Frailty in Young and Middle-Aged Adults: An Integrative Review.

BACKGROUND: Frailty is a public health priority resulting in poor health outcomes and early mortality in older adults. Early identification, management, and prevention of frailty may reduce frailty trajectory into later life. However, little is known about frailty in younger adults. OBJECTIVE: Describe frailty prevalence, definitions, study designs, and components contributing to multidimensional frailty in 18 to 65-year-olds and impart guidance for future research, practice, and policies with potential to positively impact frail individuals. METHODS: Integrative review approach was selected to explore frailty allowing for inclusion of diverse methodologies and varied persepectives while maintaining rigor and applicability to evidence-based practice initiatives. CINAHL, Embase, PsycInfo, PubMed databases were searched for studies describing frailty in adults age 18 to 65. Articles were excluded if published prior to 2010, not in English, lacked frailty focus, or non-Western culture. RESULTS: Twelve descriptive correlational studies were included. No intervention or qualitative studies were identified. No standard conceptual definition of frailty was discovered. Studied in participants with health disparities (n=3) and chronic conditions (n=8); HIV was most common (n=4). Frailty prevalence ranged from 3.9% (313 of 8095) to 63% (24 of 38). Many factors associated with frailty were identified among physical (18) and social (14), and fewer among psychological (11) domains. CONCLUSIONS: Universal frailty definition and multidimensional assessment tool is needed to generate generalizable results in future studies describing frailty in young and middle-aged adults. Early frailty identification by clinicians has potential to facilitate development and implementation of targeted interventions to prevent or mitigate frailty progression, but additional research is needed because risk factors in younger populations may be different than older adults.

Qualitative Assessment of Vaccination Hesitancy Among Members of the Apostolic Church of Zimbabwe: A Case Study.

Vaccine hesitancy or lack of confidence in vaccines is considered a threat to the success of vaccination programs. The rise and spread of measles outbreaks in southern Africa in 2009-2010 were linked to objections among Apostolic Church members, estimated at about 3.5 million in Zimbabwe as of 2014. To inform planning of interventions for a measles-rubella vaccination campaign, we conducted an assessment of the factors contributing to vaccine hesitancy using data from various stakeholders. Among nine districts in three regions of Zimbabwe, we collected data on religious attitudes toward, and perceptions of, vaccines through focus group discussions with health workers serving Apostolic communities and members of the National Expanded Programme on Immunization; semi-structured interviews with religious leaders; and open-ended questions in structured interviews with Apostolic parents/caregivers. Poor knowledge of vaccines, lack of understanding and appreciation of the effectiveness of vaccinations, religious teachings that emphasize prayers over the use of medicine, lack of privacy in a religiously controlled community, and low levels of education were found to be the main factors contributing to vaccine hesitancy among key community members and leaders. Accepting vaccination in public is a risk of sanctions. Poor knowledge of vaccines is a major factor of hesitancy which is reinforced by religious teachings on the power of prayers as alternatives. Because parents/caregivers perceive vaccines as dangerous for their children and believe they can cause death or disease, members of the Apostolic Church have more confidence in alternative methods such as use of holy water and prayers to treat diseases. Under these circumstances, it is important to debunk the myths about the power of holy water on the one hand and disseminate positive information of the efficacy of vaccines on the other hand in order to reduce hesitancy. Education about vaccines and vaccination in conjunction with government intervention, for example, through the use of social distancing policies can provide a framework for reducing hesitancy and increasing demand for vaccination.

Chemoresistant colorectal cancer cells and cancer stem cells mediate growth and survival of bystander cells.

BACKGROUND: Recent studies suggest that cancer stem cells (CSCs) mediate chemoresistance, but interestingly, only a small percentage of cells in a resistant tumour are CSCs; this suggests that non-CSCs survive by other means. We hypothesised that chemoresistant colorectal cancer (CRC) cells generate soluble factors that enhance survival of chemonaive tumour cells. METHODS: Chemoresistant CRC cells were generated by serial passage in oxaliplatin (Ox cells). Conditioned media (CM) was collected from parental and oxaliplatin-resistant (OxR) cells. CRC cells were treated with CM and growth and survival were assessed. Tumour growth rates were determined in nude mice after cells were treated with CM. Mass spectrometry (MS) identified proteins in CM. Reverse phase protein microarray assays determined signalling effects of CM in parental cells. RESULTS: Oxaliplatin-resistant CM increased survival of chemo-naive cells. CSC CM also increased growth of parental cells. Parental and OxR mixed tumours grew larger than tumours composed of parental or OxR cells alone. Mass spectrometry detected unique survival-promoting factors in OxR CM compared with parental CM. Cells treated with OxR CM demonstrated early phosphorylation of EGFR and MEK1, with later upregulation of total Akt .We identified progranulin as a potential mediator of chemoresistance. CONCLUSION: Chemoresistant tumour cells and CSCs may promote resistance through soluble factors that mediate survival in otherwise chemosensitive tumour cells.

