Mapping a comprehensive assessment tool to a holistic definition of health for person-centred care planning in home care: a modified eDelphi study

BACKGROUND

Researchers in the Netherlands proposed the Pillars for Positive Health (PPH) as a broadly encompassing health definition to support more realistic and meaningful care planning for people living with chronic disease and other life-long health conditions. The PPH was subsequently converted to the My Positive Health (MPH) spider web visualization tool. This study sought to identify opportunities for more person-centred care planning at the point of care in home care, using the MPH tool as a framework to link comprehensive assessment and dialogue-based goal-setting.

METHODS

A modified eDelphi method was used to conduct domain mapping with a purposively sampled expert panel (n = 25). The panel consisted of researchers, health care providers, older adults and caregivers. A two-stage eDelphi process was conducted, with each stage consisting of three survey rounds. In the first stage, participants were asked to map 201 elements of the interRAI Home Care (interRAI HC) comprehensive assessment tool to the six MPH domains or "No pillar of best fit". The second stage focused on identifying opportunities to adapt or expand comprehensive assessment as it relates to the MPH domains.

RESULTS

In Stage 1, 189 of 201 elements reached consensus in domain mapping. These included: 80 elements for Bodily Functions, 32 for Daily Functioning, 32 for Mental Wellbeing, 24 for Quality of Life, 10 for Participation, and 1 for Meaningfulness. Ten elements were identified to have no pillar of best fit. The 12 elements that did not reach consensus in Stage 1 formed the basis for Stage 2, where expert panel participants proposed four new assessment elements in Meaningfulness and Participation and 11 additional descriptors across the six MPH domains. Of these, two elements and nine of the 11 descriptors reached consensus.

CONCLUSION

Findings show that elements of the interRAI HC are oriented toward the physical, functional, and mental health domains. Consequently, complementary assessment elements and/or tools may be needed to support comprehensive assessment of 'Meaningfulness' and 'Participation' in person-centred home and community care. Additional descriptors may also be needed to aid communication regarding the understanding and application of MPH domains.

Comprehensive Health Assessment for Children in Out-of-Home Care: An Exploratory Study of Service Needs and Mental Health in a Norwegian Population

A comprehensive model for routine multi-disciplinary health assessment for children in out-of-home care was piloted in a Norwegian region. This paper reports on identified service needs and mental disorders among 196 children (0-17 years) receiving the assessment. Cross-sectional data was extracted from assessment reports. Results show needs across a range of services, with a mean of 2.8 recommended services for children aged 0-6 and 3.3 for children aged 7-17. Mental disorders were identified in 50% of younger children, and 70% of older children. For all children, overall service need was associated with mental disorders, in addition to male gender among younger children. Need for specialized mental health services was associated with mental disorders among younger children and increasing age among older children. The high frequency of service needs and mental disorders illustrate the importance of offering comprehensive health assessments routinely to this high-risk child population and necessitates coordinated service delivery.

Novel insights into impacts of the "7.20" extreme rainstorm event on water supply security of Henan Province, China: Levels and health risks of tap water disinfection by-products

Spatial distributions, levels, and comprehensive assessments of post-flood tap water disinfection by-products (DBPs) were first studied in Henan Province after the "7.20" Extreme Rainstorm Event in 2021. DBPs levels and health risks in tap water were higher in areas flooded (waterlogged) by storm or upstream flood discharge (WA) and rainstorm-affected areas (RA) compared with other areas (OA), suggesting that extreme rainstorm and flooding events may somehow exacerbate DBPs contamination of tap water through disinfection. WA sites were characterized as contamination hotspots. The results revealed high haloacetic acids (HAAs) levels in WA (Avg: 57.79 μg·L^-1) and RA (Avg: 32.63 μg·L^-1) sites. Compared with normal period, DBPs-caused cancer risk increased by 3 times, exceeding the negligible risk level. Cancer risk came primarily from the ingestion of trihalomethanes (THMs) (>80%), children were the sensitive group. Those between 30 and 69 showed approximately 1.7 times higher disability-adjusted life yearsper person-yearthan other age groups. Apart from regulated DBPs, bromochloracetic acid (BCAA) and dibromoacetonitrile (DBAN) appear to be the main toxicity contributors in these samples. Our results provide a scientific basis for preventing and controlling health risks from tap water DBPs and for assessing the social benefits and burdens of emergency disinfection.

