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WOS: 000341167400005, PubMed ID: 24997720, The prevalence of malnutrition ranges up to 50% among patients in hospitals worldwide, and diseaserelated malnutrition is all too common in long-term and other health care settings as well. Regrettably, the numbers have not improved over the past decade. The consequences of malnutrition are serious, including increased complications (pressure ulcers, infections, falls), longer hospital stays, more frequent readmissions, increased costs of care, and higher risk of mortality. Yet disease-related malnutrition still goes unrecognized and undertreated. To help improve nutrition care around the world, the feedM.E. (Medical Education) Global Study Group, including members from Asia, Europe, the Middle East, and North and South America, defines a Nutrition Care Pathway that is simple and can be tailored for use in varied health care settings. The Pathway recommends screen, intervene, and supervene: screen patients' nutrition status on admission or initiation of care, intervene promptly when needed, and supervene or follow-up routinely with adjustment and reinforcement of nutrition care plans. This article is a call-to-action for health caregivers worldwide to increase attention to nutrition care. (C) 2014 AMDA - The Society for Post-Acute and Long-Term Care Medicine., Abbott NutritionAbbott Laboratories, The feedM.E. Study Group received a grant from Abbott Nutrition to fund the international malnutrition manuscript project; this grant was used for operational activities and for funding the Rome meeting of the feedM.E. Study Group in January 2014. Members of the group did not receive payment for work on the document.

This study describes the design and development of multifuctional poly(amidoamine)s (PAAs) capable to form self-assembled nanocomplexes with peptides and proteins, as functional bioresponsive vectors for protein delivery to targeting cells in vitro and in vivo. The representative examples of this novel family of water-soluble PAAs have very promising properties to function as vectors for highly potent and non-toxic intracellular protein delivery. The synthesis procedure of these polymers is compatible with the use of a variety of functionalized amine monomers, allowing large variation in the structure of the polymers, and tuning of the chemical and biophysical properties that are of significance for efficient protein delivery. We have designed PAAs able to form nanosized complexes at neutral pH by a self-assembly process with model proteins, such as β-galactosidase, lysozyme, human serum albumin, ovalbumin, p24 and human insulin, and a model peptide for brain therapy. These nanocomplexes are stable at physiological pH and efficiently protect protein integrity (i.e. no denaturation occurs). Upon acidification of the solution after endosomal uptake, the pH decrease and consequently the change of charge lead to decreased protein-polymer interaction and thus a tendency for the nanoparticles to destabilize. Moreover, for nanocomplexes made from PAAs containing disulfide linkages in their polymeric backbone (SS-PAAs), fast disintegration of the complexes and release of the protein payload is observed in reductive solution, mimicking the intracellular environment. Profection experiments showed that proteins encapsulated in PAA nanoparticles were successfully internalized into the cells with remaining activity and excellent cell-viability. In addition of providing intracellular bioreduction, the presence of the disulfide groups also increased the mucoadhesive properties of the nanoparticles. In the presence of mucus secreting cells, we showed that the SS-PAA-based nanocomplexes were capable to successfully internalize protein into the cell cytosol with a much higher extent than nanoparticles based on PAAs lacking disulfide linkages. The results described in this thesis indicate that PAAs should create opportunities for novel applications in protein delivery for oral and nasal administration, as well as delivery to the brain.

Vaccines are an underused public health strategy for healthy aging. Considering the risks of vaccine-preventable diseases and the current low vaccine coverage rates in older European citizens, the two European geriatric and gerontological societies (European Union Geriatric Medicine Society [EUGMS] and International Association of Gerontology and Geriatrics–European Region [IAGG-ER]) convened a Joint Vaccine Working Group to develop a consensus document advocating routine vaccination of aging populations. The mandate of this Working Group was to improve the uptake of routine vaccinations in adults aged 60 years and over. The consensus statement underlines the need to establish, strengthen, and harmonize European policies that continue routine vaccinations to adulthood and that will include older populations. Improved vaccination rates will promote healthy aging by reducing the burden of vaccine-preventable infectious diseases in older populations, a population that is rapidly increasing in Europe.

