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.

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.

Exterior of synagogue; Lissa Synagogues; Exterior

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Exterior of synagogue; Lissa Synagogues; Exterior

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Rabbi Leo Baeck's arrival at La Guardia Airport, New York from London for the Union of American Hebrew Congregations American Jewish Cavalcade Portraits; Groups

Sitting l-r Leo Baeck, Maurice N. Eisendrath, Oscar M. Lazrus; Standing l-r Jane Evans, Henry W. Levy, Saul Elgart, Rabbi Daniel L. Davis, Louis Rittenberg and Leonard H. Spring

Surgical fusion of early onset severe scoliosis increases survival in Rett syndrome: A cohort study

Aim Scoliosis is a common co-morbidity in Rett syndrome and spinal fusion may be recommended if severe. We investigated the impact of spinal fusion on survival and risk of severe lower respiratory tract infection in Rett syndrome. Method Data were ascertained from hospital medical records, the Australian Rett Syndrome Database, a longitudinal and population-based registry, and from the Australian Institute of Health and Welfare National Death Index database. Cox regression and generalized estimating equation models were used to estimate the effects of spinal surgery on survival and severe respiratory infection respectively in 140 females who developed severe scoliosis (Cobb angle ≥45°) before adulthood. Results After adjusting for mutation type and age of scoliosis onset, the rate of death was lower in the surgery group (hazard ratio [HR] 0.30, 95% confidence interval [CI] 0.12–0.74; p=0.009) compared to those without surgery. Rate of death was particularly reduced for those with early onset scoliosis (HR 0.17, 95% CI 0.06–0.52; p=0.002). There was some evidence to suggest that spinal fusion was associated with a reduction in risk of severe respiratory infection among those with early onset scoliosis (risk ratio 0.41, 95% CI 0.16–1.03; p=0.06). Interpretation With appropriate cautions, spinal fusion confers an advantage to life expectancy in Rett syndrome.

Memoirs : Heida Hermanns Holde /

The author's mother Alice Goldschmidt was a gifted piano player, who studied with Carl Maria Breithaupt and became his most talented student. Childhood recollections. Early musical awakening. Outbreak of World War One. Recollections of air raids and scarceness of food. Inflation and political instability in post-war Germany. Piano lessons by her mother from an early age. Heida made her debut at age fourteen with the Wiesbaden Symphony under the conductor Carl Schuricht, who became a close mentor and friend. Close relationship to her mother, who had a great influence on her professional career. Heida had a number of outstanding teachers, among them Artur Schnabel, Karl Leimer and Egon Petri. Heida was accepted as a student of Petri at the "Hochschule fuer Musik" in Berlin, where she studied between 1922-1925. Salon at her aunt's house with guests such as the playwright Georg Kaiser and Siegfried Wagner. Her sister Elsie received her Ph.D. in economics and moved to Berlin as well. Heida graduated from the "Hochschule" in 1925. Soon after she won an international piano competition in Berlin. Engagements with various conductors such as Max Fiedler and Otto Klemperer. Private lessons with Arthur Schnabel and Carl Friedberg, the co-founder of Juilliard. Due to occasional experiences of antisemitism during her music career Heida decided to change her name from Goldschmidt to Hermanns. Position at the "Hoch Conservatory" in Frankfurt. Encounter with the music critic Artur Holde, Heida's future-husband. Engagement and wedding in 1932. Move to Berlin.

Philip Slomovitz South End collection 1969-1974

Contains 1969 and 1971-73 issues of The South End, Wayne State University student paper, as well as correspondence, public statements, petitions and a tape-recording relating to controversies generated by the printing of alleged anti-Zionist/anti-Semitic articles in the newspaper. The correspondence consists for the most part of an exchange of letters between university officials, Jewish community leaders and Leonard N. Simons, a Detroit advertising executive, during the 1969 controversy, and correspondence with Philip Slomovitz, editor of the Detroit Jewish news, in 1972-73. The tape recording is of a February 2, 1969 interview with John Watson, editor of the South end.