The presence of extra-pulmonary treatable traits increases the likelihood of responding to pulmonary rehabilitation

INTRODUCTION

Studies suggest that people with chronic obstructive pulmonary disease (COPD) who are worse at baseline respond better to pulmonary rehabilitation (PR). Identifying treatable traits (TTs) may help to distinguish responders from non-responders. We explored the impact of PR on extra-pulmonary traits of people with COPD and whether the presence of TT influences the type of response to PR.

METHODS

A comprehensive assessment of 9 TT including symptoms (dyspnoea, fatigue, anxiety and depression), functional capacity, deconditioning, balance, impact of the disease and health-related quality of life was conducted before and after a 12-week community-based PR programme. Pre-post differences between people with or without each TT at baseline were compared with independent samples t-tests or Mann-Whitney U tests. Proportion of responders between groups were explored with chi-square tests and odds ratio.

RESULTS

102 people with COPD were included (70 [65; 75] years old, 78% male, FEV₁ 47 [36; 60] %predicted). They had a median of 3 (out of 9) TTs per person and each patient responded on average to 5 (out of 9) outcomes of PR. People with TT were more responsive than those without them in all outcomes (p < 0.05) except for the 1-min sit-to-stand test. The presence of TT increased 4 to 20 times the likelihood of being a good responder.

CONCLUSIONS

Identification of baseline extra-pulmonary TT in people with COPD showed the potential to inform on PR responsiveness and might therefore be an important strategy for patient prioritization, treatment personalisation (i.e., activation of the most suitable components) and optimisation.

Cognitive, neuropsychological and emotional-behavioural functioning in a sample of children with myotonic dystrophy type 1

AIM

An observational longitudinal study to evaluate the feasibility of assessing cognitive, neuropsychological and emotional-behavioural functioning in children with myotonic dystrophy type 1 (DM1), and to estimate prospectively changes in functioning over time.

METHOD

Ten DM1 patients, aged 1.5-16 years (mean 9.1), 5 with congenital DM1, and 5 with childhood DM1, were assessed with standardized measures of intellectual, neuropsychological, and emotional-behavioural functioning. For 6 patients, assessments were repeated 2 years later.

RESULTS

At baseline, intellectual disability was found both in the congenital and the childhood group. A clear-cut reduction of the mean and individual developmental/intelligence quotient after 2 years was demonstrated in re-tested patients. As regards to the neuropsychological aspects, the baseline evaluation identified impairments in visuospatial skills and attentional functions, with no clear trend observed after two years. In executive functions, no significant profile was identified even though impairments were detected in a few patients. At the emotional-behavioural assessment, scores in clinical range were found, but they remained heterogeneous and no trends could be recognized.

CONCLUSION

Several aspects of CNS functions in DM1 children deserve better definition and a longitudinal assessment. A comprehensive protocol should include cognitive, neuropsychological, emotional and behavioural assessment but larger longitudinal studies are needed to better evaluate the trajectories over time and inform practice.

Substitution strategies for cooking energy: To use gas or electricity?

The Chinese government has called for clean and effective energy substitution for cooking in rural areas. This paper assesses the environmental and economic impacts of various types of cooking fuels and stoves. According to the assessment results, the environmental impacts are highly influenced by the types of fuels and the efficiency of stoves used for cooking. Using biogas, liquefied petroleum gas (LPG), and natural gas for cooking instead of solid fuels can significantly reduce environmental emissions. To provide 1 megajoule (MJ) of useful cooking heat, the environmental costs of lump coal, honeycomb briquettes, and straw are the largest, estimated to be 80.4 yuan/MJ, 73.1 yuan/MJ, and 71.4 yuan/MJ, respectively. In addition, the economic assessment results show that the most expensive source of cooking fuel is LPG, with an average annual cost of 1700 yuan, while the cost of straw and firewood is the cheapest, at less than 100 yuan. The average annual cost of electricity is higher than that of natural gas. Regarding the substitution effects, using natural gas for cooking is better than using electricity. The environmental benefit of electricity substitution is only 10%-20% of natural gas substitution, and the corresponding increasing cost for residents is 1.5 times that of natural gas substitution.

