Background: By 2030, the global population of people older than 60 years is expected to be higher than the number of children under 10 years, resulting in major health and social care system implications worldwide. Without a supportive environment, whether social or built, diminished functional ability may arise in older people. Functional ability comprises an individual's intrinsic capacity and people's interaction with their environment enabling them to be and do what they value. Objectives: This evidence and gap map aims to identify primary studies and systematic reviews of health and social support services as well as assistive devices designed to support functional ability among older adults living at home or in other places of residence. Search Methods: We systematically searched from inception to August 2018 in: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL, PsycINFO, AgeLine, Campbell Library, ASSIA, Social Science Citation Index and Social Policy & Practice. We conducted a focused search for grey literature and protocols of studies (e.g., ProQuest Theses and Dissertation Global, conference abstract databases, Help Age, PROSPERO, Cochrane and Campbell libraries and ClinicalTrials.gov). Selection Criteria: Screening and data extraction were performed independently in duplicate according to our intervention and outcome framework. We included completed and on-going systematic reviews and randomized controlled trials of effectiveness on health and social support services provided at home, assistive products and technology for personal indoor and outdoor mobility and transportation as well as design, construction and building products and technology of buildings for private use such as wheelchairs, and ramps. Data Collection and Analysis:We coded interventions and outcomes, and the number of studies that assessed health inequities across equity factors. We mapped outcomes based on the International Classification of Function, Disability and Health (ICF) adapted categories: intrinsic capacities (body function and structures) and functional abilities (activities). We assessed methodological quality of systematic reviews using the AMSTAR II checklist. Main Results: After de-duplication, 10,783 records were screened. The map includes 548 studies (120 systematic reviews and 428 randomized controlled trials). Interventions and outcomes were classified using domains from the International Classification of Function, Disability and Health (ICF) framework. Most systematic reviews (n = 71, 59%) were rated low or critically low for methodological quality. The most common interventions were home-based rehabilitation for older adults (n = 276) and home-based health services for disease prevention (n = 233), mostly delivered by visiting healthcare professionals (n = 474). There was a relative paucity of studies on personal mobility, building adaptations, family support, personal support and befriending or friendly visits. The most measured intrinsic capacity domains were mental function (n = 269) and neuromusculoskeletal function (n = 164). The most measured outcomes for functional ability were basic needs (n = 277) and mobility (n = 160). There were few studies which evaluated outcome domains of social participation, financial security, ability to maintain relationships and communication. There was a lack of studies in low- and middle-income countries (LMICs) and a gap in the assessment of health equity issues. Authors' Conclusions: There is substantial evidence for interventions to promote functional ability in older adults at home including mostly home-based rehabilitation for older adults and home-based health services for disease prevention. Remotely delivered home-based services are of greater importance to policy-makers and practitioners in the context of the COVID-19 pandemic. This map of studies published prior to the pandemic provides an initial resource to identify relevant home-based services which may be of interest for policy-makers and practitioners, such as home-based rehabilitation and social support, although these interventions would likely require further adaptation for online delivery during the COVID-19 pandemic. There is a need to strengthen assessment of social support and mobility interventions and outcomes related to making decisions, building relationships, financial security, and communication in future studies. More studies are needed to assess LMIC contexts and health equity issues.

Replication is an essential part of the scientific method, yet replication of systematic reviews is too often overlooked, and done unnecessarily or poorly. Excessive replication (doing the same study repeatedly) is unethical and a cause of research wastage. This article provides consensus based guidance on when to replicate and not replicate systematic reviews.

This is a protocol for a Campbell Evidence and Gap Map. The objectives are to identify and assess the available evidence on health, social care and technological interventions to improve functional ability among older adults.

OBJECTIVES:To describe the level of need and divertibility of newly admitted nursing home residents, describe the factors that drive need, and describe the outcomes of residents across different levels of need. DESIGN:Retrospective cohort study. SETTING:A total of 640 publicly funded nursing homes (also known as long-term care facilities) in Ontario, Canada. PARTICIPANTS:All newly admitted residents between January 1, 2010 and March 1, 2012. MEASUREMENTS:We categorized residents into 36 groups based on different levels of (1) cognitive impairment, (2) difficulty in activities of daily living (ADL), (3) difficulty in instrumental ADLs, and (4) whether or not they had a caregiver at home. Residents were then categorized as having low, intermediate, or high needs; applying results from previous "Balance of Care" studies, we also captured the proportion who could have been cost-effectively diverted into the community. We then contrasted the characteristics of residents across the needs and divertible groupings, and compared 4 outcomes among these groups: hospital admissions, emergency department visits, mortality, and return to home. RESULTS:A population-level cohort of 64,105 incident admissions was captured. About two-thirds had great difficulty performing ADLs (65%) and had mild to severe cognitive impairment (66%); over 90% had great difficulty with instrumental ADLs. Just less than 50% of the new admissions were considered to be residents with high care needs (cognitively impaired with great ADL difficulty), while only 4.5% (2880 residents) had low care needs (cognition and ADL intact). Those with dementia (71.0%) and previous stroke (21.5%) were over-represented in the high needs group. Those that cannot be divertible to anywhere else but an institution with 24 hour nursing care comprised 41.3% (n = 26,502) of residents. Only 5.4% (n = 3483), based on community resources available, could potentially be cost-effectively diverted to the community. Those at higher needs experienced higher rates of mortality, higher total cost across all health sectors, and lower rates of return to home. CONCLUSIONS:The majority of those admitted into nursing homes have high levels of need (driven largely by dementia and stroke) and could not have their needs met cost-effectively elsewhere, suggesting that the system is at capacity. Caring for the long-term care needs of the aging population should consider the balance of investments in institution and community settings.

