Validity and reliability of handgrip dynamometry in older adults: A comparison of two widely used dynamometers.

BACKGROUND: Among older adults, decreased handgrip strength is associated with greater risk of frailty, and loss of physical function, mobility, lean mass, and overall muscular strength and power. Frailty is also associated with sarcopenia, for which handgrip strength measurement has been recommended for diagnostic purposes. Specific cutoff points for diagnosis have been identified, but use of different devices may affect measurement. Therefore to assess validity and reliability, we compared the two most frequently used devices, the Jamar hydraulic and Smedley spring handgrip dynamometers. METHODS: Sixty-seven older (76.2 ± 0.9 years) men (n = 34) and women (n = 33) completed two trials of handgrip strength measurement on sequential days (T1, T2) using both devices in random order. Intraclass correlations were used to assess test-retest reliability, and Bland-Altman analysis was used to assess validity as the level of agreement between devices. RESULTS: There were significant (p < 0.001) relationships between devices at T1 (r = 0.94) and T2 (r = 0.94) and strong (p < 0.001) intraclass correlations were observed for both devices (Jamar = 0.98; Smedley = 0.96), indicating excellent reliability. However, there were significant differences between devices. Strength measured with Jamar was greater than Smedley at both T1 (27.4 ± 1.4 vs. 23.4 ± 1.1 kg, p < 0.001) and T2 (25.3 ± 1.4 vs. 21.8 ± 1.2 kg, p < 0.001). Bland-Altman analysis confirmed these differences. Subgroup analysis to evaluate the effect of gender and age indicated that in women and old-old (>75 years) participants, differences between devices were closer to zero for both measurements compared to men and young-old (65-75 years) participants. CONCLUSIONS: Our results demonstrate that despite excellent reliability, there is poor agreement between devices, indicating a lack of validity. For use as a diagnostic tool, standardization and device-specific cutoff points for handgrip dynamometry are needed.

Self-Perception of Aging Among Older Adults and Participation in Prevention.

Many older adults do not engage in age-based prevention despite evidence to support reduced health risks and enhanced successful aging. The purpose of this study was to determine whether self-perceived aging (SPA) differed among older adults by age (young-old vs. old-old), participation in healthy lifestyle behaviors, screening, vaccinations, and self-rated health. Community-dwelling older adults (n=204) completed questionnaires reporting their SPA, self-rated health, and participation in recommended preventive healthy lifestyle behaviors, screening, and vaccinations. Our findings indicated that adults who were older and engaged in more preventive health behaviors, yet had lower self-rated health, tended to have better SPA. Prevention was greater in older adults who scored higher on aging well and aging successfully. Old-old (75 years or older) participants scored higher on aging successfully than those who were younger. Self-rated health was inversely related to SPA scores. Reporting poor or fair health did not diminish positive SPA in this sample.

Validity of a Single Activity Question for Clinical Assessment of Older Women.

Physical activity is an important part of clinical assessment. However, objective measurement can be expensive and burdensome. The current study validated a single activity question for use in clinical assessment. Ninety-seven older women (mean age = 73.7 years, SE = 0.7) completed an activity questionnaire and measurement of anthropometrics, body composition, and strength. Activity level was reported as not active, somewhat active, active, and very active. Activity level was significantly related to hours of light, moderate, and vigorous activity; body mass index (BMI); waist circumference; percent fat and lean mass; and strength (p < 0.05). When activity levels were collapsed into two groups (not active + somewhat active, and active + very active), women in the high activity group (n = 48) were significantly (p < 0.05) more active, had healthier BMI and waist circumference values, less fat and more lean mass, and were stronger than women in the low activity group (n = 49). A single activity question is valid for use in clinical assessment. [Journal of Gerontological Nursing, 46(12), 15-22.].

Transforming Nursing Education Through Interprofessional Collaborative Innovation: A Project Story.

