Care homes’ use of medicines study: prevalence, causes and potential harm of medication errors in care homes for older people

Introduction: Care home residents are at particular risk from medication errors, and our objective was to determine the prevalence and potential harm of prescribing, monitoring, dispensing and administration errors in UK care homes, and to identify their causes. Methods: A prospective study of a random sample of residents within a purposive sample of homes in three areas. Errors were identified by patient interview, note review, observation of practice and examination of dispensed items. Causes were understood by observation and from theoretically framed interviews with home staff, doctors and pharmacists. Potential harm from errors was assessed by expert judgement. Results: The 256 residents recruited in 55 homes were taking a mean of 8.0 medicines. One hundred and seventy-eight (69.5%) of residents had one or more errors. The mean number per resident was 1.9 errors. The mean potential harm from prescribing, monitoring, administration and dispensing errors was 2.6, 3.7, 2.1 and 2.0 (0 = no harm, 10 = death), respectively. Contributing factors from the 89 interviews included doctors who were not accessible, did not know the residents and lacked information in homes when prescribing; home staff’s high workload, lack of medicines training and drug round interruptions; lack of team work among home, practice and pharmacy; inefficient ordering systems; inaccurate medicine records and prevalence of verbal communication; and difficult to fill (and check) medication administration systems. Conclusions: That two thirds of residents were exposed to one or more medication errors is of concern. The will to improve exists, but there is a lack of overall responsibility. Action is required from all concerned.

The processing of number and gender agreement in Spanish: an event related potential investigation of the effects of structural distance

Previous research suggests that the processing of agreement is affected by the distance between the agreeing elements. However, the unique contribution of structural distance (number of intervening syntactic phrases) to the processing of agreement remains an open question, since previous investigations do not tease apart structural and linear distance (number of intervening words). We used event related potentials (ERPs) to examine the extent to which structural distance impacts the processing of Spanish number and gender agreement. Violations were realized both within the phrase and across the phrase. Across both levels of structural distance, linear distance was kept constant, as was the syntactic category of the agreeing elements. Number and gender agreement violations elicited a robust P600 between 400 and 900ms, a component associated with morphosyntactic processing. No amplitude differences were observed between number and gender violations, suggesting that the two features are processed similarly at the brain level. Within-phrase agreement yielded more positive waveforms than across-phrase agreement, both for agreement violations and for grammatical sentences (no agreement by distance interaction). These effects can be interpreted as evidence that structural distance impacts the establishment of agreement overall, consistent with sentence processing models which predict that hierarchical structure impacts the processing of syntactic dependencies. However, due to the lack of an agreement by distance interaction, the possibility cannot be ruled out that these effects are driven by differences in syntactic predictability between the within-phrase and across-phrase configurations, notably the fact that the syntactic category of the critical word was more predictable in the within-phrase conditions.

Morphosyntactic processing in advanced second language (L2) learners: An event-related potential investigation of the effects of L1-L2 similarity and structural distance

Different theoretical accounts of second language (L2) acquisition differ with respect to whether or not advanced learners are predicted to show native like processing for features not instantiated in the native language (L1). We examined how native speakers of English, a language with number but not gender agreement, process number and gender agreement in Spanish. We compare agreement within a determiner phrase (órgano muy complejo “[DP organ-MASC-SG very complex-MASC-SG]”) and across a verb phrase (cuadro es auténtico “painting-MASC-SG [VP is authentic-MASC-SG]”) in order to investigate whether native like processing is limited to local domains (e.g. within the phrase), in line with Clahsen and Felser (2006). We also examine whether morphological differences in how the L1 and L2 realize a shared feature impact processing by comparing number agreement between nouns and adjectives, where only Spanish instantiates agreement, and between demonstratives and nouns, where English also instantiates agreement. Similar to Spanish natives, advanced learners showed a P600 for both number and gender violations overall, in line with the Full Transfer/Full Access Hypothesis (Schwartz and Sprouse, 1996), which predicts that learners can show native-like processing for novel features. Results also show that learners can establish syntactic dependencies outside of local domains, as suggested by the presence of a P600 for both within and across phrase violations. Moreover, similar to native speakers, learners were impacted by the structural distance (number of intervening phrases) between the agreeing elements, as suggested by the more positive waveforms for within than across-phrase agreement overall. These results are consistent with the proposal that learners are sensitive to hierarchical structure.

