HOME-BASED REHABILITATION AND ITS IMPACT ON HOSPITAL UTILIZATION

There is compelling evidence for the effectiveness of home-based occupational therapy and physiotherapy rehabilitation for community dwelling elderly who may struggle with basic activities and the functions of daily living and mobility. Nonetheless, an estimated 2% of home care’s elderly clients receive these therapies. Ontario’s home care data indicates that 78% of clients that could benefit from these specific therapies are not receiving them. The study examined a subset of elderly clients receiving home care following a hospital discharge during 2009-2010. The aim of this study was to: understand the difference between those home care clients who received occupational therapy or physiotherapy and those who did not; and determine if receiving these therapies impacted the utilization of hospital emergency departments and inpatient admissions. A retrospective cohort design and multivariate and survival analysis of hospital and home care administrative data structured the study. Results suggest that home-based rehabilitation is offered to a minority of the home care population. Distinct client characteristics and process variables significantly associated with the increased likelihood of receiving home-based occupational and physical therapies included: clients who were older, females, admitted to home care from hospital inpatient units, assessed as non-acute for clinical and service needs and required more home making support and assistance with activities of daily living. Almost one quarter of the total sample returned to hospital. Visits to emergency departments accounted for the greater part of hospital utilization and primarily for sub-acute general symptoms and signs, post-procedural complications, infections or acute episodes from chronic obstructive pulmonary disease and renal failure. Slightly over half of the clients returning to hospital did not receive home-based rehabilitation. Clients who received occupational therapy returned to the hospital sooner following their home care admission whereas clients receiving physiotherapy spent the longest time before rehospitalizing. The majority of the clients receiving occupational therapy were admitted to home care having just resolved sub-acute conditions or symptoms, many of which are known to influence functional and physical decline. Moreover, analysis of process variables indicated that the wait time for a referral to occupational therapy was two times longer compared to physiotherapy. These same clients also waited, on average, over one month before an occupational therapist’s first visit. The need to discriminate who receives home-based rehabilitation is essential to understanding how specific therapies contribute to improving systems outcomes. This study is the first examination that focuses specifically on home-based occupational therapy and physiotherapy rehabilitation and the client characteristics and process variables associated with receiving/not receiving these therapies and the impact these factors have on the time-to-rehospitalization.

Rational Attenuation of a Morbillivirus by Modulating the Activity of the RNA-Dependent RNA Polymerase

Negative-strand RNA viruses encode a single RNA-dependent RNA polymerase (RdRp) which transcribes and replicates the genome. The open reading frame encoding the RdRp from a virulent wild-type strain of rinderpest virus (RPV) was inserted into an expression plasmid. Sequences encoding enhanced green fluorescent protein (EGFP) were inserted into a variable hinge of the RdRp. The resulting polymerase was autofluorescent, and its activity in the replication/transcription of a synthetic minigenome was reduced. We investigated the potential of using this approach to rationally attenuate a virus by inserting the DNA sequences encoding the modified RdRp into a full-length anti-genome plasmid from which a virulent virus (rRPV(KO)) can be rescued. A recombinant virus, rRPV(KO)L-RRegfpR, which grew at an indistinguishable rate and to an identical titer as rRPV(KO) in vitro, was rescued. Fluorescently tagged polymerase was visible in large cytoplasmic inclusions and beneath the cell membrane. Subcutaneous injection of 10(4) TCID(50) of the rRPV(KO) parental recombinant virus into cattle leads to severe disease symptoms (leukopenia/diarrhea and pyrexia) and death by 9 days postinfection. Animals infected with rRPV(KO)L-RRegfpR exhibited transient leukopenia and mild pyrexia, and the only noticeable clinical signs were moderate reddening of one eye and a slight ocular-nasal discharge. Viruses that expressed the modified polymerase were isolated from peripheral blood lymphocytes and eye swabs. This demonstrates that a virulent morbillivirus can be attenuated in a single step solely by modulating RdRp activity and that there is not necessarily a correlation between virus growth in vitro and in vivo.

Predisposition to arrhythmia and autonomic dysfunction in Nhlh1-deficient mice.