Patient-centered placement matching of alcohol-dependent patients based on a standardized intake assessment: process evaluation within an exploratory randomized controlled trial

BACKGROUND

In the implementation of placement matching guidelines, feasibility has been concerned in previous research. Objectives of this process evaluation were to investigate whether the patient-centered matching guidelines (PCPM) are consistently applied in referral decision-making from an inpatient qualified withdrawal program to a level of care in aftercare, which factors affect whether patients actually receive matched aftercare according to PCPM, and whether its use is feasible and accepted by clinic staff.

METHODS

The study was conducted as process evaluation within an exploratory randomized controlled trial in four German psychiatric clinics offering a 7-to-21 day qualified withdrawal program for patients suffering from alcohol dependence, and with measurements taken during detoxification treatment and six months after the initial assessment. PCPM were used with patients in the intervention group by feeding back to them a recommendation for a level of care in aftercare that had been calculated from Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff on the treatment unit. As measurements, The MATE, the Client Socio-Demographic and Service Receipt Inventory-European Version, a documentation form, the Control Preference Scale, and the Motivation for Treatment Scale were administered. A workshop for the staff at the participating trial sites was conducted after data collection was finished.

RESULTS

Among 250 patients participating in the study, 165 were interviewed at follow-up, and 125 had received aftercare. Although consistency in the application of PCPM was moderate to substantial within the qualified withdrawal program (Cohen's kappa ≥ .41), it was fair from discharge to follow-up. In multifactorial multinomial regression, the number of foregoing substance abuse treatments predicted whether patients received more likely undermatched (Odds Ratio=1.27; p=.018) or overmatched (Odds Ratio=0.78; p=.054) treatment. While the implementation process during the study was evaluated critically by the staff, they stated a potential of quality assurance, more transparency and patient-centeredness in the use of PCPM.

CONCLUSIONS

While the use of PCPM has the potential to enhance the quality of referral decision making within treatment, it may not be sufficient to determine referral decisions for aftercare.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00005035 . Registered 03/06/2013.

Comprehensive analysis of resting tremor based on acceleration signals of patients with Parkinson's disease

BACKGROUND

Resting tremor is an essential characteristic in patients suffering from Parkinson's disease (PD).

OBJECTIVE

Quantification and monitoring of tremor severity is clinically important to help achieve medication or rehabilitation guidance in daily monitoring.

METHODS

Wrist-worn tri-axial accelerometers were utilized to record the long-term acceleration signals of PD patients with different tremor severities rated by Unified Parkinson's Disease Rating Scale (UPDRS). Based on the extracted features, three kinds of classifiers were used to identify different tremor severities. Statistical tests were further designed for the feature analysis.

RESULTS

The support vector machine (SVM) achieved the best performance with an overall accuracy of 94.84%. Additional feature analysis indicated the validity of the proposed feature combination and revealed the importance of different features in differentiating tremor severities.

CONCLUSION

The present work obtains a high-accuracy classification in tremor severity, which is expected to play a crucial role in PD treatment and symptom monitoring in real life.

Recommendations on the comprehensive, multidimensional assessment of hospitalized elderly people. Position of the Spanish Society of Internal Medicine

This position paper describes the most relevant and essential aspects of a comprehensive, multidimensional assessment of hospitalized elderly people. The change in demographic patterns and the epidemiological profiles of diseases makes it necessary for internal medicine departments to adapt in order to take into account the vulnerabilities of the elderly in this context. A comprehensive, multidimensional assessment and the multidisciplinary development of a care plan during hospitalization can have an impact in terms of preventing mortality, disability, and institutionalization at discharge. It is necessary for all internists to acquire skills to improve the hospitalization experience in the elderly and obtain better health outcomes in our patients. This document has been developed by the Focus Group on Aging and the Polypathological and Advanced Age Working Group and endorsed by the Spanish Society of Internal Medicine.