Understanding the vertebrate immune system: insights from the reptilian perspective.

Reptiles are ectothermic amniotes, providing the key link between ectothermic anamniotic fishes and amphibians, and endothermic amniotic birds and mammals. A greater understanding of reptilian immunity will provide important insights into the evolutionary history of vertebrate immunity as well as the growing field of eco-immunology. Like mammals, reptile immunity is complex and involves innate, cell-mediated and humoral compartments but, overall, there is considerably less known about immune function in reptiles. We review the current literature on each branch of the reptilian immune system, placing this information in context to other vertebrates. Further, we identify key areas that are prime for research as well as areas that are lagging because of lack of reagents in non-model systems.

Azacitidine prolongs overall survival and reduces infections and hospitalizations in patients with WHO-defined acute myeloid leukaemia compared with conventional care regimens: an update.

Azacitidine (AZA), as demonstrated in the phase III trial (AZA-001), is the first MDS treatment to significantly prolong overall survival (OS) in higher risk MDS pts ((2007) Blood 110 817). Approximately, one-third of the patients (pts) enrolled in AZA-001 were FAB RAEB-T (≥20-30% blasts) and now meet the WHO criteria for acute myeloid leukaemia (AML) ((1999) Blood 17 3835). Considering the poor prognosis (median survival <1 year) and the poor response to chemotherapy in these pts, this sub-group analysis evaluated the effects of AZA versus conventional care regimens (CCR) on OS and on response rates in pts with WHO AML.

The reactivity of sodium borohydride with various species as characterized by adiabatic calorimetry.

The reactivity of sodium borohydride in the presence of other species has been examined by adiabatic calorimetry. In combination with water, sodium borohydride exhibits an exotherm at room temperature accompanied by generation of gas (presumed to be hydrogen). Addition of potassium hydroxide to a sodium borohydride-water mixture is found to stabilize the solution and require a higher temperature for reaction to occur. However, if iron oxide is also included, reaction takes place near room temperature. Very rapid reaction was found when a metal chloride was brought in contact with a solution containing sodium borohydride, water, and potassium hydroxide. When sodium borohydride was added to an oxygenated hydrocarbon, reaction at room temperature also took place, but to a more limited extent. Peak temperatures above 200 degrees C and maximum pressures in excess of 2000 psia were observed in most cases. Kinetics extracted from the calorimetry data are presented for some of the sodium borohydride combinations.

Influenza vaccination coverage among children aged 6-23 months - six immunization information system sentinel sites, United States, 2005-06 influenza season.

Beginning with the 2004-05 influenza season, the Advisory Committee on Immunization Practices (ACIP) recommended that all children aged 6-23 months receive influenza vaccinations annually. Other children recommended to receive influenza vaccinations include those aged 6 months-18 years who have certain high-risk medical conditions, those on chronic aspirin therapy, those who are household contacts of persons at high risk for influenza complications, and, since 2006, all children aged 24-59 months. Previously unvaccinated children aged <9 years need 2 doses administered at least 1 month apart to be considered fully vaccinated. This report assesses influenza vaccination coverage among children aged 6-23 months during the 2005-06 influenza season by using data from six immunization information system (IIS) sentinel sites. The findings demonstrate that vaccination coverage with 1 or more doses varied widely (range: 6.6% to 60.4%) among sites, with coverage increasing from the preceding influenza season in four of the six sites. However, <23% of children in five of the sites were fully vaccinated, underscoring the need for increased measures to improve the proportion of children who are fully vaccinated.

Kinetics of acid-catalyzed cleavage of cumene hydroperoxide.

The cleavage of cumene hydroperoxide, in the presence of sulfuric acid, to form phenol and acetone has been examined by adiabatic calorimetry. As expected, acid can catalyze cumene hydroperoxide reaction at temperatures below that of thermally-induced decomposition. At elevated acid concentrations, reactivity is also observed at or below room temperature. The exhibited reactivity behavior is complex and is significantly affected by the presence of other species (including the products). Several reaction models have been explored to explain the behavior and these are discussed.

The importance of physiological ecology in conservation biology.

