Multidimensional preventive home visit programs for community-dwelling older adults: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND: Multidimensional preventive home visit programs aim at maintaining health and autonomy of older adults and preventing disability and subsequent nursing home admission, but results of randomized controlled trials (RCTs) have been inconsistent. Our objective was to systematically review RCTs examining the effect of home visit programs on mortality, nursing home admissions, and functional status decline. METHODS: Data sources were MEDLINE, EMBASE, Cochrane CENTRAL database, and references. Studies were reviewed to identify RCTs that compared outcome data of older participants in preventive home visit programs with control group outcome data. Publications reporting 21 trials were included. Data on study population, intervention characteristics, outcomes, and trial quality were double-extracted. We conducted random effects meta-analyses. RESULTS: Pooled effects estimates revealed statistically nonsignificant favorable, and heterogeneous effects on mortality (odds ratio [OR] 0.92, 95% confidence interval [CI], 0.80-1.05), functional status decline (OR 0.89, 95% CI, 0.77-1.03), and nursing home admission (OR 0.86, 95% CI, 0.68-1.10). A beneficial effect on mortality was seen in younger study populations (OR 0.74, 95% CI, 0.58-0.94) but not in older populations (OR 1.14, 95% CI, 0.90-1.43). Functional decline was reduced in programs including a clinical examination in the initial assessment (OR 0.64, 95% CI, 0.48-0.87) but not in other trials (OR 1.00, 95% CI, 0.88-1.14). There was no single factor explaining the heterogenous effects of trials on nursing home admissions. CONCLUSION: Multidimensional preventive home visits have the potential to reduce disability burden among older adults when based on multidimensional assessment with clinical examination. Effects on nursing home admissions are heterogeneous and likely depend on multiple factors including population factors, program characteristics, and health care setting.

MULTIDIMENSIONAL OPTIMAL DROOP CONTROL FOR WIND RESOURCES IN DC MICROGRIDS

Two important and upcoming technologies, microgrids and electricity generation from wind resources, are increasingly being combined. Various control strategies can be implemented, and droop control provides a simple option without requiring communication between microgrid components. Eliminating the single source of potential failure around the communication system is especially important in remote, islanded microgrids, which are considered in this work. However, traditional droop control does not allow the microgrid to utilize much of the power available from the wind. This dissertation presents a novel droop control strategy, which implements a droop surface in higher dimension than the traditional strategy. The droop control relationship then depends on two variables: the dc microgrid bus voltage, and the wind speed at the current time. An approach for optimizing this droop control surface in order to meet a given objective, for example utilizing all of the power available from a wind resource, is proposed and demonstrated. Various cases are used to test the proposed optimal high dimension droop control method, and demonstrate its function. First, the use of linear multidimensional droop control without optimization is demonstrated through simulation. Next, an optimal high dimension droop control surface is implemented with a simple dc microgrid containing two sources and one load. Various cases for changing load and wind speed are investigated using simulation and hardware-in-the-loop techniques. Optimal multidimensional droop control is demonstrated with a wind resource in a full dc microgrid example, containing an energy storage device as well as multiple sources and loads. Finally, the optimal high dimension droop control method is applied with a solar resource, and using a load model developed for a military patrol base application. The operation of the proposed control is again investigated using simulation and hardware-in-the-loop techniques.

Evaluation of reproducibility of protein identification results after multidimensional human serum protein separation

We developed a gel- and label-free proteomics platform for comparative studies of human serum. The method involves the depletion of the six most abundant proteins, protein fractionation by Off-Gel IEF and RP-HPLC, followed by tryptic digestion, LC-MS/MS, protein identification, and relative quantification using probabilistic peptide match score summation (PMSS). We evaluated performance and reproducibility of the complete platform and the individual dimensions, by using chromatograms of the RP-HPLC runs, PMSS based abundance scores and abundance distributions as objective endpoints. We were interested if a relationship exists between the quantity ratio and the PMSS score ratio. The complete analysis was performed four times with two sets of serum samples containing different concentrations of spiked bovine beta-lactoglobulin (0.1 and 0.3%, w/w). The two concentrations resulted in significantly differing PMSS scores when compared to the variability in PMSS scores of all other protein identifications. We identified 196 proteins, of which 116 were identified four times in corresponding fractions whereof 73 qualified for relative quantification. Finally, we characterized the PMSS based protein abundance distributions with respect to the two dimensions of fractionation and discussed some interesting patterns representing discrete isoforms. We conclude that combination of Off-Gel electrophoresis (OGE) and HPLC is a reproducible protein fractionation technique, that PMSS is applicable for relative quantification, that the number of quantifiable proteins is always smaller than the number of identified proteins and that reproducibility of protein identifications should supplement probabilistic acceptance criteria.