Recommendations on the comprehensive, multidimensional assessment of hospitalized elderly people. Position of the Spanish Society of Internal Medicine

This position paper describes the most relevant and essential aspects of a comprehensive, multidimensional assessment of hospitalized elderly people. The change in demographic patterns and the epidemiological profiles of diseases makes it necessary for internal medicine departments to adapt in order to take into account the vulnerabilities of the elderly in this context. A comprehensive, multidimensional assessment and the multidisciplinary development of a care plan during hospitalization can have an impact in terms of preventing mortality, disability, and institutionalization at discharge. It is necessary for all internists to acquire skills to improve the hospitalization experience in the elderly and obtain better health outcomes in our patients. This document has been developed by the Focus Group on Aging and the Polypathological and Advanced Age Working Group and endorsed by the Spanish Society of Internal Medicine.

Chlortetracycline hydrochloride removal by different biochar/Fe composites: A comparative study

In the last years, the synthesis and applications of biochar/Fe composites have been extensively studied, but only few papers have systematically evaluated their removal performances. Herein, we successfully synthesized and structurally characterized Fe⁰, Fe₃C, and Fe₃O₄-coated biochars (BCs) for the removal of chlortetracycline hydrochloride (CH). Evaluation of their removal rate and affinity revealed that Fe⁰@BC could achieve better and faster CH removal and degradation than Fe₃C@BC and Fe₃O₄@BC. The removal rate was controlled by the O-Fe content and solution pH after the reaction. The CH adsorption occurred on the O C groups of Fe⁰@BC and the OC and OFe groups of Fe₃C@BC and Fe₃O₄@BC. Electron paramagnetic resonance analysis and radical quenching experiments indicated that HO and ¹O₂/ O₂^- were mainly responsible for CH degradation by biochar/Fe composites. Additional parameters, such as effects of initial concentrations and coexisting anions, regeneration capacity, cost and actual wastewater treatment were also explored. Principal component analysis was applied for a comprehensive and quantitative assessment of the three materials, indicating Fe⁰@BC is the most beneficial functional material for CH removal.

"Establishing the criterion validity of the interRAI Check-Up Self-Report instrument"

Background

Low and middle-income countries have growing older populations and could benefit from the use of multi-domain geriatric assessments in overcoming the challenge of providing quality health services to older persons. This paper reports on the outcomes of a study carried out in Cape Town, South Africa on the validity of the interRAI Check-Up Self-Report instrument, a multi-domain assessment instrument designed to screen older persons in primary health settings. This is the first criterion validity study of the instrument. The instrument is designed to identify specific health problems and needs, including psychosocial or cognition problems and issues related to functional decline. The interRAI Check-Up Self-Report is designed to be compatible with the clinician administered instruments in the interRAI suite of assessments, but the validity of the instrument against clinician ratings has not yet been established. We therefore sought to establish whether community health workers, rather than trained healthcare professionals could reliably administer the self-report instrument to older persons.

Methods

We evaluated the criterion validity of the self-report instrument through comparison to assessments completed by a clinician assessor. A total of 112 participants, aged 60 or older were recruited from 7 seniors clubs in Khayelitsha, Cape Town. Each participant was assessed by one of two previously untrained, non-healthcare personnel using the Check-Up Self-report version and again by a trained assessor using the clinician version of the interRAI Check-Up within 48 h. Our analyses focused on the degree of agreement between the self-reported and clinician-rated versions of the Check-Up based on the simple or weighted kappa values for the two types of ratings. Binary variables used simple kappas, and ordinal variables with three or more levels were examined using weighted kappas with Fleiss-Cohen weights.

Results

Based on Cohen’s Kappa values, we were able to establish that high levels of agreement existed between clinical assessors and lay interviewers, indicating that the instrument can be validly administered by community health workers without formal healthcare training. 13% of items had kappa values ranging between 0.10 and 0.39; 51% of items had kappa values between 0.4 and 0.69; and 36% of items had values of between 0.70 and 1.00.

Conclusion

Our findings indicate that there is potential for the Check-Up Self-Report instrument to be implemented in under-resourced health systems such as South Africa’s.

