Oral liquid nutritional supplements for people with dementia in residential aged care facilities

AIM: This systematic review investigated the prescription, administration and effectiveness of oral liquid nutritional supplements (OLNS) for people with dementia in residential aged care facilities (RACF). METHODS: A comprehensive search of relevant databases, hand searching and cross-referencing found 15 relevant articles from a total of 2910 possible results. Articles which met the inclusion criteria were critically appraised by two independent reviewers using the relevant Joanna Briggs Institute (JBI) appraisal checklist. Data were extracted using the relevant JBI extraction instruments. No data synthesis was possible due to clinical and methodological heterogeneity. RESULTS: Included studies examined a range of strategies, issues and results related to OLNS for persons with dementia in RACFs; however there appear to be significant gaps in the current body of research, particularly in relation to examinations of effectiveness. CONCLUSIONS: This review was unable to produce a definitive finding regarding effectiveness. OLNS may improve the nutritional state of residents with dementia and help prevent weight loss, and there is some suggestion that it may slow the rate of cognitive decline. However, in order for OLNS to be effective, nursing and care staff need to ensure that sufficient attention is paid to the issues of prescription and administration.

Ocular refractive and biometric characteristics in patients with tilted disc syndrome

BACKGROUND Tilted disc syndrome (TDS) is associated with characteristic ocular findings. The purpose of this study was to evaluate the ocular, refractive, and biometric characteristics in patients with TDS. METHODS This case-control study included 41 eyes of 25 patients who had established TDS and 40 eyes of 20 healthy control subjects. All participants underwent a complete ocular examination, including refraction and analysis using Fourier transformation, slit lamp biomicroscopy, pachymetry, keratometry, and ocular biometry. Corneal topography examinations were performed in the syndrome group only. RESULTS There were no significant differences in spherical equivalent (P = 0.13) and total astigmatism (P = 0.37) between groups. However, mean best spectacle-corrected visual acuity (Log Mar) was significantly worse in TDS patients (P = 0.003). The lenticular astigmatism was greater in the syndrome group, whereas the corneal component was greater in controls (P = 0.059 and P = 0.028, respectively). The measured biometric features were the same in both groups, except for the lens thickness and lens-axial length factor, which were greater in the TDS group (P = 0.007 and P = 0.055, respectively). CONCLUSIONS Clinically significant lenticular astigmatism, more oblique corneal astigmatism, and thicker lenses were characteristic findings in patients with TDS.

Prevalence of refractive errors among schoolchildren in Shiraz, Iran

PURPOSE To determine the prevalence of refractive errors in Shiraz schoolchildren by age and gender. METHODS For this cross-sectional study, random cluster sampling was carried out from students of the 2008-2009 academic year. After the initial interview, ophthalmic examinations including tests of visual acuity, non-cycloplegic and cycloplegic refraction and binocular vision were performed. Myopia was defined as a spherical equivalent < or =-0.50 dioptre (D), hyperopia as > or =+2.0 D, and astigmatism as a cylinder refraction > or =0.75 D. All values for school grade and gender were directly standardized based on the total student population in the 2008-2009 school year. RESULTS A total of 2130 students were sampled, of which 1872 participated in the study (response rate = 87.88%). The prevalence of uncorrected, best-corrected, presenting and spectacle corrected visual acuity of 6/12 or worse in the better eye was 6.46%, 0%, 1.49% and 0.9%, respectively. The prevalence rates of myopia, hyperopia and astigmatism were 4.35% (95% confidence interval [CI]: 2.89-5.82%), 5.04% (95% CI: 3.50-6.58%), and 11.27% (95% CI: 9.81-12.74%), respectively. Anisometropia was detected in 2.58% of schoolchildren. The prevalence of hyperopia significantly decreased with age (P = 0.021). CONCLUSIONS Compared with other reported rates, the prevalence of myopia in the schoolchildren of Shiraz is similar to that in most places excluding East Asian countries, and that of hyperopia is in the mid range.

Ocular refractive and biometric characteristics in patients with tilted disc syndrome

Purpose: To evaluate the ocular refractive and biometric characteristics in patients with tilted disc syndrome (TDS). Methods: This case-control study comprised 41 eyes of 25 patients with established TDS and forty eyes of 20 age- and sex-matched healthy control subjects. All had a complete ocular examination including refraction and analysis using Fourier transformation, slit lamp biomicroscopy, pachymetry keratometry, and ocular biometry. Corneal topography examinations were performed in the syndrome group only. Results: There were no significant differences in spherical equivalent (p = 0.334) and total astigmatism (p= 0.246) between groups. However, mean best spectacular corrected visual acuity was significantly worse in TDS patients (P < 0.001). The lenticular astigmatism was significantly greater in the syndrome group, while the corneal component was greater in the controls (p = 0.004 and p = 0.002, respectively). The measured biometric features were the same in both groups, except for the lens thickness, relative lens position, and lens-axial length factor which were greater in the TDS group (p = 0.002, p = 0.015, and p = 0.025, respectively). Conclusions: Clinically significant lenticular astigmatism, more oblique corneal astigmatism, and thicker lens were characteristic findings in patients with TDS.