Temple Beth El Providence, Rhode Island collection, 1940-1969

In 1916, the Jewish community of Boston established Beth Israel Temple Beth-El, located on the East Side of Providence, dates back to 1849, with the creation of the group "Sons of Israel." On September 10, 1849, Solomon Pareira, Leonard Gavitts and Morris Steinberg were granted an acre of land along the New London Turnpike (now Reservoir Avenue) to establish a cemetery. In 1854, the Congregation of the Sons of Israel and David was established, leading to president Solomon Pareira's deeding of the cemetery land in 1857 for the sole utilization of the congregation. This collection contains programs, sermons and newsletters. Although the congregation was originally Orthodox, it affiliated with the Union of American Hebrew Congregations (Union for Reform Judaism) in 1877.

Assessing vulnerability at the urban interface

House loss during unplanned bushfires is a complex phenomenon where design, configuration, material and siting, can significantly influence the loss. In collaboration with the Bushfire Cooperative Research Centre the CSIRO has developed a tool to assess the vulnerability of a specific house at the urban interface. The tool is based on a spatial profiling of urban assets including their design, material, surrounding objects and their relationship amongst one another. The analysis incorporates both probabilistic and deterministic parameters, and is based on the impact of radiant heat, flame and embers on the surrounding elements and the structure itself. It provides a breakdown of the attributes and design parameters that contribute to the vulnerability level. This paper describes the tool which allows the user to explore the vulnerability of a house to varying levels of bushfire attacks. The tool is aimed at government agencies interested in building design, town planning and community education for bushfire risk mitigation.

A novel method for diameter estimation of small opaque objects using Fraunhofer diffraction

A novel optical method is proposed and demonstrated, for real-time dimension estimation of thin opaque cylindrical objects. The methodology relies on free-space Fraunhofer diffraction principle. The central region, of such tailored diffraction pattern obtained under suitable choice of illumination conditions, comprises of a pair of `equal intensity maxima', whose separation remains constant and independent of the diameter of the diffracting object. An analysis of `the intensity distribution in this region' reveals the following. At a point symmetrically located between the said maxima, the light intensity varies characteristically with diameter of the diffracting object, exhibiting a relatively stronger intensity modulation under spherical wave illumination than under a plane wave illumination. The analysis reveals further, that the said intensity variation with diameter is controllable by the illumination conditions. Exploiting these `hitherto unexplored' features, the present communication reports for the first time, a reliable method of estimating diameter of thin opaque cylindrical objects in real-time, with nanometer resolution from single point intensity measurement. Based on the proposed methodology, results of few simulation and experimental investigations carried-out on metallic wires with diameters spanning the range of 5 to 50 mu m, are presented. The results show that proposed method is well-suited for high resolution on-line monitoring of ultrathin wire diameters, extensively used in micro-mechanics and semiconductor industries, where the conventional diffraction-based methods fail to produce accurate results.

Singularity structure of third-order dynamical systems .2

The singularity structure of the solutions of a general third-order system, with polynomial right-hand sides of degree less than or equal to two, is studied about a movable singular point, An algorithm for transforming the given third-order system to a third-order Briot-Bouquet system is presented, The dominant behavior of a solution of the given system near a movable singularity is used to construct a transformation that changes the given system directly to a third-order Briot-Bouquet system. The results of Horn for the third-order Briot-Bouquet system are exploited to give the complete form of the series solutions of the given third-order system; convergence of these series in a deleted neighborhood of the singularity is ensured, This algorithm is used to study the singularity structure of the solutions of the Lorenz system, the Rikitake system, the three-wave interaction problem, the Rabinovich system, the Lotka-Volterra system, and the May-Leonard system for different sets of parameter values. The proposed approach goes far beyond the ARS algorithm.

