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With the increase in technologies to support an aging population, health technology assessment (HTA) of aging-related technologies warrants special consideration. At Health Technology Assessment international (HTAi) 2016 and HTAi 2017, an international panel explored interests in HTA focused on aging.
Panelists from five countries shared the state of aging and HTA in their countries. Opportunities were provided for participants to discuss and rate the themes identified by the panelists.
In 2016, the highest ranked themes were: (i) identifying unmet needs of older adults that could be met by technology—how can HTA help?; (ii) differences in assessment of aging-related technologies—what is the scope?; and (iii) involvement of older adults and caregivers. These themes became the starting point for discussion in 2017, for which the highest ranked themes were: (i) identification of challenges in HTA and aging; and (ii) approaches to advancing effectiveness of HTA for aging.
These discussions allowed for examination of future directions for HTA and aging: engagement of older adults to inform the agenda of HTA and the broader public policy enterprise; a systems approach to thinking about needs of older persons should support the type and level of care desired by the individual rather than the health institutions, and HTA should reflect these desires when evaluating technological aides; and there is potential for health information systems and “big data” to support HTA activities that assess usability of technologies for older adults. We hope to build on the momentum of this community to continue exploring opportunities for aging and HTA.
With the rapid increase in technologies and innovations to support a growing aging population in many countries, health technology assessment (HTA) of technologies for the aging populace warrants special consideration. Building on our efforts at Health Technology Assessment international (HTAi) conferences in 2016 and 2017, this presentation will highlight themes generated from two previous HTAi collaborations, with an aim of continuing to build interest and capacity in HTA for aging-related technologies in an international ecosystem that is responsive to local needs and global opportunities.
Researchers from Canada's technology and aging network (AGE-WELL) collaborated with international panelists at HTAi conferences in 2016 and 2017 to explore interest in HTA focused on aging. International panelists shared the current state of aging and HTA in their respective countries. At both sessions, opportunities were provided for participants to rate the importance of themes identified by the panelists.
At the 2016 session, the two most highly ranked themes were: (i) how HTA can help identify the unmet needs of older adults in society that could be met by technology; and (ii) engagement of older adults and caregivers. These two themes became the starting point for the panel discussion in 2017. At this session, the highest ranked themes were: (i) identification of challenges in HTA and aging; (ii) approaches to advancing the effectiveness of HTA in addressing technology and aging; and (iii) development of an aging-related interest group in HTAi.
International collaborations have identified a number of recommendations to consider for HTA and aging-related work including: developing a good mutual awareness and understanding of barriers and opportunities; the importance of co-creating solutions with patients, healthcare providers, researchers, innovators, and funders; and the identification of a suite of methods and tools that can help accelerate technological innovation in care delivery.
Diverse environmental conditions surrounding preimplantation embryos, including available nutrients, affect their metabolism and development in both short- and long-term manner. Thioredoxin-interacting protein (TXNIP) is a possible marker for preimplantation stress that is implicated in in vitro fertilization- (IVF) induced long-term DOHaD effects. B vitamins, as participants in one-carbon metabolism, may affect preimplantation embryos by epigenetic alterations of metabolically and developmentally important genes. In vitro-produced bovine embryos were cultured with or without Roswell Park Memorial Institute 1640 vitamin mixture, containing B vitamins and B vitamin-like substances, from day 3 after IVF and we evaluated blastocyst development and TXNIP messenger RNA (mRNA) expression in the blastocysts by reverse transcription-quantitative polymerase chain reaction. The degree of trimethylation of histone H3 lysine 27 (H3K27me3) at TXNIP promoter was examined semi-quantitatively by chromatin immunoprecipitation polymerase chain reaction. Total H3K27me3 were also compared between the groups by Western blot analysis. The vitamin treatment significantly increased the rates of blastocyst development (P<0.05) and their hatching (P<0.001) from the zona pellucida by day 8. The mRNA expression of TXNIP was lower (P<0.01) in blastocysts in the vitamin-mixture-treated group concomitant with higher (P<0.05) level of H3K27me3 of its promoter compared with the control group. The total H3K27me3 in the vitamin-mixture-treated group was also higher (P<0.01) than that in the control group. The epigenetic control of genes related to important metabolic processes during the periconceptional period by nutritional conditions in utero and/or in vitro may have possible implication for the developmental programming during this period that may impact the welfare and production traits of farm animals.