Potential sources of mouth drying in beverages fortified with dairy proteins: a comparison of casein and whey-rich ingredients

Oral nutritional supplement drinks (ONS) are beverages high in dairy proteins that are prescribed to individuals at risk of malnutrition. Consumption of ONS is poor in elderly care facilities, with patients commenting that the sensory attributes of these drinks reduce their enjoyment and willingness to consume. Mouth drying is an attribute of ONS found to build with repeated consumption, which may further limit liking of these products. This study investigated the sources of drying sensations by sequential profiling, with a trained sensory panel rating a range of model milk systems and ONS over repeated sips and during after-effects. Sequential profiling found that fortification of milk with both caseinate and whey protein concentrate significantly increased the perception of mouth drying over repeated consumption, increasing by between 35 and 85% over consumption of 40mL. Enrichment of ONS with either whey protein concentrate or milk protein concentrate to a total protein content of 8.7% (wt/wt) resulted in whey and casein levels of 4.3:4.4% and 1.7:7.0% respectively. The product higher in whey protein was substantially more mouth drying, implying that whey proteins may be the most important contributor to mouth drying in ONS. However, efforts to mask mouth drying of protein-fortified milk by increasing sweetness or fat level were unsuccessful at the levels tested. Increasing the viscosity of protein-fortified milk led to a small but significant reduction in mouth drying. However, this approach was not successful when tested within complete ONS. Further analysis is required into the mechanism of protein-derived mouth drying to mask negative sensations and improve the enjoyment and consumption of protein-rich ONS.

A gradual depth-dependent change of connectivity features of supragranular pyramidal cells in rat barrel cortex

Recent experimental evidence suggests a finer genetic, structural and functional subdivision of the layers which form a cortical column. The classical layer II/III (LII/III) of rodent neocortex integrates ascending sensory information with contextual cortical information for behavioral read-out. We systematically investigated to which extent regular-spiking supragranular pyramidal neurons, located at different depths within the cortex, show different input-output connectivity patterns. Combining glutamate-uncaging with whole-cell recordings and biocytin filling, we revealed a novel cellular organization of LII/III: (i) “Lower LII/III” pyramidal cells receive a very strong excitatory input from lemniscal LIV and much fewer inputs from paralemniscal LVa. They project to all layers of the home column, including a feedback projection to LIV whereas transcolumnar projections are relatively sparse. (ii) “Upper LII/III” pyramidal cells also receive their strongest input from LIV, but in addition, a very strong and dense excitatory input from LVa. They project extensively to LII/III as well as LVa and Vb of their home and neighboring columns, (iii) “Middle LII/III” pyramidal cell show an intermediate connectivity phenotype that stands in many ways in-between the features described for lower versus upper LII/III. “Lower LII/III” intracolumnarly segregates and transcolumnarly integrates lemniscal information whereas “upper LII/III” seems to integrate lemniscal with paralemniscal information. This suggests a finegrained functional subdivision of the supragranular compartment containing multiple circuits without any obvious cytoarchitectonic, other structural or functional correlate of a laminar border in rodent barrel cortex.