Many of the threats to the persistence of populations of sensitive species have physiological or pathological mechanisms, and those mechanisms are best understood through the inherently integrative discipline of physiological ecology. The desert tortoise was listed under the Endangered Species Act largely due to a newly recognized upper respiratory disease thought to cause mortality in individuals and severe declines in populations. Numerous hypotheses about the threats to the persistence of desert tortoise populations involve acquisition of nutrients, and its connection to stress and disease. The nutritional wisdom hypothesis posits that animals should forage not for particular food items, but instead, for particular nutrients such as calcium and phosphorus used in building bones. The optimal foraging hypothesis suggests that, in circumstances of resource abundance, tortoises should forage as dietary specialists as a means of maximizing intake of resources. The optimal digestion hypothesis suggests that tortoises should process ingesta in ways that regulate assimilation rate. Finally, the cost-of-switching hypothesis suggests that herbivores, like the desert tortoise, should avoid switching food types to avoid negatively affecting the microbe community responsible for fermenting plants into energy and nutrients. Combining hypotheses into a resource acquisition theory leads to novel predictions that are generally supported by data presented here. Testing hypotheses, and synthesizing test results into a theory, provides a robust scientific alternative to the popular use of untested hypotheses and unanalyzed data to assert the needs of species. The scientific approach should focus on hypotheses concerning anthropogenic modifications of the environment that impact physiological processes ultimately important to population phenomena. We show how measurements of such impacts as nutrient starvation, can cause physiological stress, and that the endocrine mechanisms involved with stress can result in disease. Finally, our new syntheses evince a new hypothesis. Free molecules of the stress hormone corticosterone can inhibit immunity, and the abundance of "free corticosterone" in the blood (thought to be the active form of the hormone) is regulated when the corticosterone molecules combine with binding globulins. The sex hormone, testosterone, combines with the same binding globulin. High levels of testosterone, naturally occurring in the breeding season, may be further enhanced in populations at high densities, and the resulting excess testosterone may compete with binding globulins, thereby releasing corticosterone and reducing immunity to disease. This sequence could result in physiological and pathological phenomena leading to population cycles with a period that would be essentially impossible to observe in desert tortoise. Such cycles could obscure population fluctuations of anthropogenic origin.

The reactivity of 1,3-butadiene with butadiene-derived popcorn polymer.

Adiabatic calorimetry performed on butadiene-derived popcorn polymer samples from industrial facilities has revealed exothermic behavior accompanied by non-condensible gas production, indicative of possible decomposition, at elevated temperatures. In the presence of low concentrations of 1,3-butadiene, reactivity is observed at temperatures of 60-70 degrees C; that is, 20-30 degrees C below those usually seen for butadiene alone. Once the butadiene is consumed, the reaction behavior reverts to that of the popcorn polymer alone. At higher butadiene concentrations, the low temperature reaction persists, eventually merging with typical butadiene behavior. The butadiene reactivity with popcorn polymer is attributed to polymerization reaction at free radical sites in the popcorn polymer. Different popcorn polymer samples exhibit distinct extents of reactivity, presumably depending on the nature and concentration of the free radical sites and the structure of the material. Uninhibited butadiene exposed to 100 psia air, which may act to generate peroxide species, shows a small, additional exotherm around 50-80 degrees C. Contact of butadiene with lauroyl peroxide, providing free radicals upon decomposition, generates an exotherm at temperatures as low as 60 degrees C.

Linker-assisted immunoassay and liquid chromatography/mass spectrometry for the analysis of glyphosate.

A novel, sensitive, linker-assisted enzyme-linked immunosorbent assay (L'ELISA) was compared to on-line solid-phase extraction (SPE) with high-performance liquid chromatography/mass spectrometry (HPLC/MS) for the analysis of glyphosate in surface water and groundwater samples. The L'ELISA used succinic anhydride to derivatize glyphosate, which mimics the epitotic attachment of glyphosate to horseradish peroxidase hapten. Thus, L'ELISA recognized the derivatized glyphosate more effectively (detection limit of 0.1 microg/L) and with increased sensitivity (10-100 times) over conventional ELISA and showed the potential for other applications. The precision and accuracy of L'ELISA then was compared with on-line SPE/HPLC/MS, which detected glyphosate and its degradate derivatized with 9-fluorenylmethyl chloroformate using negative-ion electrospray (detection limit 0.1 microg/ L, relative standard deviation +/- 15%). Derivatization efficiency and matrix effects were minimized by adding an isotope-labeled glyphosate (2-13C15N). The accuracy of L'EUSA gave a false positive rate of 18% between 0.1 and 1.0 microg/L and a false positive rate of only 1% above 1.0 microg/L The relative standard deviation was +/- 20%. The correlation of L'ELISA and HPLC/MS for 66 surface water and groundwater samples was 0.97 with a slope of 1.28, with many detections of glyphosate and its degradate in surface water but not in groundwater.

