Polypharmacy among inpatients aged 70 years or older in Australia

Objectives To investigate medication changes for older patients admitted to hospital and to explore associations between patient characteristics and polypharmacy. Design Prospective cohort study. Participants and setting Patients aged 70 years or older admitted to general medical units of 11 acute care hospitals in two Australian states between July 2005 and May 2010. All patients were assessed using the interRAI assessment system for acute care. Main outcome measures Measures of physical, cognitive and psychosocial functioning; and number of regular prescribed medications categorised into three groups: non-polypharmacy (0–4 drugs), polypharmacy (5–9 drugs) and hyperpolypharmacy (≥ 10 drugs). Results Of 1220 patients who were recruited for the study, medication records at admission were available for 1216. Mean age was 81.3 years (SD, 6.8 years), and 659 patients (54.2%) were women. For the 1187 patients with complete medication records on admission and discharge, there was a small but statistically significant increase in mean number of regular medications per day between admission and discharge (7.1 v 7.6), while the prevalence of medications such as statins (459 [38.7%] v 457 [38.5%] patients), opioid analgesics (155 [13.1%] v 166 [14.0%] patients), antipsychotics (59 [5.0%] v 65 [5.5%] patients) and benzodiazepines (122 [10.3%] v 135 [11.4%] patients) did not change significantly. Being in a higher polypharmacy category was significantly associated with increase in comorbidities (odds ratio [OR], 1.27; 95% CI, 1.20–1.34), presence of pain (OR, 1.31; 1.05–1.64), dyspnoea (OR, 1.64; 1.30–2.07) and dependence in terms of instrumental activities of daily living (OR, 1.70; 1.20–2.41). Hyperpolypharmacy was observed in 290/1216 patients (23.8%) at admission and 336/1187 patients (28.3%) on discharge, and the proportion of preventive medication in the hyperpolypharmacy category at both points in time remained high (1209/3371 [35.9%] at admission v 1508/4117 [36.6%] at discharge). Conclusions Polypharmacy is common among older people admitted to general medical units of Australian hospitals, with no clinically meaningful change to the number or classification (symptom control, prevention or both) of drugs made by treating physicians.

The disruptive technologies that will shape business in the years ahead

Regardless of your industry, the marketplace is continually evolving. The reason, increasingly, is the evolution of disruptive technology. Disruptive technologies are enhanced or new technological innovations that essentially displace conventional and established technology, rendering it obsolete. They can create opportunities for new products, new markets, and new ways of conducting business. In 2016, business models will again change as businesses adapt. The enhancement of current technology and the development of new technological innovations will undeniably transform how new businesses are established, and how existing businesses compete. For small and medium-sized firms, technology will also enable significant leaps forward in terms of innovation, efficiency and competitiveness. Adapting quickly will be essential, so here’s the top six we think you should be prepared for.

Swan’s Lagoon Celebrating 50 years

Swan’s Lagoon, which is 125 km south-south-west of Townsville, was purchased by the Queensland Government as a beef cattle research station in 1961. It is situated within the seasonally-dry tropical spear grass region of North Queensland. The station was expanded from 80 km2 to 340 km2 by purchase of the adjoining Expedition block in 1978. The first advisory committee formed and initiated research in 1961. The median annual rainfall of 708 mm (28 inches) is highly variable, with over 80% usually falling in December–April. Annual evaporation is 2.03 metres. The 60% of useable area is mostly flat with low fertility duplex soils, of which more than 50% is phosphorus deficient. Natural spear grass-based pastures predominate over the station. Swan’s Lagoon research has contributed to understanding the biology of many aspects of beef production for northern Australia. Research outcomes have provided options to deal with the region’s primary challenges of weaning rates averaging less than 60%, annual growth rates averaging as little as 100 kg, high mortality rates and high management costs. All these relate to the region’s variable and highly seasonal rainfall—challenges that add to insect-borne viruses, ticks, buffalo fly and internal parasites. As well as the vast amount of practical beef production science produced at Swan’s Lagoon, generations of staff have been trained there to support beef producers throughout Queensland and northern Australia to increase their business efficiency. The Queensland Government has provided most of the funds for staffing and operations. Strong beef industry support is reflected in project funding from meat industry levies, managed by Meat and Livestock Australia (MLA) and its predecessors. MLA has consistently provided the majority of operational research funding since the first grant for ‘Studies of management practices, adaption of different breeds and strains to tropical environments, and studies on tick survival and resistance’ in 1962–63. A large number of other agencies and commercial companies have also supported research.

