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The risk of undernutrition in older community-dwelling adults increases when they are no longer able to shop or cook themselves. Home-delivered products could then possibly prevent them from becoming undernourished. This single-blind randomised trial tested the effectiveness of home-delivered protein-rich ready-made meals and dairy products in reaching the recommended intake of 1·2 g protein/kg body weight (BW) per d and ≥25 g of protein per meal. Community-dwelling older adults (n 98; mean age 80·4 (sd 6·8) years) switched from self-prepared to home-delivered hot meals and dairy products for 28 d. The intervention group received ready-made meals and dairy products high in protein; the control group received products lower in protein. Dietary intake was measured at baseline, after 2 weeks (T1), and after 4 weeks (T2). Multilevel analyses (providing one combined outcome for T1 and T2) and logistic regressions were performed. Average baseline protein intake was 1·09 (se 0·05) g protein/kg BW per d in the intervention group and 0·99 (se 0·05) g protein/kg BW per d in the control group. During the trial, protein intake of the intervention group was 1·12 (se 0·05) g protein/kg BW per d compared with 0·87 (se 0·03) g protein/kg BW per d in the control group (between-group differences P < 0·05). More participants of the intervention group reached the threshold of ≥25 g protein at dinner compared with the control group (intervention T1: 84·8 %, T2: 88·4 % v. control T1: 42·9 %, T2: 40·5 %; P < 0·05), but not at breakfast and lunch. Our findings suggest that switching from self-prepared meals to ready-made meals carries the risk of a decreasing protein intake, unless extra attention is given to protein-rich choices.
The aim of this study was to explore the support needs of Dutch informal caregivers of patients with amyotrophic lateral sclerosis (ALS).
Individual semi-structured interviews were conducted with 21 caregivers of ALS patients. Audio-taped interviews were transcribed and data were analyzed thematically.
A total of four global support needs emerged: “more personal time”, “assistance in applying for resources”, “counseling”, and “peer contact”. Despite their needs, caregivers are reluctant to apply for and accept support. They saw their own needs as secondary to the needs of the patients.
Significance of results
ALS seems to lead to an intensive caregiving situation with multiple needs emerging in a short period. This study offers targets for the development of supportive interventions. A proactive approach seems essential, acknowledging the importance of the role of the caregivers in the care process at an early stage, informing them about the risk of burden, monitoring their wellbeing, and repeatedly offering support opportunities. Using e-health may help tailor interventions to the caregivers’ support needs.
During and after hospitalisation, older adults are recommended to consume 1·2–1·5 g of protein/kg body weight per d (g/kg per d) to improve recovery. This randomised controlled trial studied the effectiveness of a 12-week intervention with protein-enriched foods and drinks by following-up seventy-five older patients (mean age: 76·8 (sd 6·9) years) during their first 6 months after hospital discharge. Primary outcomes were protein intake and physical performance (measured with Short Physical Performance Battery (SPPB)). Secondary outcomes for physical recovery were gait speed, chair-rise time, leg-extension strength, hand-grip strength, body weight, nutritional status (Mini Nutritional Assessment), independence in activities of daily living (ADL) and physical activity. The intervention group consumed more protein during the 12-week intervention period compared with the control group (P<0·01): 112 (sd 34) g/d (1·5 (sd 0·6) g/kg per d) v. 78 (sd 18) g/d (1·0 (sd 0·4) g/kg per d). SPPB total score, gait speed, chair-rise time, body weight and nutritional status improved at week 12 compared with baseline (time effect P<0·05), but were not different between groups. Leg-extension strength, hand-grip strength and independence in ADL did not change. In conclusion, protein-enriched products enabled older adults to increase their protein intake to levels that are higher than their required intake. In these older adults with already adequate protein intakes and limited physical activity, protein enrichment did not enhance physical recovery in the first 6 months after hospital discharge.
This paper describes the digitization and enrichment of the Canadian House of Commons English Debates from 1901 to present. We start by laying out the general framework in which this project took place and then present the structure of the database and provide guidelines to prospective users. The paper concludes with the introduction of www.lipad.ca, an online platform designed as a hub for archiving Canadian political data, with the parliamentary proceedings at the centre of its architecture.
Feedback learning is essential for behavioral development. We investigated feedback learning in relation to behavior problems after pediatric traumatic brain injury (TBI).
Children aged 6–13 years diagnosed with TBI (n = 112; 1.7 years post-injury) were compared with children with traumatic control (TC) injury (n = 52). TBI severity was defined as mild TBI without risk factors for complicated TBI (mildRF− TBI, n = 24), mild TBI with ⩾1 risk factor for complicated TBI (mildRF+ TBI, n = 51) and moderate/severe TBI (n = 37). The Probabilistic Learning Test was used to measure feedback learning, assessing the effects of inconsistent feedback on learning and generalization of learning from the learning context to novel contexts. The relation between feedback learning and behavioral functioning rated by parents and teachers was explored.
