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Harnessing innovation to help meet the needs of elders:field testing an electronic tool to streamline geriatric assessments across healthcare settings

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Family Medicine and Community Health 2024年第2期12卷 1-11页

作者： Limor Adler Zorian Radomyslsky Miri Mizrahi Reuveni Eduardo Schejter ilan Yehoshua Yakov Segal Sara Kivity Etti Naimi Mor Saban Maccabi Healthcare Services Tel AvivIsrael Department of Health system management Ariel UniversityArielIsrael Medical&Health Sciences Tel Aviv UniversityTel AvivIsrael

Background As populations age globally,effectively managing geriatric health poses challenges for primary *** geriatric assessments(CGAs)aim to address these challenges through multidisciplinary screening and coordinated care ***,most CGA tools and workflows have not been optimised for routine primary care *** This study aimed to evaluate the impact of a computerised CGA tool,called the Golden Age Visit,implemented in primary care in *** This study employed a quasiexperimental mixed-methods design to evaluate outcomes associated with the Golden Age electronic health assessment *** analysis used electronic medical records data from Maccabi Healthcare Services,the second largest health management organisation(HMO)in *** aged 75 and older were included in analyses from January 2017 to December 2019 and January 2021 to December *** patients,data were also collected on controls who did not participate in the Golden Age Visit programme during the same time period,to allow for comparison of *** physicians,qualitative data were collected via surveys and interviews with primary care physicians who used the Golden Age Visit SMARTEST e-assessment *** A total of 9022 community-dwelling adults aged 75 and older were included in the study:1421 patients received a Golden Age Visit CGA(intervention group),and 7601 patients did not receive the assessment(control group).After CGAs,diagnosis rates increased significantly for neuropsychiatric conditions and *** to physiotherapy,occupational therapy,dietetics and geriatric outpatient clinics also rose ***,no differences were found in rates of hip fracture or relocation to long-term care between *** among physicians(n=151)found high satisfaction with the *** Implementation of a large-scale primary care CGA programme was associated with improved diagnosis and management of geriatr

关键词： diagnosis routine Golden

Taking Time, Sharing Spaces: Adaptive Risk Governance Processes in Rural Japan

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International Journal of Disaster Risk Science 2018年第4期9卷 464-471页

作者： ilan Chabay Institute for Advanced Sustainability Studies (IASS) 14467 PotsdamGermany

Rural and peri-urban communities in Japan, as well as in many other regions of the world, face risks of discrete event natural phenomena, including earthquakes,floods, and landslides. They also face persistent disruptive stress due to risks that remain active over long durations,such as the loss of community capacities due to an aging population. This article describes my observations of and subsequent reflections on adaptive risk governance and community resilience building processes in two areas of western and southern Japan—Chizu in Tottori Prefecture and towns near Kumamoto City in Kumamoto *** aspects of adaptive risk governance from this limited set of observations stood out:(1) the importance of establishing a durable, patient process,(2) initiated and facilitated by a trusted figure, in(3) a space or venue accessible and open to the community, and(4) augmented by boundary objects that facilitate role playing, iteration,and ownership by the community of solutions generated in these dialogues.

关键词： Boundary objects Case Station-Field Campuses(CASiFiCA) Community resilience Knowledge Learning and Societal Change Alliance(KLASICA) Japan Risk governance Yonmenkaigi System Method(YSM)

Leaky gut and the liver: A role for bacterial translocation in nonalcoholic steatohepatitis

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World Journal of Gastroenterology 2012年第21期18卷 2609-2618页

作者： Yaron ilan Gastroenterology and Liver Units Department of Medicine Hadassah Hebrew University Medical CenterJerusalem 91120 Israel

Gut flora and bacterial translocation (BT) play important roles in the pathogenesis of chronic liver disease, including cirrhosis and its complications. Intestinal bacterial overgrowth and increased bacterial translocation of gut flora from the intestinal lumen predispose patients to bacterial infections, major complications and also play a role in the pathogenesis of chronic liver disorders. Levels of bacterial lipopolysaccharide, a component of gram-negative bacteria, are increased in the portal and/or systemic circulation in several types of chronic liver disease. Impaired gut epithelial integrity due to alterations in tight junction proteins may be the pathological mechanism underlying bacterial translocation. Preclinical and clinical studies over the last decade have suggested a role for BT in the pathogenesis of nonalcoholic steatohepatitis (NASH). Bacterial overgrowth, immune dysfunction, alteration of the luminal factors, and altered intestinal permeability are all involved in the pathogenesis of NASH and its complications. A better understanding of the cell-specific recognition and intracellular signaling events involved in sensing gut-derived microbes will help in the development of means to achieve an optimal balance in the gut-liver axis and ameliorate liver diseases. These may suggest new targets for potential therapeutic interventions for the treatment of NASH. Here, we review some of the mechanisms connecting BT and NASH and potential therapeutic developments.

