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Instrumental activities of daily living (IADL) have been operationalized as exhibiting a greater level of complexity than basic ADL. In the same way, incorporating more advanced ADLs may increase the sensitivity of functional measures to identify cognitive changes that may precede IADL impairment. Towards this direction, the IADL-extended scale (IADL-x) consists of four IADL tasks and five advanced ADLs (leisure time activities).
Retrospective, cross-sectional study.
Athens and Larissa, Greece.
1,864 community-dwelling men and women aged over 64.
We employed both the IADL-x and IADL scales to assess functional status among all the participants. Diagnoses were assigned dividing the population of our study into three groups: cognitively normal (CN), mild cognitive impairment (MCI) and dementia patients. Neuropsychological evaluation was stratified in five cognitive domains: memory, language, attention-speed, executive functioning and visuospatial perception. Z scores for each cognitive domain as well as a composite z score were constructed. Models were controlled for age, sex, education and depression.
In both IADL-x and IADL scales dementia patients reported the most functional difficulties and CN participants the fewest, with MCI placed in between. When we restricted the analyses to the CN population, lower IADL-x score was associated with worse cognitive performance. This association was not observed when using the original IADL scale.
There is strong evidence that the endorsement of more advanced IADLs in functional scales may be useful in detecting cognitive differences within the normal spectrum.
People with cerebral palsy (CP) are less physically active than the general population and, consequently, are at increased risk of preventable disease. Evidence indicates that low-moderate doses of physical activity can reduce disease risk and improve fitness and function in people with CP. Para athletes with CP typically engage in ‘performance-focused’ sports training, which is undertaken for the sole purpose of enhancing sports performance. Anecdotally, many Para athletes report that participation in performance-focused sports training confers meaningful clinical benefits which exceed those reported in the literature; however, supporting scientific evidence is lacking. The aim of this paper is to describe the protocol for an 18-month study evaluating the clinical effects of a performance-focused swimming training programme for people with CP who have high support needs.
This study will use a concurrent multiple-baseline, single-case experimental design across three participants with CP who have high support needs. Each participant will complete a five-phase trial comprising: baseline (A1); training phase 1 (B1); maintenance phase 1 (A2); training phase 2 (B2); and maintenance phase 2 (A3). For each participant, measurement of swim velocity, health-related quality of life and gross motor functioning will be carried out a minimum of five times in each of the five phases.
The study described will produce Level II evidence regarding the effects of performance-focused swimming training on clinical outcomes in people with CP who have high support needs. Findings are expected to provide an indication of the potential for sport to augment outcomes in neurological rehabilitation.
Concerns exist over the long-term consequences of subclavian artery ligation in subclavian flap repair for coarctation of the aorta. We sought to analyse upper limb structural and functional performance in adults who have had surgery in childhood for coarctation of the aorta, using either subclavian flap repair or end to end aortic anastomosis.
Two-group observational design using anatomical and upper limb functional performance measures. Purposive sampling from our specialist adult congenital heart disease database of patients who received subclavian flap repair or end to end anastomosis for coarctation of the aorta as children. Upper limb measurements were completed using MRI and blood flow velocity with ultrasound imaging. Bilateral standardised upper limb functional testing of assessment of strength, dexterity and a standardised self-report of upper limb disability was completed.
Eighteen right-handed patients, 9 with subclavian repair, (38 ± 12 years, 78% males) were studied. Age at repair was 4.7 ± 5.9 years; mean time from initial repair 32 ± 9 years. The subclavian group had a larger difference between right and left when compared the end to end anastomosis group in: lower arm muscle mass (94.5 ± 42.3 mls versus 37.8 ± 94.5 mls, p = 0.008), lower arm maximal cross-sectional area, (5.9 ± 2.8 cm2 versus 2.9 ± 2.6 cm2, p = 0.038) and grip strength (14.7 ± 8.3 lbs versus 5.9 ± 5.3 lbs, p = 0.016) There were no significant functional differences between groups.
In adults with repaired coarctation of the aorta, those with subclavian flap repair had a greater right to left arm muscle mass and grip strength differential when compared to those with end to end anastomosis repair.