Study on serviceability and efficiency of seven pilot carbon trading exchanges in China

Carbon trading has become a major innovation for many countries to cope with climate change, where in China the 7 pilot markets have been running for over 6 years with different performances shown. Being the actual venue where buyers and sellers trade carbon permits, how well and efficient a carbon trading exchange is designed directly affects whether the market can fulfill its environmental purpose. This paper selects 13 sub-indicators from three dimensions of main settings, risk prevention & control, and regional cooperation to evaluate the serviceability of the 7 exchanges in pilot carbon markets in China. Using which as input indicator and market operational effect as output indicator that represented by 5 sub-indicators including percentage of valid trading days, dispersion of trading volume etc., the study attempts to analyze how the serviceability of exchanges affect market operation. By applying the SUP-CCR-DEA (Super-efficiency CCR Data Envelope Analyze) model on 7 exchanges' trading data from 2013 to 2017, the study finds that the serviceability of the exchanges varies significantly, with Shanghai being the best and Shenzhen ranks the second. Obvious stratification is detected but with small changes during the four years observed, differences in main settings and transaction management system being the primary cause. It is found that the serviceability has a direct and significant impact on the market performance for all 6 exchanges except for Tianjin, and for those top-ranked exchanges, strong enforcement system and legally binding agreements contribute to their high service efficiency.

Patient-Centered Placement Matching of Alcohol-Dependent Patients Based on a Standardized Intake Assessment: Primary Outcomes of an Exploratory Randomized Controlled Trial

BACKGROUND

Placement matching guidelines are promising means to optimize patient-centered care and to match patients' treatment needs. Despite considerable research regarding placement matching approaches to optimize alcohol abuse treatment, findings are inconclusive.

OBJECTIVES

To investigate whether the use of patient-centered placement matching (PCPM) guidelines is more effective in reducing heavy drinking and costs 6 months after discharge from an inpatient alcohol withdrawal treatment compared to usual referral to aftercare. Secondary aims were to investigate whether age, gender, trial site or level of care (LOC) are moderators of efficacy and whether patients who were actually referred to the recommended LOC had better treatment outcomes compared to patients who were treated under- or overmatched.

METHODS

Design. Exploratory randomized controlled trial with measurements during withdrawal treatment and 6 months after initial assessment.

SETTING

Four German psychiatric clinics offering a 7-21 day inpatient qualified withdrawal program for patients suffering from alcohol dependence.

PARTICIPANTS

From 1,927 patients who had a primary diagnosis of alcohol dependence and did not have organized aftercare when entering withdrawal treatment, 299 were invited to participate. Of those, 250 were randomized to the intervention group (IG, n = 123) or the control group (CG, n = 127).

INTERVENTION

The PCPM were applied to patients of the IG by feeding back a recommendation to a LOC for aftercare that was calculated from the Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff of the treatment unit. Patients of the CG received a general feedback regarding their MATE interview on request.

MEASUREMENTS

The MATE, the Client Socio-Demographic and Service Receipt Inventory--European Version and the MATE-Outcomes were administered. Data were analyzed using generalized linear models.

RESULTS

In the intention-to-treat analysis, there were no significant differences between IG and CG regarding days of heavy drinking (incident risk ratio [IRR] 1.09; p = 0.640), direct (IRR 1.06; p = 0.779), indirect (IRR 0.77; p = 0.392) and total costs (IRR 0.89; p = 0.496). Furthermore, none of the investigated moderator variables affected statistically significant drinking or cost-related primary outcomes. Regardless of group allocation, patients who received matched aftercare reported significantly fewer days of heavy drinking than undermatched patients (IRR 2.09; p = 0.004). For patients who were overmatched, direct costs were significantly higher (IRR 1.79; p = 0.024), but with no additional effects on alcohol consumption compared to matched patients.

CONCLUSIONS

While the use of PCPM failed to affect the actual referral to aftercare, our findings suggest that treating patients on the recommended LOC may have the potential to reduce days of heavy drinking compared to undertreatment and costs compared to overtreatment.

Transformation of nitrogen and carbon during composting of manure litter with different methods

In this study, to investigate the nitrogen and carbon characteristics throughout the composting process in different systems, four methods of composting including static treatment (ST), turning treatment (TT), forced aeration treatment (FAT), and forced aeration with acidification treatment (FAAT) were conducted. Organic matter degradation was improved in TT and FAT that accelerated the composting efficiency. The harmless time based on phytotoxicity was significantly shortened in FAT comparing with ST. However, nitrogen loss through ammonia volatilization increased 14.0%. Ammonia volatilization could be significantly decreased to 17.0% after acidification optimization with FAAT. Compared to FAT, the FAAT got an increased nitrous oxide production and decreased methane emission. Generally, the lowest global warming potential value (52.8 kg CO₂-eq/t) was found in FAAT. Therefore, considering the environmental, fertilizer and toxicity indicators, the FAAT composting method is the most promising method, and has the potential to be promoted for implementation in practice.