关键词： Nonalcoholic steatohepatitis Bacterial translocation Insulin resistance Leaky gut Lipopolysaccharide

Climate Change and the Sendai Framework for Disaster Risk Reduction

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International Journal of Disaster Risk Science 2015年第2期6卷 117-127页

作者： ilan Kelman UCL Institute for Risk and Disaster Reduction and UCL Institute for Global Health University College London Norwegian Institute of International Affairs (NUPI)

This article reviews climate change within the Sendai Framework for Disaster Risk Reduction 2015–2030(SFDRR), analyzing how climate change is mentioned in the framework’s text and the potential implications for dealing with climate change within the context of disaster risk reduction. Three main categories are examined. First,climate change affecting disaster risk and disasters,demonstrating too much emphasis on the single hazard driver and diminisher of climate change. Second, crosssectoral approaches, for which the SFDRR treads carefully,thereby unfortunately entrenching artificial differences and divisions, although appropriately offering plenty of support to other sectors from disaster risk reduction. Third,implementation, for which climate change plays a suitable role without being overbearing, but for which other hazard influencers should have been treated similarly. Overall, the mentions of climate change within the SFDRR put too much emphasis on the hazard part of disaster risk. Instead,within the context of the three global sustainable development processes that seek agreements in 2015, climate change could have been used to further support an allvulnerabilities and all-resiliences approach. That could be achieved by placing climate change adaptation as one subset within disaster risk reduction and climate change mitigation as one subset within sustainable development.

关键词： Climate change Climate change adaptation Climate change mitigation Climate variability Disaster mitigation Disaster risk reduction

Lost for Words Amongst Disaster Risk Science Vocabulary?

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International Journal of Disaster Risk Science 2018年第3期9卷 281-291页

作者： ilan Kelman Institute for Global Health and Institute for Risk and Disaster Reduction University College London University of Agder

Like other subjects, disaster risk science has developed its own vocabulary with glossaries. Some keywords, such as resilience, have an extensive literature on definitions, meanings, and interpretations. Other terms have been less explored. This article investigates core disaster risk science vocabulary that has not received extensive attention in terms of examining the meanings,interpretations, and connotations based on key United Nations glossaries. The terms covered are hazard, vulnerability, disaster risk, and the linked concepts of disaster risk reduction and disaster risk management. Following a presentation and analysis of the glossary-based definitions,discussion draws out understandings of disasters and disaster risk science, which the glossaries do not fully provide in depth, especially vulnerability and disasters as processes. Application of the results leads to considering the possibility of a focus on risk rather than disaster risk while simplifying vocabulary by moving away from disaster risk reduction and disaster risk management.

关键词： Disaster risk Disaster risk management(DRM) Disaster risk reduction(DRR) Hazard Vulnerability

Introduction to “Five Years of the Sendai Framework for Disaster Risk Reduction”

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International Journal of Disaster Risk Science 2020年第2期11卷 145-146页

作者： ilan Kelman Institute for Risk&Disaster Reduction and Institute for Global Health University College LondonLondon WC1E 6BTUK University of Agder KristiansandNorway

Are birthdays important, especially for documents? While some might use the candles on the cake as an excuse to burn the offending paper, they also offer a chance to reflect on any milestones or achievements that were hoped for while examining possible futures based on guidance from the document. Thus was born the idea of this special issue on "Five Years of the Sendai Framework for Disaster Risk Reduction."

