Geriatrician interventions on medication prescribing for frail older people in residential aged care facilities

Objective: In Australian residential aged care facilities (RACFs), the use of certain classes of high-risk medication such as antipsychotics, potent analgesics, and sedatives is high. Here, we examined the prescribed medications and subsequent changes recommended by geriatricians during comprehensive geriatric consultations provided to residents of RACFs via videoconference. Design: This is a prospective observational study. Setting: Four RACFs in Queensland, Australia, are included. Participants: A total of 153 residents referred by general practitioners for comprehensive assessment by geriatricians delivered by video-consultation. Results: Residents’ mean (standard deviation, SD) age was 83.0 (8.1) years and 64.1% were female. They had multiple comorbidities (mean 6), high levels of dependency, and were prescribed a mean (SD) of 9.6 (4.2) regular medications. Ninety-one percent of patients were taking five or more medications daily. Of total medications prescribed (n=1,469), geriatricians recommended withdrawal of 9.8% (n=145) and dose alteration of 3.5% (n=51). New medications were initiated in 47.7% (n=73) patients. Of the 10.3% (n=151) medications considered as high risk, 17.2% were stopped and dose altered in 2.6%. Conclusion: There was a moderate prevalence of potentially inappropriate high-risk medications. However, geriatricians made relatively few changes, suggesting either that, on balance, prescription of these medications was appropriate or, because of other factors, there was a reluctance to adjust medications. A structured medication review using an algorithm for withdrawing medications of high disutility might help optimize medications in frail patients. Further research, including a broader survey, is required to understand these dynamics.

Officer guards and inmates, including Norbert Pollock, of the Boergermoor Labor Camp; Germany.

Viehhandler (cattle dealer) Norbert Pollock of Ruethen, Westpflahlen (standing center in dark pants, white t-shirt and cap)

Probing into the role of conserved N-glycosylation sites in the Tyrosinase glycoprotein family

N-linked glycosylation has a profound effect on the proper folding, oligomerization and stability of glycoproteins. These glycans impart many properties to proteins that may be important for their proper functioning, besides having a tendency to exert a chaperone-like effect on them. Certain glycosylation sites in a protein however, are more important than other sites for their function and stability. It has been observed that some N-glycosylation sites are conserved over families of glycoproteins over evolution, one such being the tyrosinase related protein family. The role of these conserved N-glycosylation sites in their trafficking, sorting, stability and activity has been examined here. By scrutinizing the different glycosylation sites on this family of glycoproteins it was inferred that different sites in the same family of polypeptides can perform distinct functions and conserved sites across the paralogues may perform diverse functions.

Arrival of Ludwig Marum and other socialist leaders from Baden (Karlsruhe) to the concentration camp Kislau.

Includes l-r: Hermann Stenz, Adam Remmele, Erwin Sammet, Ludwig Marum, Gustav Heller, Sally Gruenebaum and August Furrer

Deportation of Ludwig Marum and other socialist leaders from Baden (Karlsruhe) to the concentration camp Kislau.

Typed caption on verso: Schaufahrt durch Karlsruhe, 16 May 1933 auf der Kaiserstrasse mit dem Blick auf die Fahrbahn: ganz hinten allein: Ludwig Marum dann: Erwin Sammet u. Hermann Stenz verdeckt: Sally Gruenebaum u. August Furrer vorne: Gustav Heller u. Adam Remmele

Dormitory in the concentration camp Kislau.

Reprinted almost identically in "Fuehrer" on 23 July 1933 with the caption "Sozialistischer Schlafsaal"

Evaluation of polymorphisms in predicted target sites for micro RNAs differentially expressed in endometriosis

Previous microarray analyses identified 22 microRNAs (miRNAs) differentially expressed in paired ectopic and eutopic endometrium of women with and without endometriosis. To investigate further the role of these miRNAs in women with endometriosis, we conducted an association study aiming to explore the relationship between endometriosis risk and single-nucleotide polymorphisms (SNPs) in miRNA target sites for these differentially expressed miRNAs. A panel of 102 SNPs in the predicted miRNA binding sites were evaluated for an endometriosis association study and an ingenuity pathway analysis was performed. Fourteen rare variants were identified in this study. We found SNP rs14647 in the Wolf-Hirschhorn syndrome candidate gene1 (WHSC1) 3'UTR (untranslated region) was associated with endometriosis-related infertility presenting an odds ratio of 12.2 (95% confidence interval = 2.4-60.7, P = 9.03 x 10(-5)). SNP haplotype AGG in the solute carrier family 22, member 23 (SLC22A23) 3'UTR was associated with endometriosis-related infertility and more severe disease. With the individual genotyping data, ingenuity pathways analysis identified the tumour necrosis factor and cyclin-dependant kinase inhibitor as major factors in the molecular pathways. Significant associations between WHSC1 alleles and endometriosis-related infertility and SLC22A23 haplotypes and the disease severe stage were identified. These findings may help focus future research on subphenotypes of this disease. Replication studies in independent large sample sets to confirm and characterize the involvement of the gene variation in the pathogenesis of endometriosis are needed.