Development and validation of the comprehensive assessment scale for chemotherapy-induced peripheral neuropathy in survivors of cancer

Background

Appropriate assessment is essential for the management of chemotherapy-induced peripheral neuropathy (CIPN), an intractable symptom that cannot yet be palliated, which is high on the list of causes of distress for cancer patients. However, objective assessment by medical staff makes it easy to underestimate the symptoms and effects of CIPN in cancer survivors. As a result, divergence from subjective evaluation of cancer survivors is a significant problem. Therefore, there is an urgent need to develop a subjective scale with high accuracy and applicability that reflects the experiences of cancer patients. We developed a comprehensive assessment scale for CIPN in cancer survivors, named the Comprehensive Assessment Scale for Chemotherapy-Induced Peripheral Neuropathy in Survivors of Cancer (CAS-CIPN), and demonstrated its reliability and validity.

Methods

We developed a questionnaire based on qualitative studies of peripheral neuropathy in Japanese cancer patients and literature review. Twelve cancer experts confirmed the content validity of the questionnaire. A draft version comprising 40 items was finalized by a pilot test on 100 subjects. The participants in the present study were 327 Japanese cancer survivors. Construct validity was determined by factor analysis, and internal validity by confirmation factor analysis and Cronbach’s α.

Results

Factor analysis showed that the structure consisted of 15 items in four dimensions: “Threatened interference in daily life by negative feelings”, “Impaired hand fine motor skills”, “Confidence in choice of treatment/management,” and “Dysesthesia of the palms and soles.” The CAS-CIPN internal consistency reliability was 0.826, and the reliability coefficient calculated using the Spearman-Brown formula [q = 2r/(1 + r)] was 0.713, confirming high internal consistency and stability. Scores on this scale were strongly correlated with Gynecologic Oncology Group-Neurotoxicity scores (r = 0.714, p < 0.01), confirming its criterion-related validity.

Conclusions

The CAS-CIPN is an assessment tool with high reliability and validity for the comprehensive evaluation of CIPN in cancer survivors. The CAS-CIPN is simple to use, and can be used by medical professionals for appropriate situational assessment and intervention.

Comprehensive assessment of paddy soil quality under land consolidation: a novel perspective of microbiology

Soil quality assessment is an important means to demonstrate how effective land consolidation is. However, the existing assessment system is not sufficient to reflect actual soil quality. So, the purpose of this study is to integrate abiological and biological indicators into a comprehensive assessment to evaluate the paddy soil quality under different land consolidation practices. Soil samples were collected from 35 paddy sites under different land consolidation practices including land merging, land leveling (LL), ditch construction (DC) and application of organic fertilizer (AO). A total of 10 paddy sites were selected under conventional tillage (CT) from non-land consolidation area as a control group in Y county, China. The results indicated that soil organic matter (OM), total nitrogen (TN), available phosphorus, bacterial functional diversity (BFD), bacterial and fungal abundances were significantly improved. Fields under LL, among all the land consolidation practices, might still face the risk of land degradation caused by low TN, OM and microbial diversity. High microbial biomass, BFD and OM were significantly higher in fields under AO in nutrient cycle. According to the results of comprehensive assessment, the samples with severe heavy metal contamination and low microbial diversity were generally concentrated in CT. These results indicated that land consolidation was an efficient technique to improve soil quality and could achieve higher quality of agricultural products.