No evidence was found for an effect of TBI on learning from inconsistent feedback, while the moderate/severe TBI group showed impaired generalization of learning from the learning context to novel contexts (p = 0.03, d = −0.51). Furthermore, the mildRF+ TBI and moderate/severe TBI groups had higher parent and teacher ratings of internalizing problems (p's ⩽ 0.04, d's ⩾ 0.47) than the TC group, while the moderate/severe TBI group also had higher parent ratings of externalizing problems (p = 0.006, d = 0.58). Importantly, poorer generalization of learning predicted higher parent ratings of externalizing problems in children with TBI (p = 0.03, β = −0.21) and had diagnostic utility for the identification of children with TBI and clinically significant externalizing behavior problems (area under the curve = 0.77, p = 0.001).
Moderate/severe pediatric TBI has a negative impact on generalization of learning, which may contribute to post-injury externalizing problems.
In this paper, we investigate examples of good and optimal Drinfeld modular towers of function fields. Surprisingly, the optimality of these towers has not been investigated in full detail in the literature. We also give an algorithmic approach for obtaining explicit defining equations for some of these towers and, in particular, give a new explicit example of an optimal tower over a quadratic finite field.
Silica gels are prepared by acidification (pH = 2 − 4) of water glass. SAXS measurements show that the gel consists of fractal aggregates (D = 2.2). Although the fractal dimension is not influenced by addition of cations, Al3+ and Mg2+ retard the growth of the fractal aggregates, while TMA+ has a promoting effect.
Combination of SAXS and USAXS measurements provide an extended q-range (0.006–3.0 nm-1) to study fractal growth of both aging silica gel as well as precursors of zeolite-A. Mass (silica) and surface (zeolite) fractals are observed. Scanning transmission X-ray microscopy (STXM) proves to be an extremely useful technique to obtain direct images of wet samples in the 0.1–100 micron range, confirming the SAXS/USAXS results on even larger length scales.
In this paper, a clear view on the bulk microstructure of MDMO-PPV:PCBM blends as used in bulk hetero-junction organic solar cells is obtained by means of TEM (Transmission Electron Microscopy). Using TEM, 3-dimensional information is acquired on phase separated regions, formed during casting. Particle statistics illustrate quantitatively that a.o. drying conditions and choice of solvent dramatically influence the blend structure. More information about the lateral blend structure and distribution is obtained in cross-sectional view. Since blend morphology is strongly related to photovoltaic performance, TEM can be a powerful tool for understanding today's photovoltaic performances and screening new sets of materials.
Leucine has been suggested to have the potential to modulate muscle protein metabolism by increasing muscle protein synthesis. The objective of this study was to investigate the surplus value of the co-ingestion of free leucine with protein hydrolysate and carbohydrate following physical activity in elderly men. Eight elderly men (mean age 73 ± 1 years) were randomly assigned to two cross-over treatments consuming either carbohydrate and protein hydrolysate (CHO+PRO) or carbohydrate, protein hydrolysate with additional leucine (CHO+PRO+leu) after performing 30 min of standardized physical activity. Primed, continuous infusions with l-[ring-13C6]phenylalanine and l-[ring-2H2]tyrosine were applied, and blood and muscle samples were collected to assess whole-body protein turnover as well as protein fractional synthetic rate in the vastus lateralis muscle over a 6 h period. Whole-body protein breakdown and synthesis rates were not different between treatments. Phenylalanine oxidation rates were significantly lower in the CHO+PRO+leu v. CHO+PRO treatment. As a result, whole-body protein balance was significantly greater in the CHO+PRO+leu compared to the CHO+PRO treatment (23·8 (sem 0·3) v. 23·2 (sem 0·3) μmol/kg per h, respectively; P < 0·05). Mixed muscle fractional synthetic rate averaged 0·081 (sem 0·003) and 0·082 (sem 0·006) %/h in the CHO+PRO+leu and CHO+PRO treatment, respectively (NS). Co-ingestion of leucine with carbohydrate and protein following physical activity does not further elevate muscle protein fractional synthetic rate in elderly men when ample protein is ingested.
Children with developmental disabilities often show a variety of associated impairments that lead to a lifelong need for additional care. Careful assessment of these impairments is required not only for diagnostic purposes but also to inform the parents about the expected additional care needs in the future. We present a systematic review of the literature to identify instruments that classify the type and amount of this care for the individual child. A literature search was performed in the Medline database (January 1966 – June 2005) on instruments that classify the type and amount of expected additional care needs in the future. Seven standardized measurement instruments describing current additional care needs were identified, but none of these instruments was developed to provide information about the expected need for additional care in the future. For parents of young children with non-progressive developmental disorders it is essential to be informed on the expectations of required additional care in the future. However, comprehensive instruments providing such information are currently lacking and, thus, need to be developed.