In many programming languages subprograms incorporate both functions and procedures, however, in Python these are combined into a simple single subprogram and it is not necessary to define the type. The reader is shown how to call subprograms, return values from a subprogram and use variables in subprograms. They complete six challenges and use menus to make the programs user-friendly.
The identification of determinants of dietary intake is an important prerequisite for the development of interventions to improve diet. The present systematic literature review aimed to compile the current knowledge on individual functional determinants of dietary intake in community-dwelling older adults.
A systematic search was performed in PubMed, Scopus, Web of Science and the Cochrane Library. Titles, abstracts and full texts were screened according to predefined inclusion and exclusion criteria. Studies were included when focusing on dietary intake as an outcome and on chemosensory, oral, cognitive or physical function as a determinant.
Older adults at least 65 years old without acute or specific chronic diseases.
From initially 14 585 potentially relevant papers, thirty-six were included. For chemosensory, cognitive and physical function only a few papers were found, which reported inconsistent results regarding the relationship to dietary intake. In contrast, oral function was extensively studied (n 31). Different surrogates of oral function like dental status, number of teeth, bite force or chewing problems were associated with food as well as nutrient intakes including fibre. As all except six studies had a cross-sectional design, no causal relationships could be derived.
Among functional determinants of dietary intake oral factors are well documented in older adults, whereas the role of other functional determinants remains unclear and needs further systematic research.
This paper presents the requirements and needs for establishing a benchmarking protocol that considers representation characteristics, supported cognitive criteria, and enabled reasoning activities for the systematic comparison of function modeling representations. Problem types are defined as reverse engineering, familiar products, novel products, and single-component systems. As different modeling approaches share elements, a comparison of modeling approaches on multiple levels was also undertaken. It is recommended that researchers and developers of function modeling representations collaborate to define a canonically acceptable set of benchmark tests and evaluations so that clear benefits and weaknesses for the disparate collection of approaches can be compared. This paper is written as a call to action for the research community to begin establishing a benchmarking standard protocol for function modeling comparison purposes. This protocol should be refined with input from developers of the competing approaches in an academically open environment. At the same time, the benchmarking criteria identified should also serve as a guide for validating a modeling approach or analyzing its failure.
Although there has been considerable computer-aided conceptual design research, most of the proposed approaches are domain specific and can merely achieve conceptual design of energy flows-processing systems. Therefore, this research is devoted to the development of a general (i.e., domain-independent) and knowledge-based methodology that can search in a wide multidisciplinary solution space for suitable solution principles for desired material-flow processing functions without designers' biases toward familiar solution principles. It first proposes an ontology-based approach for representing desired material-flow processing functions in a formal and unambiguous manner. Then a rule-based approach is proposed to represent the functional knowledge of a known solution principle in a general and flexible manner. Thereafter, a simulation-based retrieval approach is developed, which can search for suitable solution principles for desired material-flow processing functions. The proposed approaches have been implemented as a computer-aided conceptual design system for test. The conceptual design of a coin-sorting device demonstrates that our functional representation methodology can make the proposed computer-aided conceptual design system to effectively and precisely retrieve suitable solution principles for a desired material-flow processing function.
We aimed to obtain a better understanding of how different aspects of patient functioning affect key cost and caregiver outcomes in Alzheimer's disease (AD).
Baseline data from a prospective observational study of community-living AD patients (GERAS) were used. Functioning was assessed using the Alzheimer's Disease Cooperative Study – Activities of Daily Living Scale. Generalized linear models were conducted to analyze the relationship between scores for total activities of daily living (ADL), basic ADL (BADL), instrumental ADL (IADL), ADL subdomains (confirmed through factor analysis) and individual ADL questions, and total societal costs, patient healthcare and social care costs, total and supervision caregiver time, and caregiver burden.
Four distinct ADL subdomains were confirmed: basic activities, domestic/household activities, communication, and outside activities. Higher total societal costs were associated with impairments in all aspects of ADL, including all subdomains; patient costs were associated with total ADL and BADL, and basic activities subdomain scores. Both total and supervision caregiver hours were associated with total ADL and IADL scores, and domestic/household and outside activities subdomain scores (greater hours associated with greater functional impairments). There was no association between caregiver burden and BADL or basic activities subdomain scores. The relationship between total ADL, IADL, and the outside activities subdomain and outcomes differed between patients with mild and moderate-to-severe AD.
