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This study is aimed at developing a Rural Primary Health Care (PHC) Model for delivering comprehensive PHC for dementia in rural settings and addressing the gap in knowledge about disseminating and implementing evidence-based dementia care in a rural PHC context.
Limited access to specialists and services in rural areas leads to increased responsibility for dementia diagnosis and management in PHC, yet a gap exists in evidence-based best practices for rural dementia care.
Elements of the Rural PHC Model for Dementia were based on seven principles of effective PHC for dementia identified from published research and organized into three domains: team-based care, decision support, and specialist-to-provider support. Since 2013 the researchers have collaborated with a rural PHC team in a community of 1000 people in the Canadian province of Saskatchewan to operationalize these elements in ways that were feasible in the local context. The five-step approach included: building relationships; conducting a problem analysis/needs assessment; identifying core and adaptable elements of a decision support tool embedded in the model and resolving applicability issues; implementing and adapting the intervention with local stakeholders; and sustaining the model while incrementally scaling up.
Developing and sustaining relationships at regional and PHC team levels was critical. A comprehensive needs assessment identified challenges related to all domains of the Rural PHC Model. An existing decision support tool for dementia diagnosis and management was adapted and embedded in the team’s electronic medical record. Strategies for operationalizing other model elements included integrating team-based care co-ordination into the decision support tool and family-centered case conferences. Research team specialists provided educational sessions on topics identified by the PHC team. This paper provides an example of a community-based process for adapting evidence-based practice principles to a real-world setting.
Cystic echinococcosis (CE) caused by the larval stage of Echinococcus granulosus is a disease that affects both humans and animals. In humans the disease is treated by surgery with a supplementary option of chemotherapy with a benzimidazole compound. During the present study heat-shock protein 60 (HSP 60) was identified as one of the most frequently expressed biomolecules by E. granulosus after albendazole treatment. Data were correlated with 14-3-3 protein signature, and overexpression of this molecule after albendazole induction was an indicator of cell survival and signal transduction during in vitro maintenance of E. granulosus for up to 72 h. This observation was further correlated with a uniform expression pattern of a housekeeping gene (actin II). Out of three β-tubulin gene isoforms of E. granulosus, β-tubulin gene isoform 2 showed a conserved point mutation indicative of benzimidazole resistance.
The first of several cases of meningococcal meningitis was reported in April 2005, in New Delhi, India. Subsequent to this the Government declared an outbreak, which persisted for two periods, from April–July 2005 and January–March 2006. The National Institute of Communicable Diseases (NICD) recommended using WHO criteria for diagnosis of disease. During the outbreak 380 clinically suspected cases were investigated. Of 55 cases diagnosed as confirmed/probable the mortality rate was 14·6%. Meningitis was reported in 60% of cases and meningococcaemia in 40%. Microscopy of petechial rash was positive in 87·5%, CSF Gram stain positive in 68·3%, and latex agglutination test of CSF positive in 64·9% of samples. Neisseria meningitidis (serogroup A) was isolated from 37·7% of cases, 57·7% from CSF. Blood culture was positive in 10·4% of cases. CrgA polymerase chain reaction for N. meningitidis confirmed the isolates. All isolates were susceptible to third-generation cephalosporins, azithromycin and rifampicin, with increasing resistance to ceftriaxone. Penicillin resistance was encountered in 15·4% of strains. Resistance to quinolones was very high at 100% for levofloxacin, 84·6% for ofloxacin and 65·4% for ciprofloxacin. All patients with penicillin-resistant organisms (4) or intermediate sensitivity (4) succumbed to the disease. These patients also had a higher minimum inhibitory concentration to ceftriaxone.
Fourteen strains of S. Typhi (n=13) and S. Paratyphi A (n=1) resistant to ciprofloxacin were compared with 30 ciprofloxacin decreased-susceptibility strains on the basis of qnr plasmid analysis, and nucleotide substitutions at gyrA, gyrB, parC and parE. In ciprofloxacin-resistant strains, five S. Typhi and a single S. Paratyphi A showed triple mutations in gyrA (Ser83→Phe, Asp87→Asn, Glu133→Gly) and a novel mutation outside the quinolone resistance determining region (QRDR) (Met52→Leu). Novel mutations were also discovered in an isolate (minimum inhibitory concentration 8 μg/ml) in gyrA gene Asp76→Asn and outside the QRDR Leu44→Ile. Out of 30 isolates with reduced susceptibility, single mutation was found in 12 strains only. Genes encoding qnr plasmid (qnr A, qnr B, AAC1-F) were not detected in ciprofloxacin-resistant or decreased-susceptibility strains. Antimicrobial surveillance coupled with molecular analysis of fluoroquinolone resistance is warranted for reconfirming novel and established molecular patterns of resistance, which is quintessential for reappraisal of enteric fever therapeutics.
