Polypharmacy as predictor of drug cost, length of hospital stay and mortality rate in nursing homes : a retrospective analysis of pharmacy medication records

Background and objectives: Polypharmacy (PP) is a typical con-sequence of multiple chronic conditions in elderly patients. PP is commonly defined as the use of multiple concurrent drug therapies although a standard definition is not used. The aims of this study were to assess the PP rate among nursing home (NH) residents using the data of the pharmacy medication records and to investigate the threshold level of PP as predictor of drug cost, length of hospital stay and mortality rate

A Computer Based Information System for County Equipment Cost Records, Interim Report, HR-173, 1975

This report describes the work accomplished to date on research project HR-173, A Computer Based Information System for County Equipment Cost Records, and presents the initial design for this system. The specific topics discussed here are findings from the analysis of information needs, the system specifications developed from these findings, and the proposed system design based upon the system specifications. The initial system design will include tentative input designs for capturing input data, output designs to show the output formats and the items to be output for use in decision making, file design showing the organization of information to be kept on each piece of equipment in the computer data file, and general system design explaining how the entire system will operate. The Steering Committee appointed by Iowa Highway Research Board is asked to study this report, make appropriate suggestions, and give approval to the proposed design subject to any suggestions made. This approval will permit the designer to proceed promptly with the development of the computer program implementation phase of the design.

A Computer Based Information System for County Equipment Cost Records, Final Report, HR-173, 1975

This appendix is divided into three sections. The first section contains abstracts of each of the eight computer programs in the system, instructions for keypunching the three input documents, and computer operating instructions pertaining to each program. The second section contains system flowcharts for the entire system as well as program flowcharts for each program. The last section contains PL/l program listings of each program.

Paleohydrological Reconstruction from Late Holocene Records in Interdune Lakes (N'Guigmi, Northern Bank of the Lake Chad, Niger)

An old erg covers the northern part of the Lake Chad basin. This dune landform allowed the formation of many inter- dune ponds of various sizes. Still present in certain zones where the groundwater level is high (e.g. Kanem, southern Manga), these ponds formed in the past a vast network of lacustrine microsystems, as shown by the nature and the dis- tribution of their deposits. In the Manga, these interdune deposits represent the main sedimentary records of the Holo- cene environmental succession. Their paleobiological (pollens, diatoms, ostracods) and geochemical (δ18O, δ13C, Sr/ Ca) contents are often the basis for paleoenvironmental reconstruction. On the other hand, their sedimentological char- acters are rarely exploited. This study of palustro-lacustrine deposits of the Holocene N'Guigmi lake (northern bank of the Lake Chad; Niger) is based on the relationships between the sedimentological features and the climato-hydrological fluctuations. The mineralogical parameters (e.g. calcium carbonate content, clay mineralogy) and the nature of autoch- thonous mineralization (i.e. amorphous silica, clays, calcium carbonates) can be interpreted using a straightforward hy- dro-sedimentary model. Established to explain the geochemical dynamics of Lake Chad, this model is based on a bio- geochemical cycle of the main elements (i.e. silicium, calcium) directly controlled by the local hydrological balance (i.e. rainfall/evaporation ratio). All these results show that a detailed study of sedimentological features can provide impor- tant paleohydrological informations about the regional aridification since ca 6500 14C BP.

The Mixed Management of Patients' Medical Records: Responsibility Sharing Between the Patient and the Physician

Through this article, we propose a mixed management of patients' medical records, so as to share responsibilities between the patient and the Medical Practitioner by making Patients responsible for the validation of their administrative information, and MPs responsible for the validation of their Patients' medical information. Our proposal can be considered a solution to the main problem faced by patients, health practitioners and the authorities, namely the gathering and updating of administrative and medical data belonging to the patient in order to accurately reconstitute a patient's medical history. This method is based on two processes. The aim of the first process is to provide a patient's administrative data, in order to know where and when the patient received care (name of the health structure or health practitioner, type of care: out patient or inpatient). The aim of the second process is to provide a patient's medical information and to validate it under the accountability of the Medical Practitioner with the help of the patient if needed. During these two processes, the patient's privacy will be ensured through cryptographic hash functions like the Secure Hash Algorithm, which allows pseudonymisation of a patient's identity. The proposed Medical Record Search Engines will be able to retrieve and to provide upon a request formulated by the Medical ractitioner all the available information concerning a patient who has received care in different health structures without divulging the patient's identity. Our method can lead to improved efficiency of personal medical record management under the mixed responsibilities of the patient and the MP.