Nhlh1 is a basic helix-loop-helix transcription factor whose expression is restricted to the nervous system and which may play a role in neuronal differentiation. To directly study Nhlh1 function, we generated null mice. Homozygous mutant mice were predisposed to premature, adult-onset, unexpected death. Electrocardiograms revealed decreased total heart rate variability, stress-induced arrhythmia, and impaired baroreceptor sensitivity. This predisposition to arrhythmia is a likely cause of the observed death in the mutant mice. Heterozygosity for the closely related transcription factor Nhlh2 increased the severity of the Nhlh1-null phenotype. No signs of primary cardiac structural or conduction abnormalities could be detected upon necropsy of the null mice. The pattern of altered heart rhythm observed in basal and experimental conditions (stress and pharmacologically induced) suggests that a deficient parasympathetic tone may contribute to the arrhythmia in the Nhlh1-null mouse. The expression of Nhlh1 in the developing brain stem and in the vagal nuclei in the wild-type mouse further supports this hypothesis. The Nhlh1 mutant mouse may thus provide a model to investigate the contribution of the autonomic nervous system to arrhythmogenesis.

Surface alloying and mixing at the Mn/Fe(001) interface: Real-time photoelectron spectroscopy and modified embedded atom simulations

Structural and magnetic properties of thin Mn films on the Fe(001) surface have been investigated by a combination of photoelectron spectroscopy and computer simulation in the temperature range 300 Kless than or equal toTless than or equal to750 K. Room-temperature as deposited Mn overlayers are found to be ferromagnetic up to 2.5-monolayer (ML) coverage, with a magnetic moment parallel to that of the iron substrate. The Mn atomic moment decreases with increasing coverage, and thicker samples (4-ML and 4.5-ML coverage) are antiferromagnetic. Photoemission measurements performed while the system temperature is rising at constant rate (dT/dtsimilar to0.5 K/s) detect the first signs of Mn-Fe interdiffusion at T=450 K, and reveal a broad temperature range (610 Kless than or equal toTless than or equal to680 K) in which the interface appears to be stable. Interdiffusion resumes at Tgreater than or equal to680 K. Molecular dynamics and Monte Carlo simulations allow us to attribute the stability plateau at 610 Kless than or equal toTless than or equal to680 K to the formation of a single-layer MnFe surface alloy with a 2x2 unit cell and a checkerboard distribution of Mn and Fe atoms. X-ray-absorption spectroscopy and analysis of the dichroic signal show that the alloy has a ferromagnetic spin structure, collinear with that of the substrate. The magnetic moments of Mn and Fe atoms in the alloy are estimated to be 0.8mu(B) and 1.1mu(B), respectively.

La incidencia de los valores culturales en el voluntariado: el caso de Europa

La realidad del voluntariado es sumamente compleja hasta el punto de que resulta complicado definir y caracterizar el trabajo voluntario, dada la gran variedad de interpretaciones, motivaciones, variables sociodemográficas y aspectos culturales que configuran el perfil de los voluntarios. El objetivo de este trabajo es analizar la influencia conjunta de algunas variables sociodemográficas, así como de los valores culturales de índole secular o tradicional, sobre el perfil de los voluntarios en Europa. Además, se investiga qué variables orientan a los voluntarios hacia un determinado tipo de voluntariado u otro. Para ello se ha aplicado principalmente una metodología de regresión logística a partir de la información disponible en la European Value Study. Los resultados obtenidos ayudan a establecer una caracterización del voluntariado en Europa, y confirman la influencia de los valores culturales, en primer lugar, en la realización o no de trabajos de voluntariado, y en segundo lugar, en la elección que hacen estas personas del tipo de actividad con la que están comprometidos. Al analizar dos tipos de voluntariado de motivación supuestamente muy diferente, se concluye que existe un grupo de valores que influyen en ambos, aunque el sentido y la intensidad en la que lo hacen sea diferente; por otra parte, algunos valores tienen influencia o no en la realización de trabajos de voluntariado, dependiendo del tipo específico al que nos refiramos.

‘Close as a kiss’: Gyn/Affection in Margaret Atwood’s The Penelopiad

Margaret Atwood’s novella The Penelopiad (2005) seemingly celebrates Penelope’s agency in opposition to Homer’s myth in The Odyssey. However, the twelve murdered maids steal the book to suggest the possibility of what Janice Raymond calls gyn/affection, a female bonding based on the logic of emotion that, in Atwood’s revision, verges on Kristevan abjection, the sinister and the fantastic, and serves a cathartic effect not only in the maids but also in the reader. This essay aims to question the generally accepted empowerment of Atwood’s Penelope and celebrates the murdered maids as the locus of emotion, where marginal aspects of gender and class merge to weave a powerful metaphorical tapestry of popular and traditionally feminized literary genres that, in plunging into and embracing the semiotic realm, ultimately solidify into an eclectic but compact alternative tradition of women’s writing and myth-making.