Comprehensive assessment of microbial aggregation characteristics of activated sludge bioreactors using fuzzy clustering analysis

Understanding microbial aggregation dynamics in response to the often violent environmental fluctuations is important for activated sludge wastewater biotreatment practice, yet remains poorly understood. We investigated microbial aggregation process of an activated sludge reactor in response to various operating conditions of resource limitations, disinfectant and pH stresses, and quantified aggregation characteristics by employing a fuzzy clustering analysis (FCA) method. The results revealed that the FCA provided a means for comprehensive assessment of microbial aggregation dynamics of the bioreactor relying solely on simple parameter estimation. Proper disinfectant stress (of NaClO 1.00% or 2.00%) is a promising strategy to improve the comprehensive performance of microbial aggregation and sludge settleability. Nitrogen- (of C/N ratio > 40) and dissolved oxygen-limitations (of DO < 0.2 mg/L) had medium influence on the comprehensive performance of the activated sludge system, while little impacts for acidic and alkaline conditions. These quantitative estimations offer insights into the underlying bio-physicochemical processes of an activated sludge bioreactor in response to practical fluctuations that is often beyond typical assessment practice. In addition, it may represent a step towards uncoupling the complex biophysical interactions that is essential for optimized designing and proper engineering practice of biological wastewater treatment reactors.

Multimorbidity care model: Recommendations from the consensus meeting of the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS)

Patients with multimorbidity have complex health needs but, due to the current traditional disease-oriented approach, they face a highly fragmented form of care that leads to inefficient, ineffective, and possibly harmful clinical interventions. There is limited evidence on available integrated and multidimensional care pathways for multimorbid patients. An expert consensus meeting was held to develop a framework for care of multimorbid patients that can be applied across Europe, within a project funded by the European Union; the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS). The experts included a diverse group representing care providers and patients, and included general practitioners, family medicine physicians, neurologists, geriatricians, internists, cardiologists, endocrinologists, diabetologists, epidemiologists, psychologists, and representatives from patient organizations. Sixteen components across five domains were identified (Delivery of Care; Decision Support; Self Management Support; Information Systems and Technology; and Social and Community Resources). The description and aim of each component are described in these guidelines, along with a summary of key characteristics and relevance to multimorbid patients. Due to the lack of evidence-based recommendations specific to multimorbid patients, this care model needs to be assessed and validated in different European settings to examine specifically how multimorbid patients will benefit from this care model, and whether certain components have more importance than others.

A damage assessment model of oil spill accident combining historical data and satellite remote sensing information: a case study in Penglai 19-3 oil spill accident of China

Oil spills are one of the major sources of marine pollution; it is important to conduct comprehensive assessment of losses that occur as a result of these events. Traditional methods are required to assess the three parts of losses including cleanup, socioeconomic losses, and environmental costs. It is relatively slow because assessment is complex and time consuming. A relatively quick method was developed to improve the efficiency of assessment, and then applied to the Penglai 19-3 accident. This paper uses an SAR image to calculate the oil spill area through Neural Network Classification, and uses historical oil-spill data to build the relationship between loss and other factors including sea-surface wind speed, and distance to the coast. A multiple regression equation was used to assess oil spill damage as a function of the independent variables. Results of this study can be used for regulating and quickly dealing with oil spill assessment.

Cardiac rehabilitation and mid-term follow-up after transcatheter aortic valve implantation

BACKGROUND

Evaluation of patient outcomes following transcatheter aortic valve implantation (TAVI) has usually been based on survival and clinical improvement. Studies on quality of life are limited, and data from comprehensive assessments after the procedure are lacking.

METHODS

Sixty patients referred for cardiac rehabilitation after TAVI underwent in-hospital and after-discharge multidimensional assessments to evaluate clinical, functional, and nutritional statuses, degree of autonomy, cognitive impairment, depression and quality of life.

RESULTS

On admission to rehabilitation, approximately half of the patients had severe functional impairment and dependence for basic activities of daily living. During their hospital stay, one-third of the patients suffered significant clinical complications and two had to be transferred to the implantation center. Despite this, the overall outcome was very good. All of the remaining patients were clinically stable at discharge and functional status, autonomy and quality of life were improved in most. During a mean follow-up of 540 days (range: 192-738 days), five patients died from noncardiac causes, three were hospitalized for cardiac events, and nine for non cardiac reasons. Functional status and autonomy remained satisfactory in the majority of patients and most continued to live independently.

CONCLUSIONS

Patients referred for rehabilitation after TAVI are often very frail, with a high grade of functional impairment, dependence on others and high risk of clinical complications. During a rehabilitation programme, based on a multidimensional assessment and intervention, most patients showed significant improvement in functional status, quality of life, and autonomy, which remained stable in the majority of subjects during mid-term follow-up.