Chapitre dans Matériaux et Joints d Etanchéité pour les Hautes Pressions édité dans la collection • Intégrations des savoirs et savoir faire • -- Collection dirigée et éditée par Stéphane MOTTIN -- ———————————————————— Sommaire de ce volume 18 de la collection: Préface / Dominique Leguillon P. 13; Introduction générale / Patrick Boissinot, Patrick Langlois, Agílio A.H. Pádua P. 17; Introduction au dimensionnement / Agílio A.H. Pádua; 1 Définition du problème; 2 Dimensionnement; 3 Obturateurs; 4 Conclusion P. 27; Frettage et autofrettage / Patrick Langlois; 1 Considérations préliminaires au frettage; 2 Frettage d une enceinte bibloc; 3 Frettage d une enceinte multibloc; 4 Formulation de l autofrettage; 5 Modes de réalisation de l autofrettage; 6 Conclusion P. 51; Méthodes d éléments finis en calcul de structures élastiques / Joël Frelat; 1 Introduction; 2 Rappel de la formule théorique; 3 Formulation variationnelle; 4 Formulation numérique; 5 Etapes d une mise en oeuvre pratique; 6 Conclusion Extension aux problèmes non linéaires P. 61; Les matériaux sidérurgiques et les hautes pressions / Jean-Paul Dichtel; 1 Caractérisation mécanique des aciers; 2 Métallurgie des aciers et superalliages; 3 Commentaires : la Directive Européenne Appareils à Pression P. 73; Les métaux non ferreux Alliage cuivre-béryllium et titane / Jean-Pierre Petitet; 1 Introduction; 2 Le cuivre-béryllium; 3 Le titane P. 81; Les Carbures cémentés WC-Co / Emmanuel Pauty; 1 Les procédés de fabrication; 2 Les propriétés des carbures cémentés; 3 Conclusions P. 95; Choix et usinage des carbures de tungstène / Jacques Calzas; 1 Choix des carbures de tungstène; 2 Usinage du carbure de tungstène P. 107; Céramiques et matériaux pour l optique / Jean-Claude Chervin; 1 Céramiques; 2 Matériaux pour l optique P. 137; Types de joints et de montage / Roger Argoud et Jacques Roux; 1 Introduction; 2 Généralités; 3 Joints à basse pression; 4 Joints cône sur cône; 5 Joints Bridgman Champignon; 6 Joints annulaires auto-serrés; 7 Joints coniques d Amagat; 8 Autres joints; 9 Conclusion P. 157; Joints hautes pressions pour la compression de gros volumes solides / Sylvie Le Floch; 1 Joints solides utilisés dans les différents types d enceintes hautes pressions; 2 Matières premières des joints; 3 Assemblages HP-HT P. 169; Le matériel standard / Jean-Pierre Petitet; 1 Tubes, conduites et raccords; 2 Les vannes; 3 Quelques types d enceintes commercialisées; 4 Les générateurs de pression; 5 Le matériel moins standard P. 183; Assemblages haute pression / Gérard Hamel; 1 Montage des raccords de pressions; 2 Montage de quelques passages électriques; 3 Les passages de thermocouple; 4 Les passages optiques, montage des fenêtres; 5 Montage des joints et des obturateurs sur une cellule haute pression P. 193; Usinage / Jean-Pierre Michel; 1 Introduction; 2 Les joints de faible épaisseur; 3 Les bagues anti-extrusion à 45; 4 Les joints à 45; 5 Les joints double Bridgman ; 6 Les joints plats en élastomères; 7 Les joints en indium (étanchéité en hélium et azote liquide; 8 Joints métal-métal type Lens ring; 9 Les passages du courant; 10 Usinage de matériaux exotiques P. 207; Les règles de sécurité / Patrick Boissinot; 1 Dangers présentés par les appareils à pression; 2 Appareils à pression rencontrés dans les laboratoires et facteurs de risques; 3 Principes généraux de prévention et réglementation; 4 Moyens de protection; 5 Conclusion

Comprehensive geriatric assessment (CGA) may benefit frail or chronically ill patients in the emergency department (ED), but take too much time to be performed routinely in ED. An alternative approach is to use first a screening tool to detect high-risk patients and then perform CGA in these patients only. This systematic review focuses on the use and value of CGA in ED for evaluation of older patients and its influence on adverse outcomes. This approach is compared with an alternative one using existing screening tools, validated in ED, to detect high-risk patients needing subsequent CGA. This review ends by suggesting a short assessment of CGA to be used in ED and ways to improve home discharge management from ED.

PURPOSE OF REVIEW: Highly prevalent in the population older than 65 years and leading to poor outcomes (functional decline and its related consequences), sarcopenia does not benefit yet either of a clear understanding of its pathophysiology or of precise clinical or biological markers allowing its identification. RECENT FINDINGS: The new scientific definition of 'geriatric syndromes' challenges the authors to review the current sarcopenia literature, allowing them to affirm that sarcopenia cannot be considered as an age-related disease but as a true 'geriatric syndrome'. More than 50% of the population older than 80 years suffer from this medical condition, which is linked to multiple causations: the ageing process itself, genetic susceptibility, certain life habits, changes in living conditions and a number of chronic diseases. Moreover, sarcopenia favours poor outcomes such as mobility disorders, disability, poor quality of life and death. SUMMARY: Considering sarcopenia as a geriatric syndrome allows us to request its recognition and assess its multiple risk factors, to implement a clinical and public health approach to the management of sarcopenic patients and population at risk and to disentangle the links among sarcopenia, frailty, disability and mortality.

In 2010 in Switzerland, vaccine-preventable infectious diseases still cause a significant morbi-mortality, notably among old adults. While the vaccination-based prevention in the aged population has been neglected for a long time, the two European geriatrics and gerontology societies, EUGMS, IAGG-ER has recently proposed a vaccine schedule dedicated to adults aged over 60 and promote a life-course vaccination programme. To convince of the importance of such measures in Switzerland, this article: recounts the beneficial impact of vaccines on the incidence of measles, pertussis, diphtheria, tetanus as well as influenza and pneumococcal diseases; presents the burden of these infectious diseases among the population no or insufficiently immunized; demonstrates that vaccinating in the respect of a life-course vaccine programme will reduce considerably the burden of these infectious disease.