"Jonas Moore’s Mapp of the Great Levell of the Fenns, 1658. Accompanying text by Frances Willmoth and Elizabeth Stazicker." Imago Mundi, 70(1), pp. 135–136

We report a promoted sensitivity to 2‐chlorophenol (2‐CP) molecules of a fabricated back gated, interdigitated electrode field effect transistor based on separated semiconducting single‐walled carbon nanotubes (CNTFET). The origin of the interaction between the nanotubes that serve as channels across the source and drain contacts and organic volatile compound is suggested due to peculiarities gained after the nanotube separation technique. The semiconducting nanotubes that were used for building‐up the CNTFETs had an average diameter of 1.4 nm and have been separated by the efficient aqueous two‐phase extraction technique. The advantage of the technique is in the one‐step extraction of semiconducting type of conductivity nanotubes with high yield. Chlorophenols are widely studied due to the toxicity and hazardous health effects depending on the exposure. Previously chlorophenols were reported to be not interacting with pristine nanotubes. As prepared CNTFET device demonstrates a detection limit below 100 parts per million for the 2‐CP molecules with a reaction time of 150 s. CNTFET devices have good repeatability, low bias stress, and electron charge carrier mobility of 17.5 ± 0.1 cm2 (Vs)−1. We discuss possible physical mechanisms of the 2‐CP adsorption induced current drop and potential ways to improve sensitivity.

How to Make Relief More Accountable The global humanitarian system, already under considerable strain, will soon be tested as never before. In 2013, the gap between the funds available for humanitarian aid and estimated global needs reached $4.5 billion, leaving at least one-third of the demand unmet. The gap seems certain to widen, as key donors cut their contributions and humanitarian disasters grow more frequent and severe. Complex humanitarian emergencies, such as the war in Syria, have shown just how poorly the world is prepared to respond to human suffering on a large scale, despite considerable practice. The international community's response to last year's outbreak of Ebola in West Africa, for example, was slow off the mark and then stumbled, leaving everyone worried about future public health emergencies. Meanwhile, climate change has increased the destructive force of natural disasters, which fuel violence and put tremendous pressure on governments and aid agencies alike. And rapid urbanization, coupled with massive migration to coasts, has amplified the toll of such crises