This project story is about transforming nursing education through interprofessional collaborative innovation to develop and use a complement of technology-based portable simulation devices collectively known as the Healthcare Education Simulation Station. This collection of inexpensive, simulated point-of-care instruments controlled wirelessly by an instructor or simulation operator were developed and field tested by an interdisciplinary team to enhance learning experiences in several configurations, including those using standardized patients and those using static and low-, mid-, and high-fidelity manikins. The core feature of this project story is the collaboration of students and faculty from two unrelated disciplines, nursing and engineering. The story includes a description of the development, field testing, and initial deployment of a simulated pulse oximeter, capnograph, automated sphygmomanometer, cardiac monitor, thermometer, and fetal monitor. Underpinning this project story is Rogers' Diffusion of Innovation theory and how the characteristics of the innovation, the personnel, and the environment worked together to enable this project and the innovation's subsequent diffusion into nursing education. The aspiration to improve learning experiences for students in multiple disciplines was paramount. The desire to acquire high-quality, dynamic educational tools for nursing educators, coupled with an environment that encourages collaboration, led to an innovation that can transform nursing preparation and ultimately improve patient care, while minimizing cost.

Post-Translational Modification Mimicry for Programmable Assembly of Elastin-Based Protein Polymers.

Post-translational modification (PTM) of protein polymers is emerging as a powerful bioinspired strategy to create protein-based hybrid materials with molecularly encoded assembly and function for applications in nanobiotechnology and medicine. While these modifications can be accomplished by harnessing native biological machinery (i.e., enzymes), the evolutionarily programmed specificity of these enzymes (recognition of select substrates and the limited repertoire of ligation chemistries catalyzed by these enzymes) can limit the type and linkage of PTMs appended to proteins. One approach to overcome this limitation is to leverage advances in site-selective biomolecular modification to prepare synthetic mimics of naturally occurring PTMs that are absent in nature. As a proof of concept, we used scalable bio-orthogonal reactions to prepare synthetic mimics of lipidated proteins with tunable assembly and disassembly. Additionally, we demonstrated that our PTM mimicry regulates the stimuli-responsive phase behavior of intrinsically disordered biopolymers, modulates their self-assembly at the nanoscale, and can be used for programmable disassembly of these materials in acidic environments. Synthetic PTM mimicry opens a path to encode new assembly and disassembly capabilities into hybrid materials that cannot be produced via biosynthesis.

Impact of Advertising on Tampon Wear-time Practices.

OBJECTIVES: (1) To determine whether advertising nighttime tampon use for up to eight hours was understood to be consistent with label recommendations and (2) to determine whether television and print advertising with this message affected tampon wear times in adults and teens. METHODS: (1) A comprehension study (online advertising and follow-up questionnaire) among women aged 14-49 years (300 per group) who viewed either the test or a control advertising message; (2) Diary-based surveys of tampon wear times performed prior to (n = 292 adults, 18-49 years, 74 teens, 12-17 years) and after (n = 287 adults, 104 teens) the launch of national advertising. RESULTS: Significantly more test message viewers than controls stated tampons should be worn less than or equal to eight hours (93.6% vs. 88.6%, respectively, P = 0.049). A directionally higher percentage of test message viewers said they would use a pad if sleeping longer than eight hours (52% vs. 42% of controls). Among the women who used tampons longer than eight hours when sleeping, 52% reported they would wake up and change compared with 45% of controls. No significant difference between baseline and follow-up diary surveys was found among teens or adults in various measures of tampon wear time (mean wear times; usage intervals from less than two hours to more than 10 hours; percentage of tampons used for more than or equal to eight hours; frequency of wearing at least one tampon more than eight hours). CONCLUSIONS: Advertising nighttime tampon wear for up to eight hours effectively communicated label recommendations but did not alter tampon wear times. The informational intervention had limited impact on established habits.

Improving staff reports of falls in assisted living.

This study examined falls data reported by staff to (a) describe characteristics of falls in this population and (b) analyze the quality and utility of the data available from incident reports (IRs) to improve fall prevention. Data from 34 incident reports were analyzed. Descriptive and frequency analyses were conducted to describe fall characteristics, use of assistive devices, high-risk medication use, and prevalence of omitted data on IRs. Thirty-four falls occurred among 15 residents (age, M = 84 years). More than half resulted in injury. Significant omissions of data were noted in the IRs, which may have limited full analysis of fall events and the ability to communicate about health outcomes of these events and the prevention of subsequent falls. This study provides data about falls in assisted living and recommendations for enhanced data collection to support the monitoring of falls risk and the prevention of future falls.

Effects of a physical activity and healthy eating intervention to reduce stroke risk factors in older adults.

