•CGA based multidisciplinary intervention was reviewed for past 10 years and summarized.•Consensus of domains derived from articles was effective in older hospitalized people.•Subdomain performance ...improves general strategy knowledge for multidisciplinary teams.•Consensus among the articles is the cornerstone for further CGA based intervention.•Findings warrant in geriatric health sector, to ensure policies improve outcomes.•Emerging trend of CGA and intervention would be an extension of current research.
Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic and treatment process to evaluate medical, psychosocial, and functional capability. It is useful to develop a coordinated and integrated plan for frail older patients. This study aimed to examine the current scope of CGA based multidisciplinary team interventions in acute care setting to improve the health outcomes for older adults.
We searched electronic databases: PubMed, Ovid, PsychINFO, Scopus, RISS and KoreaMed from 2011 to 2021. The selected articles were extracted by three reviewers and cross checked by the fourth reviewer to resolve any conflicts. Data were synthesized and analyzed descriptively and thematically. Articles are nested three themes: inpatient (IN), emergency room (ER) and oncology patient (ONCO).
Of the 1830 articles that were screened, 710 were potentially eligible. Finally, 26 articles were selected and categorized as IN (n=8), ER (n=7) and ONCO (n=11). Geriatricians and nurses participated in most of the multidisciplinary teams followed by other health professionals. The most effective primary outcomes were focused and retrieved across five domains, screening, prevention, treatment, quality of care, and rehabilitation. The subdomains are problem lists which is common and problematic among hospitalized older patients and retrieved from the most commonly used multidisciplinary interventions according to each domain.
CGA based multidimensional intervention (MDI) are likely to be an effective in care of older adults. There is remarkable paradigm shift required to improve better health outcomes for hospitalized older adults. It also suggests that there is a need to design the CGA based MDI to build a standardized protocol for older adults to maintain functional capacity and increase likelihood of living in their own home.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Endoplasmic reticulum (ER) stress is triggered by various metabolic factors, such as cholesterol and proinflammatory cytokines. Recent studies have revealed that ER stress is closely related to ...skeletal disorders, such as osteoporosis. However, the precise mechanism by which ER stress regulates osteoclast differentiation has not been elucidated. In this study, we identified an ER-bound transcription factor, cAMP response element-binding protein H (CREBH), as a downstream effector of ER stress during RANKL-induced osteoclast differentiation. RANKL induced mild ER stress and the simultaneous accumulation of active nuclear CREBH (CREBH-N) in the nucleus during osteoclastogenesis. Overexpression of CREBH-N in osteoclast precursors enhanced RANKL-induced osteoclast formation through NFATc1 upregulation. Inhibiting ER stress using a specific inhibitor attenuated the expression of osteoclast-related genes and CREBH activation. In addition, inhibition of reactive oxygen species using
-acetylcysteine attenuated ER stress, expression of osteoclast-specific marker genes, and RANKL-induced CREBH activation. Furthermore, inhibition of ER stress and CREBH signaling pathways using an ER stress-specific inhibitor or CREBH small interfering RNAs prevented RANKL-induced bone destruction in vivo. Taken together, our results suggest that reactive oxygen species/ER stress signaling-dependent CREBH activation plays an important role in RANKL-induced osteoclastogenesis. Therefore, inactivation of ER stress and CREBH signaling pathways may represent a new treatment strategy for osteoporosis.
While pressure on marine ecosystems leading to declines in global fish catches have been attributed to excessive fishing and to unregulated and unreported fishing, existing management practices have ...yet to fully address these declines. Estimation of spatial and temporal distribution of fisheries resources and the extent of fishing impacts on marine ecosystems using vessel trajectories has become central in recent studies. This study proposed the use of trajectories of 771 Korean coastal and offshore fishing vessels and one-year fish landing data to estimate variations in commercial fish species, vessel, and fishing gear activity distributions in the waters around Jeju island. A set of standards were applied to identify individual fishing tracks of major gears and uniformly distributed catch to fishing segments of trajectories to produce spatio-temporal distributions of catch, fishing activities, and vessel reliance on fishing grounds at a fine spatial scale. The method identified reference points that can inform management at local and regional scales. We discuss the opportunities of combining larger datasets collected over a longer period and applying predictive modeling techniques in making extensive assessments, including climate change impacts on fishing activities that can inform resource management and marine spatial planning.