Inscribir el declive en el tiempo. Detroit: Auge y crisis de la ciudad industrial

A comienzos del siglo XX, Detroit era una ciudad dinámica en pleno desarrollo. Pronto se convirtió en la cuarta ciudad de Estados Unidos, la capital de la naciente industria automovilística. El crecimiento se prolongó hasta finales de los años 50, cuando, a pesar del auge económico de Estados Unidos y de su área metropolitana, Detroit comenzó a mostrar los primeros signos de estancamiento. La crisis se ha prolongado hasta hoy, cuando Detroit constituye el paradigma de la ciudad industrial en declive. Estas dos imágenes contrapuestas, el auge y la crisis, no parecen explicar por sí mismas las causas de la intensidad y persistencia del declive de Detroit. Analizar las interacciones entre crecimiento económico, políticas públicas locales y desarrollo urbano a lo largo del tiempo permitirá subrayar las continuidades y comprender en qué medida el declive de Detroit ancla sus raíces en el modelo planteado durante la etapa de auge.

Tracing early stages of species differentiation: Ecological, morphological and genetic divergence of Galapagos sea lion populations

Background: Oceans are high gene flow environments that are traditionally believed to hamper the build-up of genetic divergence. Despite this, divergence appears to occur occasionally at surprisingly small scales. The Galápagos archipelago provides an ideal opportunity to examine the evolutionary processes of local divergence in an isolated marine environment. Galápagos sea lions (Zalophus wollebaeki) are top predators in this unique setting and have an essentially unlimited dispersal capacity across the entire species range. In theory, this should oppose any genetic differentiation.
Results: We find significant ecological, morphological and genetic divergence between the western colonies and colonies from the central region of the archipelago that are exposed to different ecological conditions. Stable isotope analyses indicate that western animals use different food sources than those from the central area. This is likely due to niche partitioning with the second Galápagos eared seal species, the Galápagos fur seal (Arctocephalus galapagoensis) that exclusively dwells in the west. Stable isotope patterns correlate with significant differences in foraging-related skull morphology. Analyses of mitochondrial sequences as well as microsatellites reveal signs of initial genetic differentiation.
Conclusion: Our results suggest a key role of intra- as well as inter-specific niche segregation in the evolution of genetic structure among populations of a highly mobile species under conditions of free movement. Given the monophyletic arrival of the sea lions on the archipelago, our study challenges the view that geographical barriers are strictly needed for the build-up of genetic divergence. The study further raises the interesting prospect that in social, colonially breeding mammals additional forces, such as social structure or feeding traditions, might bear on the genetic partitioning of populations.

Presbyterians and science in the north of Ireland before 1874

In his presidential address to the Belfast meeting of the British Association for the Advancement of Science in 1874, John Tyndall launched what David Livingstone has called a ‘frontal assault on teleology and Christian theism’. Using Tyndall's intervention as a starting point, this paper seeks to understand the attitudes of Presbyterians in the north of Ireland to science in the first three-quarters of the nineteenth century. The first section outlines some background, including the attitude of Presbyterians to science in the eighteenth century, the development of educational facilities in Ireland for the training of Presbyterian ministers, and the specific cultural and political circumstances in Ireland that influenced Presbyterian responses to science more generally. The next two sections examine two specific applications by Irish Presbyterians of the term ‘science’: first, the emergence of a distinctive Presbyterian theology of nature and the application of inductive scientific methodology to the study of theology, and second, the Presbyterian conviction that mind had ascendancy over matter which underpinned their commitment to the development of a science of the mind. The final two sections examine, in turn, the relationship between science and an eschatological reading of the signs of the times, and attitudes to Darwinian evolution in the fifteen years between the publication of The Origin of Species in 1859 and Tyndall's speech in 1874.

Development and evaluation of a vaginal ring device for sustained delivery of HIV microbicides to non-human primate

Background There is considerable interest in developing coitally indepen- dent, sustained release formulations for long-term administration of HIV microbicides. Vaginal ring devices are at the forefront of this formulation strategy. Methods Non-medicated silicone elastomer vaginal rings were prepared having a range of appropriate dimensions for testing vaginal ?t in pig- tailed and Chinese rhesus macaques. Cervicovaginal proin?ammatory markers were evaluated. Compression testing was performed to compare the relative ?exibility of various macaque and commercial human rings. Results All rings remained in place during the study period and no tissue irritation or signi?cant induction of cervicovaginal proin?ammatory mark- ers or signs of physical discomfort were observed during the 8-week study period. Conclusions Qualitative evaluation suggests that the 25 · 5-mm ring pro- vided optimal ?t in both macaque species. Based on the results presented here, low-consistency silicone elastomers do not cause irritation in maca-