A different perspective on poverty in Lao PDR: Multidimensional poverty in Lao PDR for the years 2002/2003 and 2007/2008

This paper presents an indicator for measuring multidimensional poverty in the Lao People’s Democratic Republic applying the Alkire–Foster methodology to the Lao Expenditure and Consumption Survey 2002/2003 and 2007/2008. We calculated a multidimensional poverty index (MPI) that includes three dimensions: education, health, and standard of living. Making use of the MPI’s decomposability, we analyse how much each of the different dimensions and its respective indicators contribute to the overall MPI. We find a marked reduction in the multidimensional poverty headcount ratio over the study period, regardless of how the indicators are weighted or how the deprivation and poverty cut-offs are set. This reduction is based on improvements regarding all indicators except cooking fuel and nutrition. We observe no significant reduction in the intensity of poverty, however; there are wide disparities between the country’s regions and between urban and rural areas. The proportion of poor people in rural areas is more than twice as high as that in urban areas. By complementing the traditional income-based poverty measure, we hope to provide useful information that can support knowledge-based decision-making for poverty alleviation.

A novel multidimensional geriatric screening tool in the ED: evaluation of feasibility and clinical relevance

PURPOSES Geriatric problems frequently go undetected in older patients in emergency departments (EDs), thus increasing their risk of adverse outcomes. We evaluated a novel emergency geriatric screening (EGS) tool designed to detect geriatric problems. BASIC PROCEDURES The EGS tool consisted of short validated instruments used to screen 4 domains (cognition, falls, mobility, and activities of daily living). Emergency geriatric screening was introduced for ED patients 75 years or older throughout a 4-month period. We analyzed the prevalence of abnormal EGS and whether EGS increased the number of EGS-related diagnoses in the ED during the screening, as compared with a preceding control period. MAIN FINDINGS Emergency geriatric screening was performed on 338 (42.5%) of 795 patients presenting during screening. Emergency geriatric screening was unfeasible in 175 patients (22.0%) because of life-threatening conditions and was not performed in 282 (35.5%) for logistical reasons. Emergency geriatric screening took less than 5 minutes to perform in most (85.8%) cases. Among screened patients, 285 (84.3%) had at least 1 abnormal EGS finding. In 270 of these patients, at least 1 abnormal EGS finding did not result in a diagnosis in the ED and was reported for further workup to subsequent care. During screening, 142 patients (42.0%) had at least 1 diagnosis listed within the 4 EGS domains, significantly more than the 29.3% in the control period (odds ratio 1.75; 95% confidence interval, 1.34-2.29; P<.001). Emergency geriatric screening predicted nursing home admission after the in-hospital stay (odds ratio for ≥3 vs <3 abnormal domains 12.13; 95% confidence interval, 2.79-52.72; P=.001). PRINCIPAL CONCLUSIONS The novel EGS is feasible, identifies previously undetected geriatric problems, and predicts determinants of subsequent care.

Clitics, affixes, and wordhood in Garifuna (Arawak): A multidimensional continuum of morphosyntactic boundness

Recent research on wordhood and morphosyntactic boundness suggests that the domains word and clitic do not lend themselves to cross-linguistic categorization but must be defined language specifically. In most languages, it is necessary to define word on two separate levels, the phonological word (p-word) and the grammatical word (g-word), and to describe mismatches between the two. This paper defines those domains for Garifuna, an Arawak language spoken in Honduras, Central America. Garifuna has auxiliary and classifier constructions which make up two p-words, and only one g-word. P-words made up of more than one g-word involve second position enclitics, word scope clitics, and proclitic connectives and prepositions. Garifuna clitics are typically unstressed, able to attach to hosts of any word class and able to string together into clusters. Enclitics are used to express tense-aspect, modality, and adverbial meanings, among others. In other languages, clitic clusters tend to display a fixed order; Garifuna clitic order seems quite free, although certain orders are preferred. Also, contrary to cross-linguistic tendencies, proclitic connectives can act as hosts for enclitic clusters, contradicting the commonly used definition of clitics as phonologically weak elements that need to attach to a host to form a p-word; such clitic-only p-words are problematic for traditional definitions of clitics.

