Epidemiology of Sarcopenia and Frailty

Sarcopenia and frailty are common in older persons and pose particular challenges for health and social care systems especially in the context of global population ageing. Sarcopenia, the loss of skeletal muscle mass, strength and function with age is associated with adverse individual physical and metabolic changes contributing to morbidity and mortality. The health and socioeconomic implications of sarcopenia are also considerable. Sarcopenia is a core component of physical frailty that together impact negatively on an individual’s capability to live independently. Frailty is a biological syndrome of low reserve and resistance to stressors resulting from cumulative declines across multiple physiological systems that collectively predispose an individual to adverse outcomes. Frailty develops along a continuum from independence through to death as physiological reserves progressively diminish an individual’s capacity to recover from an acute insult or illness. Managing sarcopenia and frailty involves the multidisciplinary led completion of a comprehensive care plan that is patient centred, responsive to the needs of the patient and adaptable therefore enabling an individual to maintain their independence

Exploration of PET and MRI radiomic features for decoding breast cancer phenotypes and prognosis.

Radiomics is an emerging technology for imaging biomarker discovery and disease-specific personalized treatment management. This paper aims to determine the benefit of using multi-modality radiomics data from PET and MR images in the characterization breast cancer phenotype and prognosis. Eighty-four features were extracted from PET and MR images of 113 breast cancer patients. Unsupervised clustering based on PET and MRI radiomic features created three subgroups. These derived subgroups were statistically significantly associated with tumor grade (p = 2.0 × 10-6), tumor overall stage (p = 0.037), breast cancer subtypes (p = 0.0085), and disease recurrence status (p = 0.0053). The PET-derived first-order statistics and gray level co-occurrence matrix (GLCM) textural features were discriminative of breast cancer tumor grade, which was confirmed by the results of L2-regularization logistic regression (with repeated nested cross-validation) with an estimated area under the receiver operating characteristic curve (AUC) of 0.76 (95% confidence interval (CI) = [0.62, 0.83]). The results of ElasticNet logistic regression indicated that PET and MR radiomics distinguished recurrence-free survival, with a mean AUC of 0.75 (95% CI = [0.62, 0.88]) and 0.68 (95% CI = [0.58, 0.81]) for 1 and 2 years, respectively. The MRI-derived GLCM inverse difference moment normalized (IDMN) and the PET-derived GLCM cluster prominence were among the key features in the predictive models for recurrence-free survival. In conclusion, radiomic features from PET and MR images could be helpful in deciphering breast cancer phenotypes and may have potential as imaging biomarkers for prediction of breast cancer recurrence-free survival

Folding transition of the triangular lattice in a discrete three--dimensional space

A vertex model introduced by M. Bowick, P. Di Francesco, O. Golinelli, and E. Guitter (cond-mat/9502063) describing the folding of the triangular lattice onto the face centered cubic lattice has been studied in the hexagon approximation of the cluster variation method. The model describes the behaviour of a polymerized membrane in a discrete three--dimensional space. We have introduced a curvature energy and a symmetry breaking field and studied the phase diagram of the resulting model. By varying the curvature energy parameter, a first-order transition has been found between a flat and a folded phase for any value of the symmetry breaking field.Comment: 11 pages, latex file, 2 postscript figure

First-order transition of tethered membranes in 3d space

We study a model of phantom tethered membranes, embedded in three-dimensional space, by extensive Monte Carlo simulations. The membranes have hexagonal lattice structure where each monomer is interacting with six nearest-neighbors (NN). Tethering interaction between NN, as well as curvature penalty between NN triangles are taken into account. This model is new in the sense that NN interactions are taken into account by a truncated Lennard-Jones potential including both repulsive and attractive parts. The main result of our study is that the system undergoes a first-order crumpling transition from low temperature flat phase to high temperature crumpled phase, in contrast with early numerical results on models of tethered membranes.Comment: 5 pages, 6 figure

A feasibility study of implementing grip strength measurement into routine hospital practice (GRImP): study protocol.

