Adherence to nutrition supplements among patients with a fall-related lower limb fracture

Background The purpose of this study was to provide a detailed evaluation of adherence to nutrition supplements by patients with a lower limb fracture. Methods These descriptive data are from 49 nutritionally“ at-risk” patients aged 70+ years admitted to the hospital after a fall-related lower limb fracture and allocated to receive supplementation as part of a randomized, controlled trial. Supplementation commenced on day 7 and continued for 42 days. Prescribed volumes aimed to meet 45% of individually estimated theoretical energy requirements to meet the shortfall between literature estimates of energy intake and requirements. The supplement was administered by nursing staff on medication rounds in the acute or residential care settings and supervised through thrice-weekly home visits postdischarge. Results Median daily percent of the prescribed volume of nutrition supplement consumed averaged over the 42 days was 67% (interquartile range [IQR], 31–89, n = 49). There was no difference in adherence for gender, accommodation, cognition, or whether the supplement was self-administered or supervised. Twenty-three participants took some supplement every day, and a further 12 missed <5 days. For these 35 “nonrefusers,” adherence was 82% (IQR, 65–93), and they lost on average 0.7% (SD, 4.0%) of baseline weight over the 6 weeks of supplementation compared with a loss of 5.5% (SD, 5.4%) in the “refusers” (n = 14, 29%), p = .003. Conclusions We achieved better volume and energy consumption than previous studies of hip fracture patients but still failed to meet target supplement volumes prescribed to meet 45% of theoretical energy requirements. Clinicians should consider alternative methods of feeding such as a nasogastric tube, particularly in those patients where adherence to oral nutrition supplements is poor and dietary intake alone is insufficient to meet estimated energy requirements.

Cluster-based network model for time-course gene expression data

We propose a model-based approach to unify clustering and network modeling using time-course gene expression data. Specifically, our approach uses a mixture model to cluster genes. Genes within the same cluster share a similar expression profile. The network is built over cluster-specific expression profiles using state-space models. We discuss the application of our model to simulated data as well as to time-course gene expression data arising from animal models on prostate cancer progression. The latter application shows that with a combined statistical/bioinformatics analyses, we are able to extract gene-to-gene relationships supported by the literature as well as new plausible relationships.

An epidemiological study of the relationship between time to surgery and health status for elderly patients with a hip fracture

A hip fracture causes permanent changes to life style for older people. Further, two important mortality indicators found post operatively for this group include, the time until surgery after fracture, and pre-operative health status prior to surgery, yet no research is available investigating relationships between time to surgery and health status. The researchers aimed to establish the health status risks for patients aged over 65 years with a non-pathological hip fracture to guide nursing care interventions. A prospective cohort design was used to investigate relationships between time to surgery and measures on pre-operative health status indicators including, skin integrity risk, vigor, mental state, bowel function and continence. Twenty-nine patients with a mean age in years of 81.93 (SD,9.49), were recruited. The mean number of hours from time 1 assessment to surgery was 52.72 (SD,58.35) and the range was 1 hour to 219 hours. At Time 2, the mean scores of vigor and skin integrity risk were significantly higher, indicating poorer health status. A change in health status occurred but possibly due to the small sample size it was difficult to relate this result to time. However the results informed preoperative care prior to surgery, for this group.

On the feasibility of using servo-mechanisms in wireless multimedia sensor network deployments

This paper considers the use of servo-mechanisms as part of a tightly integrated homogeneous Wireless Multi- media Sensor Network (WMSN). We describe the design of our second generation WMSN node platform, which has increased image resolution, in-built audio sensors, PIR sensors, and servo- mechanisms. These devices have a wide disparity in their energy consumption and in the information quality they return. As a result, we propose a framework that establishes a hierarchy of devices (sensors and actuators) within the node and uses frequent sampling of cheaper devices to trigger the activation of more energy-hungry devices. Within this framework, we consider the suitability of servos for WMSNs by examining the functional characteristics and by measuring the energy consumption of 2 analog and 2 digital servos, in order to determine their impact on overall node energy cost. We also implement a simple version of our hierarchical sampling framework to evaluate the energy consumption of servos relative to other node components. The evaluation results show that: (1) the energy consumption of servos is small relative to audio/image signal processing energy cost in WMSN nodes; (2) digital servos do not necessarily consume as much energy as is currently believed; and (3) the energy cost per degree panning is lower for larger panning angles.

Influences of age and mechanical stability on volume, microstructure, and mineralization of the fracture callus during bone healing : Is osteoclast activity the key to age-related impaired healing?