Pulse-shaping assisted multidimensional coherent electronic spectroscopy

Understanding nuclear and electronic dynamics of molecular systems has advanced considerably by probing their nonlinear responses with a suitable sequence of pulses. Moreover, the ability to control crucial parameters of the excitation pulses, such as duration, sequence, frequency, polarization, slowly varying envelope, or carrier phase, has led to a variety of advanced time-resolved spectroscopic methodologies. Recently, two-dimensional electronic spectroscopy with ultrashort pulses has become a more and more popular tool since it allows to obtain information on energy and coherence transfer phenomena, line broadening mechanisms, or the presence of quantum coherences in molecular complexes. Here, we present a high fidelity two-dimensional electronic spectroscopy setup designed for molecular systems in solution. It incorporates the versatility of pulse-shaping methods to achieve full control on the amplitude and phase of the individual exciting and probing pulses. Selective and precise amplitude- and phase-modulation is shown and applied to investigate electronic dynamics in several reference molecular systems.

Estilos de desarrollo, ideología e Intervención antrópica en Misiones (Argentina): Un análisis multidimensional y comparativo. 16H201

Esta es una continuación del Programa ECIS (Estudio Comparativo de los Impactos Sociales de los Grandes Proyectos de Desarrollo), constituído a partir del 2005 en el Programa de Ecología Humana (PEH). Los ejes convocantes para esta nueva etapa, son, en primer lugar, la compleción del análisis del Proyecto Yacyretá, que en el período anterior concretó la publicación de un volumen. Una segunda vertiente remite a la ideología de los movimientos sociales opuestos a la construcción de represas y a la concepción de desarrollo explícitas o implícitas en sus propuestos y su comparación con otros movimientos ecologistas (Córdoba). Asimismo, nos proponemos realizar estudios de campo de las prácticas agrícolas de los colonos asentados en áreas de la provincia incluidas en el proyecto de "corredor verde", con el objeto de analizar su compatibilidad o no con los modelos de "explotación sustentable" que se vienen manejando, así como analizar otros desarrollos recientes en el agro misionero. Finalmente, se contemplan estudios comparativos sobre desarrollo socioeconómico de minorías en la Patagonia argentina.

Estilos de desarrollo, ideologia e intervención antropica en misiones (argentina): un análisis multidimensional y comparativo. Programa de Ecología Humana. PIP CONICET 11220080101659. 16H288

Actividades desarrolladas durante el período: se continuó con la sistematización y clasificación de los datos sobre la represa de Yacyreta. y con la preparación del libro, para lo cual se cuenta con la colaboracón de la Lic. María del Rosario Millán. Se sistematizaron los datos recopilados hasta este momento; Durante el año 2009 nos ocupamos específicamente del análisis de distintas asambleas ambientales que desarrollan sus actividades en la provincia de Córdoba. Entre otras reivindicaciones, cabe destacar la relevancia de las luchas llevadas a cabo por asambleas movilizadas para lograr la prohibición de la explotación minera a cielo abierto en todo el territorio provincial. Se realizaron registros bibliográficos, se recogió y analizó diversas folletería, observaciones, se participó de diversos eventos (reuniones, marchas, congreso, etc,) y se realizaron entrevistas en profundidad; análisis las prácticas y representaciones de los productores rurales sobre el ambiente. Se estudiaron los proyectos, discursos y actores ambientalistas que circulan en la región y que, de manera creciente, están influyendo sobre la manera en que los productores rurales se relacionan con el ambiente. De manera que en segundo lugar se estudió la expansión de discursos, actores y prácticas ambientalistas en la provincia de Misiones.