas to be consistently tracked and provide data needed to assess hazard risks.Boone Pickens School of Geolog

Adam and Eve, Designed Diversity, and Allele Frequencies

Theistic evolutionists present multiple genetic arguments against a literal Adam and Eve. One key argument asserts it would be impossible for a single human couple to give rise to the genetic diversity seen in the modern human population. This implicitly assumes Adam and Eve would have been created without internal genetic diversity. If this were true, all observed variations would have to arise recently via random mutations. This would require incredibly high mutation rates, logically leading to rapid extinction. Yet, Adam and Eve could have been created massively heterozygous. We have argued for over a decade that they could have been created with “designed diversity”. We have previously shown that a vast amount of genetic variation could have been pre-programmed into their genomes. This could logically provide the genetic basis for: 1) our human gifts and talents; 2) the many forms of human beauty; and 3) the various ways people have rapidly adapted to new habitats. It is also claimed that the currently observed human allele frequency patterns could not arise from a single couple. The logic here is that, since there were only four sets of chromosomes in Eden, all variants would have had an initial frequency of either 25%, 50%, or 75%. Today, most allelic variants have frequencies in the range of 0–10%. Therefore, it is claimed that observed human diversity disproves a literal Adam and Eve. In this paper we have critically examined these arguments. Our analyses highlight several genetic mechanisms that can help reconcile a literal Adam and Eve with the human allele frequency distributions seen today. We use numerical simulation to show that two people, if they contain designed alleles, can in fact give rise to allele frequency distributions of the very same type as are now seen in modern man. We cannot know how God created Adam and Eve, nor exactly how Adam and Eve gave rise to the current human population. However, the genetic argument that there is no way that a literal Adam and Eve could have given rise to the observed human allele frequencies is clearly over-reaching and appears to be theologically reckless. There is no compelling reason to reject Adam and Eve based on modern allele frequencies

Implementing Telerehabilitation Research For Stroke Rehabilitation With Community Dwelling Veterans: Lessons Learned

Telerehabilitation (TR) is the use of telehealth technologies to provide distance support, rehabilitation services and information exchange between people with disabilities and their clinical providers. This article discusses the barriers experienced when implementing a TR multi-site randomized controlled trial for stroke patients in their homes, and the lessons learned from conducting the study. The barriers are divided into two sections: those specific to TR and those pertinent to research overall. The TR specific barriers included the rapidly changing telecommunications and health care environment and inconsistent equipment functionality. The barriers applicable to research overall included the need for telehealth research to meet regulations in diverse departments and the rapidly expanding and changing research regulations. Solutions to the barriers included having various telehealth equipment available to allow for functionality with the currently diverse telecommunications infrastructure, rigorous pilot testing all equipment in different situations, and having biomedical engineering staff on-call and on-site

Qualitative study of primary care clinicians\u27 views on point-of-care testing for C-reactive protein for acute respiratory tract infections in family medicine.

OBJECTIVE: To explore clinicians views of the barriers and facilitators to use of C-reactive protein (CRP) point-of-care tests (POCT) in US family medicine clinics for the management of acute respiratory tract infections (ARTIs) in adults. SETTING: Five family medicine clinics across two US states. PARTICIPANTS: 30 clinicians including 18 physicians, 9 physician residents, 2 physician assistants and 1 nurse practitioner, took part in the study. DESIGN: A qualitative study using a grounded theory approach to thematically analyse focus group interviews. RESULTS: These clinicians had limited access to diagnostic tests for patients with ARTI, and very little knowledge of CRP POCT. Three major themes were identified and included the potential clinical role of CRP POCT, concerns related to implementing CRP POCT and evidence needed prior to wider adoption in family medicine. Clinicians believed CRP POCT could support decision-making for some presentations of ARTIs and patient populations when used in conjunction with clinical criteria. Clinicians had concerns about possible overuse and inaccuracy of CRP POCT which they believed might increase antibiotic prescribing rates. Other concerns identified included integration of the test with clinic workflows and cost-effectiveness. CONCLUSIONS: Clinicians stand at the forefront of antibiotic stewardship efforts, but have few diagnostic tests to help them confidently manage ARTIs. CRP POCT may facilitate some aspects of clinical practice. Incorporating CRP POCT with clinical guidelines may strengthen utility of this test, when there is diagnostic uncertainty

The mPEG-PCL Copolymer for Selective Fermentation of Staphylococcus lugdunensis Against Candida parapsilosis in the Human Microbiome.

