Frailty: A key indicator to minimize inappropriate medication in older people

Older populations are more likely to have multiple co-morbid diseases that require multiple treatments, which make them a large consumer of medications. As a person grows older, their ability to tolerate medications becomes less due to age-related changes in pharmacokinetics and pharmacodynamics often heading along a path that leads to frailty. Frail older persons often have multiple co-morbidities with signs of impairment in activities of daily living. Prescribing drugs for these vulnerable individuals is difficult and is a potentially unsafe activity. Inappropriate prescribing in older population can be detected using explicit (criterion-based) or implicit (judgment-based) criteria. Unfortunately, most current therapeutic guidelines are applicable only to healthy older adults and cannot be generalized to frail patients. These discrepancies should be addressed either by developing new criteria or by refining the existing tools for frail older people. The first and foremost step is to identify the frail patient in clinical practice by applying clinically validated tools. Once the frail patient has been identified, there is a need for specific measures or criteria to assess appropriateness of therapy that consider such factors as quality of life, functional status and remaining life expectancy and thus modified goals of care.

Access To Justice In The ASEAN The Key Role Of UNCITRAL

UNCITRAL’s operation as a subsidiary of the UN General Assembly, tasked to unify and harmonise international trade law is a necessary and indispensable element of the UN’s mandate to maintain international peace and security. Strong legal frameworks which are compatible with those of international trading partners often accompany accelerated growth in economic capacity and stability. Over time, access to markets and resultant growth in economic and human development creates a disincentive for instability as incomes and standards of living rise. Human and economic development, facilitated by a modernised and just legal framework that is available to the broadest range of recipients goes hand in hand with the maintenance of domestic and regional peace, particularly in regions such as the ASEAN , one of the fastest growing in the world covering approximately 30% of global population and with a number of strong global economic neighbours including Japan, Korea, China (to the north), Australia (to the south) and Singapore (to the west). In an increasingly interconnected world, the ability of government, enterprise and individuals to participate in the global supply chain offers opportunities for economic growth and development. Over its almost 50 years of operations, UNCITRAL has produced a range of important texts that are designed to underpin world trade. A key implicit assumption underpinning the development of UNCITRAL texts is that the texts, once adopted can and will be applied in adopting states.

Dislocation after total hip replacement: there is no such thing as a safe zone for socket placement with the posterior approach

Introduction Malorientation of the socket contributes to instability after hip arthroplasty but the optimal orientation of the cup in relation to the pelvis has not been unequivocally described. Large radiological studies are few and problems occur with film standardisation, measurement methodology used and alternative definitions of describing acetabular orientation. Methods A cohort of 1,578 patients from a single institution is studied where all patient data was collected prospectively. Risk factors for patients undergoing surgery are analysed. Radiological data was compared between a series of non-dislocating hips and dislocating cases matched 2:1 by operation type, age and diagnosis. Results The overall dislocation rate for all 1,578 cases was 3.23% but the rate varied according to the type of surgery performed. The rate in uncomplicated primary cases was 2.4% which increased to 9.3% for second stage implantation for a two stage procedure for infection. There was no significant difference in the variability of the dislocating and non-dislocating groups for either inclination (p = 0.393) or anteversion (p = 0.661). Conclusions A “safe zone” for socket orientation to avoid dislocation could not be defined. The cause of dislocation is multifactorial, re-establishing the anatomic centre of rotation, balancing soft tissues and avoidance of impingement around the hip are important considerations.

Cloud computing services for the small and medium enterprises: Key considerations for sourcing sustainable business value

The concept of cloud computing services (CCS) is appealing to small and medium enterprises (SMEs). However, while there is a significant push by various authorities on SMEs to adopt the CCS, knowledge of the key considerations to adopt the CCS is very limited. We use the technology-organization-environment (TOE) framework to suggest that a strategic and incremental intent, understanding the organizational structure and culture, understanding the external factors, and consideration of the human resource capacity can contribute to sustainable business value from CCS. Using survey data, we find evidence of a positive association between these considerations and the CCS-related business objectives. We also find evidence of positive association between the CCS-related business objectives and CCS-related financial objectives. The results suggest that the proposed considerations can ensure sustainable business value from the CCS. This study provides guidance to SMEs on a path to adopting the CCS with the intention of a long-term commitment and achieving sustainable business value from these services.