Excessive information significantly increases the mental burden on operators of critical monitoring services such as maritime and air traffic control. In these fields, vessels and aircraft have ...sensors that transmit data to a control center. Because of the large volume of collected data, it is infeasible for monitoring stations to display all of the information on monitoring screens that have limited sizes. This paper proposes a method for automatically selecting maritime traffic stream data for display from a large number of candidates in a context-aware manner. Safety is the most important concern in maritime traffic control, and special care must be taken to avoid collisions between vessels at sea. It presents an architecture for an adaptive information visualization system for a maritime traffic control service. The proposed system adaptively determines the information to be displayed based on the safety evaluation scores and expertise of vessel traffic service operators. It also introduces a method for safety context acquisition to assess the risk of collisions between vessels, using parallel and distributed processing of maritime stream data transmitted by sensors on the vessels at sea. It provides an information-filtering, knowledge extraction method based on the work logs of traffic service operators, using a machine learning technique to generate a decision tree. We applied the proposed system architecture to a large dataset collected at a port. Our results indicate that the proposed system can adaptively select traffic information according to port conditions and to ensure safety and efficiency.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
White spot syndrome virus (WSSV) is the most problematic pathogen in crustaceans. In this study, we investigated the horizontal transmission model of WSSV based on the correlation between the disease ...severity grade and viral shedding rate and determined the minimum infective dose of WSSV via the waterborne route. Intramuscular injection challenges at different doses and water temperatures revealed that the thresholds of viral shedding and mortality were G1 (3.1 × 10
copies/mg) and G2 (8.5 × 10
copies/mg), respectively. Furthermore, a positive linear correlation was observed between viral copies of pleopods and viral shedding rate (y = 0.7076x + 1.414;
< 0.001). Minimum infective doses of WSSV were determined via an immersion challenge. Infection was observed within 1, 3, and 7 d in 10
-, 10
-, and 10
copies/mL of seawater, respectively. In the cohabitation challenge, infection was observed within six days with viral loads of 10
to 10
copies/mL of seawater, which further increased in the recipient group. Our results indicate a positive correlation between disease severity grade and viral shedding rate of infected shrimp and suggest that the waterborne transmission of WSSV depends on the viral load and exposure period.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Frailty and low handgrip strength (HGS) are associated with adverse outcomes after hip fracture (HF) surgery. We aimed to compare the predictive role of frailty and HGS for adverse outcome in HF ...patients.
We included older patients (age ≥ 65 years) who underwent HF surgery to compare the predictive role of HGS and hip-multidimensional frailty score (Hip-MFS) for postoperative complications and mortality. The Hip-MFS was calculated based on comprehensive geriatric assessment (CGA), and HGS was measured with a hand dynamometer. The primary outcome was a composite of postoperative complications (e.g., pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned intensive care unit admission). The secondary outcomes were 6-month mortality and mortality at the end of follow-up.
The median observation time was 620.5 days (interquartile range: 367.0-784.8 days). Among the 242 patients (mean age: 81.5 ± 6.7 years, 73.1% women), 106 (43.8%) experienced postoperative complications. The 6-month mortality and mortality at the end of follow-up were 7.4% (n = 18) and 20.7% (n = 50), respectively. The Hip-MFS (odds ratio OR, 1.250; 95% confidence interval CI, 1.092-1.432) and HGS (OR, 1.147; 95% CI, 1.082-1.215) could predict postoperative complications. The Hip-MFS could predict both 6-month mortality (hazard ratio HR, 1.403; 95% CI, 1.027-1.917) and mortality at the end of follow-up (HR, 1.493; 95% CI, 1.249-1.769) after adjustment, while HGS was only associated with mortality at the end of follow-up (HR, 1.080; 95% CI, 1.024-1.139). For mortality at the end of follow-up, predictive models with the Hip-MFS were superior to those with HGS in the time-dependent receiver-operating curve analysis after adjustment (p = 0.017). Furthermore, the addition of Hip-MFS or HGS to the American Society of Anesthesiologists (ASA) classification improved its prognostic ability.
Both the Hip-MFS and HGS could predict postoperative complications and improve prognostic utility when combined with the ASA classification. The Hip-MFS was a stronger predictor of mortality than HGS after HF surgery. HGS could be a useful pre-screening tool to identify patients at a high risk of postoperative complications and those who may benefit from further CGA.
Purpose
The purpose of this study was to elucidate the effect of decreased muscle mass on the toxicity and survival of patients with colon cancer treated with adjuvant chemotherapy after surgery.
...Methods
We reviewed the data of 229 consecutive patients with stage III colon cancer who received adjuvant oxaliplatin, 5-fluorouracil, and leucovorin chemotherapy at a single center between 2003 and 2010. Baseline muscle mass was assessed by measuring the cross-sectional area of the psoas muscle at the level of the fourth lumbar vertebra on computed tomography images. Effects of muscle mass on toxicity of chemotherapy and survival were assessed.
Results
The median age of the 229 patients was 61 years (range, 28–80) and 134 (58.5 %) were men. The mean psoas muscle mass index (PI, psoas muscle area divided by height
2
mm
2
/m
2
) was 548.3. A 1 SD decrement in the PI was associated with an increase in all grade 3–4 toxicities in univariate (OR = 1.69, 95 % CI = 1.18–2.27) and multivariate (OR = 1.56, 95 % CI = 1.05–2.38) analyses. In univariate analysis, the PI was not associated with overall survival. However, multivariate analysis showed that a 1 SD decrement in the PI increased the hazard of overall mortality by 85 % (HR = 1.85, 95 % CI = 1.10–3.13). This effect of the PI on mortality was maintained in subgroup analyses, especially in older and obese patients.