Le rapport que le Comité Consultatif National d'Éthique français a consacré au vieillissement, en 1998, observait : « L'espérance de vie de l'homme connaît depuis plusieurs décades la phase de croissance la plus rapide de toute l'histoire de toute l'humanité ». La situation de ceux qu'on appelle « les aidants naturels », sur lesquels reposaient autrefois, presque exclusivement, la prise en charge informelle en soins de leurs parents âgés. Les buts de cette présentation sont tout d'abord d'évaluer l'implication des aidants naturels (soins informels par la famille) dans les soins aux personnes très âgées et/ou dépendantes en France, puis d'envisager les difficultés numériques et qualitatives à venir afin de pouvoir au mieux anticiper quelques possibles solutions. Pour atteindre ces buts, les liens de dépendance intergénérationnelle sont rappelés de même que les différences entre âge chronologique et fonctionnel, affections de longue durée et dépendance pour les actes de la vie quotidienne. Le nombre des personnes dépendantes âgées de plus de 75 ans et leurs conditions actuelles de vie démontrent l'importance et l'intensité du travail (encore non reconnu) des aidants naturels, dont le nombre va décroître dans les prochaines décades. En France, le taux de support qui était en 1950 voisin de 45 potentiels aidants naturels pour une personne âgée de plus de 85 ans se réduira en 2050 aux alentours de cinq. Ce changement drastique des rapports entre classes d'âge aura des implications majeures. En effet, il n'est aujourd'hui plus contesté que le maintien à domicile demeure la meilleure réponse au respect de la dignité de la personne. Mais, si le maintien à domicile est la solution la plus économiquement valable, elle paraît bien devoir être aussi de plus en plus difficile à préserver. Parmi les possibles solutions à cet important défi de société, il importe de parfaitement intégrer l'extrême avance en âge dans l'ensemble du parcours de vie individuel, de reconnaître et soutenir le travail des aidants naturels, de maintenir des ressources adéquates en professionnels de santé travaillant dans la communauté, d' assurer une formation adaptée tant aux aidants naturels qu'aux soignants professionnels et enfin de trouver des systèmes de soinsnovateurs et financièrement attractifs. The 1998 report on Aging by the French National Ethical Advisory Committee stated that: ‘‘ human life expectancy is increasing at its fastest rate in history ''. Professor Denys Pellerin, one of the rapporteurs, stressed the problems this would pose in coming years. More than 10 years later, these forecasts have been confirmed and new emerging problems call for further reflection. In particular, the place of informal caregivers needs to be reevaluated. This article examines informal caregivers' involvement in the care of the oldest-old and dependent adults in France, and the implications of the ongoing reduction in their numbers. Intergenerational links are examined, along with differences between chronological and functional age, chronic health impairments and disabilities in daily living. The large number of people over 75 years of age, and their difficult living conditions, underline the importance of informal caregivers. In France, in the 1950s, the oldest-old support ratio (OOSR) between persons aged 50 to 75 years and persons over 85 years was 45 to 1. In 2050 the OOSR is likely to be closer to 5 to 1 ! This trend will have important consequences for home care, which is widely considered to be the best way of preserving human dignity, as underlined by Professor Maurice Tubiana in a 2005 report on ‘‘ Social insertion of the elderly at home ''. While homecare is the most economic form of care, it also appears to be the most difficult to maintain and develop. Possible solutions include:—Better integration of old age within the human life cycle — Recognizing and supporting informal caregivers' excellent work — Maintaining adequate numbers of community-based healthcare professionals — Providing caregivers and healthcare professionals with specific training — Developing new and financially attractive care programs

Older patients often suffer from multiple co-morbid conditions. Few co-morbidity indices are valid and reliable in elderly patients and comparison between them is rare. Our objective was to compare the performance, relevance, and abilities of six widely used and validated co-morbidity indices--the Charlson Cumulative Illness Rating Scale-Geriatrics (CIRS), Index of Co-Existent Disease, Kaplan Scale, Geriatrics Index of Co-morbidity (GIC), and Chronic Disease Score--to predict 5 years of survival after hospital discharge. Data came from a prospective study with yearly follow up, conducted 2004-2009 in 444 patients (mean age 85 years; 74% female) discharged from the acute geriatric hospital of the Geneva University Hospitals. In univariate analysis, mortality was significantly associated with age; each supplementary year added 7% of additional risk; and with sex, being male increased the risk by 1.5-fold. The best prognostic predictor was the GIC class 4 followed by the CIRS quartile 4 multiplying the risk of death by 4 and 3, respectively. After 1 year of discharge, for both scores approximately 50% of the high-score patients were already deceased and 80% were deceased after 5 years, compared with