Incidence of congenital rubella syndrome at a hospital serving a predominantly Hispanic population, El Paso, Texas.

OBJECTIVE: The current epidemiology of rubella reveals an increase in the number of cases among adult Hispanics and an increase in the number of congenital rubella syndrome (CRS) cases among infants of Hispanic mothers. Recent rubella outbreaks have occurred primarily among adult Hispanics, many of whom are foreign-born natives of countries where rubella vaccination is not routine or has only recently been implemented. The objective of this study was to estimate the incidence of CRS in a hospital serving a predominantly Hispanic population. METHODS: Hospital charts of infants <1 year old discharged between January 1, 1994 and December 31, 1996 with International Classification of Diseases, Ninth Revision (ICD-9) discharge codes consistent with CRS were reviewed; we looked for cataracts, deafness, congenital heart defects, dermal erythropoiesis, microcephaly, meningoencephalitis, and other defects associated with CRS. We abstracted data on maternal and infant ethnicity, maternal age, gestational age, infants' birth weight, infants' clinical characteristics, and laboratory evaluation. Cases were categorized according to the Council of State and Territorial Epidemiologists' case classification for CRS. RESULTS: Of the 182 infants with 1 or more ICD-9 codes consistent with CRS, 6 (3.3%) met either the confirmed or probable case definition for CRS. Two infants met the definition for confirmed CRS. Although laboratory tests for rubella immunoglobulin M antibodies were positive for both of these infants, only 1 of the cases had been reported to the state health department. Four other infants had clinical presentations that met the definition for a probable case. One of these had been tested for rubella immunoglobulin M antibodies, and the test was negative. The other 3 had not been tested. The rate of infants meeting the definition of confirmed and probable CRS was 3.1 per 10 000 hospital births. All confirmed and probable cases were among infants born to Hispanic mothers. Maternal country of origin was Mexico for the 2 confirmed cases and 1 of the probable cases, and unknown for the remaining 3 probable cases. CONCLUSION: The rate of confirmed and probable CRS among infants in this predominantly Hispanic population is higher than the reported rate in the United States in the vaccine era, which has been reported to range from approximately 0.01-0.08 per 10 000 live births. These findings indicate a need for heightened awareness of CRS among physicians who serve populations at risk for rubella. Physicians should report all confirmed and probable CRS cases to the state health department. The lack of appropriate laboratory testing in 3 infants with probable CRS indicates that physicians should consider a diagnosis of CRS in infants with some signs consistent with CRS, particularly in areas serving high numbers of individuals at risk for rubella.

Congeners of N(alpha)-acetyl-L-cysteine but not aminoguanidine act as neuroprotectants from the lipid peroxidation product 4-hydroxy-2-nonenal.

Increased generation of neurotoxic lipid peroxidation products is proposed to contribute to the pathogenesis of Alzheimer's disease (AD). Current antioxidant therapies are directed at limiting propagation of brain lipid peroxidation. Another approach would be to scavenge the reactive aldehyde products of lipid peroxidation. N(alpha)-acetyl-L-cysteine (NAC) and aminoguanidine (AG) react rapidly and irreversibly with 4-hydroxy-2-nonenal (HNE) in vitro, and both have been proposed as potential scavengers of HNE in biological systems. We have compared NAC, AG, and a series of congeners as scavengers of HNE and as neuroprotectants from HNE. Our results showed that while both NAC and AG had comparable chemical reactivity with HNE, only NAC and its congeners were able to block HNE-protein adduct formation in vitro and in neuronal cultures. Moreover, NAC and its congeners, but not AG, effectively protected brain mitochondrial respiration and neuronal microtubule structure from the toxic effects of HNE. We conclude that NAC and its congeners, but not AG, may act as neuroprotectants from HNE.

Unanticipated consequences: a comparison of expected and actual retirement timing among older women.

The present study adds to the growing body of literature on women and retirement by means of a comparative analysis of the factors associated with anticipated retirement timing (among pre-retirees) and actual retirement timing (among retirees). Adopting a political economy of aging perspective, we argue that socially-structured patterns of gender inequality related to women's multiple roles across the life course affect patterns of retirement timing. Specifically, we hypothesize that the gendered nature of women's work-retirement decision-making is unanticipated during pre-retirement years. Logistic regression analyses are performed on data drawn from a sample of 275 women aged 45 and older living in the Vancouver area of British Columbia. A central finding is that while actual timing of retirement is affected by family caregiving responsibilities and by health/stress factors, pre-retirees do not perceive these to be important in their own expected retirement timing. Implications for social policy, education, and women's financial and psychological well-being in old age are elaborated.