Aenny Catzenstein nee Gottschalk in her last years, blind from glaucoma; London.

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Studio portrait of Nanny Stern (Oberglen) at eighty-four years old; Frankfurt.

Grandmother of Fred Herz; Born 27 September 1845, died 9 May 1929

Performance of Pinus elliottii, Pinus caribaea, their F-1, F-2 and backcross hybrids and Pinus taeda to 10 years in the Mesopotamia region, Argentina

Performances of Pinus taxa were studied to 10 years of age in two trials in each of Misiones and Entre Rios provinces across the Mesopotamia region of Argentina. Taxa comprised 22 populations from sources in Argentina, Australia, Brazil and Zimbabwe including Pinus elliottii var. elliottii (Pee), Pinus caribaea var. hondurensis (Pch), their four, inter-specific hybrids (F-1, F-2 and backcrosses from F-1 to Pch and to Pee-all as broadly based bulks); other Pee and Pinus taeda (Pt) comprised narrower or unspecified bulks. Variable numbers of taxa were missing at each site. Mean survival across sites at age 10 years ranged 53.2-91.3% averaging 74.2%. Analysis of variance of plot means indicated population effect was statistically significant (p < 0.05) for all or most growth and quality traits at all sites. However, significant differences from the nominated check seedlot at the Entre Rios sites (Pee, Australia) were extremely rare, while quite common at the northern, Misiones sites (check seedlot a Pt population). In the Misiones trials, F-1, F-2 and both backcross hybrids showed better stem straightness than Pee and Pt from Argentina, generally with statistically significant differences (p < 0.05). Pt showed lowest forking scores (desirable). Taxon x environment interaction was statistically significant (p < 0.01) for growth traits only (p > 0.05). However, this interaction contributed an average of only 34.1% of the taxon variance suggesting a lack of practical importance. Taxa most suitable for deployment in the Mesopotamia region, Argentina are suggested.

Resilience of a eucalypt forest woody understorey to long-term (34–55 years) repeated burning in subtropical Australia

We investigated the effects of annual burning since 1952, triennial burning since 1973, fire exclusion since 1946 and infrequent wildfire (one fire in 61 years) on woody understorey vegetation in a dry sclerophyll eucalypt forest, south-eastern Queensland, Australia. We determined the influence of these treatments, and other site variables (rainfall, understorey density, topsoil C : N ratio, tree basal area, distance to watercourse and burn coverage) on plant taxa density, richness and composition. The richness of woody understorey taxa 0–1 m in height was not affected by burning treatments, but richness of woody plants 1–7.5 m in height was lower in the annually burnt treatment than in the triennially burnt treatment from 1989 to 2007. Fire frequency and other site variables explained 34% of the variation in taxa composition (three taxon groups and 10 species), of which 33% of the explained variance was explained by fire treatment and 46% was explained by other site variables. Annual burning between 1974 and 1993 was associated with lower understorey densities mainly due to reduced densities of eucalypts 1–7.5 m in height. Triennial burning during the same period was associated with higher densities of eucalypts 0–7.5 m in height relative to the annually burnt and unburnt treatments. Most woody taxa persisted in the frequently burnt treatments through resprouting mechanisms (e.g. lignotuberous regeneration), and fire patchiness associated with low-intensity burning was also found to be important. Persistence of plants <1 m tall demonstrates the resilience of woody taxa to repeated burning in this ecosystem, although they mainly exist in a suppressed growth state under annual burning.

