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\"IAN K. SMITH, M.D., is the bestselling author of Shred, The Fat Smash Diet, Extreme Fat Smash Diet, and The 4 Day Diet. He was the diet expert for six seasons on VH1's Celebrity Fit Club, and has created two national health initiatives: the 50 Million Pound Challenge and the Makeover Mile. A graduate of Harvard, Columbia, and the University of Chicago's Pritzker School of Medicine, Smith was appointed by President Obama in 2010 to the President's Council on Fitness, Sports, and Nutrition\"-- Provided by publisher.

Background Sinks in patient rooms are associated with hospital-acquired infections. The aim of this study was to evaluate the effect of removal of sinks from the Intensive Care Unit (ICU) patient rooms and the introduction of ‘water-free’ patient care on gram-negative bacilli colonization rates. Methods We conducted a 2-year pre/post quasi-experimental study that compared monthly gram-negative bacilli colonization rates pre- and post-intervention using segmented regression analysis of interrupted time series data. Five ICUs of a tertiary care medical center were included. Participants were all patients of 18 years and older admitted to our ICUs for at least 48 h who also received selective digestive tract decontamination during the twelve month pre-intervention or the twelve month post-intervention period. The effect of sink removal and the introduction of ‘water-free’ patient care on colonization rates with gram-negative bacilli was evaluated. The main outcome of this study was the monthly colonization rate with gram-negative bacilli (GNB). Yeast colonization rates were used as a ‘negative control’. In addition, colonization rates were calculated for first positive culture results from cultures taken ≥3, ≥5, ≥7, ≥10 and ≥14 days after ICU-admission, rate ratios (RR) were calculated and differences tested with chi-squared tests. Results In the pre-intervention period, 1496 patients (9153 admission days) and in the post-intervention period 1444 patients (9044 admission days) were included. Segmented regression analysis showed that the intervention was followed by a statistically significant immediate reduction in GNB colonization in absence of a pre or post intervention trend in GNB colonization. The overall GNB colonization rate dropped from 26.3 to 21.6 GNB/1000 ICU admission days (colonization rate ratio 0.82; 95%CI 0.67–0.99; P  = 0.02). The reduction in GNB colonization rate became more pronounced in patients with a longer ICU-Length of Stay (LOS): from a 1.22-fold reduction (≥2 days), to a 1.6-fold (≥5 days; P  = 0.002), 2.5-fold (for ≥10 days; P  < 0.001) to a 3.6-fold (≥14 days; P  < 0.001) reduction. Conclusions Removal of sinks from patient rooms and introduction of a method of ‘water-free’ patient care is associated with a significant reduction of patient colonization with GNB, especially in patients with a longer ICU length of stay.

\"Alessio Fasano, MD, world-renowned expert and founder of Boston's Center for Celiac Research, reveals the latest developments in scientific research and treatment, and the answers they provide for this rapidly expanding audience. This groundbreaking, authoritative guide is an invaluable roadmap for the newly diagnosed, for those already dealing with gluten-related issues, and for anyone who thinks they may have an issue with gluten\"--Provided by publisher.

Background The world aims to achieve universal health coverage by removing all forms of financial barriers to improve access to healthcare as well as reduce maternal and child deaths by 2030. Although free maternal healthcare has been embraced as a major intervention towards this course in some countries in sub-Saharan Africa (SSA), the perception of the quality of healthcare may influence utilization and maternal health outcomes. We systematically mapped literature and described the evidence on maternal perceptions of the quality of care under the free care financing policies in SSA. Methods We employed the Arskey and O’Malley’s framework to guide this scoping review. We searched without date limitations to 19th May 2019 for relevant published articles in PubMed, Google Scholar, Web of Science, Science Direct, and CINAHL using a combination of keywords, Boolean terms, and medical subject headings. We included primary studies that involved pregnant/post-natal mothers, free maternal care policy, quality of care, and was conduct in an SSA country. Two reviewers independently screened the articles at the abstract and full-text screening guided by inclusion and exclusion criteria. All relevant data were extracted and organized into themes and a summary of the results reported narratively. The recent version of the mixed methods appraisal tool was used to assess the methodological quality of the included studies. Results Out of 390 studies, 13 were identified to have evidence of free maternal healthcare and client perceived quality of care. All the 13 studies were conducted in 7 different countries. We found three studies each from Ghana and Kenya, two each in Burkina Faso and Nigeria, and a study each from Niger, Sierra Leone, and Tanzania. Of the 13 included studies, eight reported that pregnant women perceived the quality of care under the free maternal healthcare policy to be poor. The following reasons accounted for the poor perception of service quality: long waiting time, ill-attitudes of providers, inadequate supply of essential drugs and lack of potable water, unequal distribution of skilled birth attendants, out-of-pocket payment and weak patient complaint system. Conclusion This study suggests few papers exist that looked at maternal perceptions of the quality of care in the free care policy in SSA. Considering the influence mothers perceptions of the quality of care can have on future health service utilisation, further studies at the household, community, and health facility levels are needed to help unearth and address all hidden quality of care challenges and improve maternal health services towards attaining the sustainable development goals on maternal and child health.