Sleep disturbances are commonly observed in older nursing home residents, mainly in combination with dementia. However, sleep-associated circadian motor activity patterns have not been thoroughly investigated in Japanese nursing homes. The present study aimed to respectively clarify the effect of community living and the presence of dementia on sleep disturbances and interrupted activity rhythm of older nursing-home residents with or without dementia and older community-dwelling people without dementia.
Actigraph devices worn on the participants’ non-dominant wrists for seven days were used to collect objective measurements of the sleep/awake status throughout the night and the circadian motor activity patterns. The presence of dementia was assessed by a trained medical doctor using the residents’ records and the Clinical Dementia Rating (CDR). The functional capacity of the participants was determined using the Barthel Index (BI).
Fifty-one older people in Akita prefecture were included in the current study, consisting of 17 residents with dementia (mean age: 82.2 years), 17 residents without dementia (84.5 years), and 17 community-dwelling people (83.6 years). The results showed that older nursing-home residents with dementia had significantly a lower rate of sleep efficiency and a longer awake time throughout the night than the other groups. Older nursing-home residents with and without dementia had more fragmented rhythm than community-dwelling people without dementia.
These results provide evidence of poor sleep/awake status throughout the night and interrupted circadian activity rhythms in nursing-home residents with and without dementia. However, further studies performed according to dementia classifications are needed.
Irregular circadian rhythm and cognitive impairment are frequently observed in patients with chronic schizophrenia. However, their effects in different living environments or with aging remain unclear. The aim of this study was to clarify the characteristics of circadian rhythm and cognition function in the patients with chronic schizophrenia.
This report described data collected using continuous wrist-active monitoring in real-life settings for seven days and the Brief Assessment of Cognition in Schizophrenia Japanese Version (BACS-J) from 10 inpatients with chronic schizophrenia, 10 outpatients with chronic schizophrenia, and 15 healthy elderly people. The Global Assessment of Functioning (GAF) Scale was used to measure the social functioning in the patients with chronic schizophrenia.
The outpatients with chronic schizophrenia exhibited highly interrupted circadian patterns in terms of stability and the fragmentation of activity (p < 0.05) as indexed according to Interdaily Stability (IS) and Intradaily Variability (IV). The inpatients with chronic schizophrenia indicated the most stable rhythm (p < 0.05) and inactive state (p = 0.001) among the groups. Also, the inpatients with chronic schizophrenia showed poorer cognitive functioning with Z-scores of subtests except digit sequencing (p < 0.01). According to stepwise linear regression analysis, the motor speed of BACS-J and IS of circadian parameters were the most powerful variables to predict the GAF in patients with chronic schizophrenia.
The characteristics of circadian rhythm and cognition function in the inpatients with chronic schizophrenia appear distinct from those in the outpatients and the healthy elderly people. Circadian rhythm and cognition function in the patients with chronic schizophrenia may, in part, be affected by different living environments.