OBJECTIVE: To evaluate the effects of a theory-based physical activity and healthy eating intervention aimed at reducing stroke risk factors among overweight/obese and sedentary older adults. METHODS: Between 12/2009-1/2011, participants (n=69) were randomly assigned to an 8-week group motivational intervention or biweekly newsletters by mail. Physical activity (blinded pedometer, 7-day recall) body composition, theoretical mediator, and dietary (24-hour recall) variables were measured at pre-test and post-test. The physical activity and dietary outcomes are reported. RESULTS: For outcome measures, the follow-up was 90% for the intervention group (n=29) and 91% for the control group (n=34) for this sample. Statistically significant differences in the 7-day physical activity self-report were noted at post-test in the intervention group. The dietary measures were not statistically significant at post-test; however, the intervention group increased the quantity of vegetable servings. CONCLUSION: Limited efficacy testing was supported for a combined physical activity-dietary intervention, framed by a wellness-motivation theory, and designed to reduce stroke risk factors in older adults who are sedentary and overweight/obese. Limitations were identified and recommendations for additional research provided.

Political and economic aspects of the transition to universal health coverage.

Countries have reached universal health coverage by different paths and with varying health systems. Nonetheless, the trajectory toward universal health coverage regularly has three common features. The first is a political process driven by a variety of social forces to create public programmes or regulations that expand access to care, improve equity, and pool financial risks. The second is a growth in incomes and a concomitant rise in health spending, which buys more health services for more people. The third is an increase in the share of health spending that is pooled rather than paid out-of-pocket by households. This pooled share is sometimes mobilised as taxes and channelled through governments that provide or subsidise care--in other cases it is mobilised in the form of contributions to mandatory insurance schemes. The predominance of pooled spending is a necessary condition (but not sufficient) for achieving universal health coverage. This paper describes common patterns in countries that have successfully provided universal access to health care and considers how economic growth, demographics, technology, politics, and health spending have intersected to bring about this major development in public health.

From Toyota to the bedside: nurses can lead the lean way in health care reform.

The advent of health care reform means new pressures on American hospitals, which will be forced to do more with less. In the next decade, increased use of "Lean" principles and practices in hospitals can create real value by reducing waste and improving productivity, costs, quality, and the timely delivery of patient care services. In 2010, the Institute of Medicine recommended that nurses lead collaborative quality improvement efforts and assume a major role in redesigning health care in the United States. In this article, we provide an overview of the use of Lean techniques in health care and 2 case studies of successful, nurse-directed Lean initiatives at the Robert Wood Johnson University Hospital. The article concludes with some lessons we have learned and implications for nursing education in the future that must include the concepts, tools, and skills required for adapting Lean to the patient care environment.

Effect of salt concentration on the conformation of TAR RNA and its association with aminoglycoside antibiotics.

RNA is an important biological target because it plays essential roles in many pathogenic and normal cellular processes. The design of inhibitors that target RNA involves optimization of noncovalent interactions, including van der Waals, hydrogen bond, and electrostatic interactions. Although sometimes regarded as nonspecific, electrostatic interactions are important in this optimization because the specific position of the phosphates may allow for specific charge-charge interactions with bound ligands. In this work, we have investigated the contribution of electrostatic interactions to the binding affinity of aminoglycoside antibiotics for TAR RNA. Because the charges in aminoglycoside antibiotics are provided by protonated amino groups, it is difficult to separate the contribution of hydrogen bonds and electrostatics to their binding specificity. Hence, we have investigated the dependence of the binding affinity on salt concentration, which should affect only the electrostatic contributions. Our results show that four aminoglycoside antibiotics (paromomycin, kanamycin-B, gentamycin, and tobramycin) bind TAR RNA with different affinities. Furthermore, the dependence of the binding affinity on salt concentration is different for kanamycin-B and paromomycin, with kanamycin-B showing a stronger dependence. Because all these antibiotics contain five positive charges, the results suggest that each antibiotic orients its charges in different ways when bound to TAR RNA. Our overall results support the idea that charge-charge interactions can contribute significantly to the specific binding of antibiotics to TAR RNA. Hence, the exact position of the charges should be considered in the design of any inhibitor of the interactions of TAR RNA.

The Palisades: an interdisciplinary wellness model in senior housing.