The identification of teaching interactions used in one-to-one teaching of number in the early years of schooling

This research paper reports on phase one of an investigation of video recorded intensive one-to-one teaching interactions with 6–7-year-old students who were in their second year of schooling in Australia and identified by the their teacher as low attaining in early number. The two-phased study from which this paper emerges was originally conducted in 1998 as part of my Bachelor of Teaching Honours (Research) program at Southern Cross University Lismore, New South Wales. That study identified teaching interactions particularly suited to one-to-one teaching in the Maths Recovery Program, a program designed for these students who were at risk of failure in early number. Since that time a great deal has not changed with limited literature available that comprehensively reports on teaching interactions in intensive one-to-one settings. Revisiting the original study is considered timely given the increasing number of withdrawal and intensive programs now funded and adopted by schools and yet, rarely reported on in terms of the effectiveness of the teaching interactions that occur in such settings. This paper then presents a discussion of a preliminary series of teaching interactions that either positively and or negatively influence an intensive one-to-one teaching and learning setting

In search of Gustav: The story of the Lilienfeld (later Lynfield) family covering the last 200 years 1800-1920

This is the first of three books about the history of Geoffrey Lynfield's family. It is about four Lilienfeld brothers--Geoffrey Lynfield's grandfather and his brothers. They were born in the Jewish enclave of Marburg and ended up in South Africa when and where the first diamonds were discovered. The manuscript also includes photographs and documents.

Sleep and self-regulation from birth to 7 years: A retrospective study of children with and without ADHD at 8-9 years

Objective To examine mean level differences, and longitudinal and reciprocal relations among behavioral sleep problems, emotional dysregulation, and attentional regulation across early childhood for children with and without ADHD at 8-9 years. Method This study used data from Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC) – Infant Cohort (n = 4109 analyzed). Children with and without ADHD were identified at age 8-9 years via parent-report of ADHD diagnosis and the 5-item Inattention-Hyperactivity subscale from the Strengths and Difficulties Questionnaire. Maternal report of child sleep problems and self-regulation was collected at 0-1, 2-3, 4-5 and 6-7 years of age. ANOVA was used to compare mean level differences in sleep problems, emotional and attentional regulation by ADHD group. Longitudinal structural equation modeling examined the relations among sleep and self-regulation across time in children with and without ADHD. Results Children with ADHD had persistently elevated levels of sleep problems (from infancy) and emotional and attentional dysregulation compared to controls (from 2-3 years of age). Sleep problems, emotional dysregulation, and attentional regulation were stable over time for both groups. Sleep problems were associated with greater emotional dysregulation two years later from 2-3 years of age for both groups, which in turn was associated with poorer attentional regulation. There was no direct relationship between sleep problems and later attentional regulation. Conclusion Sleep problems in children with and without ADHD are associated with emotional dysregulation, which in turn contributes to poorer attentional functioning. This study highlights the importance of assessing and managing sleep problems in young children.

100 Years of Settlement Commemorative Medal

Obverse: Shape of the State of Israel filled with flowers in blossom. Reverse: A stylized plough.

Spatial and temporal variability in midge (Nematocera) assemblages in shallow Finnish lakes (60−70 °N) : community-based modelling of past environmental change