Identification of ADL subdomains may lead to a better understanding of the association between patient function and costs and caregiver outcomes at different stages of AD, in particular the outside activities subdomain within mild AD.
Function-based design approaches have been criticized for being too narrow to properly guide design. Specifically, they are said to be unable to cope with nonfunctional considerations, such as cost or maintenance issues without invoking other concepts, such as constraints. This paper investigates two alternative conceptualizations of the design process: the practical affordance-based design approach, as elaborated by Maier and Fadel, and the more theoretical use plan approach by Houkes and Vermaas. This paper compares function-, affordance-, and use plan-based design approaches. It highlights strengths and weaknesses of each approach and proposes a definition of the function of an artifact in terms of its affordances.
Glutathione S-transferases (GSTs, EC 22.214.171.124) are a family of super enzymes with multiple functions that play a major role in the detoxification of endogenous and xenobiotic compounds. In our previous study, we have predicted 23 putative cytosolic GSTs in the silkworm genome using bioinformatic methods. In this study, we cloned and studied the insect-specific epsilon-class GST gene GSTe4 from the silkworm, Bombyx mori. The recombinant BmGSTe4 (Bac-BmGSTe4) was overexpressed in SF-9 cell lines, and it was found to have effective GST activity. We also found that the expression of BmGSTe4 was especially down-regulated after the silkworms were fumigated with or ingested phoxim. Moreover, BmGSTe4 protected HEK293 cells against UV-induced cell apoptosis. These results demonstrated that BmGSTe4 has GST activity, is sensitive to phoxim, and plays a role in inhibition of UV-induced cell apoptosis.
Unemployment can negatively impact quality of life among patients with schizophrenia. Employment status depends on ability, opportunity, education, and cultural influences. A clinician-rated scale of work readiness, independent of current work status, can be a valuable assessment tool. A series of studies were conducted to create and validate a Work Readiness Questionnaire (WoRQ) for clinicians to assess patient ability to engage in socially useful activity, independent of work availability.
Content validity, test–retest and inter-rater reliability, and construct validity were evaluated in three separate studies.
Content validity was supported. Cronbach’s α was 0.91, in the excellent range. Clinicians endorsed WoRQ concepts, including treatment adherence, physical appearance, social competence, and symptom control. The final readiness decision showed good test–retest reliability and moderate inter-rater reliability. Work readiness was associated with higher function and lower levels of negative symptoms. Low positive and high negative predictive values confirmed the concept validity.
The WoRQ has suitable psychometric properties for use in a clinical trial for patients with a broad range of symptom severity. The scale may be applicable to assess therapeutic interventions. It is not intended to assess eligibility for supported work interventions.
The WoRQ is suitable for use in schizophrenia clinical trials to assess patient work functional potential.
There has been an increasing interest in the relationship between severity of disease and costs in the care of people with dementia. Much of the current evidence is based on cross-sectional data, suggesting the need to examine trends over time for this important and growing cohort of the population.
This paper estimates resource use and costs of care based on longitudinal data for 72 people with dementia in Ireland. Data were collected from the Enhancing Care in Alzheimer's Disease (ECAD) study at two time points: baseline and follow-up, two years later. Patients’ dependence on others was measured using the Dependence Scale (DS), while patient function was measured using the Disability Assessment for Dementia (DAD) scale. Univariate and multivariate analysis were used to explore the effects of a range of variables on formal and informal care costs.
Total costs of formal and informal care over six months rose from €9,266 (Standard Deviation (SD): 12,947) per patient at baseline to €21,266 (SD: 26,883) at follow-up, two years later. This constituted a statistically significant (p = 0.0014) increase in costs over time, driven primarily by an increase in estimated informal care costs. In the multivariate analysis, a one-point increase in the DS score, that is a one-unit increase in patient's dependence on others, was associated with a 19% increase in total costs (p = 0.0610).
Higher levels of dependence in people with Alzheimer's disease are significantly associated with increased costs of informal care as the disease progresses. Formal care services did not respond to increased dependence in people with dementia, leaving it to families to fill the caring gap, mainly through increased supervision with the progress of disease.