Decisions and actions of distracted drivers at the onset of yellow light

Driving on an approach to a signalized intersection while distracted is relatively risky, as potential vehicular conflicts and resulting angle collisions tend to be relatively more severe compared to other locations. Given the prevalence and importance of this particular scenario, the objective of this study was to examine the decisions and actions of distracted drivers during the onset of yellow lights. Driving simulator data were obtained from a sample of 69 drivers under baseline and handheld cell phone conditions at the University of Iowa – National Advanced Driving Simulator. Explanatory variables included age, gender, cell phone use, distance to stop-line, and speed. Although there is extensive research on drivers’ responses to yellow traffic signals, the examinations have been conducted from a traditional regression-based approach, which do not necessary provide the underlying relations and patterns among the sampled data. In this paper, we exploit the benefits of both classical statistical inference and data mining techniques to identify the a priori relationships among main effects, non-linearities, and interaction effects. Results suggest that the probability of yellow light running increases with the increase in driving speed at the onset of yellow. Both young (18–25 years) and middle-aged (30–45 years) drivers reveal reduced propensity for yellow light running whilst distracted across the entire speed range, exhibiting possible risk compensation during this critical driving situation. The propensity for yellow light running for both distracted male and female older (50–60 years) drivers is significantly higher. Driver experience captured by age interacts with distraction, resulting in their combined effect having slower physiological response and being distracted particularly risky.

Interaction design for tablet based edutainment systems for mathematical education of primary student

Mathematics has been perceived as the core area of learning in most educational systems around the world including Sri Lanka. Unfortunately, it is clearly visible that a majority of Sri Lankan students are failing in their basic mathematics when the recent grade five scholarship examination and ordinary level exam marks are analysed. According to Department of Examinations Sri Lanka , on average, over 88 percent of the students are failing in the grade 5 scholarship examinations where mathematics plays a huge role while about 50 percent of the students fail in there ordinary level mathematics examination. Poor or lack of basic mathematics skills has been identified as the root cause.

Author's reply to: Ankylosing spondylitis: evidence for a non-HLA-B*27 protective effect, Sjef Van Der Linden, Desieree Van Der Heijde

As mentioned in the letter by van der Linden and van der Heijde, Jurgen Braun’s excellent recent paper describing a survey of blood donors by questionnaire, clinical, and magnetic resonance imaging examinations revealed a prevalence of ankylosing spondylitis in B27 positive blood donors (6.4%)1-1 very similar to that reported by Gran et al(6.7%).1-2 It is probable that some of the differences in reported prevalence of ankylosing spondylitis by the various studies are because of methodological differences.

Susceptibility to ankylosing spondylitis in twins: The role of genes, HLA, and the environment

Objective To determine the relative effects of genetic and environmental factors in susceptibility to ankylosing spondylitis (AS). Methods Twins with AS were identified from the Royal National Hospital for Rheumatic Diseases database. Clinical and radiographic examinations were performed to establish diagnoses, and disease severity was assessed using a combination of validated scoring systems. HLA typing for HLA-B27, HLA-B60, and HLA-DR1 was performed by polymerase chain reaction with sequence- specific primers, and zygosity was assessed using microsatellite markers. Genetic and environmental variance components were assessed with the program Mx, using data from this and previous studies of twins with AS. Results Six of 8 monozygotic (MZ) twin pairs were disease concordant, compared with 4 of 15 B27-positive dizygotic (DZ) twin pairs (27%) and 4 of 32 DZ twin pairs overall (12.5%). Nonsignificant increases in similarity with regard to age at disease onset and all of the disease severity scores assessed were noted in disease-concordant MZ twins compared with concordant DZ twins. HLA-B27 and B60 were associated with the disease in probands, and the rate of disease concordance was significantly increased among DZ twin pairs in which the co- twin was positive for both B27 and DR1. Additive genetic effects were estimated to contribute 97% of the population variance. Conclusion Susceptibility to AS is largely genetically determined, and the environmental trigger for the disease is probably ubiquitous. HLA-B27 accounts for a minority of the overall genetic susceptibility to AS.