PURPOSE: The conceptual model and implementation strategies for a university-private housing collaboration in a multilevel housing campus for older adults are described. The faculty and private developers viewed senior housing as an opportunity for people to downsize their space in order to upsize their lives within a community rich with resources to support their developmental needs. METHODS: A wellness program that includes assessments developed and performed by a multidisciplinary team provides the basis for the development of resources and interventions aimed at upsizing residents' lives. Semi-annual assessments and feedback sessions provide the residents with opportunities to set and revise goals and to work with members of the team to identify resource needs. RESULTS: After the first year, the wellness assessment scheduling and protocol were streamlined and recruitment barriers were addressed. The addition of a system for providing feedback to residents about their assessment results enhanced the meaning and value of the process. IMPLICATIONS: The Palisades team hopes to assist in promoting similar projects designed to positively impact wellness in older adults.

The multiply injured trauma patient: resuscitation, rehabilitation, recovery.

The care of the acutely injured patient requires a multidisciplinary approach from the moment of injury through rehabilitation and reintegration into society. In addition to the doctors and nurses providing many aspects of the acute and chronic medical care, the rehabilitation component is delivered by several skilled specialists focused on maximizing functional outcomes.

Restructuring life: preparing for and beginning a new caregiving role.

Family caregivers of stroke survivors who are just beginning their role must learn new skills and incorporate new knowledge into their daily activities. This can be a time of increased anxiety and stress for them. Nurses and other health professionals need more knowledge about this transition from the perspective of the caregivers. The purpose of this grounded theory study was to describe the process associated with preparing for and beginning a new caregiving role following a family member's stroke. Caregivers who were new to the role were interviewed prior to the stroke survivor's discharge and 4 weeks after discharge. The grounded theory, Restructuring Life for Caregiving, was associated with five dimensions of participants' lives: daily life, managing multiple roles, relationship with the stroke survivor, future hopes and plans, and time for self. The process of waiting, rearranging, and stabilizing further explained the timing and elements of restructuring activities.

Positive gain: rethinking the outcomes of dependency.

While independent behavior by older adults is routinely encouraged, some individuals can benefit from engaging in dependent behavior. In traditional views of dependency, dependent behaviors are considered maladaptive and dysfunctional. The purpose of this article is to consider the interactions between health professionals and older patients, the ways that dependent behaviors can lead to both positive outcomes for older adults, as well as serve as barriers to self-care and examine the role of nurses and institutions in interactions with older adults. An improved understanding of dependency and its relevance to nursing practice will contribute to a heightened awareness of the control dynamics occurring in everyday nursing care activities. An understanding of potential gains attained through dependency can add another dimension to assessment of a patient's progress and capability for present and future self-care.

Importance of aromatic content for peptide/single-walled carbon nanotube interactions.

We have previously demonstrated that a designed amphiphilic peptide helix, denoted nano-1, coats and debundles single-walled carbon nanotubes (SWNTs) and promotes the assembly of these coated SWNTs into novel hierarchical structures via peptide-peptide interactions. The purpose of this study is to better understand how aromatic content impacts interactions between peptides and SWNTs. We have designed a series of peptides, based on the nano-1 sequence, in which the aromatic content is systematically varied. Atomic force microscopy measurements and optical absorption spectroscopy reveal that the ability to disperse individual SWNTs increases with increasing aromatic residues in the peptide. Altogether, the results indicate that pi-stacking interactions play an important role in peptide dispersion of SWNTs.

Modulation of the voltage-dependent K+ current by intracellular Mg2+ in rat aortic smooth muscle cells.