Summary of Early Triassic carbon isotope records

Much attention has been given to the negative d13C anomaly nearly coincident with the Permian-Triassic boundary. New data indicate a stepwise decline in d13C initiating before the Latest Permian extinction event followed by highly variable d13C values during the remaining Early Triassic. d13C values appear much less erratic as global metazoan diversity increased in the Middle Triassic. Given the previously unappreciated magnitude of isotopic change and the number of large d13C excursions that occurred during the Early Triassic, catastrophic mechanisms like methane release/bolide impact become less attractive to explain the Early Triassic carbon isotopic record as a whole.

Transfer Behavior Transfer Among Iowa Community College Students and Post-college Earnings of Iowa Community College Students, May 15, 2007

Iowa State Board of Education issued a five-year strategic plan to meet accountability goals of Iowa Community Colleges through well defined and articulated performance indicators. More specifically, the fifth strategic goal stated that “the community colleges of Iowa [would] recruit, enroll, retain to completion or graduation persons of underrepresented groups in all programs. Data were obtained to examine the transfer behaviors of the 2002 cohort of Iowa community college award recipients and non-award recipients. Three data files containing demographic information, educational records, enrollment data and fiscal year 2002 degree award files were merged to analyze transfer behavior in the state of Iowa.

Earthworms from Mato Grosso, Brazil, and new records of species from the state

The objective of this work was to undertake a qualitative assessment of earthworm diversity in areas under human influence, in a region of Cerrado-Pantanal-Amazon rainforest transition, in the state of Mato Grosso, Brazil. The earthworms were collected in the municipalities of Barra do Bugres and Arenápolis, and were studied together with species previously identified from other municipalities. Seventeen municipalities, at 29 sampling points of Mato Grosso State, have been sampled. Seven species of earthworms were collected and identified in Barra do Bugres: Goiascolex vanzolinii, Pontoscolex (Pontoscolex) corethrurus, Opisthodrillus borellii borellii, Opisthodrillus sp., Dichogaster (Diplothecodrilus) gracilis, Dichogaster sp. and a species of the Criodrilidae family. Four species of earthworms were identified in Arenápolis: Pontoscolex (Pontoscolex) corethrurus, Dichogaster (Diplothecodrilus) gracilis, Dichogaster (Diplothecodrilus) affinis and Dichogaster sp. In total, 32 earthworm species/subspecies are known from Mato Grosso, 22 native and 10 exotic.

Medical record search engines, using pseudonymised patient identity: an alternative to centralised medical records

Purpose The purpose of our multidisciplinary study was to define a pragmatic and secure alternative to the creation of a national centralised medical record which could gather together the different parts of the medical record of a patient scattered in the different hospitals where he was hospitalised without any risk of breaching confidentiality. Methods We first analyse the reasons for the failure and the dangers of centralisation (i.e. difficulty to define a European patients' identifier, to reach a common standard for the contents of the medical record, for data protection) and then propose an alternative that uses the existing available data on the basis that setting up a safe though imperfect system could be better than continuing a quest for a mythical perfect information system that we have still not found after a search that has lasted two decades. Results We describe the functioning of Medical Record Search Engines (MRSEs), using pseudonymisation of patients' identity. The MRSE will be able to retrieve and to provide upon an MD's request all the available information concerning a patient who has been hospitalised in different hospitals without ever having access to the patient's identity. The drawback of this system is that the medical practitioner then has to read all of the information and to create his own synthesis and eventually to reject extra data. Conclusions Faced with the difficulties and the risks of setting up a centralised medical record system, a system that gathers all of the available information concerning a patient could be of great interest. This low-cost pragmatic alternative which could be developed quickly should be taken into consideration by health authorities.