The longitudinal effects of age on confrontation naming using the
60-item Boston Naming Test (BNT) were studied in 541 “normal”
elderly (ages 50–99). For participants with at least 4 annual
assessments (n = 238), 150 were followed for ≥6 years, 81 for
≥8 years, and 43 for ≥10 years. A small practice effect (0.21 words,
p = 0.06) and moderately high test-retest reliability were found
when comparing the first 2 assessments, which were 9–15 months apart
(r = 0.76, n = 353). Reliable change index scores
indicated that an annual decline of ≥4 points on the BNT is needed for
a statistically reliable decline in an individual. A gradient in the mean
annual rate of change on the BNT was found with improvement in the 50s age
group, no change in the 60s age group, and decline in the 70s and 80s age
groups. When projected over 10 years, the magnitudes of the mean changes
were relatively small, that is, a 1-word improvement for
participants in their 50s and a 1.3-word decline for participants
in their 70s. These findings demonstrate that lexical retrieval as
measured by a visual object confrontation naming task is generally well
preserved in aging with only subtle decline in the 7th and 8th decades of
age. (JINS, 2005, 11, 716–726.)
Shallow ice cores were obtained from widely distributed sites across the West Antarctic ice sheet, as part of the United States portion of the International Trans-Antarctic Scientific Expedition (US ITASE) program. The US ITASE cores have been dated by annual-layer counting, primarily through the identification of summer peaks in non-sea-salt sulfate (nssSO42–) concentration. Absolute dating accuracy of better than 2 years and relative dating accuracy better than 1 year is demonstrated by the identification of multiple volcanic marker horizons in each of the cores, Tambora, Indonesia (1815), being the most prominent. Independent validation is provided by the tracing of isochronal layers from site to site using high-frequency ice-penetrating radar observations, and by the timing of mid-winter warming events in stable-isotope ratios, which demonstrate significantly better than 1 year accuracy in the last 20 years. Dating precision to ±1 month is demonstrated by the occurrence of summer nitrate peaks and stable-isotope ratios in phase with nssSO42–, and winter-time sea-salt peaks out of phase, with phase variation of <1 month. Dating precision and accuracy are uniform with depth, for at least the last 100 years.
The objectives of the present study were to investigate the recovery of [14C]allantoin in urine of sheep dosed intravenously and degradation of allantoin by rumen micro-organisms. The recovery of [14C]allantoin in the urine of eight sheep was measured during three periods in two experiments. Individual values of [14C]allantoin recovery varied from 66 to 95 % (mean value 83 (SE 1·6) %). The recovery of [14C]allantoin showed no relation to the level of feed intake. There was some evidence that glomerular filtration rate was an important factor affecting the amount of urinary allantoin recovered in one experiment. Incomplete recovery of plasma [14C]allantoin in the urine indicated losses of plasma [14C]allantoin via non-renal routes. This is supported by the disappearance of 14C from rumen contents incubated in vitro with [14C]allantoin for 48 h (88 %) and the presence of 14C in saliva in vivo from sheep sampled after dosing with [14C]allantoin. However, the amount of 14C activity in the saliva was very low (equivalent to only 1·5 % of the total dose in sheep producing saliva at a rate of 15 litres/d). The proportion of renal and non-renal excretion of purine derivatives was found to be unpredictable both between and within individual animals. The factors responsible for this variability need to be identified, and existing models of excretion of purine derivatives may need to be modified accordingly to improve their accuracy of prediction. A single intravenous injection of [4,5-14C]allantoin provides a simple alternative to infusion methods used to measure the proportion of plasma allantoin excreted in the urine of sheep. Using this method it may be feasible to validate PD excretion models in other ruminant livestock.
Ba0.6Sr0.4(YTa)yTi1-2yO3 has been shown to have properties which are promising for tunable applications requiring low dielectric constant . Ba0.6Sr0.4(YTa)yTi1-2yO3 with y ≤ 0.10 has been synthesized and well-characterized using x-ray diffraction, EDAX, and Raman Spectroscopy. The dependence of the dielectric properties on concentration, y, of Y and Ta are discussed along with implications for improved performance in device applications.