Improving management of summer weeds in dryland cropping systems with Cotton

In 2001 a scoping study (phase I) was commissioned to determine and prioritise the weed issues of cropping systems with dryland cotton. The main findings were that the weed flora was diverse, cropping systems complex, and weeds had a major financial and economical impact. Phase II 'Best weed management strategies for dryland cropping systems with cotton' focused on improved management of the key weeds, bladder ketmia, sowthistle, fleabane, barnyard grass and liverseed grass.In Phase III 'Improving management of summer weeds in dryland cropping systems with cotton', more information on the seed-bank dynamics of key weeds was gained in six pot and field studies. The studies found that these characteristics differed between species, and even climate in the case of bladder ketmia. Species such as sowthistle, fleabane and barnyard grass emerged predominately from the surface soil. Sweet summer grass was also in this category but also had a significant proportion emerging from 5 cm depth. Bladder ketmia in central Queensland emerged mainly from the top 2 cm, whereas in southern Queensland it emerged mainly from 5 cm. Liverseed grass had its highest emergence from 5 cm below the surface. In all cases the persistence of seed increased with increasing soil depth. Fleabane was also found to be sensitive to soil type with no seedlings emerging in the self-mulching black vertisol soil. A strategic tillage trial showed that burial of fleabane seed, using a disc or chisel plough, to a depth of greater than 2 cm can significantly reduce subsequent fleabane emergence. In contrast, tillage increased barnyard grass emergence and tended to decrease persistence. This research showed that weed management plans can not be blanketed across all weed species, rather they need to be targeted for each main weed species.This project has also resulted in an increased knowledge of how to manage fleabane from the eight experiments; one in wheat, two in sorghum, one in cotton and three in fallow on double knock. For summer crops, the best option is to apply a highly effective fallow treatment prior to sowing the crops. For winter crops, the strategy is the integration of competitive crops, residual herbicide followed by a knockdown to control survivors. This project explored further the usefulness of the double knock tactic for weed control and preventing seed set. Two field and one pot experiments have shown that this tactic was highly effective for fleabane control. Paraquat products provided good control when followed by glyphosate. When 2, 4-D was added in a tank mix with glyphosate and followed by paraquat products, 99-100% control was achieved in all cases. The ideal follow-up times for paraquat products after glyphosate were 5-7 days. The preferred follow-up times for 2, 4-D after glyphosate were on the same day and one day later. The pot trial, which compared a population from a cropping field with previous glyphosate exposure and a population from a non-cropping area with no previous glyphosate herbicide exposure, showed that the pervious herbicide exposure affected the response of fleabane to herbicidal control measures. The web-based brochure on managing fleabane has been updated.Knowledge on management of summer grasses and safe use of residual herbicides was derived from eight field and pot experiments. Residual grass and broadleaf weed control was excellent with atrazine pre-plant and at-planting treatments, provided rain was received within a short interval after application. Highly effective fallow treatments (cultivation and double knock), not only gave excellent grass control in the fallow, also gave very good control in the following cotton. In the five re-cropping experiments, there were no adverse impacts on cotton from atrazine, metolachlor, metsulfuron and chlorsulfuron residues following use in previous sorghum, wheat and fallows. However, imazapic residues did reduce cotton growth.The development of strategies to reduce the heavy reliance on glyphosate in our cropping systems, and therefore minimise the risk of glyphosate resistance development, was a key factor in the research undertaken. This work included identifying suitable tactics for summer grass control, such as double knock with glyphosate followed by paraquat and tillage. Research on fleabane also concentrated on minimising emergence through tillage, and applying the double knock tactic. Our studies have shown that these strategies can be used to prevent seed set with the goal of driving down the seed bank. Utilisation of the strategies will also reduce the reliance on glyphosate, and therefore reduce the risk of glyphosate resistance developing in our cropping systems.Information from this research, including ecological and management data were collected from an additional eight paddock monitoring sites, was also incorporated into the Weeds CRC seed bank model "Weed Seed Wizard", which will be able to predict the impact of different management options on weed populations in cotton and grain farming systems. Extensive communication activities were undertaken throughout this project to ensure adoption of the new strategies for improved weed management and reduced risk for glyphosate resistance.

Phosphine fumigation of cool grain

The biosecurity problem addressed was the need to understand and evaluate phosphine fumigation of cool grain (i.e. 20°C or less) as a means of controlling resistant biotypes of insect pests of stored grain which are major EPPs threatening the grain industry. The benefits of cooling and phosphine fumigation are that cooling preserves grain quality and reduces insect population growth, and phosphine kills insects and has a residue free status in all major markets. The research objectives were to: - conduct laboratory experiments on phosphine efficacy against resistant insects in cool grain, and determine times to population extinction. - conduct laboratory experiments on phosphine sorption in cool grain and quantify. - complete fumigation trials in three states (Queensland, WA and NSW) on cool grain stored insealed farm silos. - make recommendations for industry on effective phosphine fumigation of cool grain. Phosphine is used by growers and other stakeholders in the grain industry to meet domesticand international demands for insect-free grain. The project aim was to generate new information on the performance of phosphine fumigation of cool grain relevant to resistant biotypes. Effective control of resistant biotypes using phosphine to fumigate cool grain will benefit growers and other sectors of the grain industry, needing to fumigate grain in the cooler months of the year, or grain that has been cooled using aeration.