An adequate immune system is required to prevent diarrhoea in neonates, and IgA provides protection against microbial antigens on mucosal surfaces. Although β-carotene supplementation has been expected to enhance the retinoic acid (RA)-mediated immune response in neonates, the exact mechanism of the enhancement of mucosal IgA production in the small intestine by β-carotene is still unclear. In the present study, we investigated the effect of supplemental β-carotene on the concentrations of IgA, the numbers of IgA antibody-secreting cells (ASC) and the mRNA expressions of IgA C-region, CCL25, retinoid X receptor (RXR) α, retinoic acid receptor (RAR) α and RARγ in the jejunum and ileum of weanling mice. Weanling mice were fed rodent feed or 50 mg/kg β-carotene-supplemented rodent feed for 7, 14 or 21 d. The concentrations of IgA and the numbers of IgA ASC in the jejunum and ileum of mice increased markedly with age, and supplemental β-carotene increased the concentrations of IgA, the numbers of IgA ASC and the mRNA expressions of IgA C-region, CCL25 and RARγ in the jejunum after 14 and 21 d of treatment. Supplemental β-carotene increased the numbers of IgA ASC in the ileum after 14 and 21 d of treatment, but the concentrations of IgA in the ileum were not affected by β-carotene supplementation. The mRNA expressions of RXRα and RARα in the jejunum and those of RXRα and RARγ in the ileum after 21 d of treatment were enhanced by β-carotene supplementation. These results indicate that β-carotene supplementation in weanling mice is effective to enhance mucosal IgA induction in the jejunum or ileum and that the effects are mainly due to the RA-mediated immune response.
A specific and simple competitive enzyme-linked immunosorbent assay (ELISA) was developed to determine bovine β-casein phosphopeptides (β-CPP) in casein phosphopeptides (CPP) or CPP complexes such as casein phosphopeptide amorphous calcium phosphate complexes added into dairy products. The method combines sample pretreatment designed for CPP enrichment and anti-β-CPP(f(1–25)) monoclonal antibody 1A5 (mAb 1A5). The mAb 1A5 bound specifically to the tryptic phosphopeptides from β-casein but not from αs1- or αs2-casein. Reactivity was also influenced by the extent of the phosphorylated form of serine residues. Based on the sequence-specific recognition and contribution of phosphorylated serine residues, the epitope of mAb 1A5 was found to reside within the cluster motif Ser(P)-Ser(P)-Ser(P)-Glu-Glu and the surrounding residues in β-CPP. The competitive ELISA developed here can be used as an alternative to specialised and expensive techniques such as mass spectrometry. In particular, it is suitable for the measurement of CPP or CPP complexes in dairy products, which contain closely related endogenous molecular species.
To examine the association between the consumption of green tea, coffee and caffeine and depressive symptoms.
Cross-sectional study. Consumption of green tea and coffee was ascertained with a validated dietary questionnaire and the amount of caffeine intake was estimated from these beverages. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Multiple logistic regression analysis was performed to compute odds ratios and 95 % confidence intervals for depressive symptoms with adjustments for potential confounders.
Two workplaces in north-eastern Kyushu, Japan, in 2009.
A total of 537 men and women aged 20–68 years.
Higher green tea consumption was associated with a lower prevalence of depressive symptoms. Compared with participants consuming ≤1 cup/d, those consuming ≥4 cups green tea/d had a 51 % significantly lower prevalence odds of having depressive symptoms after adjustment for potential confounders, with significant trend association (P for trend = 0·01). Further adjustment for serum folate slightly attenuated the association. Coffee consumption was also inversely associated with depressive symptoms (≥2 cups/d v. <1 cup/d: OR = 0·61; 95 % CI 0·38, 0·98). Multiple-adjusted odds for depressive symptoms comparing the highest with the lowest quartile of caffeine consumption was OR = 0·57 (95 % CI 0·30, 1·05; P for trend = 0·02).
Results suggest that higher consumption of green tea, coffee and caffeine may confer protection against depression.