Serum carbon and nitrogen stable isotopes as potential biomarkers of dietary intake and their relation with incident type 2 diabetes: the EPIC-Norfolk study

Background: Stable-isotope ratios of carbon (13C/12C, expressed as δ13C) and nitrogen (15N/14N, or δ15N) have been proposed as potential nutritional biomarkers to distinguish between meat, fish, and plant-based foods. Objective: The objective was to investigate dietary correlates of δ13C and δ15N and examine the association of these biomarkers with incident type 2 diabetes in a prospective study. Design: Serum δ13C and δ15N (‰) were measured by using isotope ratio mass spectrometry in a case-cohort study (n = 476 diabetes cases; n = 718 subcohort) nested within the European Prospective Investigation into Cancer and Nutrition (EPIC)–Norfolk population-based cohort. We examined dietary (food-frequency questionnaire) correlates of δ13C and δ15N in the subcohort. HRs and 95% CIs were estimated by using Prentice-weighted Cox regression. Results: Mean (±SD) δ13C and δ15N were −22.8 ± 0.4‰ and 10.2 ± 0.4‰, respectively, and δ13C (r = 0.22) and δ15N (r = 0.20) were positively correlated (P < 0.001) with fish protein intake. Animal protein was not correlated with δ13C but was significantly correlated with δ15N (dairy protein: r = 0.11; meat protein: r = 0.09; terrestrial animal protein: r = 0.12, P ≤ 0.013). δ13C was inversely associated with diabetes in adjusted analyses (HR per tertile: 0.74; 95% CI: 0.65, 0.83; P-trend < 0.001], whereas δ15N was positively associated (HR: 1.23; 95% CI: 1.09, 1.38; P-trend = 0.001). Conclusions: The isotope ratios δ13C and δ15N may both serve as potential biomarkers of fish protein intake, whereas only δ15N may reflect broader animal-source protein intake in a European population. The inverse association of δ13C but a positive association of δ15N with incident diabetes should be interpreted in the light of knowledge of dietary intake and may assist in identifying dietary components that are associated with health risks and benefits.

The potential impact of changes in lower stratospheric water vapour on stratospheric temperatures over the past 30 years

This study investigates the potential contribution of observed changes in lower stratospheric water vapour to stratospheric temperature variations over the past three decades using a comprehensive global climate model (GCM). Three case studies are considered. In the first, the net increase in stratospheric water vapour (SWV) from 1980–2010 (derived from the Boulder frost-point hygrometer record using the gross assumption that this is globally representative) is estimated to have cooled the lower stratosphere by up to ∼0.2 K decade−1 in the global and annual mean; this is ∼40% of the observed cooling trend over this period. In the Arctic winter stratosphere there is a dynamical response to the increase in SWV, with enhanced polar cooling of 0.6 K decade−1 at 50 hPa and warming of 0.5 K decade−1 at 1 hPa. In the second case study, the observed decrease in tropical lower stratospheric water vapour after the year 2000 (imposed in the GCM as a simplified representation of the observed changes derived from satellite data) is estimated to have caused a relative increase in tropical lower stratospheric temperatures by ∼0.3 K at 50 hPa. In the third case study, the wintertime dehydration in the Antarctic stratospheric polar vortex (again using a simplified representation of the changes seen in a satellite dataset) is estimated to cause a relative warming of the Southern Hemisphere polar stratosphere by up to 1 K at 100 hPa from July–October. This is accompanied by a weakening of the westerly winds on the poleward flank of the stratospheric jet by up to 1.5 m s−1 in the GCM. The results show that, if the measurements are representative of global variations, SWV should be considered as important a driver of transient and long-term variations in lower stratospheric temperature over the past 30 years as increases in long-lived greenhouse gases and stratospheric ozone depletion.

Potential role of NF-kappaB in adult neural stem cells: the underrated steersman?

