One- and two-year change in body composition as measured by DXA in a population-based cohort of older men and women.

Changing body composition has been suggested as a pathway to explain age-related functional decline. No data are available on the expected changes in body composition as measured by dual-energy X-ray absorptiometry (DXA) in a population-based cohort of older persons. Body composition data at baseline, 1-yr follow-up, and 2-yr follow-up was measured by DXA in 2,040 well-functioning black and white men and women aged 70-79 yr, participants of the Health, Aging, and Body Composition Study. After 2 yr, a small decline in total body mass was observed (men: -0.3%, women: -0.4%). Among men, fat-free mass and appendicular lean soft tissue mass (ALST) decreased by -1.1 and -0.8%, respectively, which was masked by a simultaneous increase in total fat mass (+2.0%). Among women, a decline in fat-free mass was observed after 2 yr only (-0.6%) with no change in ALST and body fat mass. After 2 yr, the decline in ALST was greater in blacks than whites. Change in total body mass was associated with change in ALST (r = +0.58 to +0.70; P < 0.0001). Among participants who lost total body mass, men lost relatively more ALST than women, and blacks lost relatively more ALST than whites. In conclusion, the mean change in body composition after a 1- to 2-yr follow-up was 1-2% with a high interindividual variability. Loss of ALST was greater in men compared with women, and greater in blacks compared with whites, suggesting that men and blacks may be more prone to muscle loss.     

QDR 4500A DXA overestimates fat-free mass compared with criterion methods.

This study evaluated the accuracy with which the dual-energy X-ray absorptiometer (Hologic QDR 4500A) measured fat-free mass (FFM), fat mass (FM), and hydration of FFM. In a study of 58 men and women (ages 70-79 yr), the QDR 4500A was found to provide a systematically higher estimate of FFM and lower estimate of FM than a four-component model of body composition. A correction factor from this study was developed and applied to two other samples (n = 13 and 37). We found mean corrected levels of FFM and FM to be equivalent to that obtained by the four-component model or total body water. In addition, the hydration of the corrected FFM was closer to the established hydration level in adult samples and that obtained from the four-component model. These findings suggest that the current calibration of the fan-beam system of the Hologic QDR 4500A provides an overestimate of FFM and underestimate of FM compared with reference methods.     

Larger Thigh and Hip Circumferences Are Associated with Better Glucose Tolerance: The Hoorn Study

Objective: A higher waist‐to‐hip ratio, which can be due to a higher waist circumference, a lower hip circumference, or both, is associated with higher glucose levels and incident diabetes. A lower hip circumference could reflect either lower fat mass or lower muscle mass. Muscle mass might be better reflected by thigh circumference. The aim of this study was to investigate the contributions of thigh and hip circumferences, independent of waist circumference, to measures of glucose metabolism. Research Methods and Procedures: For this cross‐sectional study we used baseline data from the Hoorn Study, a population‐based cohort study of glucose tolerance among 2484 men and women aged 50 to 75. Glucose tolerance was assessed by a 75‐g oral glucose tolerance test; hemoglobin A_1c and fasting insulin were also measured. Anthropometric measurements included body mass index (BMI) and waist, hip, and thigh circumferences. Results: Stratified analyses and multiple linear regression showed that after adjustment for age, BMI, and waist circumference, thigh circumference was negatively associated with markers of glucose metabolism in women, but not in men. Standardized β values in women were ?0.164 for fasting, ?0.206 for post‐load glucose, ?0.190 for hemoglobin A_1c (all p < 0.001), and ?0.065 for natural log insulin levels (p = 0.061). Hip circumference was negatively associated with markers of glucose metabolism in both sexes (standardized betas ranging from ?0.093 to ?0.296, p < 0.05) except for insulin in men. Waist circumference was positively associated with glucose metabolism. Discussion: Thigh circumference in women and hip circumference in both sexes are negatively associated with markers of glucose metabolism independently of the waist circumference, BMI, and age. Both fat and muscle tissues may contribute to these associations.     

The RapGEF PDZ-GEF2 is required for maturation of cell-cell junctions

The small G-protein Rap1 is a critical regulator of cell-cell contacts and is activated by the remodeling of adherens junctions. Here we identify the Rap1 guanine nucleotide exchange factor PDZ-GEF2 as an upstream activator of Rap1 required for the maturation of adherens junctions in the lung carcinoma cells A549. Knockdown of PDZ-GEF2 results in the persistence of adhesion zippers at cell-cell contacts. Activation of Rap1A rescues junction maturation in absence of PDZ-GEF2, demonstrating that Rap1A is downstream of PDZ-GEF2 in this process. Moreover, depletion of Rap1A, but not Rap1B, impairs adherens junction maturation. siRNA for PDZ-GEF2 also lowers the levels of E-cadherin, an effect that can be mimicked by Rap1B, but not Rap1A siRNA. Since junctions in Rap1B depleted cells have a mature appearance, these data suggest that PDZ-GEF2 activates Rap1A and Rap1B to perform different functions. Our results present the first direct evidence that PDZ-GEF2 plays a critical role in the maturation of adherens junctions.     

Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study

Objective To assess the cost effectiveness of community based occupational therapy compared with usual care in older patients with dementia and their care givers from a societal viewpoint.Design Cost effectiveness study alongside a single blind randomised controlled trial.Setting Memory clinic, day clinic of a geriatrics department, and participants’ homes.Patients 135 patients aged ≥65 with mild to moderate dementia living in the community and their primary care givers.Intervention 10 sessions of occupational therapy over five weeks, including cognitive and behavioural interventions, to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision.Main outcome measures Incremental cost effectiveness ratio expressed as the difference in mean total care costs per successful treatment (that is, a combined patient and care giver outcome measure of clinically relevant improvement on process, performance, and competence scales) at three months after randomisation. Bootstrap methods used to determine confidence intervals for these measures.Results The intervention cost €1183 (£848, $1738) (95% confidence interval €1128 (£808, $1657) to €1239 (£888, $1820)) per patient and primary care giver unit at three months. Visits to general practitioners and hospital doctors cost the same in both groups but total mean costs were €1748 (£1279, $2621) lower in the intervention group, with the main cost savings in informal care. There was a significant difference in proportions of successful treatments of 36% at three months. The number needed to treat for successful treatment at three months was 2.8 (2.7 to 2.9).Conclusions Community occupational therapy intervention for patients with dementia and their care givers is successful and cost effective, especially in terms of informal care giving.     

Complementary systems for understanding action intentions

How humans understand the intention of others' actions remains controversial. Some authors have suggested that intentions are recognized by means of a motor simulation of the observed action with the mirror-neuron system [1-3]. Others emphasize that intention recognition is an inferential process, often called "mentalizing" or employing a "theory of mind," which activates areas well outside the motor system [4-6]. Here, we assessed the contribution of brain regions involved in motor simulation and mentalizing for understanding action intentions via functional brain imaging. Results show that the inferior frontal gyrus (part of the mirror-neuron system) processes the intentionality of an observed action on the basis of the visual properties of the action, irrespective of whether the subject paid attention to the intention or not. Conversely, brain areas that are part of a "mentalizing" network become active when subjects reflect about the intentionality of an observed action, but they are largely insensitive to the visual properties of the observed action. This supports the hypothesis that motor simulation and mentalizing have distinct but complementary functions for the recognition of others' intentions.     

The Effect of Chemical Information on the Spatial Distribution of Fruit Flies: II Parameterization,Calibration, and Sensitivity

In a companion paper (Lof et al., in Bull. Math. Biol., 2008), we describe a spatio-temporal model for insect behavior. This model includes chemical information for finding resources and conspecifics. As a model species, we used Drosophila melanogaster, because its behavior is documented comparatively well. We divide a population of Drosophila into three states: moving, searching, and settled. Our model describes the number of flies in each state, together with the concentrations of food odor and aggregation pheromone, in time and in two spatial dimensions. Thus, the model consists of 5 spatio-temporal dependent variables, together with their constituting relations. Although we tried to use the simplest submodels for the separate variables, the parameterization of the spatial model turned out to be quite difficult, even for this well-studied species. In the first part of this paper, we discuss the relevant results from the literature, and their possible implications for the parameterization of our model. Here, we focus on three essential aspects of modeling insect behavior. First, there is the fundamental discrepancy between the (lumped) measured behavioral properties (i.e., fruit fly displacements) and the (detailed) properties of the underlying mechanisms (i.e., dispersivity, sensory perception, and state transition) that are adopted as explanation. Detailed quantitative studies on insect behavior when reacting to infochemicals are scarce. Some information on dispersal can be used, but quantitative data on the transition between the three states could not be found. Second, a dose-response relation as used in human perception research is not available for the response of the insects to infochemicals; the behavioral response relations are known mostly in a qualitative manner, and the quantitative information that is available does not depend on infochemical concentration. We show how a commonly used Michaelis–Menten type dose-response relation (incorporating a saturation effect) can be adapted to the use of two different but interrelated stimuli (food odors and aggregation pheromone). Although we use all available information for its parameterization, this model is still overparameterized. Third, the spatio-temporal dispersion of infochemicals is hard to model: Modeling turbulent dispersal on a length scale of 10 m is notoriously difficult. Moreover, we have to reduce this inherently three-dimensional physical process to two dimensions in order to fit in the two-dimensional model for the insects. We investigate the consequences of this dimension reduction, and we demonstrate that it seriously affects the parameterization of the model for the infochemicals. In the second part of this paper, we present the results of a sensitivity analysis. This sensitivity analysis can be used in two manners: firstly, it tells us how general the simulation results are if variations in the parameters are allowed, and secondly, we can use it to infer which parameters need more precise quantification than is available now. It turns out that the short term outcome of our model is most sensitive to the food odor production rate and the fruit fly dispersivity. For the other parameters, the model is quite robust. The dependence of the model outcome with respect to the qualitative model choices cannot be investigated with a parameter sensitivity analysis. We conclude by suggesting some experimental setups that may contribute to answering this question.     