II-VI compound semiconductor ZnO has a potential for high radiation hardness since large threshold displacement energy of constituent atoms can be expected due to the small unit-cell volume and large bandgap energy of 3.37 eV. In order to study the radiation hardness, singlecrystalline c-axis-oriented O-polar ZnO films with and without two-dimensional electron gas, a Zn-polar ZnO bulk crystal, and a Ga-polar GaN bulk crystal for comparison, were irradiated by an 8 MeV proton beam using a tandem-type accelerator. The radiation damage increased the electrical resistance and decreased the photoluminescence (PL) intensity of these samples with the increase of proton fluence over specific threshold values. In agreement with the expectation, ZnO samples were revealed to have superior radiation hardness; the threshold fluences for the deterioration of PL intensity were 3×1013 p/cm2 for the GaN bulk crystal, 2×1014 p/cm2 for the ZnO bulk crystal, and 5×1014 p/cm2 for the two ZnO films, in accordance with the order of the threshold fluences for the electrical resistance increase. The effect of post-irradiation annealing was also studied for these damaged bulk crystals; both electrical and optical properties of the ZnO bulk crystal were almost recovered to the pre-irradiation values, however, only the electrical properties of the GaN bulk crystal were recovered, by the annealing up to 700°C. Such a rapid recovery of the ZnO bulk crystal indicates the easy annihilation of Zn vacancy complexes acting as non-radiative centers by the recombination with interstitial Zn atoms. Since the migration barrier height energy of interstitial Zn atoms is known to be so small that it might occur even at room temperature, we ascribed the superior radiation hardness of ZnO crystals to the restoration of damage-induced defects by a self-annealing effect during irradiation.
Why are citizens in advanced industrialized countries willing to accept high prices for agricultural products? Conventional wisdom suggests that agricultural interests secure government protection because producers are concentrated and better politically organized than diffused consumers. Due to its focus on producer capacity for collective action, however, the literature fails to account for the high levels of mass support for agricultural protectionism in advanced industrialized nations. This article presents new evidence from a survey experiment in Japan conducted during the recent global recession (December 2008) that accounts for this puzzle. Using randomly assigned visual stimuli, the experiment activates respondents' identification with either producer or consumer interests and proceeds to ask attitudinal questions regarding food imports. The results suggest that consumer priming has no reductive or additive effects on the respondents' support for liberalizing food imports. Surprisingly, producer priming increases respondents' opposition to food import, particularly among those who fear future job insecurity. We further disentangle the puzzling finding that consumers think like producers on the issue of food import along two mechanisms: “sympathy” for farmers and “projection” of their own job insecurity. The results lend strong support to the projection hypothesis.
Mortality of neonates continues to be a major problem in humans and animals. IgA provides protection against microbial antigens at mucosal surfaces. Although β-carotene supplementation has been expected to enhance retinoic acid-mediated immune response in neonates, the exact mechanism by which β-carotene enhances IgA production is still unclear. We investigated the effect of supplemental β-carotene for maternal mice during pregnancy and lactation on IgA antibody-secreting cells (ASC) in mammary gland and guts and on IgA transfer from milk to neonatal mice. Pregnant mice were fed untreated or 50 mg/kg β-carotene-supplemented diets from 6·5 d postcoitus (dpc) to 14 d postpartum (dpp). Supplemental β-carotene increased the numbers of IgA ASC in mammary gland (P < 0·05) and ileum (P < 0·001), and also mRNA expression of IgA C-region in ileum (P < 0·05) of maternal mice at 14 dpp, but few IgA ASC were detected in mammary gland at 17·5 dpc. IgA concentration in stomach contents, which represents milk IgA level, was significantly higher (P < 0·01) in neonatal mice born to β-carotene-supplemented mothers at 7 and 14 dpp, and IgA concentration in serum, stomach contents and faeces increased (P < 0·001) drastically with age. These results suggest that β-carotene supplementation for maternal mice during pregnancy and lactation is useful for enhancing IgA transfer from maternal milk to neonates owing to the increase in IgA ASC in mammary gland and ileum during lactation.