Law as lore

Law is saturated with stories. People tell their stories to lawyers; lawyers tell their clients’ stories to courts; legislators develop regulation to respond to their constituents’ stories of injustice or inequality. In legal education, professors devise hypothetical scenarios to test student understanding of legal doctrine; in law examinations and assignments, students construct advice to fictional clients. The common law legal system derives many of its foundational principles from case law — in effect, stories with legal solutions — that have accumulated over time. The civil law system, despite a different design centred on legal codes, also relies on judicial story-telling to interpret the code provisions and flesh out the gaps.

Respiratory Exacerbations in Indigenous Children From Two Countries With Non-Cystic Fibrosis Chronic Suppurative Lung Disease/Bronchiectasis

BACKGROUND: Acute respiratory exacerbations (AREs) cause morbidity and lung function decline in children with chronic suppurative lung disease (CSLD) and bronchiectasis. In a prospective longitudinal cohort study, we determined the patterns of AREs and factors related to increased risks for AREs in children with CSLD/bronchiectasis. METHODS: Ninety-three indigenous children aged 0.5 to 8 years with CSLD/bronchiectasis in Australia (n = 57) and Alaska (n = 36) during 2004 to 2009 were followed for > 3 years. Standardized parent interviews, physical examinations, and medical record reviews were undertaken at enrollment and every 3 to 6 months thereafter. RESULTS: Ninety-three children experienced 280 AREs (median = 2, range = 0-11 per child) during the 3-year period; 91 (32%) were associated with pneumonia, and 43 (15%) resulted in hospitalization. Of the 93 children, 69 (74%) experienced more than two AREs over the 3-year period, and 28 (30%) had more than one ARE in each study year. The frequency of AREs declined significantly over each year of follow-up. Factors associated with recurrent (two or more) AREs included age < 3 years, ARE-related hospitalization in the first year of life, and pneumonia or hospitalization for ARE in the year preceding enrollment. Factors associated with hospitalizations for AREs in the first year of study included age < 3 years, female caregiver education, and regular use of bronchodilators. CONCLUSIONS: AREs are common in children with CSLD/bronchiectasis, but with clinical care and time AREs occur less frequently. All children with CSLD/bronchiectasis require comprehensive care; however, treatment strategies may differ for these patients based on their changing risks for AREs during each year of care.

Does PGA external stenting reduce compliance mismatch in venous grafts?

Background: Autogenous vein grafting is widely used in regular bypassing procedures. Due to its mismatch with the host artery in both mechanical property and geometry, the graft often over expands under high arterial blood pressure and forms a step-depth where eddy flow develops, thus causing restenosis, fibrous graft wall, etc. External stents, such as sheaths being used to cuff the graft, have been introduced to eliminate these mismatches and increase the patency. Although histological and immunochemical studies have shown some positive effects of the external stent, the mechanical mismatch under the protection of an external stent remains poorly analyzed. Methods: In this study, the jugular veins taken from hypercholesterolemic rabbits were transplanted into the carotid arteries, and non-woven polyglycolic acid (PGA) fabric was used to fabricate the external stents to study the effect of the biodegradable external stent. Eight weeks after the operation, the grafts were harvested to perform mechanical tests and histological examinations. An arc tangent function was suggested to describe the relationship between pressure and cross-sectional area to analyse the compliance of the graft. Results: The results from the mechanical tests indicated that grafts either with or without external stents displayed large compliance in the low-pressure range and were almost inextensible in the high-pressure range. This was very different from the behavior of the arteries or veins in vivo. The data from histological tests showed that, with external stents, collagen fibers were more compact, whilst those in the graft without protection were looser and thicker. No elastic fiber was found in either kind of grafts. Furthermore, grafts without protection were over-expanded which resulted in much bigger cross-sectional areas. Conclusion: The PGA external extent contributes little to the reduction of the mechanical mismatch between the graft and its host artery while remodeling develops. For the geometric mismatch, it reduces the cross-section area, therefore matching with the host artery much better. Although there are some positive effects, conclusively the PGA is not an ideal material for external stent.