This study reviews the instruments used for the clinical assessment of spasticity in children with cerebral palsy, and evaluates their compliance with the concept of spasticity, defined as a velocity-dependent increase in muscle tone to passive stretch. Searches were performed in Medline, Embase, and Cinahl, including the keywords ‘spasticity’, ‘child’, and ‘cerebral palsy’, to identify articles in which a clinical method to measure spasticity was reported. Thirteen clinical spasticity assessment instruments were identified and evaluated using predetermined criteria. This review consists of reports on the standardization applied for assessment at different velocities, testing posture, and quantification of spasticity. Results show that most instruments do not comply with the concept of spasticity; standardization of assessment method is often lacking, and scoring systems of most instruments are ambiguous. Only the Tardieu Scale complies with the concept of spasticity, but this instrument has a comprehensive and time-consuming clinical scoring system.
This paper concerns towers of curves over a finite field with many rational points, following Garcia–Stichtenoth and Elkies. We present a new method to produce such towers. A key ingredient is the study of algebraic solutions to Fuchsian differential equations modulo p. We apply our results to towers of modular curves, and find new asymptotically good towers.
In this pilot study we investigated the feasibility of The Infant Behavioral Assessment and Intervention Program (IBAIP) in a group of preterm infants. At the age of 6 months, the neurobehavioural organization and self-regulatory competence of an intervention group was compared with a control group who had received the standard follow-up care. The intervention group consisted of 13 males and seven females (mean gestational age [GA] 29.2 weeks, SD1.3wks; mean birthweight 1232g, SD320g). The control group consisted of 11 males and nine females (mean GA 29wks, SD1.6wks; mean birthweight 1198g, SD397g). Inclusion criteria were: a GA of 32 weeks and family residence in the district of Amsterdam. Exclusion criteria were: severe congenital abnormalities, intraventricular haemorrhage grade III or IV, periventricular leukomalacia grade III or IV, and infants whose mothers had a history of illicit drug use. The intervention infants received 6 to 8 IBAIP interventions at home, from discharge until 6 months of age. The Neonatal Behavioral Assessment Scale was administered at term; the Infant Behavioral Assessment (IBA) at term, 3, and 6 months of age; and the Bayley Scales of Infant Development–II at 3 and 6 months (corrected age). At 6 months, intervention infants showed less stress and more approach behaviours on the IBA compared with control infants. These promising results warrant further evaluation in a randomized controlled trial.
The dependence of the cellular (biogenic) and frustule-associated (mineralized) silica content of the diatoms Navicula salinarum and
Thalassiosira weissflogii on salinity and aluminium conditions was studied in order to make it possible to manipulate silicification in vitro
and maximize it to levels required for physico-chemical frustule characterization by physisorption, X-ray scattering analysis and NMR,
which is our ultimate objective. Enrichments with AlCl3 increased growth and the final cell density of the pennate N. salinarum, but not of
the centric species T. weissflogii. Aluminium additions did not, however, result in a significant increase in the biogenic or mineralized
silica content per cell and could not be detected in the silica matrix of the frustule. In contrast, lowering the salinity from 28 practical
salinity units (PSU) to 20 and 15 resulted in a significant increase in the biogenic silica content per cell of both species, which is in line
with an increase in density of the chemically derived silica under low salt conditions. The silica content per cell was variable during
culture growth; increase in cell densities (during exponential growth) was accompanied by a decrease in contents of biogenic silica per
cell. Electron microscopy and energy dispersive X-ray analysis (EDXA) support the chemical analyses and also suggest higher biogenic
silica contents at lower salinities. The results indicate that besides silicate concentration and pH, the concentration of salts is an important
inorganic factor that affects the silica polymerization inside the silica deposition vesicle of diatoms.
During the decade beginning in 1910 the economic involvement of the United States in Mexico increased while diplomatic relations deteriorated. Between 1911 and 1920 United States' imports from Mexico increased from $57,000,000 to $179,000,000 and exports from $61,000,000 to $208,000,000. Much of this economic growth related to petroleum and to land where investments in each of these areas increased phenomenally. The new Mexican Constitution of 1917, however, forecast trouble for foreign investors, especially those who depended upon Mexico's unreplenishable subsoil resources. Concessionaires who mined the subsoil appeared to hold their title only at the will of the state. Additionally, the right of foreigners to hold property in Mexico was often restricted. Land on the shores or borders of Mexico, for example, could not be owned by foreigners. Such provisions were designed to limit the economic subservience of Mexico to the United States. Like other Latin Americans, the Mexicans wanted economic self-sufficiency. They resented the fact that their economy was tied to the fluctuating world demand for staple raw materials and that they were caught in an American vise which squeezed both their imports and their exports.
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