We demonstrate that one can detect minuscule amounts of hydrogen diffusion out of a-Si:H under illumination at room temperature, by monitoring the changes in the Raman spectrum of amorphous tungsten oxide as a function of illumination. The Staebler-Wronski effect, the light-induce creation of metastable defects in hydrogenated amorphous silicon (a-Si:H), has been one of the major problems that has limited the performance of such devices as solar cells. Recently, Branz suggested the hydrogen collision model that can explain many aspects of the Staebler-Wronski effect. One of the main predictions of this model is that the photogenerated mobile hydrogen atoms can move a long distance at room temperature. However, light-induced hydrogen motion in a-Si:H has not been experimentally observed at room temperature. We utilized the high sensitivity of the Raman spectrum of electrochromic a-WO3 to hydrogen insertion to probe the long-range motion of hydrogen at room temperature. We deposited a thin (200 nm) layer of a-WO3 on top of a-Si:H, and under illumination, a change in the Raman spectrum was detected. By comparing the Raman signal changes with those for control experiments where hydrogen is electrochemically inserted into a-WO3, we can estimate semiquantitatively the amount of hydrogen that diffuses out of the a-Si:H layer.
Recent studies of the relationship between the apolipoprotein E (APOE) gene and Alzheimer's disease in adults with Down's syndrome have revealed inconsistent results.
To assess the role of the APOE gene in the manifestation of Alzheimer's disease in adults with Down's syndrome.
We studied the APOE genotypes of 24 adults with dementia and 33 non-demented adults with Down's syndrome over 35 years of age, and an additional group of 164 non-learning disabled adults. We also carried out a meta-analysis of all previously published studies of association between APOE and Down's syndrome, incorporating the current data.
We observed a non-significant excess of APOE ε4 and a reduction of ε2 in adults with dementia compared with non-demented adults with Down's syndrome in our sample. However, meta-analysis showed a significantly higher frequency of ε4 in adults with dementia compared with non-demented adults with Down's syndrome (odds ratio=2.02, 95% CI 1.33–3.07, P=0.001), but no significant reduction in the frequency of ε2.
The APOE ε4 allele acts as a risk factor for the age-specific manifestation of Alzheimer's disease in people with Down's syndrome.
Pyrite is an ubiquitous constituent of the Proterozoic massive sulphide deposit at Deri, in the South Delhi Fold Belt of southern Rajasthan. Preserved pyrite microfabrics in the Zn-Pb-Cu sulphide ores of Deri reveal a polyphase growth history of the iron sulphide and enable the tectono-thermal evolution of the deposit to be reconstructed.
Primary sedimentary features in Deri pyrites are preserved as compositional banding. Regional metamorphism from mid-greenschist to low amphibolite facies is recorded by various microtextures of pyrite. Trails of fine grained pyrite inclusions within hornblende porphyroblasts define S1-schistosity. Pyrite boudins aligned parallel to S1 mark the brittle–ductile transformation of pyrite during the earliest deformation in the region. Isoclinal to tight folds (F1 and F2) in pyrite layers relate to a ductile deformation stage during progressive regional metamorphism. Peak metamorphic conditions around 550°C, an estimation supported by garnet–biotite thermometry, resulted in annealing of pyrite grains, while porphyroblastic growth of pyrite (up to 900 µm) took place along the retrogressive path. Brittle deformation of pyrite and growth of irregular pyritic mass around such fractured porphyroblasts characterize the waning phase of regional metamorphism. A subsequent phase of stress-free, thermal metamorphism is recorded in the decussate and rosette textures of arsenopyrite prisms replacing irregular pyritic mass. Annealing of such patchy pyrite provides information regarding the temperature conditions during this episode of thermal metamorphism which is consistent with the hornblendehornfels facies metamorphism interpreted from magnetite–ilmenite geothermometry (550°C) and sphalerite geobarometry (3.5 kbar). A mild cataclastic deformation during the penultimate phase produced microfaults in twinned arsenopyrite prisms.
The effect of body fat content on the protein metabolism of energy-restricted sheep has been studied in two experiments. In the first experiment, six Suffolk-cross wether sheep, three weighing about 39 kg and three of about 61 kg, were given progressively increasing amounts of casein-N from 0 to 3000 mg N/kg metabolic body weight (W0·75) daily with constant energy, 91 kJ/kg W0·75 daily, from a high-propionic acid mixture of volatile fatty acids (VFA). In the second experiment, two lean and two fat sheep of similar body weights were given progressively increasing amounts of casein with the same VFA mixture. All the animals attained a positive N balance when they were in negative energy balance. N balance was not affected by body fatness of the magnitude studied, although lean animals utilized increasing levels of standard VFA (acetate-propionate-butyrate 65:25:10, molar proportions) infusion for N accretion more efficiently than fat animals. Endogenous energy was utilized for protein accretion with an efficiency of 0·56. Supply of glucogenic VFA equivalent to 28 mmol glucose/kg W0·75 reduced fasting N excretion by 39%. Fasting heat production decreased from 335 to 300 kJ/kg W0·75 with the infusion of casein and glucogenic VFA. It is argued that fasting induces additional heat losses due to raised protein metabolism and is unsuited as a baseline for dietary assessment.