Validation of hamstrings musculoskeletal modeling by calculating peak hamstrings length at different hip angles

Accurate estimates of hamstrings lengths are useful, for example, to facilitate planning for surgical lengthening of the hamstrings in patients with cerebral palsy. In this study, three models used to estimate hamstrings length (M1: Delp, M2: Klein Horsman, M3: Hawkins and Hull) were evaluated. This was done by determining whether the estimated peak semitendinosus, semimembranosus and biceps femoris long head lengths, as measured in eight healthy subjects, were constant over a range of hip and knee angles. The estimated peak hamstrings length depended on the model that was used, even with length normalized to length in anatomical position. M3 estimated shorter peak lengths than M1 and M2, showing that more advanced models (M1 and M2) are more similar. Peak hamstrings length showed a systematic dependence on hip angle for biceps femoris in M2 and for semitendinosus in M3, indicating that either the length was not correctly estimated, or that the specific muscle did not limit the movement. Considerable differences were found between subjects. Large inter-individual differences indicate that modeling results for individual subjects should be interpreted with caution. Testing the accuracy of modeling techniques using in vivo data, as performed in this study, can provide important insights into the value and limitations of musculoskeletal models.     

Implementation fidelity trajectories of a health promotion program in multidisciplinary settings: managing tensions in rehabilitation care

Background

Although the importance of evaluating implementation fidelity is acknowledged, little is known about heterogeneity in fidelity over time. This study aims to generate insight into the heterogeneity in implementation fidelity trajectories of a health promotion program in multidisciplinary settings and the relationship with changes in patients’ health behavior.

Methods

This study used longitudinal data from the nationwide implementation of an evidence-informed physical activity promotion program in Dutch rehabilitation care. Fidelity scores were calculated based on annual surveys filled in by involved professionals (n?=?±?70). Higher fidelity scores indicate a more complete implementation of the program’s core components. A hierarchical cluster analysis was conducted on the implementation fidelity scores of 17 organizations at three different time points. Quantitative and qualitative data were used to explore organizational and professional differences between identified trajectories. Regression analyses were conducted to determine differences in patient outcomes.

Results

Three trajectories were identified as the following: ‘stable high fidelity’ (n?=?9), ‘moderate and improving fidelity’ (n?=?6), and ‘unstable fidelity’ (n?=?2). The stable high fidelity organizations were generally smaller, started earlier, and implemented the program in a more structured way compared to moderate and improving fidelity organizations. At the implementation period’s start and end, support from physicians and physiotherapists, professionals’ appreciation, and program compatibility were rated more positively by professionals working in stable high fidelity organizations as compared to the moderate and improving fidelity organizations (p?<?.05). Qualitative data showed that the stable high fidelity organizations had often an explicit vision and strategy about the implementation of the program. Intriguingly, the trajectories were not associated with patients’ self-reported physical activity outcomes (adjusted model β?=???651.6, t(613)?=???1032, p?=?.303).

Conclusions

Differences in organizational-level implementation fidelity trajectories did not result in outcome differences at patient-level. This suggests that an effective implementation fidelity trajectory is contingent on the local organization’s conditions. More specifically, achieving stable high implementation fidelity required the management of tensions: realizing a localized change vision, while safeguarding the program’s standardized core components and engaging the scarce physicians throughout the process. When scaling up evidence-informed health promotion programs, we propose to tailor the management of implementation tensions to local organizations’ starting position, size, and circumstances.

Trial registration

The Netherlands National Trial Register NTR3961. Registered 18 April 2013.

     

Monocyte-chemoattractant-protein-1-mediated migration of human monocytes towards blasts from patients with acute myeloid leukemia

 Purpose: In the present study the possible clinical relevance of monocyte chemoattractant protein (MCP)-1 in patients with acute myeloid leukemia (AML) was established. Methods: The pattern of migration of human monocytes towards the supernatants of blasts from 15 patients with AML was studied and the role of MCP-1, produced by these blasts, was assessed. Results: In 4 patients (group 1) the amount of monocyte migration was low and not inhibited by the addition of anti-hMCP-1. In 11 patients, the amount of monocyte migration was high; after addition of anti-hMCP-1, monocyte migration was either completely (8 patients, group 2), or partly or not (3 patients, group 3) inhibited to the level of chemokinesis. In groups 1 and 2, there was a good correlation (r=0.67) between the concentration of MCP-1 in the supernatants and the amount of monocyte migration. In group 3, such a correlation was not evident, suggesting that another chemokine might be involved or MCP-1 function was impaired by an unknown substance. Finally, measurements of MCP-1 during culture of AML blasts showed that the time at which maximal amounts of MCP-1 are produced differs between the AML samples. Conclusions: AML blasts produce different amounts of MCP-1, which plays an important role in monocyte migration towards most AML blasts. Therefore, in the context of adoptive immunotherapy, MCP-1 might be involved in future tumor vaccination programmes using autologous MCP-1-transfected irradiated AML blasts. Received: 4 May 2000 / Accepted: 26 October 2000