Key drivers of the economic burden of community-associated Methicillin-resistant Staphylococcus aureus in Australia

Estimates of the economic cost of community-associated Methicillin-resistant Staphylococcus aureus(CA-MRSA) in the United States (US) are substantial, ranging from $1.4-13.8 billion. In Australia, it has been shown that rates of CA-MRSA are increasing, and individual studies have looked at the morbidity and mortality associated with CA-MRSA, however, it is not clear what is driving the economic burden of CA-MRSA at a national level. This study presents preliminary findings about the key drivers of the economic cost of CA-MRSA infections in Australia

A digital beehive could warn beekeepers when their hives are under attack

Honey bees are in decline, and the current method of keeping them can be disruptive to a colony. But new designs allow beekeepers to monitor a hive remotely, even sniff out disease and pests.

Denitrification losses from an intensively managed sub-tropical pasture: Impact of soil moisture on the partitioning of N2 and N2O emissions

Intensively managed pastures in subtropical Australia under dairy production are nitrogen (N) loaded agro-ecosystems, with an increased pool of N available for denitrification. The magnitude of denitrification losses and N2:N2O partitioning in these agro-ecosystems is largely unknown, representing a major uncertainty when estimating total N loss and replacement. This study investigated the influence of different soil moisture contents on N2 and N2O emissions from a subtropical dairy pasture in Queensland, Australia. Intact soil cores were incubated over 15 days at 80% and 100% water-filled pore space (WFPS), after the application of 15N labelled nitrate, equivalent to 50 kg N ha−1. This setup enabled the direct quantification of N2 and N2O emissions following fertilisation using the 15N gas flux method. The main product of denitrification in both treatments was N2. N2 emissions exceeded N2O emissions by a factor of 8 ± 1 at 80% WFPS and a factor of 17 ± 2 at 100% WFPS. The total amount of N-N2 lost over the incubation period was 21.27 kg ± 2.10 N2-N ha−1 at 80% WFPS and 25.26 kg ± 2.79 kg ha−1 at 100% WFPS respectively. N2 emissions remained high at 100% WFPS, while related N2O emissions decreased. At 80% WFPS, N2 emissions increased constantly over time while N2O fluxes declined. Consequently, N2/(N2 + N2O) product ratios increased over the incubation period in both treatments. N2/(N2 + N2O) product ratios responded significantly to soil moisture, confirming WFPS as a key driver of denitrification. The substantial amount of fertiliser lost as N2 reveals the agronomic significance of denitrification as a major pathway of N loss for sub-tropical pastures at high WFPS and may explain the low fertiliser N use efficiency observed for these agro-ecosystems.

Nutrition during noninvasive ventilation: clinical determinants and key practical recommendations

Malnutrition and poor nutritional intake have been identified as key issues associated with poorer clinical outcomes in chronic obstructive pulmonary disease (COPD) patients. There is strong evidence showing nutritional support is effective in treating malnutrition in stable COPD, but there is only limited research regarding nutritional status in patients treated with noninvasive ventilation (NIV). The impact of NIV during acute exacerbations of respiratory disease on nutritional status requires further investigation.

YB-1, a key regulator of androgen receptor signalling

Reactivation of androgen receptor signalling is one of the hallmarks of prostate cancer progression to the terminal castrate resistant stage. A better understanding of mechanisms driving this adaptive response is essential for the development of innovative intervention strategies that effectively delay or halt prostate cancer progression. The Y-box binding protein 1 (YB-1) has been found to be closely associated with prostate cancer progression. By characterising its role in the adaptive process leading to castrate resistance, we aim to promote YB-1 as a novel therapeutic target in advanced prostate cancer.