Objectives: To establish if proprietary status (ie, for-profit or not-for-profit) is associated with mortality and hospitalizations among publicly funded long-term care (nursing) homes.Methods: We conducted a retrospective cohort study of new admissions in 640 publicly funded long-term care facilities in Ontario, Canada (384 for-profit, 256 not-for-profit). A population-based cohort of 53,739 incident admissions into long-term care facilities between January 1, 2010, and March 1, 2012, was observed. We measured adjusted rates of hospital admissions and mortality, per 1000 person-years (PY) of follow-up, among for-profit and not-for-profit facilities at 3, 6, and 12 months postadmission. Rates were measured postadmission and until discharge or death, whichever came first.Results: One year after admission and before discharge, 11.7% of residents died and 25.7% had at least one hospitalization. After 12 months of follow-up, residents in for-profit facilities had a hospitalization rate of 462 per 1000 PY versus 358 per 1000 PY in not-for-profit facilities. During this period, the crude mortality rate in for-profit facilities was 208 per 1000 PY versus 185 per 1000 PY in not-for-profit facilities. At 3, 6, and 1 year after admission, for-profit facilities had an adjusted hazard ratio of 1.36 (95% confidence interval [CI] 1.28-1.43), 1.33 (95% CI 1.27-1.39), and 1.25 (95% CI 1.21-1.30) for hospitalizations and hazards of 1.20 (95% CI 1.11-1.29), 1.16 (95% CI 1.09-1.24), and 1.10 (95% CI 1.05-1.16) for mortality, respectively.Conclusions: Publicly funded for-profit facilities have significantly higher rates of both mortality and hospital admissions. (C) 2015 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Background Coordinated and appropriate health care across sectors is an ongoing challenge, especially at the end-of-life. Population-level data on end-of-life health care use and cost, however, are seldom reported across a comprehensive array of sectors. Such data will identify the level of care being provided and areas where care can be optimized. Methods This retrospective cohort study identified all deaths in Ontario from April 1, 2010 to March 31, 2013. Using population-based health administrative databases, we examined health care use and cost in the last year of life. Results Among 264,755 decedents, the average health care cost in the last year of life was $53,661 (Quartile 1-Quartile 3: $19,568-$66,875). The total captured annual cost of $4.7 billion represents approximately 10% of all government-funded health care. Inpatient care, incurred by 75% of decedents, contributed 42.9% of total costs ($30,872 per user). Physician services, medications/devices, laboratories, and emergency rooms combined to less than 20% of total cost. About one-quarter used long-term-care and 60% used home care ($34,381 and $7,347 per user, respectively). Total cost did not vary by sex or neighborhood income quintile, but were less among rural residents. Costs rose sharply in the last 120 days prior to death, predominantly for inpatient care. Interpretation This analysis adds new information about the breadth of end-of-life health care, which consumes a large proportion of Ontario’s health care budget. The cost of inpatient care and long-term care are substantial. Introducing interventions that reduce or delay institutional care will likely reduce costs incurred at the end of life.

Evolution has endowed all humans with a continuum of innate, hard-wired, automatically activated defense behaviors, termed the defense cascade. Arousal is the first step in activating the defense cascade; flight or fight is an active defense response for dealing with threat; freezing is a flight-or-fight response put on hold; tonic immobility and collapsed immobility are responses of last resort to inescapable threat, when active defense responses have failed; and quiescent immobility is a state of quiescence that promotes rest and healing. Each of these defense reactions has a distinctive neural pattern mediated by a common neural pathway: activation and inhibition of particular functional components in the amygdala, hypothalamus, periaqueductal gray, and sympathetic and vagal nuclei. Unlike animals, which generally are able to restore their standard mode of functioning once the danger is past, humans often are not, and they may find themselves locked into the same, recurring pattern of response tied in with the original danger or trauma. Understanding the signature patterns of these innate responses--the particular components that combine to yield the given pattern of defense-is important for developing treatment interventions. Effective interventions aim to activate or deactivate one or more components of the signature neural pattern, thereby producing a shift in the neural pattern and, with it, in mind-body state. The process of shifting the neural pattern is the necessary first step in unlocking the patient's trauma response, in breaking the cycle of suffering, and in helping the patient to adapt to, and overcome, past trauma.

Rapid reviews have attained increasing recognition as a product sought after by decision makers, demonstrated by the February 2015 Rapid Review Summit (https://www.cadth.ca/cadth-summit-series) convened by the Canadian Association for Drugs and Technology for Health (CADTH), which celebrated 10 years of conducting rapid health technology assessments this year. As another example, a recent policy dialogue concluded that there is sufficient appetite in Canada to explore a sustainable rapid response service for decision makers in Canada [ [1] Wilson M.G. Lavis J.N. Gauvin F.P. Developing a rapid-response program for health system decision-makers in Canada: findings from an issue brief and stakeholder dialogue. Syst Rev. 2015; 4: 25 Crossref PubMed Scopus (24) Google Scholar ]. Despite their popularity with decision makers and interest in rapid reviews, there is little known about their methods, risk of bias, or utility for decision making. A taxonomy of rapid reviews links report types and methods to specific decision-making contextsJournal of Clinical EpidemiologyVol. 68Issue 12PreviewDescribe characteristics of rapid reviews and examine the impact of methodological variations on their reliability and validity. Full-Text PDF