Multidisciplinary review of teaching and assessing competency attainment by non-medical prescribers

Background Prescribing is a complex task, requiring specific knowledge and skills, and the execution of effective, context-specific clinical reasoning. Systematic reviews indicate medical prescribing errors have a median rate of 7% [IQR 2%-14%] of medication orders [1-3]. For podiatrists pursuing prescribing rights, a clear need exists to ensure practitioners develop a well-defined set of prescribing skills, which will contribute to competent, safe and appropriate practice. Aim To investigate the methods employed to teach and assess the principles of effective prescribing in the undergraduate podiatry program and compare and contrast these findings with four other non-medical professions who undertake prescribing after training at Queensland University of Technology. Method The NPS National Prescribing Competency Standards were employed as the prescribing standard. A curriculum mapping exercise was undertaken to determine whether the prescribing principles articulated in the competency standards were addressed by each profession. Results A range of methods are currently utilised to teach prescribing across disciplines. Application of prescribing competencies to the context of each profession appears to influence the teaching methods used. Most competencies were taught using a multimodal format, including interactive lectures, self-directed learning, tutorial sessions and clinical placement. In particular clinical training was identified as the most consistent form of educating safe prescribers across all five disciplines. Assessment of prescribing competency utilised multiple techniques including written and oral examinations and research tasks, case studies, objective structured clinical examination exercises and the assessment of clinical practice. Effective and reliable assessment of prescribing undertaken by students in diverse settings remains challenging e.g. that occurring in the clinical practice environment. Conclusion Recommendations were made to refine curricula and to promote efficient cross-discipline teaching by staff from the disciplines of podiatry, pharmacy, nurse practitioner, optometry and paramedic science. Students now experience a sophisticated level of multidisciplinary learning in the clinical setting which integrates the expertise and skills of experience prescribers combined with innovative information technology platforms (CCTV and live patient assessments). Further work is required to establish a practical, effective approach to the assessment of prescribing competence especially between the university and clinical settings.

Limitations of the manual supination resistance test

The aim of this study was to asses results obtained from a range of commonly performed lower extremity “open and closed” chain kinetic tests used for predicting foot function and correlate these test findings to data obtained from the Zebris WinFDM-T system®. When performed correctly these tests are thought to be indicators of lower extremity function. Podiatrists frequently perform examinations of joint and muscle structures to understand biomechanical function; however the relationship between these routine tests and forces generated during the gait cycle are not always well understood. This can introduce a degree of variability in clinical interpretation which creates conjecture regarding the value of these tests.

Online grocery shopping: The impact of shopping frequency on perceived risk

Online grocery shopping has enjoyed strong growth and it is predicted this channel will continue to grow exponentially in the coming years. While online shopping has attracted an abundance of research interest, examinations of online grocery shopping behaviour are only now emerging. Shopping online for groceries differs considerably from general online shopping due to the perishability and variability of the product, and frequency of the shopping activity. Two salient gaps underpin this research into online grocery shopping. This study responds to calls to investigate the online shoppers’ experience in the context of online purchasing frequency. Second, this study examines the mediating effect of perceived risk between trust and online repurchase intention of groceries. An online survey was employed to collect data from shoppers who were recruited from a multi-channel grocery e-retailer’s database. The online survey, comprising 16 reflective validated scale items, was sent to 555 frequent and infrequent online grocery shoppers. Results find that while customer satisfaction predicts trust for both infrequent and frequent online grocery shoppers, perceived risk fully mediates the effect of trust on repurchase intentions for infrequent online grocery shoppers. Furthermore path analysis reveals that the developed behavioural model is variant across both groups of shoppers. Theoretically, we provide a deeper understanding of the online customer experience, while gaining insight into two shopper segments identified as being important to grocery e-retailers. For managers, this study tests an online customer behavioural model with actual purchasing behaviour and identifies the continued presence of perceived risk in grocery e-retailing regardless of purchase frequency or experience.

Teledermatology: Its use in the detection and management of actinic keratosis

Teledermatology can profoundly improve access to medical services for those who may have limited access to dermatology due to workforce shortages, distance to providers, or limitations in their mobility. Two common ways of teledermatology are differentiated: life synchronous, where patient and doctor communicate directly, or store and forward asynchronous methods, where the patient and doctor provide and assess the medical information independently. Teledermatology has been tested for its safety, feasibility and accuracy for a number of dermatological conditions, including the early detection of skin cancer and is usually safe, feasible and accurate. Studies reported somewhat better results for synchronous than asynchronous methods, possibly because of loss of information if no direct patient doctor contact is feasible. However asynchronous methods are easier to organize, require less sophisticated technology and are more widely accessible, and are more convenient for both patients and doctors. No study to date focused solely on teledermatology of actinic keratosis, but such lesions are typically found during teledermatology examinations for other main target lesions. In studies where such results were reported, actinic keratoses seemed to be readily identifiable for teledermatologists and adequate management and treatment can be suggested within remote consultations.