From marginality to resurgence: the case of the Irish islands

Abstract: The islands off the coast of Ireland declined after the Irish famine of the 1840s. The number inhabited and the size of the population on those that remain populated both fell dramatically, faring worse collectively than the Irish mainland to which they were marginal in every sense. The reasons for this decline are examined. In the early 20th Century there are some signs of resurgence. The article considers that this might be put down to the efforts of islanders themselves, coupled with state and European Union support. There is an interest in and regard for the islands associated with their being seen as repositories of Irish culture and heritage. This has had positive benefits regarding the attitude of the state agencies and also for tourism, which is an important factor in many contemporary island economies. In fact, some of the resurgence as measured by population totals can be put down to people having holiday cottages on the islands rather than an increase in the size of traditional communities.

Alegoría: su pertinencia en la predicación y uso en "La novena maravilla"

En este artículo se focaliza el recurso de la alegoría como método exegético en la composición de los sermones panegíricos de Juan Espinosa Medrano (Perú, siglo XVII). Se traza el recorrido de la alegoría (y las humanidades en general) en relación –siempre tensa– con el cristianismo a lo largo de su historia; y se llega a la Contrarreforma y el uso exacerbado del método en la predicación barroca; particularmente en la oratoria sagrada de Espinosa Medrano, quien abarca elementos diversos y extraídos de distintas fuentes (filosofía natural, mitología clásica, tradición emblemática, relatos bíblicos), a los que hace funcionar como signos de otra verdad mayor, la sagrada. Si bien las preceptivas sagradas impulsaban una predicación más llana y simple, la profusión de alegorías mitológicas, que el autor resemantiza según su interés de guiar la interpretación, pueden explicarse por varias circunstancias, motivos de estudio en este trabajo.

Controls on the contemporary distribution of lake thecamoebians (testate amoebae) in the Greater Toronto Area and their potential as water quality indicators.

Thecamoebians were examined from 71 surface sediment samples collected from 21 lakes and ponds in the Greater Toronto Area to (1) elucidate the controls on faunal distribution in modern lake environments; and (2) to consider the utility of thecamoebians in quantitative studies of water quality change. This area was chosen because it includes a high density of kettle and other lakes which are threatened by urban development and where water quality has deteriorated locally as a result of contaminant inputs, particularly nutrients. Fifty-eight samples yielded statistically significant thecamoebian populations. The most diverse faunas (highest Shannon Diversity Index values) were recorded in lakes beyond the limits of urban development, although the faunas of all lakes showed signs of sub-optimal conditions. The assemblages were divided into five clusters using Q-mode cluster analysis, supported by Detrended Correspondence Analysis. Canonical Correspondence Analysis (CCA) was used to examine species-environment relationships and to explain the observed clusterings. Twenty-four measured environmental variables were considered, including water property attributes (e.g., pH, conductivity, dissolved oxygen), substrate characteristics, sediment-based phosphorus (Olsen P) and 11 environmentally available metals. The thecamoebian assemblages showed a strong association with phosphorus, reflecting the eutrophic status of many of the lakes, and locally to elevated conductivity measurements, which appear to reflect road salt inputs associated with winter de-icing operations. Substrate characteristics, total organic carbon and metal contaminants (particularly Cu and Mg) also influenced the faunas of some samples. A series of partial CCAs show that of the measured variables, sedimentary phosphorus has the largest influence on assemblage distribution, explaining 6.98% (P < 0.002) of the total variance. A transfer function was developed for sedimentary phosphorus (Olsen P) using 58 samples from 15 of the studied lakes. The best performing model was based on weighted averaging with inverse deshrinking (WA Inv, r jack 2= 0.33, RMSEP = 102.65 ppm). This model was applied to a small modern thecamoebian dataset from a eutrophic lake in northern Ontario to predict phosphorus and performed satisfactorily. This preliminary study confirms that thecamoebians have considerable potential as quantitative water quality indicators in urbanising regions, particularly in areas influenced by nutrient inputs and road salts.

La música práctica en san Agustín: "vestigium" y "signum"

En distintos momentos de su producción intelectual, Agustín se refirió al asunto de la música. En este artículo mostraremos que Agustín uso dos esquemas conceptuales distintos para describir el fenómeno de la música práctica en su relación con el mundo espiritual, el esquema de las Artes Liberales y el de la teoría del signo, y que en virtud de ello la música sería concebida de dos modos diferentes: como vestigium y como signum del mundo espiritual, respectivamente. Al final del artículo analizaremos la diferencia entre las dos concepciones considerando tres elementos: la naturaleza de la relación entre mundo material y espiritual, el contenido espiritual al que remite y la noción de belleza que implica.