Fishery of the Goliath grouper, Epinephelus itajara (Teleostei: Epinephelidae) based on local ecological knowledge and fishery records in Yucatan, Mexico

The Goliath grouper, Epinephelus itajara, a large-bodied (similar to 2.5 m TL, > 400 kg) and critically endangered fish (Epinephelidae), is highly Vulnerable to overfishing. Although protected from fishing in many countries, its exploitation in Mexico is unregulated; a situation that puts its populations at risk. Fishery records of E. itajara are scarce, which prevents determination of its fishery status. This work aimed to elucidate the E itajara fishery in the northern Yucatan Peninsula by 1) analyzing available catch records and 2) interviewing veteran fishermen (local ecological knowledge) from two traditional landing sites: Dzilam de Bravo and Puerto Progreso. Historic fishery records from two fishing cooperatives were analyzed in order to elucidate the current situation and offer viable alternatives for conservation and management. Catches have decreased severely. Local knowledge obtained from fishermen represented a very important source of information for reconstructing the fisheries history of this species. Conservation measures that incorporate regional and international regulations on critically endangered fish species are suggested

Reporting of methodologic information on trial registries for quality assessment: a study of trial records retrieved from the WHO search portal

Background: Although randomized clinical trials (RCTs) are considered the gold standard of evidence, their reporting is often suboptimal. Trial registries have the potential to contribute important methodologic information for critical appraisal of study results. Methods and Findings: The objective of the study was to evaluate the reporting of key methodologic study characteristics in trial registries. We identified a random sample (n = 265) of actively recruiting RCTs using the World Health Organization International Clinical Trials Registry Platform (ICTRP) search portal in 2008. We assessed the reporting of relevant domains from the Cochrane Collaboration’s ‘Risk of bias’ tool and other key methodological aspects. Our primary outcomes were the proportion of registry records with adequate reporting of random sequence generation, allocation concealment, blinding, and trial outcomes. Two reviewers independently assessed each record. Weighted overall proportions in the ICTRP search portal for adequate reporting of sequence generation, allocation concealment, blinding (including and excluding open label RCT) and primary outcomes were 5.7% (95% CI 3.0–8.4%), 1.4% (0–2.8%), 41% (35–47%), 8.4% (4.1–13%), and 66% (60–72%), respectively. The proportion of adequately reported RCTs was higher for registries that used specific methodological fields for describing methods of randomization and allocation concealment compared to registries that did not. Concerning other key methodological aspects, weighted overall proportions of RCTs with adequately reported items were as follows: eligibility criteria (81%), secondary outcomes (46%), harm (5%) follow-up duration (62%), description of the interventions (53%) and sample size calculation (1%). Conclusions: Trial registries currently contain limited methodologic information about registered RCTs. In order to permit adequate critical appraisal of trial results reported in journals and registries, trial registries should consider requesting details on key RCT methods to complement journal publications. Full protocols remain the most comprehensive source of methodologic information and should be made publicly available.

Un còctel de records reals i falsos

Un experiment realitzat amb ratolins transgènics per científics nord-americans ha demostrat que la memòria està formada per la combinació de fets ocorreguts i imaginaris

First records and potential palaeoecological significance of Dianella (Xanthorrhoeaceae), an extinct representative of the native flora of Rapa Nui (Easter Island).

Easter Island, a remote island in the Pacific Ocean, is currently primarily covered by grasslands, but palaeoecological studies have shown the former presence of different vegetation. Much of its original biota has been removed during the last two millennia, most likely by human activities, and little is known about the native flora.Macrofossil and pollen analyses of a sediment core from the Raraku crater lake have revealed the occurrence of a plant that is currently extinct from the island: Dianella cf. intermedia/adenanthera (Xanthorrhoeaceae), which grew and disappeared at the Raraku site long before human arrival. The occurrence of Dianella within the Raraku sedimentary sequence (between 9.4 and 5.4 cal. kyr B.P.) could have been linked to the existence of favorable palaeoenvironmental conditions (peatland rather than the present-day lacustrine environment) during the early to mid Holocene. This finding contributes new knowledge about indigenous plant diversity on Easter Island and reinforces the usefulness of further macrofossil and pollen analyses to identify native species on Easter Island and elsewhere.