关键词： Framework Reduction hoped

Thoughts on Dealing with Climate Change…As if the Future Matters

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International Journal of Disaster Risk Science 2013年第1期4卷 1-8页

作者： Michael H.Glantz ilan Kelman Consortium for Capacity Building INSTAARUniversity of ColoradoBoulderCO 80309U.S.A. Center for International Climate and Environmental Research–Oslo N-0318 OsloNorway

This article uses the need for more inspiration in people to act on climate change as a basis for exploring some thoughts on the societal and environmental challenges of climate change. It aims to provide ways of interpreting what is often presented on climate change without considering how the audience receives that information and might or might not be inspired to take action based on it. Different meanings of “change” are examined in the context of “climate change.” The term “adaptation” is similarly analyzed. Based on the understanding of those terms, four notions are defined and outlined in relation to decision-making for climate change adaptation: Ignorance versus “Ignore-ance,” surprise, foreseeability, and forecasting by analogy. The conclusions explore the interlinkages between society and the environment as well as how to turn lessons identified into lessons that are actually learned in order to be implemented. Achieving inspiration is not straightforward, but without it, the future will be bleak under a changing society and environment.

关键词： forecasting analogy straight

Climate Change’s Role in Disaster Risk Reduction’s Future:Beyond Vulnerability and Resilience

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International Journal of Disaster Risk Science 2015年第1期6卷 21-27页

作者： ilan Kelman JC Gaillard Jessica Mercer UCL Institute for Risk and Disaster Reduction and UCL Institute for Global Health University College London Norwegian Institute of International Affairs(NUPI School of Environment The University of Auckland Secure Futures

A seminal policy year for development and sustainability occurs in 2015 due to three parallel processes that seek long-term agreements for climate change, the Sustainable Development Goals, and disaster risk *** reason exists to separate them, since all three examine and aim to deal with many similar processes, including vulnerability and resilience. This article uses vulnerability and resilience to explore the intersections and overlaps amongst climate change, disaster risk reduction, and sustainability. Critiquing concepts such as 'return to normal'and 'double exposure'demonstrate how separating climate change from wider contexts is counterproductive. Climate change is one contributor to disaster risk and one creeping environmental change amongst many, and not necessarily the most prominent or fundamental contributor. Yet climate change has become politically important, yielding an opportunity to highlight and tackle the deep-rooted vulnerability processes that cause 'multiple exposure'to multiple threats. To enhance resilience processes that deal with the challenges, a prudent place for climate changewould be as a subset within disaster risk reduction. Climate change adaptation therefore becomes one of many processes within disaster risk reduction. In turn, disaster risk reduction should sit within development and sustainability to avoid isolation from topics wider than disaster risk. Integration of the topics in this way moves beyond expressions of vulnerability and resilience towards a vision of disaster risk reduction’s future that ends tribalism and separation in order to work together to achieve common goals for humanity.

关键词： Adaptation Climate change Disaster risk reduction Mitigation Resilience Vulnerability

Point-of-care continuous ^(13)C-methacetin breath test improves decision making in acute liver disease: Results of a pilot clinical trial

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World Journal of Gastroenterology 2009年第8期15卷 966-972页

作者： Gadi Lalazar Tomer Adar Yaron ilan Gastroenterology and Liver Units Department of Medicine Hadassah-Hebrew University Medical Center Ein-Kerem IL 91120 POB 12000 Jerusalem Israel

AIM: To assess the role of the 13C-methacetin breath test (MBT) in patients with acute liver disease. METHODS: Fifteen patients with severe acute liver disease from diverse etiologies were followed-up with 13C-MBT during the acute phase of their illnesses (range 3-116 d after treatment). Patients fasted for 8 h and ingested 75 mg of methacetin prior to the MBT. We compared results from standard clinical assessment, serum liver enzymes, synthetic function, and breath test scores. RESULTS: Thirteen patients recovered and two patients died. In patients that recovered, MBT parameters improved in parallel with improvements in lab results. Evidence of consistent improvement began on day 3 for MBT parameters and between days 7 and 9 for blood tests. Later convergence to normality occurred at an average of 9 d for MBT parameters and from 13 to 28 d for blood tests. In both patients that died, MBT parameters remained low despite fluctuating laboratory values. CONCLUSION: The 13C-MBT provides a rapid, noninvasive assessment of liver function in acute severe liver disease of diverse etiologies. The results of this pilot clinical trial suggest that the MBT may offer greater sensitivity than standard clinical tests for managing patients with severe acute liver disease.

关键词： Acute liver disease Methacetin Breath test Fulminant hepatitis