Conclusions
Decreased muscle mass was associated with increased risk of grade 3–4 toxicity and poor prognosis in patients with stage III colon cancer.
There are limited data regarding blood pressure (BP) variability among older adults living in long-term care hospitals (LTCHs). We aimed to collect data from LTCH and analyse BP characteristics and ...its variability among these patients using a novel platform.
The Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT) platform was used to construct a daily BP dataset using data of 394 older patients from 6 LTCHs. BP variability was expressed as coefficient of variation (CV = standard deviation/mean of BP × 100). Physical frailty and cognitive function were evaluated using the K-FRAIL questionnaire and the Cognitive Performance Scale of the interRAI Long-Term Care Facilities tool, respectively.
From September 2019 to September 2020, 151,092 BP measurements, 346.5 (IQR 290.8-486.3) measurements per patient, were included. The mean BP was 123.4 ± 10.8/71.3 ± 6.5 mmHg. BP was significantly lower in frail patients (122.2 ± 11.3/70.4 ± 6.8 mmHg) than in pre-frail/robust patients (124.4 ± 10.4/72.1 ± 6.1 mmHg, P < 0.05). However, CV of systolic (10.7 ± 2.3% versus 11.3 ± 2.3%, P = 0.005) and diastolic (11.6 ± 2.3% versus 12.4 ± 2.4%, P < 0.001) BP was higher in frail patients. The mean BP was lower, but BP variability was higher in patients with cognitive impairment. The mean BP, but not BP variability, was higher in treated hypertensive patients, as the number of antihypertensive medications increased.
Older patients with physical or cognitive frailty had lower BP but higher BP variability. Relationship among frailty, increased BP variability and adverse clinical outcomes should be investigated.
The fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale is a screening tool for frailty status using a simple 5-item questionnaire. The aim of this study was to evaluate the ...clinical feasibility and validity of the Korean version of the FRAIL (K-FRAIL) scale.
Questionnaire items were translated and administered to 103 patients aged ≥ 65 years who underwent a comprehensive geriatric assessment at the Seoul National University Bundang Hospital. In this cross-sectional study, the K-FRAIL scale was compared with the domains and the multidimensional frailty index of the comprehensive geriatric assessment. We also assessed the time required to complete the scale.
The participants' mean age was 76.8 years (standard deviation SD, 6.1), and 55 (53.4%) were males. The mean overall frailty index was 0.19 (SD, 0.17). For K-FRAIL-robust, prefrail, and frail patients, the mean frailty indices were 0.09, 0.18, and 0.34, respectively (p for trend < 0.001). A higher degree of impairment in the K-FRAIL scale was associated with worse nutritional status, poor physical performance, functional dependence, and polypharmacy. The number of items with impairment in the K-FRAIL scale was positively associated with the frailty index (B = 3.73, p < 0.001). The K-FRAIL scale could differentiate vulnerability from robustness with a sensitivity of 0.90 and a specificity of 0.33. Of all patients, 75 (72.8%) completed the K-FRAIL scale within < 3 minutes.
The K-FRAIL scale is correlated with the frailty index and is a simple tool to screen for frailty in a clinical setting.
A numerical simulator entitled TOUGH-UDEC is introduced for the analysis of coupled thermal-hydraulic-mechanical processes in fractured porous media. Two existing well-established codes, TOUGH2 and ...UDEC, are coupled to model multiphase fluid flows, heat transfers, and discontinuous deformations in fractured porous media by means of discrete fracture representation. TOUGH2 is widely used for the modeling of heat transfers and multiphase multicomponent fluid flows, and UDEC is a well-known distinct element code for rock mechanics. The two codes are solved sequentially, with coupling parameters passed to each equation at specific intervals. After solving thermal-hydraulic equations within the TOUGH2 code, pressure and temperature information is imported into the UDEC model. After solving the mechanical equation within the UDEC code the calculated fracture apertures are converted to the equivalent permeability and porosity values for a TOUGH2 flow analysis. The solution is calculated by iteratively following an explicit sequence for numerical efficiency. Verifications are presented to demonstrate the capabilities of the coupled TOUGH-UDEC simulator. Three application examples of (1) shear dilation due to increased pore pressure, (2) thermal stress and (3) CO2 injection, show that the new simulator can be an effective tool for geoengineering applications involving shear activation of fractures and faults.
•TOUGH2 and UDEC are linked to model coupled THM processes in fractured porous rock.•TOUGH-UDEC is verified by hydromechanical and thermomechanical verification cases.•TOUGH-UDEC is applied to two basic hydroshearing and thermoshearing models.•TOUGH-UDEC is applied to a large-scale CO2 injection and leakage analysis.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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