Many human skin diseases, such as seborrheic dermatitis, potentially occur due to the over-growth of fungi. It remains a challenge to develop fungicides with a lower risk of generating resistant fungi and non-specifically killing commensal microbes. Our probiotic approaches using a selective fermentation initiator of skin commensal bacteria, fermentation metabolites or their derivatives provide novel therapeutics to rein in the over-growth of fungi. Staphylococcus lugdunensis (S. lugdunensis) bacteria and Candida parapsilosis (C. parapsilosis) fungi coexist in the scalp microbiome. S. lugdunensis interfered with the growth of C. parapsilosis via fermentation. A methoxy poly(ethylene glycol)-b-poly(ε-caprolactone) (mPEG-PCL) copolymer functioned as a selective fermentation initiator of S. lugdunensis, selectively triggering the S. lugdunensis fermentation to produce acetic and isovaleric acids. The acetic acid and its pro-drug diethyleneglycol diacetate (Ac-DEG-Ac) effectively suppressed the growth of C. parapsilosis in vitro and impeded the fungal expansion in the human dandruff. We demonstrate for the first time that S. lugdunensis is a skin probiotic bacterium that can exploit mPEG-PCL to yield fungicidal short-chain fatty acids (SCFAs). The concept of bacterial fermentation as a part of skin immunity to re-balance the dysbiotic microbiome warrants a novel avenue for studying the probiotic function of the skin microbiome in promoting health

Study protocol: home-based telehealth stroke care: a randomized trial for veterans

<p>Abstract</p> <p>Background</p> <p>Stroke is one of the most disabling and costly impairments of adulthood in the United States. Stroke patients clearly benefit from intensive inpatient care, but due to the high cost, there is considerable interest in implementing interventions to reduce hospital lengths of stay. Early discharge rehabilitation programs require coordinated, well-organized home-based rehabilitation, yet lack of sufficient information about the home setting impedes successful rehabilitation. This trial examines a multifaceted telerehabilitation (TR) intervention that uses telehealth technology to simultaneously evaluate the home environment, assess the patient's mobility skills, initiate rehabilitative treatment, prescribe exercises tailored for stroke patients and provide periodic goal oriented reassessment, feedback and encouragement.</p> <p>Methods</p> <p>We describe an ongoing Phase II, 2-arm, 3-site randomized controlled trial (RCT) that determines primarily the effect of TR on physical function and secondarily the effect on disability, falls-related self-efficacy, and patient satisfaction. Fifty participants with a diagnosis of ischemic or hemorrhagic stroke will be randomly assigned to one of two groups: (a) TR; or (b) Usual Care. The TR intervention uses a combination of three videotaped visits and five telephone calls, an in-home messaging device, and additional telephonic contact as needed over a 3-month study period, to provide a progressive rehabilitative intervention with a treatment goal of safe functional mobility of the individual within an accessible home environment. Dependent variables will be measured at baseline, 3-, and 6-months and analyzed with a linear mixed-effects model across all time points.</p> <p>Discussion</p> <p>For patients recovering from stroke, the use of TR to provide home assessments and follow-up training in prescribed equipment has the potential to effectively supplement existing home health services, assist transition to home and increase efficiency. This may be particularly relevant when patients live in remote locations, as is the case for many veterans.</p> <p>Trial Registration</p> <p>Clinical Trials.gov Identifier: NCT00384748</p

Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis.

BACKGROUND: Management of degenerative spondylolisthesis with spinal stenosis is controversial. Surgery is widely used, but its effectiveness in comparison with that of nonsurgical treatment has not been demonstrated in controlled trials. METHODS: Surgical candidates from 13 centers in 11 U.S. states who had at least 12 weeks of symptoms and image-confirmed degenerative spondylolisthesis were offered enrollment in a randomized cohort or an observational cohort. Treatment was standard decompressive laminectomy (with or without fusion) or usual nonsurgical care. The primary outcome measures were the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36) bodily pain and physical function scores (100-point scales, with higher scores indicating less severe symptoms) and the modified Oswestry Disability Index (100-point scale, with lower scores indicating less severe symptoms) at 6 weeks, 3 months, 6 months, 1 year, and 2 years. RESULTS: We enrolled 304 patients in the randomized cohort and 303 in the observational cohort. The baseline characteristics of the two cohorts were similar. The one-year crossover rates were high in the randomized cohort (approximately 40% in each direction) but moderate in the observational cohort (17% crossover to surgery and 3% crossover to nonsurgical care). The intention-to-treat analysis for the randomized cohort showed no statistically significant effects for the primary outcomes. The as-treated analysis for both cohorts combined showed a significant advantage for surgery at 3 months that increased at 1 year and diminished only slightly at 2 years. The treatment effects at 2 years were 18.1 for bodily pain (95% confidence interval [CI], 14.5 to 21.7), 18.3 for physical function (95% CI, 14.6 to 21.9), and -16.7 for the Oswestry Disability Index (95% CI, -19.5 to -13.9). There was little evidence of harm from either treatment. CONCLUSIONS: In nonrandomized as-treated comparisons with careful control for potentially confounding baseline factors, patients with degenerative spondylolisthesis and spinal stenosis treated surgically showed substantially greater improvement in pain and function during a period of 2 years than patients treated nonsurgically. (ClinicalTrials.gov number, NCT00000409 [ClinicalTrials.gov].)