Tobacco Streak Virus in cotton-scoping study

In 2006, Tobacco streak virus (TSV) was identified as the causal agent of the devastating sunflower necrosis disease in central Queensland (CQ), and subsequently in 2007 as the cause of major losses in mungbeans in the same area. It has been a major factor in the recent downturn in the sunflower industry in CQ. Surveys in 2007/2008 as part of a one year scoping study (project 03DAQ005) found TSV in cotton in CQ. The symptoms were mostly confined to the feeding sites of the thrips and appeared as reddish spots and rings, but only occasionally the plants were systemically infected and showed a chlorotic mosaic and leaf deformation. The major objectives of this project (DAQ0002) were to determine: the incidence and distribution of TSV in cotton and its likely effect on yield; the thrips vector species associated with TSV infections in cotton; and the factors that may lead to systemic infections. In contrast to the extensive damage observed in sunflower and mungbean crops from the same region, TSV has caused no measurable damage in commercial cotton crops surveyed in CQ over the seasons 2008/9 to 2010/11. No TSV infected cotton was found in regions outside of CQ and the geographical distribution of TSV disease in cotton (and other susceptible hosts) appears to be closely related to the distribution of the major alternative host, parthenium weed. The most likely thrips species responsible for transmission of TSV into cotton is the tomato thrips (Frankliniella schultzei) and onion thrips (Thrips tabaci). Systemically infected plants are rarely seen in commercial crops and have also been rarely produced in controlled tests. It appears that systemic infection may be transient with only mild symptoms being produced intermittently. With current cultivars and conditions, it appears likely that TSV will continue to cause only minor levels of mild local lesions with no impact on yield in cotton crops. It appears that no specific control strategies are required to limit the impact of TSV in cotton. However, general farm hygiene to minimise the presence of the major alternative host of TSV, parthenium weed, is advised and may be of vital importance if TSV susceptible rotational crops such as mung beans are grown.

Unidentified Group at Swimming Pool; Pioneer Youth Camp Portraits Groups

Digital Image

Prescribing for older people discharged from the acute sector to residential aged-care facilities

For frail older people, admission to hospital is an opportunity to review the indications for specific medications. This research investigates prescribing for 206 older people discharged into residential aged care facilities from 11 acute care hospitals in Australia. Patients had multiple comorbidities (mean 6), high levels of dependency, and were prescribed a mean of 7.2 regular medications at admission to hospital and 8.1 medications on discharge, with hyper-polypharmacy (≥10 drugs) increasing from 24.3% to 32.5%. Many drugs were preventive medications whose time until benefit was likely to exceed the expected lifespan. In summary, frail patients continue to be exposed to extensive polypharmacy and medications with uncertain risk–benefit ratio.

Freddy Godshaw (Gottschalk) sailing with his friend Peter Zander at a camp shortly after Freddy left Germany; England.

Left: Freddy Godshaw (Gottschalk); right: Peter Zander

Fisheries Queensland Long Term Monitoring Program Underwater Visual Census of twenty-four reefs on the Great Barrier Reef between 1999 and 2004.

In 1999, the Department of Employment, Economic Development and Innovation (DEEDI), Fisheries Queensland undertook a new initiative to collect long term monitoring data of various important stocks including reef fish. This data and monitoring manual for the reef fish component of that program which was based on Underwater Visual Census methodology of 24 reefs on the Great Barrier Reef between 1999 and 2004. Data was collected using six 50m x 5m transects at 4 sites on 24 reefs. Benthic cover type was also recorded for 10m of each transect. The attached Access Database contains 5 tables being: SITE DETAILS TABLE Survey year Data entry complete REF survey site ID Site # (1-4) Location (reef name) Site Date (date surveyed) Observer 1 (3 initials to identify who estimated fish lengths and recorded benthic cover) TRANSECT DETAILS Survey ID Transect Number (1-6) Time (the transect was surveyed) Visibility (in metres) Minimum Depth surveyed (m) Maximum Depth surveyed (m) Percent of survey completed (%) Comments SUBSTRATE Survey ID Transect Number (1-6) then % cover of each of eth following categories of benthic cover types Dead Coral Live Coral Soft Coral Rubble Sand Sponge Algae Sea Grass Other COORDINATES (over survey sites) from -14 38.792 to -19 44.233 and from 145 21.507 to 149 55.515 SIGHTINGS ID Survey ID Transect Number (1-6) CAAB Code Scientific Name Reef Fish Length (estimated Fork Length of fish; -1 = unknown or not recorded) Outside Transect (if a fish was observed outside a transect -1 was recorded) Morph Code (F = footballer morph for Plectropomus laevis, S = Spawning colour morph displayed)