OBJECTIVE: Intracellular magnesium ions (Mg2+i) are important in the regulation of a wide range of cellular metabolic processes and modulation of a variety of ion channels. Mg2+ deficiency has been implicated in the aetiology of various cardiovascular diseases. However, potential targets and mechanisms of action of Mg2+i in the cardiovascular system remain poorly understood. We therefore investigated the effect of Mg2+i on the voltage-gated K+ (KV) channels in rat aortic myocytes (RAMs). METHODS: KV currents (IKv) were investigated in single RAMs isolated from adult Wistar rat thoracic aorta using the whole-cell patch clamp technique. Changes in the vascular reactivity were also assessed in endothelium-denuded rat aortic rings loaded with Mg2+. RESULTS: An increase in Mg2+i caused several significant effects on IKv: (1) slowed down kinetics of activation at high (10 mM) Mg2+; (2) caused inward rectification at positive membrane potentials; (3) shifted the voltage-dependent inactivation, but not steady-state IKv activation; (4) the effect of Mg2+i on IKv inactivation was enhanced in the presence of intracellular ATP. Selective changes in the voltage-dependent characteristics predict a significant inhibition of the whole-cell steady-state IKv ("window current"), resulting in membrane depolarisation and enhanced tissue excitability. An increased sensitivity to KCl and the inhibitors of the IKv, tetraethylammonium and 4-aminopyridine (4-AP), was observed in Mg2+-loaded aortas, confirming this hypothesis. CONCLUSION: Our results demonstrate that intracellular magnesium can act as a potent modulator of the KV channel function in vascular smooth muscle cells in the physiological range of membrane potentials, representing a novel mechanism for the regulation of KV channel activity in the vasculature.

Effect of the BACE intervention on agitation of people with dementia.

PURPOSE: This study tests the effectiveness of the theoretically driven BACE (i.e., Balancing Arousal Controls Excesses) intervention in decreasing agitation in residents of long-term care with moderate or severe dementia. DESIGN AND METHODS: A pretest-posttest double-blinded experimental design with random assignment was used with a sample of 78 participants. The BACE intervention controls the daily activity schedule so that there is a balance between a person's high-arousal and low-arousal states. The outcome measure was observed agitation. RESULTS: When time spent in arousal imbalance at pretest was controlled for, a repeated measures analysis of covariance revealed a statistically significant Group x Time interaction, F(1, 69) = 4.26, p =.043, with a partial eta(2) =.06. The average change in agitation for the treatment group was a decrease of 8.43 points (SD = 12.01) from pretest to posttest, an effect size of.7. IMPLICATIONS: The results of this study support the theory that balancing arousal states by using an individualized approach is effective in decreasing agitation levels of people with dementia.

Pharmacological evidence for a key role of voltage-gated K+ channels in the function of rat aortic smooth muscle cells.

The role of voltage-dependent (I(K(v))) and large conductance Ca(2+)-activated (BK(Ca)) K(+) currents in the function of the rat aorta was investigated using specific BK(Ca) and K(V) channel inhibitors in single rat aortic myocytes (RAMs) with patch-clamp technique and in endothelium-denuded aortic rings with isometric tension measurements. The whole-cell K(+) currents were recorded in RAMs dialysed with 200 and 444 nm Ca(2+) and in perforated-patch configuration. Electrophysiological analysis demonstrated that I(K(v)) appeared at >/=-40 mV, while BK(Ca) (isolated using 1 microm paxilline) were seen positive to -20 mV in all conditions. Voltage-dependent characteristics, but not maximal conductance, of I(K(v)) was significantly altered in increased [Ca(2+)](i). Correolide (1 microm) (a K(V)1 channel blocker) did not inhibit the I(K(v)), whereas millimolar concentration of TEA (IC(50)=3.1+/-0.6 mm, n=5) and 4-aminopyridine (4-AP, IC(50)=5.9+/-1.9 mm, n=7) suppressed I(K(v)). These results and immunocytochemical analysis suggest the K(V)2.1 channel to be a molecular correlate for I(K(v)). In nonstimulated aortic rings 1-5 mm TEA and 4-AP (inhibitors of I(K(v))), but not paxilline (1 microm), caused contraction. The frequency of contractile responses to TEA and 4-AP was increased in the presence of 10 mm KCl, which itself did not significantly affect the aortic basal tone. Phenylephrine (15-40 nm) induced sustained tension with superimposed slow oscillatory contractions (termed OWs). OWs were blocked by diltiazem, ryanodine and cyclopiazonic acid, suggesting the involvement of L-type Ca(2+) channels and ryanodine-sensitive Ca(2+) stores in this process. TEA and 4-AP, but not IbTX, paxilline or correolide, increased the duration and amplitude of OWs, indicating that I(K(v)) is involved in the control of oscillatory activity. In conclusion, our findings suggest that the K(V)2.1-mediated I(K(v)), and not BK(Ca), plays an important role in the regulation of the excitability and contractility of rat aorta.