Earlier studies have shown that the influence of fixation stability on bone healing diminishes with advanced age. The goal of this study was to unravel the relationship between mechanical stimulus and age on callus competence at a tissue level. Using 3D in vitro micro-computed tomography derived metrics, 2D in vivo radiography, and histology, we investigated the influences of age and varying fixation stability on callus size, geometry, microstructure, composition, remodeling, and vascularity. Compared were four groups with a 1.5-mm osteotomy gap in the femora of Sprague–Dawley rats: Young rigid (YR), Young semirigid (YSR), Old rigid (OR), Old semirigid (OSR). Hypothesis was that calcified callus microstructure and composition is impaired due to the influence of advanced age, and these individuals would show a reduced response to fixation stabilities. Semirigid fixations resulted in a larger ΔCSA (Callus cross-sectional area) compared to rigid groups. In vitro μCT analysis at 6 weeks postmortem showed callus bridging scores in younger animals to be superior than their older counterparts (pb0.01). Younger animals showed (i) larger callus strut thickness (pb0.001), (ii) lower perforation in struts (pb0.01), and (iii) higher mineralization of callus struts (pb0.001). Callus mineralization was reduced in young animals with semirigid fracture fixation but remained unaffected in the aged group. While stability had an influence, age showed none on callus size and geometry of callus. With no differences observed in relative osteoid areas in the callus ROI, old as well as semirigid fixated animals showed a higher osteoclast count (pb0.05). Blood vessel density was reduced in animals with semirigid fixation (pb0.05). In conclusion, in vivo monitoring indicated delayed callus maturation in aged individuals. Callus bridging and callus competence (microstructure and mineralization) were impaired in individuals with an advanced age. This matched with increased bone resorption due to higher osteoclast numbers. Varying fixator configurations in older individuals did not alter the dominant effect of advanced age on callus tissue mineralization, unlike in their younger counterparts. Age-associated influences appeared independent from stability. This study illustrates the dominating role of osteoclastic activity in age-related impaired healing, while demonstrating the optimization of fixation parameters such as stiffness appeared to be less effective in influencing healing in aged individuals.

National health and hospital network for Australia's future : Implications for emergency medicine

The proposals arising from the agreement reached between the Rudd government and the States and Territories (except Western Australia) in April 2010 represent the most fundamental realignment of health responsibilities since the creation of Medicare in 1984. They will change the health system, and the structures that will craft its future direction and design. These proposals will have a significant impact on Emergency Medicine; an impact from not only the system-wide effects of the proposals but also those that derive from the specific recommendations to create an activity-based funding mechanism for EDs, to implement the four hour rule and to develop a performance indicator framework for EDs. The present paper will examine the potential impact of the proposals on Emergency Medicine to inform those who work within the system and to help guide further developments. More work is required to better evaluate the proposals and to guide the design and development of specific reform instruments. Any such efforts should be based upon a proper analysis of the available evidence, and a structured approach to research and development so as to deliver on improved services to the community, and on improved quality and safety of emergency medical care.

Alleviating ‘overfitting’ via genetically-regularised neural network

A hybrid genetic algorithm/scaled conjugate gradient regularisation method is designed to alleviate ANN `over-fitting'. In application to day-ahead load forecasting, the proposed algorithm performs better than early-stopping and Bayesian regularisation, showing promising initial results.

Power network in loop : a paradigm for real-time simulation and hardware testing

This paper discusses a new paradigm of real-time simulation of power systems in which equipment can be interfaced with a real-time digital simulator. In this scheme, one part of a power system can be simulated by using a real-time simulator; while the other part is implemeneted as a physical system. The only interface of the physical system with the computer-based simulator is through data-acquisition system. The physical system is driven by a voltage-source converter (VSC)that mimics the power system simulated in the real-time simulator. In this papar, the VSC operates in a voltage-control mode to track the point of common coupling voltage signal supplied by the digital simulator. This type of splitting a network in two parts and running a real-time simulation with a physical system in parallel is called a power network in loop here. this opens up the possibility of study of interconnection o f one or several distributed generators to a complex power network. The proposed implementation is verified through simulation studies using PSCAD/EMTDC and through hardware implementation on a TMS320G2812 DSP.

Network structure, knowledge governance, and firm performance : evidence from innovation networks and SMEs in the UK

It is increasingly understood that learning and thus innovation often occurs via highly interactive, iterative, network-based processes. Simultaneously, economic development policy is increasingly focused on small and medium-sized enterprises (SMEs) as a means of generating growth, creating a clear research issue in terms of the roles and interactions of government policy, universities, and other sources of knowledge, SMEs, and the creation and dissemination of innovation. This paper analyses the contribution of a range of actors in an SME innovation creation and dissemination framework, reviewing the role of various institutions therein, exploring the contribution of cross-locality networks, and identifying the mechanisms required to operationalise such a framework. Bivariate and multivariate (regression) techniques are employed to investigate both innovation and growth outcomes in relation to these structures; data are derived from the survey responses of over 450 SMEs in the UK. Results are complex and dependent upon the nature of institutions involved, the type of knowledge sought, and the spatial level of the linkages in place but overall highlight the value of cross-locality networks, network governance structures, and certain spillover effects from universities. In general, we find less support for the factors predicting SME growth outcomes than is the case for innovation. Finally, we outline an agenda for further research in the area.

Parallel linear system solution and its application to railway power network simulation

The Streaming SIMD extension (SSE) is a special feature embedded in the Intel Pentium III and IV classes of microprocessors. It enables the execution of SIMD type operations to exploit data parallelism. This article presents improving computation performance of a railway network simulator by means of SSE. Voltage and current at various points of the supply system to an electrified railway line are crucial for design, daily operation and planning. With computer simulation, their time-variations can be attained by solving a matrix equation, whose size mainly depends upon the number of trains present in the system. A large coefficient matrix, as a result of congested railway line, inevitably leads to heavier computational demand and hence jeopardizes the simulation speed. With the special architectural features of the latest processors on PC platforms, significant speed-up in computations can be achieved.

SSE based parallel solution for power systems network equations

Streaming SIMD Extensions (SSE) is a unique feature embedded in the Pentium III class of microprocessors. By fully exploiting SSE, parallel algorithms can be implemented on a standard personal computer and a theoretical speedup of four can be achieved. In this paper, we demonstrate the implementation of a parallel LU matrix decomposition algorithm for solving power systems network equations with SSE and discuss advantages and disadvantages of this approach.