Revocation and update of trust in autonomous delay tolerant networks

A Delay Tolerant Network (DTN) is a dynamic, fragmented, and ephemeral network formed by a large number of highly mobile nodes. DTNs are ephemeral networks with highly mobile autonomous nodes. This requires distributed and self-organised approaches to trust management. Revocation and replacement of security credentials under adversarial influence by preserving the trust on the entity is still an open problem. Existing methods are mostly limited to detection and removal of malicious nodes. This paper makes use of the mobility property to provide a distributed, self-organising, and scalable revocation and replacement scheme. The proposed scheme effectively utilises the Leverage of Common Friends (LCF) trust system concepts to revoke compromised security credentials, replace them with new ones, whilst preserving the trust on them. The level of achieved entity confidence is thereby preserved. Security and performance of the proposed scheme is evaluated using an experimental data set in comparison with other schemes based around the LCF concept. Our extensive experimental results show that the proposed scheme distributes replacement credentials up to 35% faster and spreads spoofed credentials of strong collaborating adversaries up to 50% slower without causing any significant increase on the communication and storage overheads, when compared to other LCF based schemes.

Identification methods of key contributing factors in crashes with high numbers of fatalities and injuries in China

Objectives In China, “serious road traffic crashes” (SRTCs) are those in which there are 10-30 fatalities, 50-100 serious injuries or a total cost of 50-100 million RMB ($US8-16m), and “particularly serious road traffic crashes” (PSRTCs) are those which are more severe or costly. Due to the large number of fatalities and injuries as well as the negative public reaction they elicit, SRTCs and PSRTCs have become great concerns to China during recent years. The aim of this study is to identify the main factors contributing to these road traffic crashes and to propose preventive measures to reduce their number. Methods 49 contributing factors of the SRTCs and PSRTCs that occurred from 2007 to 2013 were collected from the database “In-depth Investigation and Analysis System for Major Road traffic crashes” (IIASMRTC) and were analyzed through the integrated use of principal component analysis and hierarchical clustering to determine the primary and secondary groups of contributing factors. Results Speeding and overloading of passengers were the primary contributing factors, featuring in up to 66.3% and 32.6% of accidents respectively. Two secondary contributing factors were road-related: lack of or nonstandard roadside safety infrastructure, and slippery roads due to rain, snow or ice. Conclusions The current approach to SRTCs and PSRTCs is focused on the attribution of responsibility and the enforcement of regulations considered relevant to particular SRTCs and PSRTCs. It would be more effective to investigate contributing factors and characteristics of SRTCs and PSRTCs as a whole, to provide adequate information for safety interventions in regions where SRTCs and PSRTCs are more common. In addition to mandating of a driver training program and publicisation of the hazards associated with traffic violations, implementation of speed cameras, speed signs, markings and vehicle-mounted GPS are suggested to reduce speeding of passenger vehicles, while increasing regular checks by traffic police and passenger station staff, and improving transportation management to increase income of contractors and drivers are feasible measures to prevent overloading of people. Other promising measures include regular inspection of roadside safety infrastructure, and improving skid resistance on dangerous road sections in mountainous areas.

Characterization of the carbonic anhydrase gene family and other key osmoregulatory genes in Australian freshwater crayfish (genus Cherax)

Cherax quadricarinatus (Redclaw), C. destructor (Yabby) and C. cainii (Marron) are a group of economically important freshwater crayfish and have been developed for aquaculture production in many countries. As crayfish are farmed in a wide range of culture conditions, optimisation of water quality parameters, are crucial for their maximum growth performance. Previous reports have shown that fluctuations in water quality can negatively impact on growth of crayfish. Therefore, this project aims to identify and characterize the major genes that enable freshwater crayfish to persist in different water chemistries and evaluate their patterns of expression under different water parameters. Overall, this project found a number of candidate genes in all three species and determined that water chemistry had a strong influence on the expression of candidate genes. This information is important in the optimization of water quality parameters in freshwater crayfish aquaculture production.

Food literacy: Key concepts and the elephants in the room

This chapter summarizes the content of this book. It identifies key issues that require further investigation and development. It re-enforces key concepts.