Structure and activity cyclase activated of OK-GC: A kidney receptor-guanylate cyclase activated by guanylin peptides

Uroguanylin, guanylin, and lymphoguanylin are small peptides that activate renal and intestinal receptor guanylate cyclases (GC). They are structurally similar to bacterial heat-stable enterotoxins (ST) that cause secretory diarrhea. Uroguanylin, guanylin, and ST elicit natriuresis, kaliuresis, and diuresis by direct actions on kidney GC receptors. A 3,762-bp cDNA characterizing a uroguanylin/guanylin/ST receptor was isolated from opossum kidney (OK) cell RNA/cDNA. This kidney cDNA (OK-GC) encodes a mature protein containing 1,049 residues sharing 72.4�75.8% identity with rat, human, and porcine forms of intestinal GC-C receptors. COS or HEK-293 cells expressing OK-GC receptor protein were activated by uroguanylin, guanylin, or ST13 peptides. The 3.8-kb OK-GC mRNA transcript is most abundant in the kidney cortex and intestinal mucosa, with lower mRNA levels observed in urinary bladder, adrenal gland, and myocardium and with no detectable transcripts in skin or stomach mucosa. We propose that OK-GC receptor GC participates in a renal mechanism of action for uroguanylin and/or guanylin in the physiological regulation of urinary sodium, potassium, and water excretion. This renal tubular receptor GC may be a target for circulating uroguanylin in an endocrine link between the intestine and kidney and/or participate in an intrarenal paracrine mechanism for regulation of kidney function via the intracellular second messenger, cGMP.

A Raman study of CdSe and ZnSe nanostructures

Raman studies have been carried out on CdSe nanotubes and ZnSe nanorods produced by surfactant-assisted synthesis. The Raman spectrum of CdSe nanotubes shows modes at 207.5 and 198 cm(-1); the former arises from the longitudinal optic phonon mode red-shifted with respect to the bulk mode because of phonon confinement, and the latter is the I = 1 surface phonon. Analysis based on the phonon confinement model demonstrates that the size of the nanoparticle responsible for the red-shift is about 4 nm, close to the estimate from the blue-shift of the photoluminescence. The Raman spectrum of ZnSe,nanorods shows modes at 257 and 213 cm(-1), assigned to longitudinal and transverse optic phonons, blue-shifted with respect to the bulk ZnSe modes because of compressive strain. The mode at 237 cm(-1) is the surface phonon.

Expression of the receptor guanylyl cyclase C and its ligands in reproductive tissues of the rat: A potential role for a novel signaling pathway in the epididymis

Guanylyl cyclase C (GC-C) is a membrane-associated form of guanylyl cyclase and serves as the receptor for the heat-stable enterotoxin (ST) peptide and endogenous ligands guanylin, uroguanylin, and lymphoguanylin. The major site of expression of GC-C is the intestinal epithelial cell, although GC-C is also expressed in extraintestinal tissue such as the kidney, airway epithelium, perinatal liver, stomach, brain, and adrenal glands. Binding of ligands to GC-C leads to accumulation of intracellular cGMP, the activation of protein kinases G and A, and phosphorylation of the cystic fibrosis transmembrane conductance regulator (CFTR), a chloride channel that regulates salt and water secretion. We examined the expression of GC-C and its ligands in various tissues of the reproductive tract of the rat. Using reverse transcriptase and the polymerase chain reaction, we demonstrated the presence of GC-C, uroguanylin, and guanylin mRNA in both male and female reproductive organs. Western blot analysis using a monoclonal antibody to GC-C revealed the presence of differentially glycosylated forms of GC-C in the caput and cauda epididymis. Exogenous addition of uroguanylin to minced epididymal tissue resulted in cGMP accumulation, suggesting an autocrine or endocrine activation of GC-C in this tissue. Immunohistochemical analyses demonstrated expression of GC-C in the tubular epithelial cells of both the caput epididymis and cauda epididymis. Our results suggest that the GC-C signaling pathway could converge on CFTR in the epididymis and perhaps control fluid and ion balance for optimal sperm maturation and storage in this tissue.