The aim of this study was to determine whether home telehealth, when integrated with the health facility's electronic medical record system, reduces healthcare costs and improves quality-of-life outcomes relative to usual home healthcare services for elderly high resource users with complex co-morbidities. Study patients were identified through the medical center's database. Intervention patients received home telehealth units that used standard phone lines to communicate with the hospital. FDA-approved peripheral devices monitored vital signs and valid questionnaires were used to evaluate quality-of-life outcomes. Out-of-range data triggered electronic alerts to nurse case managers. (No live video or audio was incorporated in either direction.) Templated progress notes facilitated seamless data entry into the patient's electronic medical record. Participants (n = 104) with complex heart failure, chronic lung disease, and/or diabetes mellitus were randomly assigned to an intervention or control group for 6-12 months. Parametric and nonparametric analyses were performed to compare outcomes for (1) subjective and objective quality-of-life measures, (2) health resource use, and (3) costs. In contrast to the control group, scores for home telehealth subjects showed a statistically significant decrease at 6 months for bed-days-of-care (p < 0.0001), urgent clinic/emergency room visits (p = 0.023), and A1C levels (p < 0.0001); at 12 months for cognitive status (p < 0.028); and at 3 months for patient satisfaction (p < 0.001). Functional levels and patient-rated health status did not show a significant difference for either group. Integrating home telehealth with the healthcare institution's electronic database significantly reduces resource use and improves cognitive status, treatment compliance, and stability of chronic disease for homebound elderly with common complex co-morbidities.

No abstract

Identifying forage species that are productive in saline environments is an important research priority in many areas of the world affected by salinity. The salt and waterlogging tolerances of 19 species of Melilotus were evaluated in a series of glasshouse experiments. Measurements taken on each species included: dry matter (DM) production, root growth and development, shoot ion (Na + , K + and Cl − ) concentrations, root porosity, and in vitro estimates of nutritive value. Research on several species was restricted because of their potential as weed risks. Of the remaining species, M. siculus (syn. M. messanensis), an annual species, showed high relative salt and waterlogging tolerances, good DM production under non-stressed and stressed (saline and hypoxic) conditions, a high level of root porosity under stagnant conditions, low tissue ion (Na + , Cl − ) concentrations, and a reasonable dry matter digestibility content (range 66-69%) under highly saline conditions. M. sulcatus ssp. segetalis and M. indicus were also identified as species with good DM production and tolerance to salinity and waterlogging stresses. Further weed risk assessments and field trials on these species are required before they can be promoted for use as pasture forages on saline areas.

Melilotus siculus (common name messina) has shown potential as a productive annual forage legume in saline and waterlogged areas in temperate Australia. The salt and waterlogging tolerances of 30 M. siculus accessions were evaluated at germination and as established plants. Many accessions germinated at 240 mm NaCl, but germination was <15% at 320 mm NaCl. In vegetative plants, accessions differed in the degree of growth reduction at 300 mm NaCl, with some producing >90%, but others <20%, of non-saline controls. A negative relationship (r = 0.47, P < 0.001) was found between dry weight under non-saline conditions and relative salt tolerance (i.e. salt-treated as % of controls). Concentrations of Cl– and Na+ in shoots of all accessions increased significantly with increasing NaCl in the medium, although these differed among accessions. No relationships were found between shoot Cl–, Na+, or K+ concentrations and relative salt tolerance at 300 mm NaCl, whereas net K+ : Na+ selectivity to shoots was positively correlated with relative salt tolerance (r = 0.30, P = 0.1). All accessions showed good tolerance to stagnant, O2-deficient conditions in the root medium, and shoot growth was not reduced by >20% in any accession. Root porosity (% gas volume/root volume) in both the main and lateral roots increased in all accessions when in stagnant medium, but accessions differed in root porosity. Lateral root porosity was not, however, correlated with either shoot dry weight or root dry weight in stagnant conditions. No single accession of M. siculus had the highest tolerance to saline conditions both at germination and the vegetative stage, but some accessions (e.g. SA 40002 and SA 40004) performed consistently well under saline and waterlogged conditions. Further research and selection is warranted on these accessions with the aim to release a cultivar.

The effects of salinity and hypoxia on growth, nutritive value, and ion relations were evaluated in 38 species of Trifolium and 3 check legume species (Trifolium fragiferum, Trifolium michelianum, and Medicago sativa) under glasshouse conditions, with the aim of identifying species that may be suitable for saline and/or waterlogged conditions. In the first set of experiments, plants were grown hydroponically at four NaCl concentrations (0, 40, 80, and 160 mm NaCl) and harvested after exposure to these treatments for 4 weeks. NaCl concentrations up to 160 mm reduced dry matter production in most species; however, there were differences in salt tolerance among species, with T. argutum, T. diffusum, T. hybridum, and T. ornithopodioides performing well under the saline conditions (dry matter production was reduced by less than 20%). Concentrations of Na+ and Cl− in the shoots increased with increasing salinity levels, and species again differed in their capacity to limit the uptake of these ions. Dry matter digestibility at 0 mm ranged from 49.8% (T. palaestinum) to 74.0% (T. vesiculosum) and decreased with increasing NaCl concentrations. A second set of experiments evaluated the tolerance of Trifolium species to hypoxic conditions in the glasshouse. Shoot growth, and to a lesser extent root growth, were reduced in all Trifolium species when plants were exposed to stagnant, non-aerated conditions for 28 days, but T. michelianum, T. resupinatum, T. squamosum, T. nigrescens, T. ornithopodioides, T. salmoneum, and T. fragiferum were the least affected species. All species acclimated to the oxygen-depleted conditions by increasing the gas-filled porosity in the roots. This study has provided information that will assist in the identification of forage species for saline and/or waterlogged areas.