BACKGROUND: Handgrip strength is a non-invasive marker of muscle strength, and low grip strength in hospital inpatients is associated with poor healthcare outcomes including longer length of stay, increased functional limitations, and mortality. Measuring grip strength is simple and inexpensive. However, grip strength measurement is not routinely used in clinical practice. The aim of this study is to evaluate the feasibility of implementing grip strength measurement into routine clinical practice. METHODS/DESIGN: This feasibility study is a mixed methods design combining qualitative, quantitative, and economic elements and is based on the acute medical wards for older people in one hospital. The study consists of three phases: phase 1 will define current baseline practice for the identification of inpatients at high risk of poor healthcare outcomes, their nutrition, and mobility care through interviews and focus groups with staff as well as a review of patients' clinical records. Phase 2 will focus on the feasibility of developing and implementing a training programme using Normalisation Process Theory to enable nursing and medical staff to measure and interpret grip strength values. Following the training, grip strength will be measured routinely for older patients as part of admission procedures with the use of a care plan for those with low grip strength. Finally, phase 3 will evaluate the acceptability of grip strength measurement, its adoption, coverage, and basic costs using interviews and focus groups with staff and patients, and re-examination of clinical records. DISCUSSION: The results of this study will inform the translation of grip strength measurement from a research tool into clinical practice to improve the identification of older inpatients at risk of poor healthcare outcomes. TRIAL REGISTRATION: Clinicaltrials.gov NCTO2447445

Folding transitions of the triangular lattice with defects

A recently introduced model describing the folding of the triangular lattice is generalized allowing for defects in the lattice and written as an Ising model with nearest-neighbor and plaquette interactions on the honeycomb lattice. Its phase diagram is determined in the hexagon approximation of the cluster variation method and the crossover from the pure Ising to the pure folding model is investigated, obtaining a quite rich structure with several multicritical points. Our results are in very good agreement with the available exact ones and extend a previous transfer matrix study.Comment: 16 pages, latex, 5 postscript figure

Folding of the Triangular Lattice with Quenched Random Bending Rigidity

We study the problem of folding of the regular triangular lattice in the presence of a quenched random bending rigidity + or - K and a magnetic field h (conjugate to the local normal vectors to the triangles). The randomness in the bending energy can be understood as arising from a prior marking of the lattice with quenched creases on which folds are favored. We consider three types of quenched randomness: (1) a ``physical'' randomness where the creases arise from some prior random folding; (2) a Mattis-like randomness where creases are domain walls of some quenched spin system; (3) an Edwards-Anderson-like randomness where the bending energy is + or - K at random independently on each bond. The corresponding (K,h) phase diagrams are determined in the hexagon approximation of the cluster variation method. Depending on the type of randomness, the system shows essentially different behaviors.Comment: uses harvmac (l), epsf, 17 figs included, uuencoded, tar compresse

2005 Annual Synthesis Report, Pallid Sturgeon Population Assessment Program and Associated Fish Community Monitoring for the Missouri River

Pallid sturgeon, Scaphirhynchus albus, have declined throughout the Missouri River since dam construction and inception of the Bank Stabilization and Navigation Project in 1912. Their decline likely is due to the loss and degradation of their natural habitat as a result of changes in the river’s structure and function, as well as the pallid sturgeon’s inability to adapt to these changes. The U. S. Army Corps of Engineers has been working with state and federal agencies to develop and conduct a Pallid Sturgeon Monitoring and Assessment Program (Program), with the goal of recovering pallid sturgeon populations. The Program has organized the monitoring and assessment efforts into distinct geographic segments, with state and federal resource management agencies possessing primary responsibility for one or more segment. To date, the results from annual monitoring have been reported for individual Program segments. However, monitoring results have not been summarized or evaluated for larger spatial scales, encompassing more than one Program segment. This report describes a summary conducted by the Pacific Northwest National Laboratory (PNNL) that synthesizes the 2005 sampling year monitoring results from individual segments

Implementation of grip strength measurement in medicine for older people wards as part of routine admission assessment: identifying facilitators and barriers using a theory-led intervention.