Immune senescence potentially leads to an increased risk of infections. It is desirable to augment the immune system and protect against infections by daily consumption of immunostimulatory food. The present study evaluated whether the intake of yoghurt fermented with Lactobacillus delbrueckii ssp. bulgaricus (L. bulgaricus) OLL1073R-1 has an effect on resistance to the common cold. We conducted two independent studies, in which fifty-seven (median age 74·5 years) and eighty-five healthy elderly individuals (median age 67·7 years) were participants. In each study, the subjects were divided into two groups based on age and sex and instructed to eat 90 g yoghurt or drink 100 ml milk once per d over an 8- or 12-week period. A meta-analysis of the results of these two independent studies showed the risk of catching the common cold was about 2·6 times lower (OR 0·39; P = 0·019) in the yoghurt group than in the milk group and the increase of natural killer cell activity was significantly higher in the yoghurt group than in the milk group (P = 0·028). In addition, the quality of life score for the ‘eye/nose/throat’ system after intake was significantly higher in the yoghurt group than in the milk group and the improvement of the score was correlated with the promotion of natural killer cell activity. In conclusion, consumption of yoghurt fermented with L. bulgaricus OLL1073R-1 augmented natural killer cell activity and reduced the risk of catching the common cold in elderly individuals.
Today we packed our luggage and left Washington, D.C., on the noon train. After travelling north through Baltimore, we passed to the west of Philadelphia at seven in the evening.
We had accepted an invitation from Mr. Jay Cooke, a wealthy Philadelphia banker. When we reached a small village station some ten miles north of Philadelphia, we were met by carriages of the Cooke family and taken to his country estate. In recent years Mr. Cooke has come to be highly regarded for his enormous wealth and benevolence. On the evening we arrived, he was away on business and had not yet returned. His younger brother welcomed and entertained us.
July 28th. Fine.
Mr. Cooke returned this morning. He had travelled fifteen miles into the mountains the previous day to inspect some mines and had mistaken the departure time of the return train. He apologised for being late. Today we also enjoyed a banquet with his whole family in the grand dining-room. The family welcomed us wholeheartedly at each meal, doing everything possible to entertain us.
July 29th. Fine.
The Philadelphia municipal government had urged us to visit the city and we could not refuse such hospitality, so at nine o'clock in the morning we said goodbye to the Cooke family and left by train for Philadelphia, where we took rooms at the Continental Hotel.
At first light this morning the sea fog was so thick that we could not distinguish objects which were only a foot away from us. The entire deck of the America was shrouded in mist. The captain therefore ordered the ship to heave to in the ocean for a while to await the dawn. As the sun rose and the mists began to lift, we could distinguish the mountains of California ahead. They emerged more clearly as the sun rose higher. The America advanced slowly. Directly to the east, two mountains ridges parted to reveal a great natural gateway. Through it we could see steamships passing to and fro with smoke rising from their funnels, making a truly beautiful sight. This was the celebrated Golden Gate.
In our twenty-two-day voyage across the Pacific Ocean this was the first land we had glimpsed east of Japan. Words are inadequate to express our pleasure as we gazed upon this golden gateway, where sea and sky meet directly to the west and coastal mountains rise on both sides.
Today the America steamed into the bay flying the flag of Japan emblazoned with the red sun. The citizens of San Francisco had learnt of the Embassy's visit from newspaper reports, and the news of our actual arrival was telegraphed from the Golden Gate to City Hall and to our consul.
At ten o'clock we were taken to the naval dockyards at the express wish of the king. The dockyards are on the coast in the east, and we went first to the docks themselves, which are on the seashore and very basic in construction, for the ships are simply moored directly to the bank. Here we were shown three iron-clads with turrets.
Next we went to the training facilities, where we watched a company of the royal Norwegian guards, more than one hundred men, being drilled. There is only one company of these Norwegian royal guards, and they are apparently accommodated here. The king himself was already present; he took Ambassador Iwakura by the hand, and they observed the proceedings together. Soon after the king's departure we boarded our carriages and returned along the route taken by His Majesty, following on the heels of his carriage, so we saw his military escort. His coach was protected by two platoons of guardsmen at the front and back, and his roofed one-man vehicle was surrounded by guns and helmets moving in a dignified manner. It is a great mistake to suppose that European monarchs are but lightly protected and do not travel in ceremonial procession.
At two o'clock in the afternoon we went to the museum of antiquities [now the National Museum]. The collection of old bronze artefacts from three thousand years ago includes a kind of sword in use at that time which had been found in excavations at various sites in Sweden, Norway and Denmark.