Neural stem cells are precursors of neurons and glial cells. During brain development, these cells proliferate, migrate and differentiate into specific lineages. Recently neural stem cells within the adult central nervous system were identified. Informations are now emerging about regulation of stem cell proliferation, migration and differentiation by numerous soluble factors such as chemokines and cytokines. However, the signal transduction mechanisms downstream of these factors are less clear. Here, we review potential evidences for a novel central role of the transcription factor nuclear factor kappa B (NF-kappaB) in these crucial signal transduction processes. NF-kappaB is an inducible transcription factor detected in neurons, glia and neural stem cells. NF-kappaB was discovered by David Baltimore's laboratory as a transcription factor in lymphocytes. NF-kappaB is involved in many biological processes such as inflammation and innate immunity, development, apoptosis and anti-apoptosis. It has been recently shown that members of the NF-kappaB family are widely expressed by neurons, glia and neural stem cells. In the nervous system, NF-kappaB plays a crucial role in neuronal plasticity, learning, memory consolidation, neuroprotection and neurodegeneration. Recent data suggest an important role of NF-kappaB on proliferation, migration and differentiation of neural stem cells. NF-kappaB is composed of three subunits: two DNA-binding and one inhibitory subunit. Activation of NF-kappaB takes place in the cytoplasm and results in degradation of the inhibitory subunit, thus enabling the nuclear import of the DNA-binding subunits. Within the nucleus, several target genes could be activated. In this review, we suggest a model explaining the multiple action of NF-kappaB on neural stem cells. Furthermore, we discuss the potential role of NF-kappaB within the so-called brain cancer stem cells.

Potential role of vegetation feedback in the climate sensitivity of high-latitude regions: a case study at 6000 years B.P.

Previous climate model simulations have shown that the configuration of the Earth's orbit during the early to mid-Holocene (approximately 10–5 kyr) can account for the generally warmer-than-present conditions experienced by the high latitudes of the northern hemisphere. New simulations for 6 kyr with two atmospheric/mixed-layer ocean models (Community Climate Model, version 1, CCMl, and Global ENvironmental and Ecological Simulation of Interactive Systems, version 2, GENESIS 2) are presented here and compared with results from two previous simulations with GENESIS 1 that were obtained with and without the albedo feedback due to climate-induced poleward expansion of the boreal forest. The climate model results are summarized in the form of potential vegetation maps obtained with the global BIOME model, which facilitates visual comparisons both among models and with pollen and plant macrofossil data recording shifts of the forest-tundra boundary. A preliminary synthesis shows that the forest limit was shifted 100–200 km north in most sectors. Both CCMl and GENESIS 2 produced a shift of this magnitude. GENESIS 1 however produced too small a shift, except when the boreal forest albedo feedback was included. The feedback in this case was estimated to have amplified forest expansion by approximately 50%. The forest limit changes also show meridional patterns (greatest expansion in central Siberia and little or none in Alaska and Labrador) which have yet to be reproduced by models. Further progress in understanding of the processes involved in the response of climate and vegetation to orbital forcing will require both the deployment of coupled atmosphere-biosphere-ocean models and the development of more comprehensive observational data sets

Some potential inaccuracies of the p -nitrophenyl phosphomonoesterase assay in the study of the phosphorus nutrition of soil borne fungi

The p-nitrophenol phosphomonoesterase assay (pNPPase) is commonly used to measure cell-wall-associated and extracellular phosphatase activity of soil fungi. pNPPases are usually assayed in the context of fungal nutrition, where inorganic P supply might be enhanced by the mineralisation of organic P sources in the soil. We report here on a series of experiments with the ectomycorrhizal basidiomycete Hebeloma cylindrosporum that highlight components of accepted methodology that might impinge on the reliability of the assay. These include the loss of pNPPase after filtration, inaccuracies in measuring wall-associated enzyme and the ample pool of intracellular pNPPase can be mistakenly measured as external pNPPase if cells are accidentally damaged.

Endothelin-1 and fibroblast growth factors stimulate the mitogen-activated protein kinase signaling cascade in cardiac myocytes. The potential role of the cascade in the integration of two signaling pathways leading to myocyte hypertrophy.