Multi- and intralake datasets of fossil midge assemblages in surface sediments of small shallow lakes in Finland were studied to determine the most important environmental factors explaining trends in midge distribution and abundance. The aim was to develop palaeoenvironmental calibration models for the most important environmental variables for the purpose of reconstructing past environmental conditions. The developed models were applied to three high-resolution fossil midge stratigraphies from southern and eastern Finland to interpret environmental variability over the past 2000 years, with special focus on the Medieval Climate Anomaly (MCA), the Little Ice Age (LIA) and recent anthropogenic changes. The midge-based results were compared with physical properties of the sediment, historical evidence and environmental reconstructions based on diatoms (Bacillariophyta), cladocerans (Crustacea: Cladocera) and tree rings. The results showed that the most important environmental factor controlling midge distribution and abundance along a latitudinal gradient in Finland was the mean July air temperature (TJul). However, when the dataset was environmentally screened to include only pristine lakes, water depth at the sampling site became more important. Furthermore, when the dataset was geographically scaled to southern Finland, hypolimnetic oxygen conditions became the dominant environmental factor. The results from an intralake dataset from eastern Finland showed that the most important environmental factors controlling midge distribution within a lake basin were river contribution, water depth and submerged vegetation patterns. In addition, the results of the intralake dataset showed that the fossil midge assemblages represent fauna that lived in close proximity to the sampling sites, thus enabling the exploration of within-lake gradients in midge assemblages. Importantly, this within-lake heterogeneity in midge assemblages may have effects on midge-based temperature estimations, because samples taken from the deepest point of a lake basin may infer considerably colder temperatures than expected, as shown by the present test results. Therefore, it is suggested here that the samples in fossil midge studies involving shallow boreal lakes should be taken from the sublittoral, where the assemblages are most representative of the whole lake fauna. Transfer functions between midge assemblages and the environmental forcing factors that were significantly related with the assemblages, including mean air TJul, water depth, hypolimnetic oxygen, stream flow and distance to littoral vegetation, were developed using weighted averaging (WA) and weighted averaging-partial least squares (WA-PLS) techniques, which outperformed all the other tested numerical approaches. Application of the models in downcore studies showed mostly consistent trends. Based on the present results, which agreed with previous studies and historical evidence, the Medieval Climate Anomaly between ca. 800 and 1300 AD in eastern Finland was characterized by warm temperature conditions and dry summers, but probably humid winters. The Little Ice Age (LIA) prevailed in southern Finland from ca. 1550 to 1850 AD, with the coldest conditions occurring at ca. 1700 AD, whereas in eastern Finland the cold conditions prevailed over a longer time period, from ca. 1300 until 1900 AD. The recent climatic warming was clearly represented in all of the temperature reconstructions. In the terms of long-term climatology, the present results provide support for the concept that the North Atlantic Oscillation (NAO) index has a positive correlation with winter precipitation and annual temperature and a negative correlation with summer precipitation in eastern Finland. In general, the results indicate a relatively warm climate with dry summers but snowy winters during the MCA and a cool climate with rainy summers and dry winters during the LIA. The results of the present reconstructions and the forthcoming applications of the models can be used in assessments of long-term environmental dynamics to refine the understanding of past environmental reference conditions and natural variability required by environmental scientists, ecologists and policy makers to make decisions concerning the presently occurring global, regional and local changes. The developed midge-based models for temperature, hypolimnetic oxygen, water depth, littoral vegetation shift and stream flow, presented in this thesis, are open for scientific use on request.

Sale of men's seats for 3 years

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The Feeding Practices and Structure Questionnaire (FPSQ-28): A parsimonious version validated for longitudinal use from 2-5 years

Prospective studies and intervention evaluations that examine change over time assume that measurement tools measure the same construct at each occasion. In the area of parent-child feeding practices, longitudinal measurement properties of the questionnaires used are rarely verified. To ascertain that measured change in feeding practices reflects true change rather than change in the assessment, structure, or conceptualisation of the constructs over time, this study examined longitudinal measurement invariance of the Feeding Practices and Structure Questionnaire (FPSQ) subscales (9 constructs; 40 items) across 3 time points. Mothers participating in the NOURISH trial reported their feeding practices when children were aged 2, 3.7, and 5 years (N = 404). Confirmatory Factor Analysis (CFA) within a structural equation modelling framework was used. Comparisons of initial cross-sectional models followed by longitudinal modelling of subscales, resulted in the removal of 12 items, including two redundant or poorly performing subscales. The resulting 28-item FPSQ-28 comprised 7 multi-item subscales: Reward for Behaviour, Reward for Eating, Persuasive Feeding, Overt Restriction, Covert Restriction, Structured Meal Setting and Structured Meal Timing. All subscales showed good fit over 3 time points and each displayed at least partial scalar (thresholds equal) longitudinal measurement invariance. We recommend the use of a separate single item indicator to assess the family meal setting. This is the first study to examine longitudinal measurement invariance in a feeding practices questionnaire. Invariance was established, indicating that the subscales of the shortened FPSQ-28 can be used with mothers to validly assess change in 7 feeding constructs in samples of children aged 2-5 years of age.