Analysis of selected herbicide metabolites in surface and ground water of the United States.

One of the primary goals of the US Geological Survey (USGS) Laboratory in Lawrence, Kansas, is to develop analytical methods for the analysis of herbicide metabolites in surface and ground water that are vital to the study of herbicide fate and degradation pathways in the environment. Methods to measure metabolite concentrations from three major classes of herbicides--triazine, chloroacetanilide and phenyl-urea--have been developed. Methods for triazine metabolite detection cover nine compounds: six compounds are detected by gas chromatography/mass spectrometry; one is detected by high-performance liquid chromatography with diode-array detection; and eight are detected by liquid chromatography/mass spectrometry. Two metabolites of the chloroacetanilide herbicides--ethane sulfonic acid and oxanilic acid--are detected by high-performance liquid chromatography with diode-array detection and liquid chromatography/mass spectrometry. Alachlor ethane sulfonic acid also has been detected by solid-phase extraction and enzyme-linked immunosorbent assay. Six phenylurea metabolites are all detected by liquid chromatography/mass spectrometry; four of the six metabolites also are detected by gas chromatography/mass spectrometry. Additionally, surveys of herbicides and their metabolites in surface water, ground water, lakes, reservoirs, and rainfall have been conducted through the USGS laboratory in Lawrence. These surveys have been useful in determining herbicide and metabolite occurrence and temporal distribution and have shown that metabolites may be useful in evaluation of non-point-source contamination.

Detection of persistent organic pollutants in the Mississippi Delta using semipermeable membrane devices.

From semipermeable membrane devices (SPMDs) placed in five Mississippi Delta streams in 1996 and 1997, the persistent organic pollutants (POPs) aldrin, chlordane, DCPA, DDT, dieldrin, endrin, heptachlor, mirex, nonachlor, and toxaphene were detected. In addition, the insecticides chlorpyriphos, endosulfan, and hexachlorocyclohexanes were detected. Two low-solubility herbicides not detected commonly in surface water, pendimethalin and trifluralin, were also detected.

Functional status outcomes of patients with a coronary artery bypass graft over time.

OBJECTIVE: To examine functional status outcomes among patients with a coronary artery bypass graft (CABG) over time (ie, at baseline; 3 months, 6 months, and 12 months after surgery) and the impact of selected patient characteristics (ie, age, sex, comorbidities, and cardiac rehabilitation participation) on functional outcomes. DESIGN: A prospective, repeated-measures design was used to examine functional status in patients with a CABG over time. SETTING: A midwestern community hospital and regional cardiac referral center was the setting for enrolling patients with a CABG. OUTCOME MEASURES: Functional status outcomes were measured by using the Medical Outcomes Study (MOS) Short Form 36 (SF-36) and Modified 7-Day Activity instruments. METHODS: Baseline data were obtained by patient interview in the hospital setting after CABG surgery. At 3 months, 6 months, and 12 months after surgery, telephone interviews were conducted to administer research instruments. RESULTS: Baseline scores on 7 of the 8 subscales of the MOS SF-36 were significantly lower than at 3 months, 6 months, or 12 months after surgery. Role-emotional functioning baseline scores were not significantly lower than 3-month scores; however, baseline scores were significantly lower than 6-month and 12-month scores. Three-month subscale scores were also significantly lower than 6-month or 12-month scores except for the subscales measuring social and general health functioning. Functional status as measured by the Modified 7-Day Activity tool did not demonstrate any significant differences between 3-month, 6-month, or 12-month activity levels. There were no significant differences by age group on any of the 8 subscales of the MOS SF-36 instrument. Women and subjects with more than 1 comorbidity had a significantly lower preoperative level of physical functioning. Cardiac rehabilitation participants had lower preoperative scores on role-emotional functioning than subjects who were not in rehabilitation. CONCLUSION: Findings from this study can assist nurses and other health care workers to gain a perspective of the recovery and rehabilitation trajectory of patients with a CABG. The results of the study provide a basis for determining areas of functional limitations during recovery from CABG surgery. Study results can also be the foundation for evaluating outcomes of patients with a CABG when specific interventions (eg, pain management, psychosocial support, physical strengthening, fatigue management) are implemented during hospitalization, home recovery, and rehabilitation to target optimal psychosocial and physiologic functioning of patients with a CABG.