Maximally effective concentrations of endothelin-1 (ET-1), acidic FGF (aFGF), or 12-O-tetradecanoylphorbol-13-acetate (TPA) activated mitogen-activated protein kinase (MAPK) by 3-4-fold in crude extracts of myocytes cultured from neonatal rat heart ventricles. Maximal activation was achieved after 5 min. Thereafter, MAPK activity stimulated by ET-1 or aFGF declined to control values within 1-2 h, whereas activation by TPA was more sustained. Two peaks of MAPK activity (a 42- and a 44-kDa MAPK) were resolved in cells exposed to ET-1 or aFGF by fast protein liquid chromatography on a Mono Q column. One major and one minor peak of MAPK kinase (MAPKK) was stimulated by ET-1 or aFGF. Cardiac myocytes expressed protein kinase C (PKC)-alpha, -delta, -epsilon and -zeta as shown immunoblotting. Exposure to 1 microM TPA for 24 h down-regulated PKC-alpha, -delta, and -epsilon, but not PKC-zeta. This maneuver wholly abolished the activation of MAPK on re-exposure to TPA but did not affect the response to aFGF. The effect of ET-1 was partially down-regulated. ET-1 stimulated phospho[3H]inositide hydrolysis 18-fold, whereas aFGF stimulated by only 30%. Agonists which initially utilize dissimilar signaling pathways may therefore converge at the level of MAPKK/MAPK and this may be relevant to the hypertrophic response of the heart.

Future change of climate in South America in the late twenty-first century: intercomparison of scenarios from three regional climate models

Regional climate change projections for the last half of the twenty-first century have been produced for South America, as part of the CREAS (Cenarios REgionalizados de Clima Futuro da America do Sul) regional project. Three regional climate models RCMs (Eta CCS, RegCM3 and HadRM3P) were nested within the HadAM3P global model. The simulations cover a 30-year period representing present climate (1961-1990) and projections for the IPCC A2 high emission scenario for 2071-2100. The focus was on the changes in the mean circulation and surface variables, in particular, surface air temperature and precipitation. There is a consistent pattern of changes in circulation, rainfall and temperatures as depicted by the three models. The HadRM3P shows intensification and a more southward position of the subtropical Pacific high, while a pattern of intensification/weakening during summer/winter is projected by the Eta CCS/RegCM3. There is a tendency for a weakening of the subtropical westerly jet from the Eta CCS and HadRM3P, consistent with other studies. There are indications that regions such of Northeast Brazil and central-eastern and southern Amazonia may experience rainfall deficiency in the future, while the Northwest coast of Peru-Ecuador and northern Argentina may experience rainfall excesses in a warmer future, and these changes may vary with the seasons. The three models show warming in the A2 scenario stronger in the tropical region, especially in the 5A degrees N-15A degrees S band, both in summer and especially in winter, reaching up to 6-8A degrees C warmer than in the present. In southern South America, the warming in summer varies between 2 and 4A degrees C and in winter between 3 and 5A degrees C in the same region from the 3 models. These changes are consistent with changes in low level circulation from the models, and they are comparable with changes in rainfall and temperature extremes reported elsewhere. In summary, some aspects of projected future climate change are quite robust across this set of model runs for some regions, as the Northwest coast of Peru-Ecuador, northern Argentina, Eastern Amazonia and Northeast Brazil, whereas for other regions they are less robust as in Pantanal region of West Central and southeastern Brazil.

Heat Conduction Equation Solution in the Presence of a Change of State in a Bounded Axisymmetric Cylindrical Domain

The heat conduction problem, in the presence of a change of state, was solved for the case of an indefinitely long cylindrical layer cavity. As boundary conditions, it is imposed that the internal surface of the cavity is maintained below the fusion temperature of the infilling substance and the external surface is kept above it. The solution, obtained in nondimensional variables, consists in two closed form heat conduction equation solutions for the solidified and liquid regions, which formally depend of the, at first, unknown position of the phase change front. The energy balance through the phase change front furnishes the equation for time dependence of the front position, which is numerically solved. Substitution of the front position for a particular instant in the heat conduction equation solutions gives the temperature distribution inside the cavity at that moment. The solution is illustrated with numerical examples. [DOI: 10.1115/1.4003542]