BACKGROUND: Low grip strength in older inpatients is associated with poor healthcare outcomes including longer length of stay and mortality. Measuring grip strength is simple and inexpensive. However, it is not routinely used in clinical practice. We aimed to evaluate the implementation of grip strength measurement into routine clinical practice. METHODS: This implementation study was a mixed methods study based in five acute medical wards for older people in one UK hospital. Intervention design and implementation evaluation were based on Normalization Process Theory (NPT). A training program was developed and delivered to enable staff to measure grip strength and use a care plan for patients with low grip strength. Routine implementation and monitoring was assessed using the "implementation outcome variables" proposed by WHO: adoption, coverage, acceptability, fidelity, and costs analysis. Enablers and barriers of implementation were identified. RESULTS: One hundred fifty-five nursing staff were trained, 63% in just 3 weeks. Adoption and monthly coverage of grip strength measurement varied between 25 and 80% patients across wards. 81% of female patients and 75% of male patients assessed had low grip strength (< 27 kg for men and < 16 kg for women). Staff and patients found grip measurement easy, cheap and potentially beneficial in identifying high-risk patients. The total cost of implementation across five wards over 12 months was less than £2302. Using NPT, interviews identified enablers and barriers. Enablers included: highly motivated ward champions, managerial support, engagement strategies, shared commitment, and integration into staff and ward daily routines. Barriers included lack of managerial and staff support, and high turnover of staff, managers and champions. CONCLUSIONS: Training a large number of nurses to routinely implement grip strength measurement of older patients was feasible, acceptable and inexpensive. Champions' motivation, managerial support, and shared staff commitment were important for the uptake and normalisation of grip strength measurement. A high percentage of older patients were identified to be at risk of poor healthcare outcomes and would benefit from nutritional and exercise interventions. Measuring grip strength in these patients could provide an opportunity to identify those with normal grip strength for fast tracking through admission to discharge thereby reducing length of stay. TRIAL REGISTRATION: Clinicaltrials.gov NCTO2447445 . Registered May 18, 2015

Can routine clinical data identify older patients at risk of poor healthcare outcomes on admission to hospital?

OBJECTIVE: Older patients who are at risk of poor healthcare outcomes should be recognised early during hospital admission to allow appropriate interventions. It is unclear whether routinely collected data can identify high-risk patients. The aim of this study was to define current practice with regard to the identification of older patients at high risk of poor healthcare outcomes on admission to hospital. RESULTS: Interviews/focus groups were conducted to establish the views of 22 healthcare staff across five acute medicine for older people wards in one hospital including seven nurses, four dieticians, seven doctors, and four therapists. In addition, a random sample of 60 patients' clinical records were reviewed to characterise the older patients, identify risk assessments performed routinely on admission, and describe usual care. We found that staff relied on their clinical judgment to identify high risk patients which was influenced by a number of factors such as reasons for admission, staff familiarity with patients, patients' general condition, visible frailty, and patients' ability to manage at home. "Therapy assessment" and patients' engagement with therapy were also reported to be important in recognising high-risk patients. However, staff recognised that making clinical judgments was often difficult and that it might occur several days after admission potentially delaying specific interventions. Routine risk assessments carried out on admission to identify single healthcare needs included risk of malnutrition (completed for 85% patients), falls risk (95%), moving and handling assessments (85%), and pressure ulcer risk assessments (88%). These were not used collectively to highlight patients at risk of poor healthcare outcomes. Thus, patients at risk of poor healthcare outcomes were not explicitly identified on admission using routinely collected data. There is a need for an early identification of these patients using a valid measure alongside staff clinical judgment to allow timely interventions to improve healthcare outcomes