Utilization of endogenous and exogenous energy for protein accretion during energy undernutrition has been studied. Nine lambs nourished by intragastric infusion were given either progressively increasing or decreasing amounts of casein-N up to 2550 mg/kg metabolic weight (W0·75), with or without 250 kJ/kg W0·75 of volatile fatty acids daily. Energy balance (respiration calorimetry) and N balance were measured. While all experimental animals were in negative energy balance, N balance increased curve-linearly with the increase in casein-N infusion and attained positive N balance. Endogenous energy (presumably body fat) was found to meet the energy needs for protein accretion during energy undernutrition. It is concluded that body fat can be effectively utilized to support lean-tissue growth during energy undernutrition, so that the classical nutritional concept of dietary energy:protein ratio is only meaningful when both endogenous and exogenous energy are considered.
We report on the results of our investigation of using porous Si to enhance the performance of crystalline silicon photovoltaic solar cells. Possible approaches include using the porous Si for (1) surface texturing to enhance light trapping, (2) front or back surface fields because of its wider bandgap, and (3) photon color conversion of blue light to longer wavelengths that have higher quantum efficiency in a Si solar cell. In our surface texturing study, a porous-Si-covered single-crystal Si wafer showed an integrated reflectance of only 1.4% at 500-nm wavelength compared to about 40% for a polished Si surface. For our solar cell study, we used a point-contact cell structure with diffused p+ and n+ point contacts on the back of the cell. This cell structure allows us to form the porous Si on the front surface after both the junction formation and the evaporation and alloying of metal contacts.
Previous studies have shown a good correlation between the degradation characteristics of roughages as measured by the in sacco nylon bag technique, and their voluntary intake by sheep (Hovell et al. 1986), and cattle (Wheeler et al. 1979; Ørskov et al. 1988). The greater intakes of better roughages are associated with a greater outflow of undegraded residues from the rumen. We have also found that even when the roughages were ground to a particle size small enough to leave the rumen without further comminution, the differences in intake between good and poor remained. Thus the differences in intake were not entirely due to material degraded in the rumen, but were associated with differences in the outflow of undegraded residues from the rumen, and therefore some animal factor appeared to be involved. The greater outflow of undegraded residues of the more degradable roughages appeared not to be mediated by the contractile behaviour of the reticulo-rumen (Hovell et al. 1987; 1988).
A Kaufman ion-beam source has been used to study the rehydrogenation and postdeposition hydrogenation of amorphous silicon. In the rehydrogenation study, hydrogen atoms were implanted into glow-discharge-deposited amorphous silicon materials in which the hydrogen content had been driven out by heating. In the posthydrogenation study, amorphous silicon samples with no hydrogen content detectable by infrared absorption and no photoconductivity were used as the starting material. These materials were deposited by thermal CVD, magnetron sputtering, or RF glow discharge.
There is a considerable literature on the effect of grinding and pelleting roughages on their intake and digestibility by ruminants. It is also well established that intake is correlated with digestibility, which parameters are themselves correlated with the rumen degradability of the roughages concerned (Hovell et al. (1986)). However there is little information in which the effect of processing on the intake and digestibility of roughages of known degradation characteristics has been examined. The objective of the experiment reported here was to examine the effect of grinding and pelleting on the voluntary intake and digestibility of two roughages whose degradation characteristics had been defined.
Four mature 63-69 kg Finn-Dorset ewes fitted with permanent rumen cannulae were used. The roughages were a hay (potential degradability 0.81), and a barley straw (potential degradability 0.57) given coarsely chopped, or ground and pelleted. The composition of the hay and straw is shown in Table 1, and the particle size distribution of the two forms is given in Fig. 1. Urea was added to the straw at 18 g/kg and to the hay at 3.6 g/kg (air dry), with 0.13 g sodium sulphate per g urea. A mineral/vitamin supplement was also given. The experimental design was a latin-square with 21 d periods. Food was offered to 10-15% excess of voluntary intake. Voluntary intakes and digestibility were measured during the last 7 d of each period.