OBJECTIVES:The introduction of endoscopic saphenous vein harvesting (ESVH) has been reported to decrease saphenectomy-associated wound pain and infection, compared with the traditional open conventional saphenous vein harvesting (OCSVH) technique. Despite all these benefits, the rate of adoption among surgeons has been variable. Criticism of this technique centres on the risk of injury at the time of vein harvest with its potential detrimental effect on structural viability and long-term patency. The aim of our study is to investigate the endothelial preservation of saphenous vein grafts harvested by various extraction methods.METHODS:A prospective, observational study of 30 human saphenous vein grafts was performed to evaluate endothelial preservation by haematoxylin-eosin and CD 31 staining methods. The saphenous vein was harvested endoscopically either by an open tunnel (OT-ESVH), closed tunnel (CT-ESVH) or an OCSVH harvesting technique. Research samples were collected without distension to avoid intraluminal dilatation and endothelial disruption. Both haematoxylin-eosin and immunohistochemistry slides were imaged by a high-resolution slide-scanning system.RESULTS:Haematoxylin-eosin staining of the CT-ESVH group showed mostly preserved endothelium (P = 0.398) with some endothelial stretching (P = 1.0) and no endothelial detachment (P = 0.197). The OT-ESVH group showed marked endothelial stretching (P = 0.053). However, the OCSVH group showed significantly more endothelial detachment than the endoscopic groups (P = 0.01). The mean grading score of immunohistochemistry using the CD 31 antibody was much lower in the OT-ESVH group (1.6 ± 0.84, P = 0.009), showing more poorly preserved endothelial cells than the CT-ESVH and OCSVH groups.CONCLUSIONS:We observed more endothelial stretching in the OT-ESVH group, which in our opinion, was due to lack of subcutaneous tissue separation, poor visualization and traction stresses across the wall of the saphenous vein. However, the OCSVH method revealed poor endothelial protection with areas of endothelial detachment, not observed with both endoscopic techniques. Interestingly, most preserved endothelium was found in the CT-ESVH group, which was previously known to be associated with worse graft patency.

The need to provide a professionalization process for the humanitarian workforce is well established. Current competency-based curricula provided by existing academically affiliated training centers in North America, the United Kingdom, and the European Union provide a route toward certification. Simulation exercises followed by timely evaluation is one way to mimic the field deployment process, test knowledge of core competences, and ensure that a competent workforce can manage the inevitable emergencies and crises they will face. Through a 2011 field-based exercise that simulated a humanitarian crisis, delivered under the auspices of the World Health Organization (WHO), a competency-based framework and evaluation tool is demonstrated as a model for future training and evaluation of humanitarian providers.

Providing a critical introduction to the notion of humanitarianism in global politics, tracing the concept from its origins to the twenty-first century, this book examines how the so called international community works in response to humanitarian crises and the systems that bind and divide them. By tracing the history on international humanitarian action from its early roots through the birth of the Red Cross to the beginning of the UN, Peter Walker and Daniel G. Maxwell examine the challenges humanitarian agencies face, from working alongside armies and terrorists to witnessing genocide. They argue that humanitarianism has a vital future, but only if those practicing it choose to make it so. Topics covered include: the rise in humanitarian action as a political tool the growing call for accountability of agencies the switch of NGOs from bit players to major trans-national actors the conflict between political action and humanitarian action when it comes to addressing causes as well as symptoms of crisis. This book is essential reading for anyone with an interest in international human rights law, disaster management and international relations.

Both US foreign policy and global attention attest to the strategic, economic, and political importance of Asia. Yet, the region faces urgent challenges that must be addressed if it is to remain stable and prosperous. The densely populated countries of the Asia-Pacific are beleaguered by poverty, population displacement, decreasing access to potable water and adequate sanitation, and high rates of disease morbidity and mortality. New and reemerging diseases known to have originated in Asia over the past decades have spread globally by international trade, tourism, worker migration, and agricultural exportation. Unremitting naturally occurring and man-made disasters have strained Southeast Asia's already fragile disaster and public health response infrastructures and the essential services they provide (eg, surveillance, vaccination, maternal and child health, and mental health programs). Following disasters, governments often contract with the broader humanitarian community (eg, indigenous and international NGOs) and seek the assistance of militaries to provide essential services. Yet, their roles and capabilities in addressing acute and chronic health issues in the wake of complex disasters remain unclear. Current mechanisms of nation-state and outside organization interaction, including dissimilar operational platforms, may limit true partnership on behalf of the health security mission. Additionally, concerns regarding skill sets and the lack of standards-based training raise questions about the balance between developing internal response capabilities and professionalizing external, deployable resources. Both the mega-disasters that are forecast for the region and the global health security threats that are expected to emanate from them require an increased focus on improving the Asia-Pacific's emergency preparedness and response posture.

Humanitarian aid remains largely driven by anecdote rather than by evidence. The contemporary humanitarian system has significant weaknesses with regard to data collection, analysis, and action at all stages of response to crises involving armed conflict or natural disaster. This paper argues that humanitarian actors can best determine and respond to vulnerabilities and needs if they use sex- and age-disaggregated data (SADD) and gender and generational analyses to help shape their assessments of crises-affected populations. Through case studies, the paper shows how gaps in information on sex and age limit the effectiveness of humanitarian response in all phases of a crisis. The case studies serve to show how proper collection, use, and analysis of SADD enable operational agencies to deliver assistance more effectively and efficiently. The evidence suggests that the employment of SADD and gender and generational analyses assists in saving lives and livelihoods in a crisis.