Background Accessing diabetes care requires effort and time. Homelessness often forces individuals to prioritize securing shelter and safety over medical appointments, particularly for the screening and prevention of long-term diabetes complications. We evaluated the effectiveness and costs associated with a point-of-care screening program with expedited referral pathways within two inner-city community sites in Calgary, Canada serving individuals experiencing homelessness. Methods We conducted a non-randomized concurrent-convergent mixed methods pilot study of the program. Adults experiencing homelessness and diabetes were recruited through the host sites and attended two separate visits. At the initial visit, screening for microvascular complications, glycemic monitoring (glycated hemoglobin testing), and footcare were offered. At the follow-up visit, the nurse shared the screening results and arranged specialist referrals. The quantitative strand of the study was comprised of a pre-post assessment, comparing screening completion rates after our program to historical screening over the past two years, based on chart review and patient reports. We used a qualitative descriptive approach to report on patient reflections of the program. Results Nearly all participants ( n  = 40) completed the screening tests offered: foot/peripheral neuropathy ( n  = 39), retinopathy ( n  = 30), and diabetic kidney disease ( n  = 38). This is compared to the previous two years, where only n  = 10, n  = 11, and n = 20 completed these tests, respectively. While n  = 23 had their glycated hemoglobin measured in the past year, n  = 40 completed it with our program. Most participants (83%) attended both clinic visits. Despite this unique and well received model, getting participants to see specialists remained challenging, with fewer than half of referred patients attending follow-up visits. The cost of the pilot ($846/visit) illustrates this model requires modifications to provide even better value. Four main themes emerged from the participant interviews regarding the program that include: improved accessibility to services, positive experiences, ideal locations of service, and willingness to return. Conclusions This point-of-care screening model significantly increased screening rates from the pre-period and participants indicated interest in and support for the program. However, innovative approaches to enhance the program are required. Potential adjustments include partnering with more community sites servicing this population and expanding the scope of care offered as well as reaching a broader population.

\"Quality living in old age is one of the key topics of our time. This book presents innovative forms of living, intelligent concepts and individual solutions for people with physical or cognitive limitations. Integrative forms of housing transcending the boundaries between individual, collective and assisted forms of living. The updated new edition includes new current international case studies on integrated housing and neighbourhood concepts\"-- Provided by publisher.

Introduction: Desatar Argentina is an interdisciplinary group of professionals dedicated to eliminating the use of physical restraints in gerontological care settings. Since its foundation in 2017 under the auspices of the Argentine Society of Gerontology and Geriatrics (SAGG), the group has been committed to promoting respect and dignity for older adults, guided by the International Convention on the Rights of Older Persons. Mission: Desatar Argentina’s mission is to raise awareness about the harm caused by physical restraints and to promote strategies for their elimination, generating a cultural change within health and social care organizations. We aim to sensitize both society and healthcare professionals about the importance of respecting the dignity of older adults. Trajectory: Since its inception, Desatar Argentina has undertaken numerous activities, including: In 2018, the first “Desatar para cuidar’’ event at LedorVador. In 2019, presenting the research on the effectiveness of a multicomponent intervention program to eliminate physical restraints in a long-term care facility (which also obtained an award) at the XVI Argentine Congress of Gerontology andGeriatrics. Publications in the SAGG Journal and other media to widely disseminate the group’s message. Training courses for care home professionals, focusing on tools and strategies to eliminate the use of physicalrestraints. Future Perspectives: Desatar Argentina will continue to work to: Promote research and dissemination of new care modalities that prioritize the fundamental rights of olderadults. Foster ongoing training of health and social care professionals on the risks and alternatives to restraints. Promote sustainable cultural change within care centers to ensure a restraint-free environment focused on respect and dignity for older adults. Undertake the evaluation and assessment of chemical restraints. Promote the elimination of physical restraints in the hospital environment. Conclusions: Desatar Argentina has shown that it is possible to eliminate physical restraints in long-term care facilities, significantly improving the quality of life for older adults. Continuous training and awareness-raising are essential to promote restraint-free care and transform organizational culture in favor of the rights and dignity of older adults.