When considering a system that performs a role, it is often stated that performing that role is a function of the system. The general form of such statements is that “the function of S is R,” where S is the functioning system and R is the functional role it plays. However, such statements do not represent how that single function was selected from many possible alternatives. This article renders those alternatives explicit by revealing the other possible function statements that might be made when either S or R is being considered. In particular, two forms of selection are emphasized. First, when we say “the function of S is R,” there are typically many systems other than S that are required to be in operation for that role to be fulfilled. The functioning system, S, does not perform the role, R, all by itself, and those systems that support S in performing that role might also have been considered as functioning. Second, when we say, “the function of S is R,” there are typically many other roles that S plays apart from R, and those other roles might also have been considered functional. When we make function assignments, we select both the functioning system, S, and the functional role, R, from a range of alternatives. To emphasize these alternatives, this article develops a diagrammatic representation of multiple systems playing multiple roles in multiple supersystems.
Populations are ageing worldwide. The prevalence of dementia will rise exponentially with the oldest old the most rapidly growing segment of society. Caring for this ageing population with dementia, many of whom will have multiple chronic and disabling diseases, will be a challenge to healthcare systems, particularly general hospitals. At any one time, a quarter of acute hospital beds in the UK are in use by people with dementia. Delivery of high-quality care to this growing and vulnerable population must be high on any health service agenda.
Current medical training not only generates relatively low numbers of geriatricians and specialists with interest in dementia, but also there is a lack of appropriate training in assessment and management of dementia. There remains huge need for better staff training and support to provide safe, holistic and dignified dementia care. Here we explore various key features for non-specialist assessment and management of older people with dementia in the general hospital setting.
The immediate clinical significance of Confusion Assessment Method (CAM)-defined core symptoms of delirium not meeting criteria for delirium is unclear. This study proposed to determine if such symptoms are associated with cognitive and functional impairment, mood and behavior problems and increased Burden of Care (BOC) in older long-term care (LTC) residents.
The study was a secondary analysis of data collected for a prospective cohort study of delirium. Two hundred and fifty-eight LTC residents aged 65 years and older in seven LTC facilities had monthly assessments (for up to six months) of CAM – defined core symptoms of delirium (fluctuation, inattention, disorganized thinking, and altered level of consciousness) and five outcome measures: Mini-Mental State Exam, Barthel Index, Cornell Scale for Depression, Nursing Home Behavioral Problems Scale, and Burden of Care. Associations between core symptoms and the five outcome measures were analyzed using generalized estimating equations.
Core symptoms of delirium not meeting criteria for delirium among residents with and without dementia were associated with cognitive and functional impairment and mood and behavior problems but not increased BOC. The associations appear to be intermediate between those of full delirium and no core symptoms and were greater for residents with than without dementia.
CAM-defined core symptoms of delirium not meeting criteria for delirium appear to be associated with cognitive and functional impairment and mood and behavior problems in LTC residents with or without dementia. These findings may have implications for the prevention and management of such impairments and problems in LTC settings.
A core thesis of Kitcher's is that thinking about objects requires awareness of necessary connections between one's object-directed representations ‘as such’ and that this is what Kant means by the transcendental unity of apperception. I argue that Kant's main point is the spontaneity or ‘self-made-ness’ of combination rather than the requirement of reflexive awareness of combination, that Kitcher provides no plausible account of how recognition of representations ‘as such’ should be constituted and that in fact Kant himself appears to lack the theoretical resources to clearly distinguish between (first-level) consciousness and self-consciousness or apperception properly so-called.
The authors have been involved in ontological modeling of function for over 15 years. As an instance of the revisionary approach discussed in Vermaas's position paper, we have proposed an ontological definition of function and a modeling framework based on it, which has been deployed in industry. In addition, as an instance of the overarching approach, we have proposed a reference ontology of function that explains some kinds, definitions, and practical expressions of functions. In this paper, we explain our methodology in an overarching approach based on perspectives for capturing functions. When one captures a function of an artifact, one focuses on a specific aspect of the artifact from a specific perspective. In this paper, we conceptualize such perspectives behind the reference ontology. In addition, based on our experiences in deployment in an industrial setting, we report some solutions, such as ontological modeling guidelines, for overcoming some of the difficulties faced in the practical functional modeling approach described in Eckert's position paper. Our findings suggest that such solutions will help engineers to describe consistent functional models compliant with a single definition of function.